Takaya Abe

A case of hemodialysis-associated amyloidosis localized to the external auditory canal

Amyloidosis of the external auditory canal is extremely rare. Only 12 cases, including the present case, have been reported, and this is the second reported case attributed to dialysis. This case involved a 56-year-old man who had been on dialysis for 12years. A tumor was visible in the right external auditory canal and caused pain. The tumor was resected at another hospital, but subsequently recurred with rapid increase in size due to infection. We therefore performed further resection at our hospital. We report our experiences herein, together with a discussion of the literature.

Human serum albumin hydropersulfide is a potent reactive oxygen species scavenger in oxidative stress conditions such as chronic kidney disease

Recently, hydropersulfide (RSSH) was found to exist in mammalian tissues and fluids. Cysteine hydropersulfide can be found in free cysteine residues as well as in proteins, and it has potent antioxidative activity. Human serum albumin (HSA) is the most abundant protein in mammalian serum. HSA possesses a free thiol group in Cys-34 that could be a site for hydropersulfide formation. HSA hydropersulfide of high purity as a positive control was prepared by treatment of HSA with Na2S. The presence of HSA hydropersulfide was confirmed by spectroscopy and ESI-TOFMS analysis where molecular weights of HSA hydropersulfide by increments of approximately 32xa0Da (Sulfur atom) were detected. The fluorescent probe results showed that Alexa Fluor 680 conjugated maleimide (Red-Mal) was a suitable assay and bromotrimethylammoniumbimane bromide appeared to be a selective reagent for hydropersulfide. The effect of oxidative stress related disease on the existence of albumin hydropersulfides was examined in rat 5/6 nephrectomy model of chronic kidney disease (CKD). Interestingly, the level of hydropersulfides in rat 5/6 nephrectomy model serum was decreased by a uremic toxin that increases oxidative stress in rat 5/6 nephrectomy model. Furthermore, we demonstrated that the levels of HSA hydropersulfide in human subjects were reduced in CKD but restored by hemodialysis using Red-Mal assay. We conclude that HSA hydropersulfide could potentially play an important role in biological anti-oxidative defense, and it is a promising diagnostic and therapeutic marker of oxidative diseases.

Standardized Prevalence Ratios for Atrial Fibrillation in Adult Dialysis Patients in Japan.

Background While it is assumed that dialysis patients in Japan have a higher prevalence of atrial fibrillation (AF) than the general population, the magnitude of this difference is not known. Methods Standardized prevalence ratios (SPRs) for AF in dialysis patients (n = 1510) were calculated compared to data from the general population (n = 26 454) living in the same area. Results The prevalences of AF were 3.8% and 1.6% in dialysis patients and the general population, respectively. In male subjects, these respective values were 4.9% and 3.3%, and in female subjects they were 1.6% and 0.6%. The SPRs for AF were 2.53 (95% confidence interval [CI], 1.88–3.19) in all dialysis patients, 1.80 (95% CI, 1.30–2.29) in male dialysis patients, and 2.13 (95% CI, 0.66–3.61) in female dialysis patients. Conclusions The prevalence of AF in dialysis patients was twice that in the population-based controls. Since AF strongly contributes to a higher risk of cardiovascular mortality and morbidity in the general population, further longitudinal studies should be conducted regarding the risk of several outcomes attributable to AF among Japanese dialysis patients.BACKGROUNDnWhile it is assumed that dialysis patients in Japan have a higher prevalence of atrial fibrillation (AF) than the general population, the magnitude of this difference is not known.nnnMETHODSnStandardized prevalence ratios (SPRs) for AF in dialysis patients (n = 1510) were calculated compared to data from the general population (n = 26 454) living in the same area.nnnRESULTSnThe prevalences of AF were 3.8% and 1.6% in dialysis patients and the general population, respectively. In male subjects, these respective values were 4.9% and 3.3%, and in female subjects they were 1.6% and 0.6%. The SPRs for AF were 2.53 (95% confidence interval [CI], 1.88-3.19) in all dialysis patients, 1.80 (95% CI, 1.30-2.29) in male dialysis patients, and 2.13 (95% CI, 0.66-3.61) in female dialysis patients.nnnCONCLUSIONSnThe prevalence of AF in dialysis patients was twice that in the population-based controls. Since AF strongly contributes to a higher risk of cardiovascular mortality and morbidity in the general population, further longitudinal studies should be conducted regarding the risk of several outcomes attributable to AF among Japanese dialysis patients.

Renal pelvic cancer with spleen invasion arising in horseshoe kidney; a case report

A 75-year-old man presented with horseshoe kidney and hydronephrosis. He had a history of cerebral infarction that had been treated with an antiplatelet drug. His body mass index (BMI) was 18.8 (kg/m2). He noticed asymptomatic gross hematuria three times within the previous three years. At each of the first two times, no apparent malignancies were detected. However, the third urine cytology examination revealed possible carcinoma. Pyuria was also detected using urinalysis. Enhanced computed tomography (CT) imaging showed a solid mass 50 mm in diameter in the left renal pelvis, and the mass had directly invaded the spleen (Fig. 1aec). Retrograde pyelography showed no filling defect, and a separate urine cytology examination revealed no malignancy. Therefore, we performed a CT-guided biopsy of the left renal pelvic mass; the

Pelvic Artery Calcification Score Is a Marker of Vascular Calcification in Male Hemodialysis Patients: Vascular Calcification Hemodiaysis

Patients who undergo hemodialysis often suffer from cardiovascular disease (CVD), and evaluation of coronary artery calcification is extremely important. These evaluations are typically conducted using a noninvasive method including electron beam computed tomography (CT) or multi‐detector CT, and the Agatston method to calculate the coronary artery calcification score (CACS). However, it is difficult to use for patients undergoing dialysis. Because patients undergoing dialysis is too strong in coronary artery calcification, and results become incorrect. Therefore, we were looking for a calcified evaluation place peculiar to a patients undergoing dialysis. We obtained pelvic artery calcification scores (PACS) using a 64‐row multi‐slice CT to assess the presence of calcification within a triangular space bordered by bordered by osseous structure. We used the Agatston method to calculate PACS. We compared male patients undergoing dialysis with male patients with normal renal function. Patients undergoing hemodialysis had a significantly higher incidence of pelvic artery calcification than normal controls (79.7% vs. 5.5%). In the dialysis group, CACS was 1660.2 (0–9056.1), and PACS was 48.8 (0–2943.1). We found a correlation between PACS and CACS and between PACS and dialysis period. We found penile artery calcification in male patients undergoing hemodialysis was more than normal controls, and it was possible to quantify PACS using the Agatston method. This study suggested the possibility that PACS became the vascular calcification evaluation method of the hemodialysis patient.

MP70-09 IDENTIFICATION OF NINE NEW SUSCEPTIBILITY LOCI FOR PROSTATE CANCER IN THE JAPANESE POPULATION

Source of Funding: The work was supported by the Natural Science Foundation of Jiangsu Province, China (Grant No. BK 20160112), the National Science Foundation for Postdoctoral Scientists of Jiangsu Province, China (Grant No. 1601018A), General Financial Grant from the China Postdoctoral Science Foundation (Grant No. 2017M611792), and Nanjing Medical Science and Technique Development Foundation (Grant No. QRX17048).

Efficacy of Everolimus for Treating Renal Angiomyolipoma with Inferior Vena Cava Thrombus Associated with Tuberous Sclerosis: A Case Report

Here we report a case of 57-year-old woman with renal angiomyolipoma associated with tuberous sclerosis complex involving inferior vena cava thrombus. We could perform less invasive nephrectomy with thrombectomy because everolimus administration reduced the inferior vena cava thrombus. To the best of our knowledge, this is the first report the use of everolimus before performing surgery to treat renal angiomyolipoma with inferior vena cava thrombus.

Non-machinery dialysis that achieves blood purification therapy without using full-scale dialysis machines

An electrical or water supply and a blood purification machine are required for renal replacement therapy. There is a possibility that acute kidney injury can occur in large numbers and on a wide scale in the case of a massive earthquake, and there is the potential risk that the current supply will be unable to cope with acute kidney injury cases. However, non-machinery dialysis requires exclusive circuits and has the characteristic of not requiring the full-scale dialysis machines. We performed perfusion experiments that used non-machinery dialysis and recent blood purification machines in 30-min intervals, and the effectiveness of non-machinery dialysis was evaluated by the assessing the removal efficiency of potassium, which causes lethal arrhythmia during acute kidney injury. The non-machinery dialysis potassium removal rate was at the same level as continuous blood purification machines with a dialysate flow rate of 5xa0L/h after 15xa0min and continuous blood purification machines with a dialysate flow rate of 3xa0L/h after 30xa0min. Non-machinery dialysis required an exclusive dialysate circuit, the frequent need to replace bags, and new dialysate exchanged once every 30xa0min. However, it can be seen as an effective renal replacement therapy for crush-related acute kidney injury patients, even in locations or facilities not having the full-scale dialysis machines.

Measurements of ionic concentrations along with endocochlear potential in wild-type and claudin 14 knockout mice

OBJECTIVEnTo examine whether the changes in endolymphatic ion concentrations were involved in hair cells degeneration in claudin-14 knockout (KO) mice (Cldn14-/-), we measured the endocochlear potential (EP) along with concentrations of K+, Na+, H+, or Ca2+ ([K]e, [Na]e, pHe, [Ca]e) in Cldn14-/-, in which hair cells were selectively damaged, and compared with measurements in wild type mice (Wt).nnnMETHODSnWe used the Cldn14-/- from 3 weeks of age, in which the auditory brain responses (ABR) was severely diminished. Using double-barreled ion-selective microelectrodes, we measured [K]e, [Na]e, pHe, and [Ca]e in both Wt and Cldn14-/- at 8-10 weeks of age.nnnRESULTSn(1) In Wt, the EP was +92mV. [K]e, [Na]e, pHe, and [Ca]e were 169mM, ∼1.0mM, 7.50, and 395nM, respectively. In the Cldn14-/-, the EP was +96mV. [K]e, [Na]e, pHe, and [Ca]e were 167mM, ∼1.0mM, 7.73, and 179nM, respectively. No significant differences in the above values were observed between Wt and Cldn14-/-. (2) A significant linear correlation between EP and [Ca]e (R=0.93) was observed for both Wt and Cldn14-/-, but no correlation was observed between EP and K+, Na+, or H+.nnnCONCLUSIONnThese findings suggest that (1) the changes in endolymphatic ion concentrations might not be involved in hair cells degeneration in Cldn14-/-, (2) [Ca]e might be regulated by EP in both Wt and Cldn14-/-.

MP49-13 SELECTIVE NEOADJUVANT CHEMOTHERAPY BY PREDICTION SYSTEMS IMPROVES THE CHEMO-SENSITIVITY OF THE MUSCLE INVASIVE BLADDER CANCERS

INTRODUCTION AND OBJECTIVES: To compare the rate of chemo-sensitivity in neoadjuvant chemotherapy for muscle invasive bladder cancer between historical control and this interventional prospective study by using our M-VAC and CaG prediction systems. METHODS: Muscle invasive bladder cancer patients (Stage II-III) were engaged in this study. They were assigned to M-VAC, CaG, operation or radiation therapy according to the result of the prediction system which we had already established. According to their responses to the neoadjuvant chemotherapy, we categorized the patients into two groups: 0responders0 who achieved significant tumor shrinking (>60%), and 0non-responders0 ( 60%). Patients were evaluated either 0accurate0 or 0 inaccurate0 according to a tumor shrinkage rate cut off line of a 60% decrease after chemotherapies. The primary endpoint of this study was comparison with the historical controls in terms of the rate of chemo-sensitivity and efficacy. The secondary endpoint was down staging ( pT1) and the overall survival. RESULTS: From March 2011 to July 2013, an intention-to-treat 35 cancer samples from patients were entered in this study. Seven patients M-VAC, 22 CaG, 2 operation and 4 radiation therapy were received respectively. The predicted responder rate for M-VAC was 42.9% (15/35) and for CaG was 57.1% (20/35). Moreover, 74.3% (26/35) of all patients could be expected to respond to both or either of these two regimens by applying our two prediction systems. While, in previous historical control studies (M-VAC 39, CaG 37, total 76 cases), the total predicted response rate of the 76 cases was 57.9% (44/76) (p1⁄40.09). And in the predicted 0responder0 cases, the response rate of M-VAC neoadjuvant chemotherapy was 85.7% (6/7) and CaG was 89.5% (17/19). Therefore, the combined response rate in this group was 88.5% (23/26). In the historical control cases, the observed response rate of M-VAC/CaG therapy was 59.0% (23/39)/54.1% (20/37), and combined observed response rate was 56.6% (43/76) (p1⁄40.004). Down staging and overall survival between this prospective study and the historical control were not significant statistical differences, however in overall survival this prospective study was better tendency than that of the historical control (p1⁄40.233). CONCLUSIONS: Combining the M-VAC and CaG prediction systems would improve the chemo-sensitivity for muscle invasive bladder cancers.