Yoichiro Tabata

Prognostic value of heart rate variability in patients with renal failure on hemodialysis

BACKGROUND In patients with renal failure on hemodialysis cardiovascular disease is a major cause of death. It has been reported that diminished heart rate variability (HRV) relates to the unfavorable prognosis in post-infarction and/or heart failure patients. However, the prognostic value of HRV in hemodialysis patients has not been fully established. METHODS AND RESULTS Time- and frequency-domain analysis of HRV on 24-hour ambulatory electrocardiography recording was assessed prospectively in 383 chronic hemodialysis patients (220 men and 163 women, mean age 57+/-13 years, ejection fraction 65+/-12%). During 2110+/-903 days of follow up, 146 patients died (31 congestive heart failure, 13 fatal myocardial infarction, 13 sudden deaths, 26 stroke, and 63 non-cardiovascular deaths). A Cox univariate analysis identified the following factors as predictors of both all-cause and cardiovascular death: age, gender, ejection fraction, presence of diabetes, and HRV parameters calculated in the time- and frequency-domain. In multivariate analysis, a low standard deviation of all normal RR intervals (SDNN) value was the strongly associated with both all-cause and cardiovascular death (hazard ratios [95% confidence intervals] 0.988 [0.982-0.994] and 0.984 [0.974-0.993], respectively). From Kaplan-Meier survival curves, the incidence of all-cause and cardiovascular death was much greater in patients with a low SDNN (<75 msec), even after adjusting for the presence of diabetes (P<0.0001). CONCLUSIONS Decreased HRV on 24-hour ambulatory electrocardiography is an independent predictor of mortality in chronic hemodialysis patients.

Expression of c‐myc oncogene in colorectal polyps as a biological marker for monitoring malignant potential

The expression of oncogenes (c‐myc, c‐fos, c‐Ki‐ras, c‐Ha‐ras, and p53) was examined by Northern blot analysis using freshly isolated human colorectal and gastric cancers and noncancerous portions as the controls. Remarkably high levels of c‐myc expression were found in colorectal cancers (eight of 11), but not in gastric cancers. High levels of c‐myc expression were also detected in colorectal polyps and in metastatic liver tumors. In colorectal polyps, the transcript levels significantly correlated with the histologic malignancy and the size. In contrast, neither c‐fos nor c‐Ki‐ras was overexpressed in colorectal and gastric cancers, and transcripts of c‐Ha‐ras and p53 were not evident in any tissue examined. In light of these observations the c‐myc expression may be specifically associated with the evolution of colorectal cancer as well as progression and maintenance stages, hence may prove to be a useful marker to evaluate the malignant potential of colorectal polyps.

Clinical Experience of Bead-Shaped Charcoal Haemoperfusion in Chronic Renal Failure and Fulminant Hepatic Failure

A new dialysis system using direct haemoperfusion with collodion-micro-encapsulated, albumin-coated, bead-shaped petroleum activated carbon and artificial kidney in series has been devised. This new system has been applied to the purpose of treatment of patients in chronic renal failure, fulminant hepatic failure and intoxication.

Depression of liver-specific gene expression in regenerating rat liver: A putative cause for liver dysfunction after hepatectomy

We carried out studies on the expression of liver-specific genes during regeneration of the liver and searched for changes in the expression of oncogenes and housekeeping genes. Albumin and ornithine transcarbamylase genes were the liver-specific genes examined by Northern blot analysis, using total RNAs isolated from residual livers of Sprague-Dawley rats subjected to a 68% partial hepatectomy. The mRNA levels of both genes began to decrease 8 hr after hepatectomy, both reaching the lowest levels at 24 hr, and then recovered to some extent at 48 hr. In contrast, these levels in the housekeeping and growth-related genes were augmented during this period. This would suggest that there is a selective expression of growth-related and housekeeping genes, in preference to liver-specific genes during liver regeneration. The expression of these genes in the regenerating liver was simulated in primary cultured hepatocytes during the dedifferentiation processes. It would appear that the first step in regeneration of the residual liver is dedifferentiation, in which the depression of liver-specific genes may be linked to liver dysfunction following hepatectomy.

Long Term Result of Ldl Selective Plasma Adsorption Therapy on Familial Hypercholesterolemia

A newly developed low density lipoprotein (LDL) selective adsorption column from the separated plasma was applied to one patient of heterozygous familial hypercholesterolemia for 20 months at intervals of two weeks. LDL selective adsorption column, Liposorber LA-40, contains 400 ml of swollen dextran sulfate cellulose beads. The long-term, 20 month results of treatment with LDL selective plasma adsorption therapy are reported. LDL selective plasma adsorption therapy by Liposorber is useful in decreasing LDL-cholesterol of familial hypercholesterolemia and is more specific and produces a smaller loss of useful components of the serum than the double filtration plasmapheresis treatment. This treatment is effective in improving clinical conditions of familial hypercholesterolemia. In spite of our lengthy treatment with this therapy, no blood transfusion and no replacement of fluids was done in 20 months.

Tissue blood flow in brain, liver, renal cortex, and renal medulla in experimental hemorrhagic shock.

Cerebral, hepatic, renal cortical, and medullary tissue blood flows of the dog during hemorrhagic shock were measured continuously using the thermoelectrical method. The effects of blood replacement, adrenergic α-stimulator and -blockade and hydrocortisone on the tissue blood flows were studied. After hemorrhage, cerebral blood flow was well maintained while renal cortical blood flow was poorly maintained. Following retransfusion, the blood flow returned rapidly to the brain and slowly to the renal cortex. Norepinephrine, phentolamine, and hydrocortisone were not effective in maintaining the organ blood flows in shock. However, when norepinephrine was given systemically and phentolamine administered to the renal artery simultaneously during shock, both cerebral and renal flows were well maintained. After the blood replacement and administration of α-blockade or hydrocortisone, all the measured blood flows returned to normal levels.

Elevation of c-myc transcript level in human liver during surgical resection of hepatocellular carcinoma: Possible cause for underestimation of c-myc gene activation in the tumor

It has been a matter of controversy as to whether c-myc gene expression is activated in human hepatocellular carcinoma (HCC). We observed that the c-myc mRNA level in HCC was similar to that of the adjacent non-cancerous portion, as determined in freshly obtained specimens after a partial liver resection. However, the c-myc transcript was at a low level in non-cancerous tissue which was biopsied prior to surgery, whereas it was still at a high level in HCC obtained without performing hepatectomy. These results suggest that the high transcript level observed in the non-cancerous tissue from the excised liver relates to liver resection itself, and that the c-myc gene expression is enhanced in the HCC.

Effects of Intradialytic Resistance Exercise on Protein Energy Wasting, Physical Performance and Physical Activity in Ambulatory Patients on Dialysis: A Single‐Center Preliminary Study in a Japanese Dialysis Facility

Patients under hemodialysis present protein‐energy wasting (PEW), which is related with higher mortality rates. The study aimed to determine whether intradialytic resistance exercise training could improve physical performance, physical activity, and PEW in hemodialysis patients. In single center study, 75 hemodialysis patients were enrolled in an intradialytic resistance exercise training consisting of 20 min of adapted leg press, with a gymnastic ball, 3 days/week, during 9 months on the same day of hemodialysis therapy. Physical performance by short physical performance battery (SPPB), physical activity by life space assessment (LSA), and PEW score based on the nomenclature proposed by the International Society of Renal Nutrition and Metabolism in 2008 were assessed at baseline and after 9 months. Intradialytic resistance exercise training significantly improved SPPB score, LSA score, and PEW score (all, P < 0.05). In addition, intradialytic resistance exercise training improved SPPB score in patients with moderate and severe PEW subgroups (P < 0.05), associated with reduced prevalence of the patients with moderate to severe PEW (53% vs. 36%, P < 0.05). Intradialytic resistance exercise training was safe and effective to improve physical performance, physical activity, and PEW in hemodialysis patients.

Assortment of Posthepatectomy Hyperbilirubinemia by the Occurring time with Reference to Indication of Plasma Exchange

This study was undertaken to assort the group of posthepatectomy hyperbilirubinemia by occurring time for helping elucidate its indication of plasma exchange (PE). PE was carried out for 14 cases among 198 hepatectomized patients. The 14 cases were classified for 3 groups due to the period between operation and PE. 1: Early type (less than 2 weeks), 2:Intermediate type (2 less than-less than 8 weeks), 3: Late type (greater than 8 weeks). The results were as follows. Number (liver cirrhosis (LC)) [table: see text]. The effect was expected for the early groups since PE would remove overload against the regenerating residual liver. However, there were no survival cases among the early group or LC group. These results suggest that PE may be effective for the slowly increasing hyperbilirubinemia in not cirrhotic patients and that the state of hyperbilirubinemia is the terminal stage for LC patients even under the particular situation such as posthepatectomy.