Shigeaki Nakazawa

Clinical characteristics and risk factors for septic shock in patients receiving emergency drainage for acute pyelonephritis with upper urinary tract calculi

BackgroundAcute pyelonephritis (APN) is a common complication of ureteral obstruction caused by urolithiasis, and it can be lethal if it progresses to septic shock. We investigated the clinical characteristics of patients undergoing emergency drainage and assessed risk factors for septic shock.MethodsA retrospective study was performed of 98 patients (101 events) requiring emergency drainage at our urology department for obstructive APN associated with upper urinary tract calculi from January 2003 to January 2011. Clinical characteristics were summarized, and risk factors for septic shock were assessed by logistic regression analysis.ResultsObjective evidence of sepsis was found in 64 (63.4%) events, and 21 events (20.8%) were categorized as septic shock. Ninety-six patients recovered, but 2 patients died of septic shock. Multivariate analysis revealed that age and the presence of paralysis were independent risk factors for septic shock.ConclusionsAPN associated with upper urinary tract calculi is a severe disease that should be treated with caution, particularly when risk factors are present.

Two cases of plasmacytoid variant of urothelial carcinoma of urinary bladder: systemic chemotherapy might be of benefit

We report two cases of the plasmacytoid variant of urothelial carcinoma of urinary bladder in which systemic chemotherapy was effective. In the first case, a 76-year-old man presented with dysphasia. Magnetic resonance imaging (MRI) and computed tomography revealed a brain tumor and a bladder tumor. Resection of the brain tumor and transurethral resection of the bladder tumor were performed. The pathological diagnosis was plasmacytoid variant of urothelial carcinoma of urinary bladder with brain metastasis (pT1N0M1). Three cycles of adjuvant MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) chemotherapy were performed. He has no evidence of recurrence 96xa0months after resection of brain metastasis. In the second case, a 76-year-old man presented with hematuria. MRI revealed a bladder tumor with abdominal wall invasion, and a transurethral biopsy was performed. The pathological diagnosis was plasmacytoid variant of urothelial carcinoma of urinary bladder (cT4bN0M0). After three cycles of neoadjuvant GC (gemcitabine and cisplatin) chemotherapy, MRI demonstrated a complete response. Radical cystectomy was performed, and the pathological diagnosis was pT0pN0. Although there was no evidence of recurrence 9xa0months after radical cystectomy, he died from other causes. Our two cases suggest that systemic chemotherapy might be effective for the plasmacytoid variant of urothelial carcinoma.

The first non-Kekulé polynuclear aromatic high-spin hydrocarbon: Generation of a triangulene derivative and band structure calculation of triangulene-based high-spin hydrocarbons

An attempt has been made to generate a triangulene derivative (3), the first non-Kekule polynuclear aromatic hydrocarbon. By oxidizing a corresponding precursor in a toluene solution by p-chloranil, the desired ground-state triplet species in the rigid matrix was identified by ESR spectroscopy. The spin Hamiltonian parameters were determined by spectral simulation as S = 1, g = 2.003, |D/hc| = 0.0073 cm -1 , |E/hc| 0 cm -1 . The mean inter-spin distance was estimated to be 5.64 A by a point-dipolar approximation, being in consistent with the spin-delocalized nature of triangulene 3. It has turned out that 3 is stable enough to give the triplet ESR spectra, but the partial exposure of reactive carbon sites with the largest spin density causes the intermolecular chemical-bond formations. The band structure calculations have been carried out for triangulene-based high-spin polymeric systems, demonstrating the generation of a flat π-nonbonding crystal orbital, which delocalizes on the whole system. The flat band with N-fold degeneracy accommodates N ferromagnetically exchange-coupled spins in the ground state.

Generation and properties of 2,5,8-tri-tert-butyl-6-oxo-7,9-diazaphenalenoxyl

Novel neutral radical, 2,5,8-tri-tert-butyl-6-oxo-7,9-diazaphenalenoxyl, was designed on the basis of 6-oxophenalenoxyl and generated by the chemical oxidation of the corresponding tetraethylammonium salt. The spin density distribution was determined by ESR, ENDOR/TRIPLE measurements and the DFT calculations, showing that then-spin structure is similar to that of the 6-oxophenalenoxyl.

Depression of Complement Regulatory Factors in Rat and Human Renal Grafts Is Associated with the Progress of Acute T-Cell Mediated Rejection

Background The association of complement with the progression of acute T cell mediated rejection (ATCMR) is not well understood. We investigated the production of complement components and the expression of complement regulatory proteins (Cregs) in acute T-cell mediated rejection using rat and human renal allografts. Methods We prepared rat allograft and syngeneic graft models of renal transplantation. The expression of Complement components and Cregs was assessed in the rat grafts using quantitative real-time PCR (qRT-PCR) and immunofluorescent staining. We also administered anti-Crry and anti-CD59 antibodies to the rat allograft model. Further, we assessed the relationship between the expression of membrane cofactor protein (MCP) by immunohistochemical staining in human renal grafts and their clinical course. Results qRT-PCR results showed that the expression of Cregs, CD59 and rodent-specific complement regulator complement receptor 1-related gene/protein-y (Crry), was diminished in the rat allograft model especially on day 5 after transplantation in comparison with the syngeneic model. In contrast, the expression of complement components and receptors: C3, C3a receptor, C5a receptor, Factor B, C9, C1q, was increased, but not the expression of C4 and C5, indicating a possible activation of the alternative pathway. When anti-Crry and anti-CD59 mAbs were administered to the allograft, the survival period for each group was shortened. In the human ATCMR cases, the group with higher MCP expression in the grafts showed improved serum creatinine levels after the ATCMR treatment as well as a better 5-year graft survival rate. Conclusions We conclude that the expression of Cregs in allografts is connected with ATCMR. Our results suggest that controlling complement activation in renal grafts can be a new strategy for the treatment of ATCMR.

Immunohistochemical features of BK virus nephropathy in renal transplant recipients

BK virus nephropathy (BKVN) is one of the factors that reduces renal graft function after transplantation. However, BKVN and rejection present similar pathological findings, as both are accompanied by cellular infiltration to the interstitium and tubulitis, thus they are difficult to distinguish for diagnosis and medical treatment. In the present study, we examined immunohistochemical pathological features of BKVN in four cases treated in our hospital from 2007 to 2010. Common immunohistological finding is that tubulitis in these cases was primarily EMA and 34βE12‐positive and existed predominantly from the collecting duct to the distal convoluted tubule. The majority of infected cells existed in EMA and 34βE12‐positive tubules, which were also located mainly from the collecting duct to the distal tubule. In addition, a large number of SV40‐positive infected cells were similarly seen. Dylon staining clearly revealed eosinophils. We concluded that the main pathological features of BKVN are the presence of tubulitis and infected cells predominantly from the collecting duct to distal tubule and the appearance of eosinophils.

A synthetic study of a homospin diradical based on 6-oxophenalenoxyl

A novel homospin diradical, 8,8-bis(2,5-di-tert-butyl-6-oxophenalenoxyl) was designed based on 6-oxophenalenoxyl. A diradical precursor, an 8,8-bis(6-hydroxyphenalenone) derivative was synthesized by the coupling reaction of the lithium enolate of phenalanone derivative as a key step. The monoradical of the precursor was generated and characterized in terms of ESR/ 1 H-ENDOR/TRIPLE measurements and the DFT calculations.

Induction Immunosuppressive Therapy With Everolimus and Low-Dose Tacrolimus Extended-Release Preserves Good Renal Function at 1 Year After Kidney Transplantation

BACKGROUNDnUtilization of everolimus (EVR) has been increasing in recent years for patients undergoing renal transplantation to reduce calcineurin inhibitor (CNI) levels. However, an optimum regimen has yet to be established.nnnMETHODSnWe retrospectively examined 12 renal transplant recipients who underwent an induction immunosuppressive protocol; the protocol comprises 5 agents, including EVR plus low-dose tacrolimus extended-release (TAC-ER) treatment. We compared those findings from those of 14 patients who underwent a conventional protocol without EVR. Clinical outcome and pathologic changes were assessed by using protocol graft biopsy findings obtained at 3 months and 1 year after transplantation.nnnRESULTSnThe estimated glomerular filtration rate was significantly higher for the EVR group at both 3 months and 1 year compared with the conventional group (Pxa0< .01 and Pxa0= .03, respectively). TAC-ER trough levels were also significantly lower at 3 months and 1 year (both, Pxa0< .01). Histologic findings of the 3-month protocol biopsy samples in the EVR group revealed 4 cases of borderline change and 2 of acute cellular-mediated rejection. The findings from the 1-year biopsy samples revealed 10 cases with normal findings with no evidence of CNI toxicity. Patients in the EVR group developed subclinical borderline change and acute cellular-mediated rejection after 3xa0monthsxa0at a significantly higher rate than the conventional group (Pxa0= .02).nnnCONCLUSIONSnUse of the present therapeutic strategy successfully maintained the trough of each drug at a lower level, and it also kept renal function stable up to 1 year after transplantation.

Heterospin diradical with 6-oxophenalenoxyl and nitronyl nitroxide

A novel heterospin diradical composed of 6-oxophenalenoxyl and α-nitronyl nitroxide moieties was designed and generated. The triplet species was detected by means of ESR spectroscopy, and the temperature dependence of the forbidden transition (ΔMs = ±2) signal intensity Ion 1/T demonstrated the high-spin preference for the ground state of the heterospin system, agreeing with theoretical studies.

Post-Transplant Anemia Has Strong Influences on Renal and Patient Outcomes in Living Kidney Transplant Patients.

BACKGROUNDnPost-transplant anemia (PTA) is a risk factor for mortality and graft loss in kidney transplant patients.nnnMETHODSnIn all, 172 patients were included in this study. PTA was defined as hemoglobinxa0<13.0xa0g/dL in men and 12.0xa0g/dL in women. The primary outcome of interest was the renal outcome, defined as a 50% increase in serum levels of creatinine, a return to chronic dialysis, and subsequent kidney transplantation (KTx). The secondary outcome was a composite of the primary outcome and death.nnnRESULTSnAt baseline, 75 patients (43.6%) had PTA. During follow-up of a median of 7.3 years, 52 patients (30.2%) had 2-fold higher creatinine levels than at baseline, 24 patients (14.0%) had to return to chronic dialysis or subsequent KTx, and 11 patients (6.4%) died; 8 (4.7%) of the deceased patients had functioning allografts. Univariate regression analyses showed that a lower hemoglobin level and positive proteinuria were significantly associated with both outcomes. After adjusting for important clinical variables, a lower hemoglobin level remained a strong predictor for both outcomes. Restricted cubic splines showed an almost linear inverse association with a hemoglobin levelxa0≥12xa0g/dL. The risk of the outcomes increased with decreasing tertiles of the baseline hemoglobin level for both men and women, but the associations in women were much weaker than those in men, suggesting a different prognostic value of the hemoglobin level between men and women.nnnCONCLUSIONSnPTA strongly influenced the renal and patient outcomes in living kidney transplant patients.