P6199Lipoprotein(a) and risk of chronic kidney disease among 4,235 Japanese hospitalized patients

Background

Lipoprotein (a) [Lp(a)] has been shown to be associated with the development of chronic kidney disease (CKD) among various ethnicities. In addition, recent Mendelian randomization studies have suggested that Lp(a) seems to be causally associated with CKD. However, few data exist regarding this issue among Japanese population.

Purpose

We aimed to investigate the association between serum Lp(a) and the CKD among Japanese population.

Methods

We retrospectively investigated 6,130 subjects whose serum Lp(a) had been measured for any reason (e.g. any operations which needs bed rest for a long duration, risk factors for atherosclerosis such as hypertension or diabetes) at our University Hospital from April 2004 to March 2014. We excluded 1,895 subjects due to the lack clinical data. We assessed their Lp(a), LDL cholesterol, HDL cholesterol, triglycerides, presence of hypertension, diabetes, chronic kidney disease, smoking, body mass index, presence of coronary artery disease (CAD), and presence of CKD (stage 3 or greater).

Results

When the study subjects were divided into 5 groups based on their CKD stage, there was a significant trend among their serum Lp(a) levels (P-trend = 2.7×10–13). Under these conditions, multiple regression analysis showed that Lp(a) was significantly associated with CKD [odds ratio (OR): 1.12, 95% confidence interval (CI): 1.08–1.17; p=1.3×10–7: per 10mg/dL)., independent of other classical risk factors, including age, gender, body mass index, hypertension, diabetes, smoking, LDL cholesterol and triglycerides. Under these conditions, Lp(a) was significantly associated with CAD [OR: 1.11, 95% CI: 1.06–1.16; p=1.7×10–6: per 10mg/dL), independent of the presence of CKD.

Conclusion

Serum Lp(a) was associated with the development of CKD independent of other classical risk factors among Japanese population as well.

Oral clonidine premedication does not alter the efficacy of epidural test doses in adult patients anesthetized with isoflurane

Clonidine premedication has been increasingly used in clinical anesthesia. Though clonidine was found to alter pressor responses to various sympathomimetics, its effect on epidural test dose efficacy to detect intravascular injection has never been evaluated. Eighty healthy patients were randomly assigned to one of four groups, each of which was anesthetized with 1% end-tidal isoflurane and 67% nitrous oxide in oxygen after endotracheal intubation. The control-epinephrine group (n=20) given no clonidine premedication received 3 ml of 1.5% lidocain with 15 μg epinephrine (1:200000) intravenously to simulate an intravenously administered epidural test dose. The control-saline group (n=20) given no clonidine premedication received 3 ml of normal saline intravenously. The clonidine-epinephrine and clonidine-saline groups (n=20 each) were identical to the control groups, but were premedicated with oral clonidine, approximately 5 μg·kg(-1), 90 min before induction of general anesthesia. Heart rate (HR) and systolic blood pressure (SBP) were measured by a blinded observer at 20-s intervals for 4 min after intravenous injections of the test dose or saline. Following intravenous test dose injection, there were no significant diferences between the control-epinephrine and the clonidine-epinephrine groups in mean maximum increments of both HR (28±3vs 30±3 bpm, [mean±standard error], respectively) and SBP (46±6vs 45±4 mmHg, respectively). Six patients in the control-epinephrine and 4 in the clonidine-epinephrine group developed negative HR responses (HR increment <20 bpm). Since HR and SBP were essentially unchanged in the two groups receiving saline, sensitivities (negative predictive values) based on the HR criterion (positive if ≥20 bpm increase in HR) were 80% and 70% (83% and 77%) with and without clonidine premedication, respectively (P>0.05 between groups). However, when a modified HR criterion (positive if ≥10 bpm increase in HR) was used, sensitivities, specificities, and positive and negative predictive values were all 100% with or without clonidine. On the other hand, all of 20 patients in the control-epinephrine and the clonidine-epinephrine groups exhibited positive SBP responses (SBP increment ≥15 mmHg). Therefore, based on the SBP criterion, sensitivities, specificities, and positive and negative predictive values were all found to be 100% regardless of the presence of clonidine. We conclude that oral clonidine 5μg·kg(-1) premedication alters neither (a) hemodynamic responses to the intravenously administered epidural test dose containing 15 μg epinephrine, nor (b) the efficacy for detecting intravascular injection based on either criterion in adult patients under stable isoflurane anesthesia.

Attenuated sympathetic tone augments nitrous oxide-induced myocardial depression during high-dose fentanyl anaesthesia in dogs

The purpose of this study was to determine whether centrally mediated sympathetic tone exerts compensatory effects on nitrous oxide-induced myocardial depression during high-dose fentanyl anaesthesia. The cardiovascular responses to 60 minutes of nitrous oxide administration after fentanyl, 100 micrograms.kg-1, were examined in 18 dogs with or without autonomic blockade induced by hexamethonium. Decreases of cardiac output and left ventricular stroke work were significantly greater in dogs with autonomic blockade (n = 9) by about 20 per cent of baseline values than in dogs without autonomic blockade (n = 9) at 30, 45, and 60 min. Similarly, left ventricular dP/dt was reduced more in dogs with autonomic blockade than in dogs without autonomic blockade, but this difference was only significant at the 60-min period. It is concluded that the sympathetic nervous system provides partial compensation for myocardial depression induced by nitrous oxide in the presence of high-dose fentanyl, suggesting that large doses of fentanyl do not ablate the centrally mediated sympathomimetic effects of nitrous oxide.

Eosinophilic pustular folliculitis (Ofuji's disease). Immunohistochemical analysis

BACKGROUND

Eosinophilic pustular folliculitis is a distinctive dermatosis that was first described in Japan. Although the histopathologic feature of eosinophilic pustular folliculitis is characterized by follicular infiltrates with numerous eosinophils, its pathophysiology remains unclear. The lesional skin of five patients with eosinophilic pustular folliculitis was examined using several monoclonal antibodies including a variety of anti-leukocyte adhesion molecules: endothelial cell adhesion molecule 1, vascular cell adhesion molecule 1, and intercellular adhesion molecule 1, by means of immunohistochemical techniques.

OBSERVATION

Intercellular adhesion molecule 1 expression by keratinocytes was observed on follicular epithelium, but not on epidermis. The migration of eosinophils and lymphocytes, which were intensely positive for antilymphocyte function-associated antigen 1, was limited to follicular epithelium. Endothelial cell adhesion molecule 1 and vascular cell adhesion molecule 1 expression of vascular endothelium was more often observed around hair follicles. There was no reactivity for interleukin 8 in follicular epithelium.

CONCLUSIONS

These findings may explain the selective migration of eosinophils and lymphocytes to the hair follicles in eosinophilic pustular folliculitis.

Prurigo pigmentosa. Case report with an electron microscopic observation

Prurigo pigmentosa is an inflammatory dermatosis characterized by pruritic, reddish, papular lesions and gross reticular pigmentation that occurs mainly on the trunk. Nearly 100 cases have been reported in Japan to date. We describe a patient with this condition who responded well to dapsone. An electron microscopic study of the reddish papular lesion showed marked intercellular edema and evidence of cellular injury of the basal cells. Direct immunofluorescence was negative. We stress that this condition is a distinct clinical entity, histologically characterized by a lichenoid tissue reaction as proposed by Pinkus, although it is little known outside Japan.