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Sobue Y, Nishi K, Kamei K, Inoki Y, Osaka K, Kaneda T, Akiyama M, Sato M, Ogura M, Ishikura K, Ishiguro A, Ito S. Feasibility of discontinuing immunosuppression in children with idiopathic nephrotic syndrome. Pediatr Nephrol 2024; 39:1825-1835. [PMID: 38270600 DOI: 10.1007/s00467-023-06270-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/22/2023] [Accepted: 12/14/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Despite adverse events associated with the long-term use of immunosuppressants, their long-term discontinuation remains challenging in children with idiopathic nephrotic syndrome. Relapse and resumption of immunosuppressants after discontinuation and associated risk factors were analyzed. METHODS This single-center retrospective cohort study included children with frequently relapsing/steroid-dependent nephrotic syndrome (FRNS/SDNS) or steroid-resistant nephrotic syndrome (SRNS) who initiated immunosuppressant treatment between 2010 and 2020. Patients treated with immunosuppressants for less than two years, those with genetic SRNS, and those with continuation of immunosuppressants were excluded. RESULTS Sixty-eight patients with FRNS/SDNS or SRNS discontinued immunosuppressants. Discontinuation of immunosuppressants was more frequently tried in patients with less relapse on initial immunosuppressants and less rituximab administration. Of 68 patients who discontinued immunosuppressants, 45 (66%) relapsed and 31 (46%) resumed immunosuppressants with a median follow-up of 39.8 months (IQR 24.6-71.2 months) after discontinuation. The relapse-free survival rates were 40.0%, 35.3%, and 35.3% in 1, 2, and 3 years from discontinuation of immunosuppressants, respectively. Relapse on initial immunosuppressants (HR 2.038, 95%CI 1.006-4.128, P = 0.048) and the relapse-free interval before discontinuation of immunosuppressants (HR 0.971, 95%CI 0.944-0.998, P = 0.037) were significant risk factors associated with relapse after the discontinuation of immunosuppressants, adjusting for sex, age at immunosuppressant treatment initiation, SRNS, and rituximab use. CONCLUSIONS Long-term discontinuation of immunosuppressants can be feasible in patients without a relapse on initial immunosuppressants, those with longer relapse-free interval before discontinuation of immunosuppressants, and those without a relapse for one year after discontinuation of immunosuppressants. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Yoko Sobue
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Kei Osaka
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomoya Kaneda
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Misaki Akiyama
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Kenji Ishikura
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Shuichi Ito
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
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Akiyama M, Kamei K, Nishi K, Kaneda T, Inoki Y, Osaka K, Sato M, Ogura M, Ito S. Frequency and prognosis of peritoneal dialysis-associated peritonitis in children. Clin Exp Nephrol 2024:10.1007/s10157-024-02482-x. [PMID: 38472543 DOI: 10.1007/s10157-024-02482-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Peritonitis is the leading cause of peritoneal dialysis (PD) discontinuation. However, few data concern risk factors of peritonitis development and catheter removal caused by treatment failure in pediatric patients. METHODS This single-center, retrospective study analyzed data from pediatric patients who underwent chronic PD between March 2002 and June 2022. The incidence rates of peritonitis by the person-year method were calculated, and they were stratified by patient age groups. Risk factors for peritonitis development and catheter removal were also analyzed by multivariate analysis using logistic regression model. RESULTS Ninety patients were enrolled, and 62 peritonitis episodes were observed in 41 (46%) patients. The incidence rate of peritonitis was 0.21 episodes per patient-year, which was the highest in children aged under 2 years old (0.26 episodes per patient-year). Moreover, 44 (71%) cases were successfully cured by antibiotics alone, although 17 (27%) cases required catheter removal, and 4 (6%) cases transitioned to chronic hemodialysis because of peritoneal dysfunction. One patient died. The risk factor for peritonitis development and catheter removal caused by treatment failure was PD insertion at under 2 years old (odds ratio = 2.5; P = 0.04) and Pseudomonas aeruginosa (odds ratio = 11.0; P = 0.04) in the multivariate analysis. P. aeruginosa was also a risk factor for difficulty in re-initiating PD (P = 0.004). CONCLUSIONS The incidence rate of peritonitis was the highest in children under 2 years old. P. aeruginosa peritonitis is a risk factor for catheter removal and peritoneal dysfunction.
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Affiliation(s)
- Misaki Akiyama
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Tomoya Kaneda
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kei Osaka
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Shuichi Ito
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
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Deguchi H, Sakamoto S, Shimizu S, Fukuda A, Uchida H, Yanagi Y, Nakao T, Kodama T, Komine R, Nishi K, Kamei K, Haga C, Yoshioka T, Matsumoto K, Horikawa R, Kasahara M. Living-donor liver transplantation for methylmalonic acidemia patient with hepatocellular carcinoma: A case report and literature review. Pediatr Transplant 2024; 28:e14719. [PMID: 38433569 DOI: 10.1111/petr.14719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Methylmalonic acidemia (MMA) is an autosomal recessive disorder caused by defects in propionyl-CoA (P-CoA) catabolism; of note, liver neoplasms rarely occur as a long-term complication of the disorder. Herein, we report the case of a patient with MMA and hepatocellular carcinoma (HCC) who was successfully treated with a living-donor liver transplant (LDLT) following prior kidney transplantation. CASE REPORT A 25-year-old male patient with MMA underwent LDLT with a left lobe graft because of metabolic instability and liver neoplasms. He had presented with chronic symptoms of MMA, which had been diagnosed by genetic testing. Additionally, he had undergone living-donor kidney transplantation with his father as the donor due to end-stage kidney disease 6 years before the LDLT. He had an episode of metabolic decompensation triggered by coronavirus disease in 2019. Imaging studies revealed an intrahepatic neoplasm in the right hepatic lobe. Due to concerns about metabolic decompensation after hepatectomy, LDLT was performed using a left lobe graft obtained from the patient's mother. Pathological findings were consistent with the characteristics of well-to-moderately differentiated HCC. The postoperative course was uneventful, and the patient was discharged 48 days after the LDLT without any complications. At the 9-month follow-up, the patient's condition was satisfactory, with sufficient liver graft function and without metabolic decompensation. CONCLUSION This case indicates that although HCC is a rare complication in patients with MMA, clinicians should be aware of hepatic malignancies during long-term follow-up.
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Affiliation(s)
- Harunori Deguchi
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Seisuke Sakamoto
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Seiichi Shimizu
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Akinari Fukuda
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Hajime Uchida
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yusuke Yanagi
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Toshimasa Nakao
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Tasuku Kodama
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Ryuji Komine
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Chizuko Haga
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Takako Yoshioka
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Kimikazu Matsumoto
- Children Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Reiko Horikawa
- Department of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
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Nishi K, Imamura I, Hoashi K, Kiyama R, Mitsuiki S. Estrogenic Prenylated Flavonoids in Sophora flavescens. Genes (Basel) 2024; 15:204. [PMID: 38397194 PMCID: PMC10887985 DOI: 10.3390/genes15020204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
Sophora flavescens is a medicinal herb distributed widely in Japan and it has been used to treat various diseases and symptoms. To explore its pharmacological use, we examined the estrogenic activity of four prenylated flavonoids, namely kurarinone, kushenols A and I, and sophoraflavanone G, which are characterized by the lavandulyl group at position 8 of ring A, but have variations in the hydroxyl group at positions 3 (ring C), 5 (ring A) and 4' (ring B). These prenylated flavonoids were examined via cell proliferation assays using sulforhodamine B, Western blotting, and RT-PCR, corresponding to cell, protein, and transcription assays, respectively, based on estrogen action mechanisms. All the assays employed here found weak but clear estrogenic activities for the prenylated flavonoids examined. Furthermore, the activities were inhibited by an estrogen receptor antagonist, suggesting that the activities were likely being mediated by the estrogen receptors. However, there were differences in the activity, attributable to the hydroxyl group at position 4', which is absent in kushenol A. While the estrogenic activity of kurarinone and sophoraflavanone G has been reported before, to the best of our knowledge, there are no such reports on kushenols A and I. Therefore, this study represents the first report of their estrogenic activity.
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Affiliation(s)
| | | | | | | | - Shinji Mitsuiki
- Faculty of Life Science, Kyushu Sangyo University, Fukuoka 813-8503, Japan; (K.N.); (I.I.); (K.H.); (R.K.)
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Inoki Y, Nishi K, Osaka K, Kaneda T, Akiyama M, Sato M, Ogura M, Kamei K. Association between the time of initial relapse and subsequent relapses in patients with childhood-onset idiopathic nephrotic syndrome. Pediatr Nephrol 2024:10.1007/s00467-024-06286-9. [PMID: 38267591 DOI: 10.1007/s00467-024-06286-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/27/2023] [Accepted: 12/27/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Nephrotic syndrome relapse within 6 months is a known risk factor for steroid-dependent nephrotic syndrome/frequently relapsing nephrotic syndrome (SDNS/FRNS), but the risk of early development of SDNS/FRNS and initiation of immunosuppression therapy remains unknown. METHODS Patients with childhood-onset idiopathic nephrotic syndrome who had the first relapse within 6 months were enrolled. We analyzed the relationship between the time of the first relapse or the time of initial remission and incidence of SDNS/FRNS or initiation of immunosuppression therapy. RESULTS Forty-five patients were enrolled. Twenty out of 23 patients (87%) with the first relapse within 30 days after discontinuing initial steroid therapy experienced a second relapse within 30 days after discontinuing steroid therapy. Additionally, most patients in this group (96%) experienced a second relapse within 6 months after the onset and were diagnosed as SDNS/FRNS at this time. In this group, the incidence of SDNS/FRNS development within 6 months was 96%. In contrast, the incidence of SDNS/FRNS development within 6 months was 18% in patients with the first relapse more than 30 days after steroid discontinuation. The incidence of initiation of immunosuppressive agents within 6 months was 83% in the former group and 14% in the latter group. CONCLUSIONS Most patients with the first relapse within 30 days after discontinuing steroid therapy developed SDNS/FRNS and were administered immunosuppressive agents within 6 months. Thus, it might be reasonable to start immunosuppression therapy in this group without waiting for the second relapse.
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Affiliation(s)
- Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Kei Osaka
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
- Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomoya Kaneda
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Misaki Akiyama
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan.
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Inoki Y, Nishi K, Osaka K, Kaneda T, Akiyama M, Sato M, Ogura M, Ide K, Kamei K. Complications and prognosis of patients diagnosed with autosomal recessive polycystic kidney disease in neonatal period. CEN Case Rep 2023:10.1007/s13730-023-00827-1. [PMID: 37875772 DOI: 10.1007/s13730-023-00827-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/29/2023] [Indexed: 10/26/2023] Open
Abstract
There are no clinical guidelines for performing nephrectomy in patients with autosomal recessive polycystic kidney disease (ARPKD). Few reports have described the clinical course of ARPKD diagnosed in the neonatal period in detail. Here, we report seven patients diagnosed with ARPKD and treated at our center during the neonatal period. Two died within 48 h of life due to pulmonary hypoplasia. Of the remaining five patients, three had anuria and required for kidney replacement therapy (KRT) within one week after birth, whereas two with a milder phenotype survived without KRT. All three patients who received KRT underwent unilateral nephrectomy and peritoneal dialysis (PD) catheter placement. To prevent fluid leakage, PD was initiated 7-14 days after catheter placement. However, peritoneal leakage occurred in two patients, resulting in peritonitis and discontinuation of PD; one who required long-term hemodialysis contracted a catheter-related bloodstream infection as well as developed subdural and epidural hematomas. Meanwhile, two patients underwent a second nephrectomy within 6 weeks after birth; one developed severe persistent hypotension and neurological complications, while the other died of bacteremia that may have resulted from cholangitis diagnosed on day 67 of life. A severe clinical course, life-threatening adverse events, and severe neurological sequalae may occur in patients with ARPKD who receive KRT in neonatal period.
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Affiliation(s)
- Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Kei Osaka
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Tomoya Kaneda
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Misaki Akiyama
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Kentaro Ide
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
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Inoki Y, Nishi K, Osaka K, Kaneda T, Akiyama M, Sato M, Ogura M, Kamei K. Postoperative management and complications after abdominal surgery in children receiving peritoneal dialysis. Pediatr Nephrol 2023; 38:3427-3434. [PMID: 37148341 DOI: 10.1007/s00467-023-06009-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Patients on peritoneal dialysis (PD) may develop PD-related complications that necessitate abdominal surgery. However, when to resume PD and how to prescribe PD fluid after surgery in pediatric patients are unknown. METHODS Patients on PD who underwent small-incision abdominal surgery between May 2006 and October 2021 were included in this retrospective observational study. The complications after surgery and characteristics of patients with PD fluid leakage were analyzed. RESULTS Thirty-four patients were included. They underwent 45 surgical procedures, including 23 inguinal hernia repairs, 17 PD catheter repositioning or omentectomy, and 5 others. The median time to resume PD was 1.0 (IQR, 1.0-3.0) days, and the median PD exchange volume at the initiation of PD after surgery was 25 (IQR, 20-30) ml/kg/cycle. PD-related peritonitis occurred in two patients after omentectomy and one after inguinal hernia repair. There was no PD fluid leakage or hernia recurrence among the 22 patients who had a hernia repair. Peritoneal leakage occurred in 3 of the 17 patients who had PD catheter repositioning or an omentectomy and was treated conservatively. No patients who resumed PD 3 days after small-incision abdominal surgery with less than half of PD volume had fluid leakage. CONCLUSIONS Our findings demonstrated that PD could be resumed within 48 h of inguinal hernia repair with no PD fluid leakage or hernia recurrence in pediatric patients. In addition, resuming PD 3 days after a laparoscopic procedure with less than half of the usual dialysate volume might reduce the risk of PD fluid leakage. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Kei Osaka
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Tomoya Kaneda
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Misaki Akiyama
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan.
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Nada T, Kamei K, Sato M, Nishi K, Ogura M, Ito S. Risk factors for early dialysate leakage around the exit site after catheter placement in pediatric peritoneal dialysis: a single-center experience. Clin Exp Nephrol 2023; 27:791-799. [PMID: 37289336 DOI: 10.1007/s10157-023-02365-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/27/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Dialysate leakage, a major complication in peritoneal dialysis (PD), causes difficulty in continuing PD. However, literature evaluating risk factors for leakage in detail and the appropriate break-in period to avoid leakage in pediatric patients is scarce. METHODS We conducted a retrospective study on children aged < 20 years who underwent Tenckhoff catheter placement between April 1, 2002, and December 31, 2021, at our institution. We compared clinical factors between patients with and without leakage within 30 days of catheter insertion. RESULTS Dialysate leakage occurred in 8 of 102 (7.8%) PD catheters placed in 78 patients. All leaks occurred in children with a break-in period of < 14 days. Leaks were significantly more frequent in patients with low body weight at the catheter insertion, single-cuffed catheter insertion, a break-in period ≤ 7 days, and a long PD treatment time per day. Only one patient who had leakage with a break-in period > 7 days was neonate. PD was suspended in four of the eight patients with leakage and continued in the others. Two of the latter had secondary peritonitis, one of whom required catheter removal, and leakage improved in the remaining patients. Three infants had serious complications from bridge hemodialysis. CONCLUSIONS A break-in period of > 7 days and if possible 14 days is recommended to avoid leakage in pediatric patients. Whereas infants with low body weight are at high risk of leakage, their difficulty in inserting double-cuffed catheter, hemodialysis complications, and possible leakage even under long break-in period make prevention of leakage challenging.
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Affiliation(s)
- Taishi Nada
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
- Department of Pediatrics, Yokohama City University Medical Center, 4-57 Urafune-Cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Shuichi Ito
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
- Department of Pediatrics, Yokohama City University Hospital, 3-9 Hukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
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Kanamori T, Kamei K, Sato M, Nishi K, Okutsu M, Ishiwa S, Ogura M, Sako M, Ishikura K, Ito S. CD4 + and CD8 + T-lymphocyte number as predictive marker of relapse after rituximab treatment in childhood-onset refractory nephrotic syndrome. Clin Exp Nephrol 2023:10.1007/s10157-023-02343-z. [PMID: 37095341 DOI: 10.1007/s10157-023-02343-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 03/23/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Rituximab is a promising option for refractory idiopathic nephrotic syndrome. However, no simple predictive markers for relapse after rituximab have been established. To determine such markers, we investigated the relationship between CD4 + and CD8 + cell counts and relapse after rituximab administration. METHODS We retrospectively investigated patients with refractory nephrotic syndrome who received rituximab followed by immunosuppressive as maintenance therapy. Patients were divided into no relapse in 2 years after rituximab treatment or relapse group. After rituximab treatment, CD4 + /CD8 + cell counts were measured monthly, at prednisolone discontinuation, and at B-lymphocyte recovery. To predict relapse, these cell counts were analyzed using receiver operating characteristic (ROC). Additionally, relapse-free survival was reevaluated based on the result of ROC analysis for 2 years. RESULTS Forty-eight patients (18 in the relapse group) were enrolled. At prednisolone discontinuation (52 days after rituximab treatment), the relapse-free group showed significantly lower cell counts than the relapse group (median CD4 + cell count: 686 vs. 942 cells/µL, p = 0.006; CD8 + : 613 vs. 812 cells/µL, p = 0.005). In the ROC analysis, CD4 + cell count > 938 cell/µL and CD8 + cell count > 660 cells/µL could predict relapse in 2 years (sensitivity, 56% and 83%; specificity, 87% and 70%). The patient group with both lower CD4 + and CD8 + cell counts showed significantly longer 50% relapse-free survival (1379 vs. 615 days, p < 0.001 and 1379 vs. 640 days, p < 0.001). CONCLUSIONS Lower CD4 + and CD8 + cell counts in the early phase after rituximab administration may predict a lower risk of relapse.
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Affiliation(s)
- Toru Kanamori
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mika Okutsu
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Ishiwa
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics, Faculty of Medicine, Oita University, Oita, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mayumi Sako
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Ishikura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Shuichi Ito
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
- Department of Pediatrics, Yokohama City University Hospital, 22-2 Seto, Kanazawa-Ku, Yokohama, Kanagawa, 236-0027, Japan.
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10
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Nishi K, Uemura O, Harada R, Yamamoto M, Okuda Y, Miura K, Gotoh Y, Kise T, Hirano D, Hamasaki Y, Fujita N, Uchimura T, Ninchoji T, Isayama T, Hamada R, Kamei K, Kaneko T, Ishikura K. Early predictive factors for progression to kidney failure in infants with severe congenital anomalies of the kidney and urinary tract. Pediatr Nephrol 2023; 38:1057-1066. [PMID: 35951131 DOI: 10.1007/s00467-022-05703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Severe congenital anomalies of the kidney and urinary tract (CAKUT) progress to infantile kidney failure with replacement therapy (KFRT). Although prompt and precise prediction of kidney outcomes is important, early predictive factors for its progression remain incompletely defined. METHODS This retrospective cohort study included patients with CAKUT treated at 12 centers between 2009 and 2020. Patients with a maximum serum creatinine level ≤ 1.0 mg/dL during the first 3 days, patients who died of respiratory failure during the neonatal period, patients who progressed to KFRT within the first 3 days, and patients lacking sufficient data were excluded. RESULTS Of 2187 patients with CAKUT, 92 were finally analyzed. Twenty-five patients (27%) progressed to KFRT and 24 (26%) had stage 3-5 chronic kidney disease without replacement therapy during the median observation period of 52.0 (interquartile range, 22.0-87.8) months. Among these, 22 (24%) progressed to infantile KFRT. The kidney survival rate during the infantile period was significantly lower in patients with a maximum serum creatinine level during the first 3 days (Cr-day3-max) ≥ 2.5 mg/dL (21.8%) compared with those with a Cr-day3-max < 2.5 mg/dL (95.2%) (log-rank, P < 0.001). Multivariate analysis demonstrated Cr-day3-max (P < 0.001) and oligohydramnios (P = 0.025) were associated with higher risk of infantile KFRT. Eighty-two patients (89%) were alive at the last follow-up. CONCLUSIONS Neonatal kidney function, including Cr-day3-max, was associated with kidney outcomes in patients with severe CAKUT. Aggressive therapy for severe CAKUT may have good long-term life outcomes through infantile dialysis and kidney transplantation. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Osamu Uemura
- Ichinomiya Medical Treatment and Habilitation Center, Aichi, Japan
| | - Ryoko Harada
- Department of Nephrology and Rheumatology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Masaki Yamamoto
- Department of Pediatrics, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Yusuke Okuda
- Department of Pediatrics, Kitasato University School of Medicine, 1-15-1 Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Kenichiro Miura
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshimitsu Gotoh
- Department of Pediatric Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan
| | - Tomoo Kise
- Department of Pediatric Nephrology, Okinawa Prefectural Nanbu Medical Center, Children's Medical Center, Okinawa, Japan
| | - Daishi Hirano
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuko Hamasaki
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Naoya Fujita
- Department of Nephrology, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Toru Uchimura
- Department of Pediatrics, Yokohama City University Medical Center, Kanagawa, Japan
| | - Takeshi Ninchoji
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Tetsuya Isayama
- Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Riku Hamada
- Department of Nephrology and Rheumatology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Tetsuji Kaneko
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
- Teikyo Academic Research Center, Teikyo University, Tokyo, Japan
| | - Kenji Ishikura
- Department of Pediatrics, Kitasato University School of Medicine, 1-15-1 Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
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11
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Takao H, Nishi K, Funaki T, Inoki Y, Osaka K, Nada T, Yokota S, Sato M, Ogura M, Ishikura K, Ishiguro A, Kamei K. Changes in Patterns of Infection Associated with Pediatric Idiopathic Nephrotic Syndrome: A Single-Center Experience in Japan. J Pediatr 2023; 254:11-16.e1. [PMID: 36223870 DOI: 10.1016/j.jpeds.2022.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/30/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We studied infection rates and risk factors for infection in current patients with idiopathic nephrotic syndrome (INS). STUDY DESIGN This retrospective cohort study included the clinical data for children with diagnosed INS in our center between January 2010 and December 2020. The infection rates and risk factors were analyzed. RESULTS We enrolled 187 patients, including 85 cases with steroid-dependent/frequently relapsing nephrotic syndrome and 45 with steroid-resistant nephrotic syndrome. Infection was observed a total of 84 times in 55 patients (95.5 per 1000 person-years). Pneumonia was the most common infection (21 cases, 23.9 per 1000 person-years), followed by febrile neutropenia (12 cases, 13.7 per 1000 person-years), whereas peritonitis and bacteremia were observed in only 3 and 2 cases, respectively. The multivariate analyses by logistic regression showed that rituximab treatment was significantly associated with infections in pediatric INS (P = .001). The infection rate during the B-cell-depleted state with immunosuppressants (318 per 1000 person-years) was greater than that with normal B-cell count with immunosuppressants (109 per 1000 person-years) or without immunosuppressants (76 per 1000 person-years). CONCLUSION Common infections, such as peritonitis and bacteremia, decreased, whereas infections associated with medication (eg, rituximab) increased. The rate of infection increases during B-cell depletion after treatments with rituximab and other immunosuppressants.
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Affiliation(s)
- Hiroyuki Takao
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
| | - Takanori Funaki
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kei Osaka
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Taishi Nada
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, Yokohama City University Medical Center, Kanagawa, Japan
| | - Shunsuke Yokota
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Ishikura
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
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12
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Inoki Y, Nishi K, Sato M, Ogura M, Kamei K. The association between hypogammaglobulinemia severity and infection risk in rituximab-treated patients with childhood-onset idiopathic nephrotic syndrome. Pediatr Nephrol 2023; 38:451-460. [PMID: 35748947 DOI: 10.1007/s00467-022-05652-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/05/2022] [Accepted: 06/01/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Hypogammaglobulinemia is a major adverse effect from rituximab. However, the association between rituximab-induced hypogammaglobulinemia and infection frequency is unknown. METHODS Patients who received rituximab for complicated nephrotic syndrome between February 2006 and October 2020 were enrolled in this retrospective observational study. Infections requiring antibacterial or antiviral agents or hospitalization were identified, and the characteristics of infections were compared according to infection type. RESULTS One hundred and forty patients were enrolled. Fifty infection events were detected in 36 patients, 45 infection events in 32 patients required hospitalization, and 1 severe infection event required intensive care unit admission. In eight patients who developed severe hypogammaglobulinemia (serum IgG level < 200 mg/dL) for more than 1 year after rituximab treatment, eight infections occurred in six patients; six of these infections did not occur during the period of severe hypogammaglobulinemia. Febrile neutropenia accounted for 54.2% (13/24) of all infections among the patients with hypogammaglobulinemia. The incidence of infections was 0.028 (95% confidence interval = 0.017-0.448), 0.071 (95% [CI] = 0.041-0.114), and 0.096 (95% [CI] = 0.019-0.282) patient-years in patients with normal serum IgG levels and those with mild and severe hypogammaglobulinemia, respectively. Immunoglobulin replacement therapy was not administered to any patients except for the treatment of infection. CONCLUSIONS Our results showed no statistically significant association between hypogammaglobulinemia severity and infection rate. In addition, the frequency of infection was relatively low even in patients with severe hypogammaglobulinemia, suggesting that immunoglobulin replacement therapy may not be necessary for rituximab-treated patients with severe hypogammaglobulinemia. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-853, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-853, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-853, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-853, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-853, Japan.
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13
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Nishi K, Ogura M, Tamai N, Gima M, Ide K, Koinuma G, Kamei K, Ito S. Correction: Successful rituximab treatment for severe rapidly progressive interstitial lung disease with anti-MDA5 antibody-positive juvenile dermatomyositis: a case report and literature review. Pediatr Rheumatol Online J 2022; 20:76. [PMID: 36064710 PMCID: PMC9446570 DOI: 10.1186/s12969-022-00736-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kentaro Nishi
- grid.63906.3a0000 0004 0377 2305Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Masao Ogura
- grid.63906.3a0000 0004 0377 2305Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Naotaka Tamai
- grid.63906.3a0000 0004 0377 2305Division of Pulmonology, National Center for Child Health and Development, Tokyo, Japan
| | - Masafumi Gima
- grid.63906.3a0000 0004 0377 2305Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Ide
- grid.63906.3a0000 0004 0377 2305Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Goro Koinuma
- grid.63906.3a0000 0004 0377 2305Division of Pulmonology, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- grid.63906.3a0000 0004 0377 2305Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Shuichi Ito
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan. .,Department of Pediatrics, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Kanagawa, Yokohama, 236-0004, Japan.
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14
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Fukayama H, Nakao H, Nishi K, Kubota M, Ishiguro A. Transient hypertension with urinary tract infection in congenital hydronephrosis. Germs 2022; 12:400-403. [PMID: 37680674 PMCID: PMC10482482 DOI: 10.18683/germs.2022.1344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 09/09/2023]
Abstract
Introduction Hypertension is occasionally associated with congenital hydronephrosis. Case report The authors report a four-month-old boy with severe left congenital hydronephrosis and transient hypertension triggered by his first urinary tract infection (UTI). Despite the satisfactory UTI clinical course, he suddenly developed severe hypertension (130/80 mmHg) on the ninth day of UTI. His aldosterone level was within the reference range and his plasma renin activity was slightly elevated. Although his hypertension was refractory to calcium channel blockers, an angiotensin-converting enzyme inhibitor was effective for hypertension. On day 24, he was able to discontinue the antihypertensive without organ damage. Conclusions Although the precise cause of hypertension was unclear in our case, we considered it to be temporary renin-associated hypertension due to decreasing renal blood flow due to UTI in a patient with severe congenital hydronephrosis. In pediatric UTI, particularly in patients with unilateral hydronephrosis, blood pressure monitoring is very important.
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Affiliation(s)
- Haruka Fukayama
- MD, National Center for Child Health and Development, Department of General Pediatrics & Interdisciplinary Medicine, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan, and National Center for Child Health and Development, Center for Postgraduate Education and Training, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Hiro Nakao
- MD, National Center for Child Health and Development, Center for Postgraduate Education and Training, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Kentaro Nishi
- MD, National Center for Child Health and Development, Division of Nephrology and Rheumatology, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Mitsuru Kubota
- MD, PhD, National Center for Child Health and Development, Department of General Pediatrics & Interdisciplinary Medicine, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Akira Ishiguro
- MD, PhD, National Center for Child Health and Development, Center for Postgraduate Education and Training, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
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15
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Abstract
Estrogen action is mediated by various genes, including estrogen-responsive genes (ERGs). ERGs have been used as reporter-genes and markers for gene expression. Gene expression profiling using a set of ERGs has been used to examine statistically reliable transcriptomic assays such as DNA microarray assays and RNA sequencing (RNA-seq). However, the quality of ERGs has not been extensively examined. Here, we obtained a set of 300 ERGs that were newly identified by six sets of RNA-seq data from estrogen-treated and control human breast cancer MCF-7 cells. The ERGs exhibited statistical stability, which was based on the coefficient of variation (CV) analysis, correlation analysis, and examination of the functional association with estrogen action using database searches. A set of the top 30 genes based on CV ranking were further evaluated quantitatively by RT-PCR and qualitatively by a functional analysis using the GO and KEGG databases and by a mechanistic analysis to classify ERα/β-dependent or ER-independent types of transcriptional regulation. The 30 ERGs were characterized according to (1) the enzymes, such as metabolic enzymes, proteases, and protein kinases, (2) the genes with specific cell functions, such as cell-signaling mediators, tumor-suppressors, and the roles in breast cancer, (3) the association with transcriptional regulation, and (4) estrogen-responsiveness. Therefore, the ERGs identified here represent various cell functions and cell signaling pathways, including estrogen signaling, and thus, may be useful to evaluate estrogenic activity.
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Affiliation(s)
- Kentaro Nishi
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University Matsukadai, Higashi-ku, Fukuoka, Japan
| | - Wenqiang Fu
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University Matsukadai, Higashi-ku, Fukuoka, Japan
| | - Ryoiti Kiyama
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University Matsukadai, Higashi-ku, Fukuoka, Japan
- * E-mail:
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16
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Nishi K, Ogura M, Tamai N, Gima N, Ide K, Koinuma G, Kamei K, Ito S. Successful rituximab treatment for severe rapidly progressive interstitial lung disease with anti-MDA5 antibody-positive juvenile dermatomyositis: a case report and literature review. Pediatr Rheumatol Online J 2022; 20:60. [PMID: 35927666 PMCID: PMC9351133 DOI: 10.1186/s12969-022-00723-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Rapidly progressive (RP) interstitial lung disease (ILD) is a life-threatening complication of juvenile dermatomyositis (JDM); however, it is generally refractory to treatment; to the best of our knowledge, no evidence-based treatment has been established for RP-ILD yet. We present the case of a 2-year-old girl with RP-ILD who showed resistance to treatment with methylprednisolone, cyclosporine A, cyclophosphamide, immunoglobulin, and plasma exchange (PE) and was finally treated with extracorporeal membrane oxygenation. We further present a literature review of 18 cases of JDM with RP-ILD. CASE PRESENTATION A 2-year-old girl presented with malar rash, mild muscle weakness, and weight loss for a few months before admission. She had a history of dry cough and dyspnea for a few days, followed by rapid respiratory failure. The patient was diagnosed with JDM with RP-ILD through physical examination (malar rashes and Gottron's sign) and based on the finding of myositis on femoral magnetic resonance imaging, elevated levels of serum muscle enzymes, positive anti-melanoma differentiation-association gene 5 (MDA5) antibody (> 7,500 index), elevated level of Krebs von den Lungen-6 glycoprotein (KL-6; 3,420 U/mL), and extensive ground-glass opacities with consolidation in the bilateral lungs on chest high-resolution computed tomography. She received combination therapy, including methylprednisolone pulse therapy, followed by oral prednisolone and intravenous cyclosporine A, cyclophosphamide, and immunoglobulin. On day 11 of hospitalization, she was placed on ventilation support and PE was initiated. However, her respiratory condition continued to deteriorate and veno-venous extracorporeal membrane oxygenation was started on day 24 of hospitalization. Rituximab was administered on day 28. After 2 weeks of rituximab therapy initiation, her respiratory condition showed gradual improvements. Eventually, on day 52 of hospitalization, the patient could be weaned off extracorporeal membrane oxygenation. Finally, she was discharged with minimal ventilation support and no neurological complications 11 months after admission. CONCLUSIONS Our literature review suggest that JDM with RP-ILD has a high mortality rate. In JDM, rituximab may be a promising treatment option for RP-ILD. In the future, the efficacy of rituximab in the early phases of ILD should be investigated.
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Affiliation(s)
- Kentaro Nishi
- grid.63906.3a0000 0004 0377 2305Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Masao Ogura
- grid.63906.3a0000 0004 0377 2305Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Naotaka Tamai
- grid.63906.3a0000 0004 0377 2305Division of Pulmonology, National Center for Child Health and Development, Tokyo, Japan
| | - Naofumi Gima
- grid.63906.3a0000 0004 0377 2305Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Ide
- grid.63906.3a0000 0004 0377 2305Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Goro Koinuma
- grid.63906.3a0000 0004 0377 2305Division of Pulmonology, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- grid.63906.3a0000 0004 0377 2305Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Shuichi Ito
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan. .,Department of Pediatrics, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Kanagawa, 236-0004, Yokohama, Japan.
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17
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Inoki Y, Kamei K, Nishi K, Sato M, Ogura M, Ishiguro A. Incidence and risk factors of rituximab-associated hypogammaglobulinemia in patients with complicated nephrotic syndrome. Pediatr Nephrol 2022; 37:1057-1066. [PMID: 34606002 DOI: 10.1007/s00467-021-05304-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/31/2021] [Accepted: 09/20/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hypogammaglobulinemia is a major adverse event after rituximab treatment; however, the precise incidence and risk factors are unclear in complicated steroid-dependent or frequently relapsing nephrotic syndrome (SDNS/FRNS) patients. METHODS This was a single-center, retrospective, observational study. Patients who received a single dose of rituximab for complicated SDNS or FRNS between February 2007 and May 2019 were enrolled. Serum IgG levels were plotted, and their trends were evaluated after rituximab treatment. The incidence of transient and persistent hypogammaglobulinemia was examined, and risk factors were calculated by multivariate analysis using logistic regression. RESULTS We enrolled 103 patients who received 238 single doses of rituximab. Hypogammaglobulinemia was observed in 58.4% of the patients at least once after a single dose of rituximab treatment and 22.3% developed persistent hypogammaglobulinemia. Serum IgG levels gradually increased during B-cell depletion, and patients with low serum IgG levels at rituximab treatment had persistent hypogammaglobulinemia. Repeated courses of rituximab treatment increased the incidence of hypogammaglobulinemia. A past history of steroid-resistant nephrotic syndrome (SRNS) (odds ratio [OR] = 10.02; 95% confidence interval [CI] = 2.65-37.81; P < 0.001) and low serum IgG levels at rituximab treatment (OR = 7.63; 95% CI = 2.10-27.71; P = 0.002) was significantly associated with hypogammaglobulinemia in multivariate analysis. CONCLUSIONS Hypogammaglobulinemia is a frequent adverse event after rituximab treatment, although IgG levels slightly increase during B-cell depletion. Low serum IgG levels at rituximab treatment and a past history of SRNS are significant risk factors for the development of hypogammaglobulinemia after rituximab treatment.
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Affiliation(s)
- Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.,Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
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Ishiwa S, Sato M, Kamei K, Nishi K, Kanamori T, Okutsu M, Ogura M, Sako M, Ito S, Orihashi Y, Ishikura K. Risks and renal outcomes of severe acute kidney injury in children with steroid-resistant nephrotic syndrome. Clin Exp Nephrol 2022; 26:700-708. [PMID: 35254549 DOI: 10.1007/s10157-022-02198-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 02/11/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Risks and renal outcomes of severe acute kidney injury (AKI) in children with steroid-resistant nephrotic syndrome (SRNS), particularly those who require dialysis, have not been fully explored. METHODS This retrospective cohort study enrolled children who had been diagnosed with idiopathic nephrotic syndrome at the National Center for Child Health and Development between March 2002 and December 2018. Children with steroid-sensitive nephrotic syndrome or SRNS-related gene mutations were excluded. RESULTS Sixty-two children with SRNS (37 boys; median age, 3.6 years [interquartile range (IQR) 2.0-10.3]) were enrolled. Sixteen patients (25.8%) had severe AKI, including nine patients (14.5%) who received dialysis. The period from nephrotic syndrome (NS) onset to partial remission (median [IQR]) was not significantly influenced by dialysis status, but tended to be longer in the dialysis group (125 days [74-225] vs. 40 days [28-113]; p = 0.09); notably, no patient developed chronic kidney disease during the follow-up period. Infection and posterior reversible encephalopathy (PRES) were significantly associated with AKI. Patients with AKI tended to require dialysis in the presence of infection, undergo treatment with cyclosporine A, and have PRES. The period from onset of NS to AKI was significantly longer in the dialysis group (26 days [15.5-46.0] vs. 4 days [0.0-14.0]; p = 0.01). CONCLUSION Dialysis was commonly required among children with SRNS who exhibited severe AKI. The period from onset of NS to partial remission tended to be longer in patients receiving dialysis, whereas renal prognosis was satisfactory during subsequent follow-up.
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Affiliation(s)
- Sho Ishiwa
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Toru Kanamori
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mika Okutsu
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mayumi Sako
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Shuichi Ito
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.,Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Yasushi Orihashi
- Division of Clinical Research, Kitasato University Hospital, Sagamihara, Japan
| | - Kenji Ishikura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan. .,Department of Pediatrics, Kitasato University School of Medicine, 1-15-1 Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
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19
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Kamei K, Ogura M, Sato M, Nishi K, Shoji K, Funaki T, Ogimi C, Ito S. Immunogenicity and safety of SARS-CoV-2 vaccine with immunosuppressive agents. Pediatr Int 2022; 64:e15331. [PMID: 36331234 PMCID: PMC9538526 DOI: 10.1111/ped.15331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/07/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND We conducted a prospective study of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccination in children and adolescents who were taking immunosuppressive agents. METHODS Two doses of SARS-CoV-2 mRNA vaccine were administered to patients taking immunosuppressive agents. Titers of SARS-CoV-2 spike protein receptor-binding domain antibodies were measured before and after vaccination. Vaccine failure was defined as a postvaccination antibody titer of <0.8 U/mL. Seroconversion rates, factors associated with antibody titers after vaccination, clinical effectiveness against breakthrough infection, and adverse events were evaluated. RESULTS A total of 42 patients (median age, 18.1 years) were enrolled. Immunogenicity was measured in 34 patients. The median SARS-CoV-2 spike antibody titer was 329 U/mL (interquartile range [IQR] 50-812 U/mL). Seroconversion (≥0.8 U/mL) was achieved in 29 patients (85%), whereas vaccine failure was diagnosed in five (15%). All patients with vaccine failure were recipients of solid organ transplants (SOTs) and were taking two immunosuppressants. The median antibody titer in SOT recipients (57 U/mL) was significantly lower than that in non-recipients (653 U/mL, P = 0.0002); that of patients taking two immunosuppressive agents (93 U/mL) was lower than that of patients taking one (506 U/mL, P = 0.003). Breakthrough infection occurred in three patients (7%). Adverse events were non-specific, and no flares of primary disease or acute rejection in SOT recipients occurred. CONCLUSIONS SARS-CoV-2 mRNA vaccine was immunogenic in children and adolescents taking immunosuppressive agents, although SOT recipients and patients taking two immunosuppressive agents tended to show lower postvaccination antibody titers.
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Affiliation(s)
- Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Takanori Funaki
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Chikara Ogimi
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Shuichi Ito
- Department of Pediatrics, Yokohama City University Hospital, Kanagawa, Japan
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20
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Mulyani R, Harmayani E, Nurliyani N, Nishi K, Ishida M, Sugahara T. Stimulation of IgM Production in HB4C5 Cell Line and Mouse Splenocytes by Egg Yolk Extract from the Egg of Indonesian Native Chicken. Trop Anim Sci J 2021. [DOI: 10.5398/tasj.2021.44.4.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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21
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Nishi K, Kamei K, Ogura M, Sato M, Ishiwa S, Shioda Y, Kiyotani C, Matsumoto K, Nozu K, Ishikura K, Ito S. Risk factors for post-nephrectomy hypotension in pediatric patients. Pediatr Nephrol 2021; 36:3699-3709. [PMID: 33988732 DOI: 10.1007/s00467-021-05115-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/12/2021] [Accepted: 04/30/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although hypotension is a life-threatening complication of nephrectomy in children, risk factors for its development remain unknown. We evaluated the incidence, clinical course, and associated risk factors of pediatric post-nephrectomy hypotension in an observational study. METHODS This retrospective observational study included the clinical data of children who underwent nephrectomy in our center between 2002 and 2020. Patients undergoing nephrectomy at kidney transplantation and those who developed hypotension before nephrectomy were excluded. RESULTS The study included 55 nephrectomies in 51 patients, including 42 unilateral, 4 two-stage bilateral, and 5 simultaneous bilateral nephrectomies. The diagnoses were isolated Wilms tumor, neuroblastoma, congenital nephrotic syndrome, Denys-Drash syndrome, WAGR (Wilms tumor, aniridia, genitourinary malformations, and mental retardation) syndrome, and autosomal recessive polycystic kidney disease in 24, 10, 9, 6, 1, and 1 patient, respectively. Post-nephrectomy hypotension developed in 11 (20%) patients. Two patients (3.6%) had persistent hypotension; both had their kidneys resected, and one patient (1.8%) died. Male sex, kidney disease, resection of both kidneys, low estimated glomerular filtration rate, increased left ventricular posterior wall thickness in diastole, hypertension before nephrectomy, antihypertensive use, hyperreninemia, and hyperaldosteronism were significantly associated with post-nephrectomy hypotension. Multivariate logistic regression analysis revealed that hypertension before nephrectomy was the only significant risk factor for post-nephrectomy hypotension (P = 0.04). CONCLUSIONS Hypertension before nephrectomy is a significant risk factor for pediatric post-nephrectomy hypotension. Life-threatening hypotension, which might occur after bilateral nephrectomy in infants, should be considered, especially in children with higher risks.
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Affiliation(s)
- Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Sho Ishiwa
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Chikako Kiyotani
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kimikazu Matsumoto
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kenji Ishikura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
- Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Shuichi Ito
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
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22
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Nishi K, Kamei K, Ogura M, Sato M, Ishiwa S, Shioda Y, Kiyotani C, Matsumoto K, Nozu K, Ishikura K, Ito S. Correction to: Risk factors for post-nephrectomy hypotension in pediatric patients. Pediatr Nephrol 2021; 36:3805-3806. [PMID: 34251496 DOI: 10.1007/s00467-021-05198-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Sho Ishiwa
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.,Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Chikako Kiyotani
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kimikazu Matsumoto
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kenji Ishikura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.,Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Shuichi Ito
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.,Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
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23
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Mori T, Fujino A, Takahashi M, Furugane R, Kobayashi T, Kano M, Yoneda A, Kanamori Y, Suzuki R, Nishi K, Kamei K, Kitamura M. Successful endoscopic surgical treatment of pleuroperitoneal communication in two infant cases. Surg Case Rep 2021; 7:181. [PMID: 34383172 PMCID: PMC8360259 DOI: 10.1186/s40792-021-01266-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background Pleuroperitoneal communication (PPC) is an uncommon, but potentially life-threatening complication of peritoneal dialysis (PD). If a fistula does not close with conservative treatment, surgical repair is required. However, approximately half of these patients are forced to shift from PD to hemodialysis. Although it is important to confirm the site of the fistula to achieve a successful surgical treatment, this identification is more difficult in pediatric patients than in adults. Case presentation We report two infantile cases of severe PPC associated with PD. In both cases, the age at onset was less than 2 years, and right-sided pleural effusion with dyspnea was observed. PPC was diagnosed by the change in color of the pleural fluid after the injection of a dye into the peritoneal cavity. Peritoneal scintigraphy and single-photon emission computed tomography and computed tomography (SPECT/CT) were performed, and these were effective in locating the fistula site. Endoscopic surgery (video-assisted thoracic surgery (VATS) and laparoscopic surgery) was performed. Indocyanine green (ICG), which was injected into the abdominal cavity, showed the exact site of the fistula. The fistula was successfully closed by attaching an absorbable sheet to it from the thoracic side and an autograft (the falciform ligament) to it from the abdominal side in one patient. In the other patient, the fistula site was resected and sutured, and reinforced with an absorbable sheet. In both cases, PD was resumed without any complication. Conclusion We successfully treated two infants of PPC by endoscopic surgery. To identify the fistula site, the ICG navigation method was useful. Even in small infants, PPC can be treated successfully by endoscopic surgical repair if the site of the fistula is identified.
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Affiliation(s)
- Teizaburo Mori
- Division of Pediatric Surgery, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Akihiro Fujino
- Division of Pediatric Surgery, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan
| | - Masataka Takahashi
- Division of Pediatric Surgery, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan
| | - Ryoya Furugane
- Division of Pediatric Surgery, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan
| | - Tamotsu Kobayashi
- Division of Pediatric Surgery, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan
| | - Motohiro Kano
- Division of Pediatric Surgery, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan
| | - Akihiro Yoneda
- Division of Pediatric Surgery, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan
| | - Yutaka Kanamori
- Division of Pediatric Surgery, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan
| | - Ryutaro Suzuki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Masayuki Kitamura
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
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24
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Yokota S, Nishi K, Ishiwa S, Uda K, Shoji K, Kamei K. Mycobacterium avium complex peritonitis in a pediatric patient on peritoneal dialysis: A case report. Medicine (Baltimore) 2021; 100:e26321. [PMID: 34128873 PMCID: PMC8213271 DOI: 10.1097/md.0000000000026321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Peritonitis due to Mycobacterium avium complex (MAC) is a rare but life-threatening complication in patients on peritoneal dialysis (PD). However, optimal therapeutic regimen, treatment duration, and appropriate timing of kidney transplantation (KT) after treatment are unknown. SYMPTOMS We herein report a 4-year-old boy on PD due to end-stage kidney disease resulting from bilateral hypoplastic kidneys. He was admitted for peritonitis complaining fever, abdominal pain, and cloudy peritoneal effluent on PD after accidentally biting and opening the PD catheter while in the bath. Initial treatment with vancomycin and ceftazidime for 2 weeks was successful, although peritonitis recurred 37 days after discharge. DIAGNOSIS Mycobacterial culture was positive 9 days after readmission, and MAC was grown in the PD culture on day 30. We diagnosed him with MAC peritonitis that occurred on PD. INTERVENTIONS Clarithromycin, ethambutol, and rifampicin were initiated. The PD catheter was removed, and hemodialysis was initiated with a cuffed catheter inserted in the internal jugular vein. Follow-up observation for 8 months after the cessation of 1-year anti-mycobacterial therapy confirmed no recurrence of MAC infection, and the patient received living-donor KT from his father. OUTCOMES His renal function was stable, with no recurrence of MAC peritonitis at 2 years after the KT. CONCLUSION To the best of our knowledge, this is the first report of a patient who successfully underwent KT after receiving treatment for MAC peritonitis. One-year anti-mycobacterial therapy, PD catheter removal, 8-month observation after the cessation of therapy led the successful KT, although further investigation is warranted to confirm the efficacy of this approach.
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Affiliation(s)
| | | | - Sho Ishiwa
- Division of Nephrology and Rheumatology
- Department of Pediatric Nephrology, Tokyo Women's Medical University
| | - Kazuhiro Uda
- Division of Infectious Diseases, National Center for Child Health and Development
- Division of Infectious Diseases, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, National Center for Child Health and Development
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25
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Suzuki R, Sato M, Murakoshi M, Kamae C, Kanamori T, Nishi K, Ogura M, Kamei K. Eosinophilic peritonitis in children on chronic peritoneal dialysis. Pediatr Nephrol 2021; 36:1571-1577. [PMID: 33219843 DOI: 10.1007/s00467-020-04832-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/11/2020] [Accepted: 10/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Eosinophilic peritonitis (EP) is sometimes difficult to distinguish from bacterial peritonitis (BP) at onset, as they are often overlapping. Previous reports show EP occurs more frequently in infants, although the reason is unknown. METHODS The study population was 77 pediatric patients receiving chronic peritoneal dialysis (PD) in our center. We compared clinical and laboratory data at onset of EP with those of BP. We also investigated age distribution at onset of EP and PD-related surgery. RESULTS Eleven patients developed EP (18 episodes) and 19 patients developed BP (38 episodes). EP patients showed lower rate of cloudy dialysate (44.4% vs. 74.4%; p = 0.04), lower rate of fever (38.9% vs. 56.4%), lower frequency of abdominal pain (16.7% vs. 38.5%), higher peripheral blood eosinophil counts (/μL) (514 vs. 160; p < 0.001), and lower serum C-reactive protein level (mg/dL) (0.4 vs. 4.7; p < 0.001) than BP patients. Thirteen EP events were observed after 169 surgical interventions. Age at surgery-related EP was similar to age at surgery without EP (2.6 vs. 2.1; p = 0.65). There was no significant difference in postoperative EP occurrence between groups <2 years and ≥ 2 years (6.2% vs. 9.1%; p = 0.48). However, infants received more operations than older children. CONCLUSION Clinical symptoms in children and laboratory data of EP in children were less severe than those of BP. As incidence of postoperative EP did not differ by age, we speculate that higher incidence of EP in infants might be associated with higher incidence of surgery, although further validation is necessary.
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Affiliation(s)
- Ryutaro Suzuki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Miki Murakoshi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Chikako Kamae
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Toru Kanamori
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
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26
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Minato S, Iijima H, Nakao H, Nishi K, Hidaka Y, Inoue N, Kubota M, Ishiguro A. Anti-complement factor H (CFH) antibodies and a novel CFH gene mutation in an atypical hemolytic uremic syndrome patient with complement activation of the classical pathway. Immunol Med 2021; 44:274-277. [PMID: 33784485 DOI: 10.1080/25785826.2021.1905303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Atypical hemolytic uremic syndrome (aHUS) is a rare disease caused by overactivation of the complement alternative pathway. aHUS involves the presence of antibodies against complement factor H and its mutations in the complement genes. A 2-month-old boy presented with discoid rash, hemolytic anemia, thrombocytopenia, multiple antibodies, and hypocomplementemia with a very low level of C4 (< 3 mg/dL), indicating activation of the complement pathway, together fulfilling the systemic lupus erythematosus (SLE) criteria of the American College of Rheumatology at 5 months of age. However, most of these findings normalized spontaneously without any intervention. Further investigations revealed a high level of anti-complement factor H antibodies and a novel heterozygous missense mutation (p.Glu1172Ala, located in exon 22) in a complement gene, CFH. At 2 years of age, his SLE-like symptoms have not recurred, but hematuria and schistocytes were persistent. Eventually, aHUS was diagnosed rather than SLE. Our findings suggest that multiple antibody complex, including anti-complement factor H antibody, may temporarily activate the classical pathway, resulting in SLE-like findings.
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Affiliation(s)
- Sonoko Minato
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan.,Center for Postgraduate Education and Training, NCCHD, Tokyo, Japan
| | - Hiroyuki Iijima
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Hiro Nakao
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, NCCHD, Tokyo, Japan
| | - Yoshihiko Hidaka
- Department of Molecular Genetics, Wakayama Medical University, Wakayama, Japan
| | - Norimitsu Inoue
- Department of Molecular Genetics, Wakayama Medical University, Wakayama, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, NCCHD, Tokyo, Japan.,Division of Hematology, NCCHD, Tokyo, Japan
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Okutsu M, Kamei K, Sato M, Kanamori T, Nishi K, Ishiwa S, Ogura M, Sako M, Ito S, Ishikura K. Prophylactic rituximab administration in children with complicated nephrotic syndrome. Pediatr Nephrol 2021; 36:611-619. [PMID: 32995922 DOI: 10.1007/s00467-020-04771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/10/2020] [Accepted: 09/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rituximab is effective for maintaining remission in patients with complicated nephrotic syndrome, although a history of steroid-resistant nephrotic syndrome (SRNS) is a risk factor for early relapse. We investigated the efficacy of prophylactic rituximab treatment for maintaining remission after B cell recovery. METHODS Patients with complicated steroid-dependent or frequently relapsing nephrotic syndrome with history of SRNS who received a single dose of rituximab (375 mg/m2) and continued immunosuppressive agents were enrolled in this retrospective study. Patients were divided into two groups: a prophylaxis group, which received additional rituximab treatment at B cell recovery and a non-prophylaxis group. The relapse-free period from the last rituximab infusion (the second treatment in prophylaxis group and the first treatment in non-prophylaxis group) was compared between two groups using the Kaplan-Meier method, and risk factors for early relapse were calculated using multivariate analysis by Cox proportional hazards model. RESULTS Sixteen patients in the prophylaxis group and 45 in the non-prophylaxis group were enrolled. Fifty-percent relapse-free survival after the last rituximab treatment was 667 days in the former and 335 days in the latter (p = 0.001). Multivariate analysis showed that additional rituximab treatment was the only significant negative factor for early relapse, with a hazard ratio of 0.40 (p = 0.02). Fifty-percent relapse-free survival after B cell recovery was much longer in the prophylaxis group (954 vs. 205.5 days, p = 0.003). CONCLUSIONS Additional rituximab treatment at B cell recovery can maintain prolonged remission even after B cell recovery in patients with complicated nephrotic syndrome with history of SRNS.
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Affiliation(s)
- Mika Okutsu
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.,Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Toru Kanamori
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.,Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Sho Ishiwa
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.,Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Mayumi Sako
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Shuichi Ito
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.,Department of Pediatrics, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Kenji Ishikura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.,Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Kanemaru T, Kondo T, Nakamura KI, Morimoto H, Nishi K, Isobe SI. A Simple Preparation Method for CLEM Using Pre-Embedding Immunohistochemistry with a Novel Fluorescent Probe and Stable Embedding Resin. Microscopy (Oxf) 2021; 70:368-374. [PMID: 33501988 DOI: 10.1093/jmicro/dfab005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/22/2021] [Indexed: 11/13/2022] Open
Abstract
Correlative light and electron microscopy (CLEM) is an excellent approach for examining the cellular localization of biomolecules. Here, we developed a simple method for CLEM by combining pre-embedding immunohistochemistry with a novel fluorescent probe, namely Fluolid NS Orange, and an embedding resin called 'Durcupan™'. Specimens were embedded in Durcupan™ or LR White after immunolabeling and post-fixation using glutaraldehyde and osmium tetroxide. Next, ultrathin sections were prepared on a finder grid with navigation markers. The section of the specimen embedded in Durcupan™ was found to be more stable against electron beam irradiation than specimens embedded in LR White. A fluorescence light microscopy (FLM) image and a transmission electron microscopy (TEM) image, at wide-field, and low magnification, were independently obtained with the same ultrathin section. Using the three corners between finder grid bars as landmarks, FLM images were superimposed with wide-field, low magnification TEM images to identify the region of interest (ROI), which was subsequently enlarged to ascertain cellular structures localized beneath fluorescent signals. However, the enlarged TEM images appeared blurred and fluorescence signals had a hazy appearance. To resolve this, the enlarged TEM images were replaced by high-resolution TEM images focused directly on the ROI, thereby facilitating the collection of high-resolution CLEM images. The simple sample processing method for CLEM using osmium-resistant Fluolid NS Orange and electron beam damage-resistant Durcupan™ allowed the determination of the precise localization of fluorescence signals at subcellular levels.
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Affiliation(s)
- Takaaki Kanemaru
- Department of Morphology Core Unit, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka-city, Fukuoka, 812-8582, Japan
| | - Teruyoshi Kondo
- Department of Animal Pharmaceutical Sciences, School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, 1714-1 Yoshinomachi, Nobeoka-city, Miyazaki, 882-8508, Japan
| | - Kei-Ichiro Nakamura
- Division of Microscopic and Developmental Anatomy, Department of Anatomy, Kurume University School of Medicine, 67 Asahi-machi, Kurume-city, Fukuoka, 830-0011, Japan
| | - Hiroyuki Morimoto
- Second Department of Anatomy, Faculty of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu-city, Fukuoka, 807-8555, Japan
| | - Kentaro Nishi
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsukadai, Higashi-ku, Fukuoka-city, Fukuoka, 813-8503, Japan
| | - Shin-Ichiro Isobe
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsukadai, Higashi-ku, Fukuoka-city, Fukuoka, 813-8503, Japan
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Hiramatsu M, Sugiu K, Hishikawa T, Haruma J, Takahashi Y, Murai S, Nishi K, Yamaoka Y, Shimazu Y, Fujii K, Kameda M, Kurozumi K, Date I. Detailed Arterial Anatomy and Its Anastomoses of the Sphenoid Ridge and Olfactory Groove Meningiomas with Special Reference to the Recurrent Branches from the Ophthalmic Artery. AJNR Am J Neuroradiol 2020; 41:2082-2087. [PMID: 33004344 DOI: 10.3174/ajnr.a6790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/15/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Detailed arterial anatomy of the sphenoid ridge and olfactory groove meningiomas is complicated due to the fine angioarchitecture and anastomoses between each feeder. Herein, we present details of the arterial anatomy and the relationships of feeders in these lesions. MATERIALS AND METHODS This study included 20 patients admitted to our department between April 2015 and March 2020. Conditions of subjects consisted of 16 sphenoid ridge meningiomas and 4 olfactory groove meningiomas. We mainly analyzed arterial anatomy using 3D rotational angiography and slab MIP images of these lesions. We also analyzed the anastomoses of each feeder. RESULTS We found that 19 (95%), 15 (75%), and 15 (75%) lesions had feeders from the ophthalmic, internal carotid, and external carotid arteries, respectively. As feeders from the ophthalmic artery, recurrent meningeal arteries were involved in 18 lesions (90%). Fifteen lesions (75%) had anastomoses between each feeder. CONCLUSIONS Most of the meningiomas in the sphenoid ridge and olfactory groove had feeders from the ophthalmic and internal carotid arteries. There were various anastomoses between each feeder. This is the first report to demonstrate the detailed arterial anatomy and frequency of recurrent branches from the ophthalmic artery and their anastomoses using detailed imaging techniques.
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Affiliation(s)
- M Hiramatsu
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Sugiu
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - T Hishikawa
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - J Haruma
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Y Takahashi
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - S Murai
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Nishi
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Y Yamaoka
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Y Shimazu
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Fujii
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - M Kameda
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Kurozumi
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Neurosurgery (K.K.), Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - I Date
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Nishi K, Kamei K, Ogura M, Sato M, Murakoshi M, Kamae C, Suzuki R, Kanamori T, Nagano C, Nozu K, Ishikura K, Ito S. Refractory Hypertension in Infantile-Onset Denys-Drash Syndrome. TOHOKU J EXP MED 2020; 252:45-51. [PMID: 32863338 DOI: 10.1620/tjem.252.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Denys-Drash syndrome is characterized by progressive nephropathy, gonadal dysgenesis, and Wilms tumor caused by a WT1 gene mutation. Infants with Denys-Drash syndrome frequently experience severe hypertension, but detailed clinical manifestations have yet to be clarified. Cases of infantile-onset Denys-Drash syndrome with severe hypertension at our hospital were retrospectively analyzed and the pathogenesis of hypertension was investigated. Six infants who received the diagnosis of Denys-Drash syndrome at the median age of 10 days (range: 2-182 days) were enrolled. Five infants had the complication of severe hypertension within a few days of diagnosis. All the patients showed rapid progression to end-stage renal disease and urgently required dialysis due to anuria/oliguria and hypervolemia with a median duration of 7.5 days (range: 0-17 days) on the day after diagnosis. Even under dialysis, all the patients continued to need antihypertensive treatment. Five patients underwent a preventive nephrectomy for Wilms tumor, and one patient underwent a nephrectomy due to progression to Wilms tumor. Two patients developed hypotension after a nephrectomy. The main causes of hypertension were hypervolemia in the predialysis stage, renin-associated hypertension in the dialysis stage, and multiple factors, including increased plasma catecholamine-associated hypertension in the postnephrectomy dialysis stage. At last the follow-up after bilateral nephrectomy, four of the five patients required antihypertensive treatment. Not all the patients showed target organ complications caused by hypertension. Severe hypertension is a common complication of infantile-onset Denys-Drash syndrome. The possibility of hypotension after nephrectomy should be considered in patients with Denys-Drash syndrome.
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Affiliation(s)
- Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development
| | - Miki Murakoshi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development
| | - Chikako Kamae
- Division of Nephrology and Rheumatology, National Center for Child Health and Development
| | - Ryutaro Suzuki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development
| | - Toru Kanamori
- Division of Nephrology and Rheumatology, National Center for Child Health and Development
| | - China Nagano
- Department of Pediatrics, Kobe University Graduate School of Medicine
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine
| | - Kenji Ishikura
- Department of Pediatrics, Kitasato University School of Medicine
| | - Shuichi Ito
- Department of Pediatrics, Yokohama City University Graduate School of Medicine
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Nishi K, Sato M, Ogura M, Okutsu M, Ishikura K, Kamei K. Two cases of idiopathic steroid-resistant nephrotic syndrome complicated with thrombotic microangiopathy. BMC Nephrol 2020; 21:323. [PMID: 32746791 PMCID: PMC7398381 DOI: 10.1186/s12882-020-01985-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/27/2020] [Indexed: 11/25/2022] Open
Abstract
Background Thrombotic microangiopathy (TMA) is a histopathological entity associated with microangiopathic hemolytic anemia, thrombocytopenia, and end-organ ischemic damage. Although TMA is caused by various diseases, there have been few reports regarding children with idiopathic nephrotic syndrome (NS) and TMA. Here we report two 1-year-old infants with steroid-resistant NS (SRNS) who presented with severe hypertension, acute kidney injury (AKI), and TMA. Case presentation The diagnosis of NS was complicated with anemia, AKI, and hypertension. Maximum blood pressure was 150/70 mmHg in Case 1 and 136/86 mmHg in Case 2. There was no thrombocytopenia during their clinical course in both cases. Renal biopsy showed the features of TMA, including endothelial cell swelling, capillarectasia or marked mesangiolysis, along with mesangial proliferation in Case 1 and TMA with minor glomerular abnormalities in Case 2. Hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and secondary TMA other than that caused by hypertension were excluded. Oral prednisolone therapy, frequent infusion of albumin and diuretics, and multiple anti-hypertensive drugs were initiated. Blood pressure was controlled after 6 and 7 days from initiation of multiple anti-hypertensive drugs and lisinopril was added due to persistent mild proteinuria and mild hypertension after improvement of renal function in both cases. Proteinuria resolved completely 4 months after admission with daily oral prednisolone for 4 weeks followed by alternative daily oral prednisolone for 4 weeks in Case 1. Proteinuria resolved completely 10 months after admission with initial prednisolone treatment for 4 weeks followed by cyclosporine A and intravenous methylprednisolone pulse therapy in Case 2. The follow-up biopsy showed no TMA findings in both patients. Because the patient in Case 1 subsequently developed frequent relapsing NS, cyclosporine A was commenced after the second biopsy and he did not have any flares for 2 years. Renal function was normal in Case 1 and mildly decreased in Case 2 at last follow-up (creatinine-eGFR of 136.2 mL/min/cm2 in Case 1 and 79.5 mL/min/cm2 in Case 2). Conclusion Severe hypertension and AKI can be signs of TMA in patients with SRNS. Strict anti-hypertensive therapy might improve renal outcomes.
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Affiliation(s)
- Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Mika Okutsu
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.,Department of Pediatrics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Kenji Ishikura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.,Department of Pediatrics, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara-shi, Kanagawa, 252-0375, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
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Kasahara K, Sone T, Nishi K, Shibata K, Araya T, Shirasaki H, Yoneda T, Kase K, Nishikawa S, Kimura H, Tambo Y. P1.04-50 Real World Efficacy of Pembrolizumab of as a 1st Line Treatment in Metastatic Non-Small Cell Lung Cancer with PD-L1 High Expression. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Itotani R, Matsumoto S, Udagawa H, Nishino K, Nakachi I, Miyamoto S, Hara S, Kuyama S, Ebi N, Tsubata Y, Shingyoji M, Kato T, Ohe Y, Nishi K, Hashimoto S, Goto K. A large scale prospective concordance study of oncogene driver detection between plasma- and tissue-based NGS analysis in advanced non-small cell lung cancer (NSCLC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ohno M, Matsuura H, Makiyama T, Nishi K, Iwasaki H, Matsuda S, Kimura T, Nishi E. P2560Metalloprotease nardilysin controls heart rate through the transcriptional regulation of ion channels critical for sinus automaticity. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Nardilysin (NRDC; N-arginine dibasic convertase) is a metalloprotease of the M16 family. We have demonstrated that NRDC in the extracellular space enhances ectodomain cleavage of multiple membrane proteins. We also reported that nuclear NRDC regulates transcription of several target genes as a transcriptional coregulator. These results indicated that NRDC is a protease having localization-dependent multiple functions. NRDC-deficient mice (Nrdc−/−) showed wide range of phenotypes such as hypomyelination, hypothermia, and bradycardia. In this study, we have explored a role of NRDC in the regulation of heart rate. (1) Pharmacological blocking of autonomic nervous system revealed that an intrinsic heart rate of Nrdc−/− was significantly reduced compared with that of wild-type mice. (2) In Nrdc−/− hearts, mRNA levels of Cav3.1 and HCN1/4, ion channels responsible for sinus automaticity, were significantly reduced. (3) Funny (If) current and T-type Ca current measured in the sinus node cells were markedly reduced in Nrdc−/− cells, indicating that the functions of Cav3.1 and HCN4 are impaired. (4) Gene knockdown of NRDC in primary rat ventricular myocyte led to the reduction of mRNA level of HCN4. (5) Chromatin immunoprecipitation-PCR analysis showed that NRDC binds to the promoter region of Cav3.1 and HCN4, suggesting the direct involvement of NRDC in transcriptional regulation of these ion channels. (6) Atrium-specific Nrdc−/− (Sarcolipin-Cre) showed mild bradycardia and reduced Cav3.1 mRNA expression. Together, our results indicated that NRDC in cardiomyocyte controls heart rate through the transcriptional regulation of ion channels critical for sinus automaticity.
Acknowledgement/Funding
KAKENHI (17K09575)
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Affiliation(s)
- M Ohno
- Shiga University of Medical Science, Otsu, Japan
| | - H Matsuura
- Shiga University of Medical Science, Otsu, Japan
| | - T Makiyama
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Nishi
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - H Iwasaki
- Shiga University of Medical Science, Otsu, Japan
| | - S Matsuda
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T Kimura
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - E Nishi
- Shiga University of Medical Science, Otsu, Japan
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Kanemaru T, Kondo T, Nishi K, Yazumi T, Nakamura KI, Morimoto H, Isobe S. 3aB_MB-3Pre-embedding correlative light and electron microscopy using FluoroNanogold combined gold nanoparticle and new fluorescent dye, Fluolid NSL Orange. Microscopy (Oxf) 2018. [DOI: 10.1093/jmicro/dfy085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | - Hiroyuki Morimoto
- University of Occupation and Environmental Health, Kitakyushu, Japan
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Nishi K, Kawai T, Kubota M, Ishiguro A, Onodera M. X-linked agammaglobulinemia complicated with pulmonary aspergillosis. Pediatr Int 2018; 60:90-92. [PMID: 29356289 DOI: 10.1111/ped.13453] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/16/2017] [Accepted: 10/31/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Kentaro Nishi
- Department of Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Toshinao Kawai
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ishiguro
- Department of Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Masafumi Onodera
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan
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Nakao H, Ishiguro A, Ikoma N, Nishi K, Su C, Nakadate H, Kubota M, Hayakawa M, Matsumoto M. Acquired idiopathic thrombotic thrombocytopenic purpura successfully treated with intravenous immunoglobulin and glucocorticoid: A case report. Medicine (Baltimore) 2017; 96:e6547. [PMID: 28383422 PMCID: PMC5411206 DOI: 10.1097/md.0000000000006547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Plasma exchange is the principal treatment for acquired thrombotic thrombocytopenic purpura (TTP) but is invasive and may have adverse effects. Reports of immunoglobulin therapy for acquired TTP without plasma exchange are rare. PATIENT CONCERNS A 14-year-old girl was admitted because of hemolytic anemia and thrombocytopenia. DIAGNOSIS Acquired TTP was diagnosed based on low ADAMTS13 (a disintegrin-like and metalloproteinase with thrombospondin type 1 motif, 13) activity and a high ADAMTS13 inhibitor level. INTERVENTIONS & OUTCOMES Fresh frozen plasma was initially effective. Prednisolone and immunoglobulin resolved the condition with no adverse effects and rendered plasma exchange unnecessary. LESSONS Compared with biological agents, immunoglobulin is cost-effective, readily available, and has a proven long-term safety record, making it a possible treatment option for acquired thrombotic thrombocytopenic purpura.
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Affiliation(s)
| | - Akira Ishiguro
- Department of Postgraduate Education and Training
- Division of Hematology, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo
| | - Nahoko Ikoma
- Department of General Pediatrics
- Department of Postgraduate Education and Training
| | - Kentaro Nishi
- Department of General Pediatrics
- Department of Postgraduate Education and Training
| | - Chemin Su
- Department of General Pediatrics
- Department of Postgraduate Education and Training
| | - Hisaya Nakadate
- Department of General Pediatrics
- Division of Hematology, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo
| | | | - Masaki Hayakawa
- Department of Blood Transfusion Medicine, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan
| | - Masanori Matsumoto
- Department of Blood Transfusion Medicine, Nara Medical University, Shijo-cho, Kashihara, Nara, Japan
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Kawahara K, Hirata H, Ohbuchi K, Nishi K, Maeda A, Kuniyasu A, Yamada D, Maeda T, Tsuji A, Sawada M, Nakayama H. The novel monoclonal antibody 9F5 reveals expression of a fragment of GPNMB/osteoactivin processed by furin-like protease(s) in a subpopulation of microglia in neonatal rat brain. Glia 2016; 64:1938-61. [PMID: 27464357 PMCID: PMC5129557 DOI: 10.1002/glia.23034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 07/02/2016] [Accepted: 07/07/2016] [Indexed: 12/19/2022]
Abstract
To differentiate subtypes of microglia (MG), we developed a novel monoclonal antibody, 9F5, against one subtype (type 1) of rat primary MG. The 9F5 showed high selectivity for this cell type in Western blot and immunocytochemical analyses and no cross-reaction with rat peritoneal macrophages (Mφ). We identified the antigen molecule for 9F5: the 50- to 70-kDa fragments of rat glycoprotein nonmetastatic melanoma protein B (GPNMB)/osteoactivin, which started at Lys(170) . In addition, 9F5 immunoreactivity with GPNMB depended on the activity of furin-like protease(s). More important, rat type 1 MG expressed the GPNMB fragments, but type 2 MG and Mφ did not, although all these cells expressed mRNA and the full-length protein for GPNMB. These results suggest that 9F5 reactivity with MG depends greatly on cleavage of GPNMB and that type 1 MG, in contrast to type 2 MG and Mφ, may have furin-like protease(s) for GPNMB cleavage. In neonatal rat brain, amoeboid 9F5+ MG were observed in specific brain areas including forebrain subventricular zone, corpus callosum, and retina. Double-immunοstaining with 9F5 antibody and anti-Iba1 antibody, which reacts with MG throughout the CNS, revealed that 9F5+ MG were a portion of Iba1+ MG, suggesting that MG subtype(s) exist in vivo. We propose that 9F5 is a useful tool to discriminate between rat type 1 MG and other subtypes of MG/Mφ and to reveal the role of the GPNMB fragments during developing brain. GLIA 2016;64:1938-1961.
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Affiliation(s)
- Kohichi Kawahara
- Department of Molecular Cell Function, Faculty of Life Sciences, Kumamoto University, 5-1 Ohe-Honmachi, Kumamoto, 862-0973, Japan. .,Department of Pharmacology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, 265-1 Higashijima, Niigata, 956-8603, Japan.
| | - Hiroshi Hirata
- Department of Molecular Cell Function, Faculty of Life Sciences, Kumamoto University, 5-1 Ohe-Honmachi, Kumamoto, 862-0973, Japan
| | - Kengo Ohbuchi
- Department of Molecular Cell Function, Faculty of Life Sciences, Kumamoto University, 5-1 Ohe-Honmachi, Kumamoto, 862-0973, Japan
| | - Kentaro Nishi
- Department of Molecular Cell Function, Faculty of Life Sciences, Kumamoto University, 5-1 Ohe-Honmachi, Kumamoto, 862-0973, Japan
| | - Akira Maeda
- Department of Molecular Cell Function, Faculty of Life Sciences, Kumamoto University, 5-1 Ohe-Honmachi, Kumamoto, 862-0973, Japan
| | - Akihiko Kuniyasu
- Department of Molecular Cell Pharmacology, Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1 Ikeda, Kumamoto, 860-0082, Japan
| | - Daisuke Yamada
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, 265-1 Higashijima, Niigata, 956-8603, Japan
| | - Takehiko Maeda
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, 265-1 Higashijima, Niigata, 956-8603, Japan
| | - Akihiko Tsuji
- Department of Biological Science and Technology, the University of Tokushima Graduate School, 2-1 Minamijosanjima, Tokushima, 770-8506, Japan
| | - Makoto Sawada
- Department of Brain Functions, Research Institute of Environmental Medicine, Nagoya University, Nagoya, 464-8601, Japan
| | - Hitoshi Nakayama
- Department of Molecular Cell Function, Faculty of Life Sciences, Kumamoto University, 5-1 Ohe-Honmachi, Kumamoto, 862-0973, Japan.
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Luo L, Nishi K, MacLeod E, Sabara MI. Expression and Characterization of HA1 Protein of Highly Pathogenic H5N1 Avian Influenza Virus for Use in a Serodiagnostic Assay. Transbound Emerg Dis 2015; 64:432-441. [PMID: 26040437 DOI: 10.1111/tbed.12382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Indexed: 11/28/2022]
Abstract
The hemagglutinin ectodomain (HA1 subunit) from highly pathogenic avian influenza (HPAI) isolate (A/chicken/Vietnam/14/2005) was cloned and expressed using a baculovirus expression vector. Biosynthesis, glycosylation and secretion of the HA1 proteins, with natural or a melittin signal peptide at the N-terminus and a six-histidine (6xHis) tag at the C-terminus, were examined in insect cells. A 40-kDa unglycosylated precursor and a fully processed, mature form of the HA1 protein migrated around 52 kDa were detected by SDS-PAGE and confirmed by Western blot using H5N1-specific antibody. Treatment of tunicamycin and peptide-N-glycosidase F (PNGase F) further revealed that the recombinant HA1 proteins produced in insect cells were indeed glycosylated with N-linked oligosaccharide side chains. Time-course experiments showed that substitution of the HA natural sequence with the signal sequence from honeybee melittin promoted a high level of expression and efficient secretion of the HA1. A high yield, 37 μg/ml, of HA1 protein was obtained from recombinant baculovirus-infected cell culture supernatant. In addition, the cell surface expression of rHA1 was detected by indirect immunofluorescent staining and showed biological activity on hemadsorption assays. Recombinant HA1 protein-based ELISA was evaluated and appeared to be sensitive and specific for the rapid detection of H5 subtype-specific antibodies in serum samples. No cross-reactivity to antibodies from 15 other influenza A subtypes was detected. Taken together, the newly developed recombinant HA1-based ELISA could offer an alternative to other diagnostic approaches for the specific detection of H5 avian influenza virus infection.
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Affiliation(s)
- L Luo
- National Centre for Foreign Animal Disease, Winnipeg, MB, Canada
| | - K Nishi
- National Centre for Foreign Animal Disease, Winnipeg, MB, Canada
| | - E MacLeod
- National Centre for Foreign Animal Disease, Winnipeg, MB, Canada
| | - M I Sabara
- National Centre for Foreign Animal Disease, Winnipeg, MB, Canada
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Obokata Y, Nishi K, Kamatani K. The dynamic characteristics of adolescent patients with spondylolysis during forward lunge—the point aimed at trunk extension angle. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Morita S, Nishi K, Furukawa F, Hitosugi M. A survey of solitary deaths in Japan for shortening postmortem interval until discover. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2015; 36:47-51. [PMID: 26076774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Recently in advanced nations, the number of solitary households is increasing. Data from Japanese population survey in 2010 showed that the percent of solitary households was 32.4% and that was the largest category of household types. The Japanese government regards solitary death as important problem, but a useful survey on solitary death has not been performed. We have focused on the postmortem interval until discovery of the death as a measure of solitary deaths. We conducted a survey of 582 forensic autopsy cases in the Osaka medical examiner's office over three years, from April in 2010 till March in 2012. We excluded suicide cases. We collected data on the, gender, age, postmortem interval (PMI) until discovery, family structure, situation of discovery of the body, cause of death, and the time interval from the last hospital visit. Here, we found that people who had high risk of solitary death ranged in, age from 60 to 69 which is the age of retirement for many people. In order to prevent solitary death, we suggest that people who live alone should take better care of themselves and participate in a community setting after their retirement. We can show that the recent efforts of the Japanese government for reducing solitary death had been working well. The government care givers take care of the person living alone almost like their own family. We also suggest that the people who unfortunately do not have any home care should subscribe to a newspaper for shortening the PMI.
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Affiliation(s)
- S Morita
- Department of Legal Medicine, Shiga University of Medical Science
| | - K Nishi
- Department of Legal Medicine, Shiga University of Medical Science
| | - F Furukawa
- Department of Legal Medicine, Shiga University of Medical Science
| | - M Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science
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Nishi K, Seto N, Iwasaki W, Matsuoka Y, Kashiwa Y, Sano Y, Kawaharada T, Yazumi T, Mizuki K. NIR-Fluorescent Ethyl 4,7-Bis(5-arylthiophen-2-yl)-1,2,5-oxadiazolo[3,4-c]pyridine-6-carboxylate. HETEROCYCLES 2015. [DOI: 10.3987/com-15-13197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Akiyama S, Kisara S, Sato Y, Seya Y, Kikuchi M, Gamoh M, Kobayashi S, Nishi K, Mori T, Ishioka C. An Effective Educational Strategy to Promote and Spread Team Medical Care and Regional Collaboration. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Luo L, Nishi K, Macleod E, Sabara MI, Lin M, Handel K, Pasick J. Baculovirus expression and antigenic characterization of classical swine fever virus E2 proteins. Transbound Emerg Dis 2012; 60:143-51. [PMID: 22510427 DOI: 10.1111/j.1865-1682.2012.01327.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Genes encoding a major structural glycoprotein, E2, of classical swine fever viruses (CSFV) Brescia (subgroup 1.2), Paderborn (subgroup 2.1) and Kanagawa (subgroup 3.4) were constructed by removing the transmembrane domain and adding a C-terminal 6 histidine (His) tag. All the E2 constructs were efficiently expressed in a baculovirus system as 53-kDa glycosylated proteins that were identified in Western blots by their reaction with anti-His and CSFV-specific antibodies. These proteins were used as ELISA antigens to confirm the existence of an antigenic relationship between the viruses using group-specific polyclonal antisera. Antigenic differences were identified by Western blot and ELISA reactivity of the E2 proteins with a panel of monoclonal antibodies. Specifically, one monoclonal antibody (WH303) reacted with all three proteins, two monoclonal antibodies (M1660 and M1665) reacted with only the Brescia E2 protein, and three monoclonal antibodies (M1654, M1664 and M1669) reacted equally well with only Brescia and Kanagawa E2 proteins. Therefore, antibody reactivity profiles, established using recombinant E2 proteins, could be used to quickly identify novel CSFV strains as illustrated in this report with only a limited number of monoclonal antibodies. These proteins could also have added utility in the production of monoclonal antibodies and as critical reagents in diagnostic assays.
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Affiliation(s)
- L Luo
- National Centre for Foreign Animal Disease, Winnipeg, MB, Canada.
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Ishikawa A, Okada J, Nishi K, Hirohata S. Efficacy of serum angiopoietin-1 measurement in the diagnosis of early rheumatoid arthritis. Clin Exp Rheumatol 2011; 29:604-608. [PMID: 21906428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 02/14/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Previous studies showed that angiopoietin-1(Ang-1) expression was increased in the synovium in early rheumatoid arthritis (RA) patients. The present study was therefore designed to examine whether determination of serum Ang-1 might be effective in diagnosis of early RA. METHODS One hundred and five serum samples of RA (21 males, 84 females) were studied for serum Ang-1 level. Serum samples were also collected from other collagen diseases, including 35 cases of SLE, 29 cases of systemic sclerosis, 16 cases of polymyositis/dermatomyositis. Serum samples were additionally obtained from 34 patients who visited our clinic for evaluation of symmetrical polyarthritis with morning stiffness. After one year of follow-up, those patients who satisfied the ACR 1987 classification criteria for RA were defined as 'early RA'. Serum Ang-1 levels were measured by sandwich ELISA using anti-angiopoietin-1 antibodies (both monoclonal and polyclonal antibodies). Serum anti-CCP antibody and rheumatoid factor (RF) were measured by ELISA and by laser nepherometry, respectively. RESULTS Serum Ang-1 in RA patients was significantly higher than those in other collagen diseases. Serum Ang-1 levels in 50 normal healthy individuals were 5.8 ± 0.31 pg/ml (mean ± SEM). There was no significant difference in CRP and serum RF at the first visit between early RA patients and non-RA patients, whereas serum Ang-1 levels at the first visit were significantly higher in early RA (58.7 ± 17.9 pg/ml [mean ± SEM]) than those in non-RA (8.2 ± 4.5 pg/ml). ROC analysis revealed that serum Ang-1 (cut-off 23.91 pg/ml) could diagnose early RA at sensitivity 57.1% and specificity 84.6%, providing comparable area under the curve (0.71, 95% CI: 0.54-0.88) to that of serum anti-CCP antibody (0.72, 95% CI: 0.53-0.92). There was no significant correlation between anti-CCP antibody and Ang-1. CONCLUSIONS These results indicate that serum Ang-1 is as useful a marker for the diagnosis of early RA as serum anti-CCP antibody.
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Affiliation(s)
- A Ishikawa
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
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Yanagawa Y, Imamura T, Nishi K, Sakamoto T. Usefulness of computed tomography in the diagnosis of an overdose. Resuscitation 2010. [DOI: 10.1016/j.resuscitation.2010.09.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nishi K, Yanagawa Y, Hagiwara A. A case of pulmonary oedema induced by suffocation. W INDIAN MED J 2010; 59:113-114. [PMID: 20931929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 57-year old female civilian was suffocated by an intruder The victim (experienced severe dyspnoea) but violently resisted the assault. Two hours after this event, on admission to a Trauma Centre, she demonstrated left facial swelling with low percutaneous oxygen saturation. Chest X-ray and computed tomography demonstrated pulmonary oedema. This improved dramatically within a short time and she was discharged on the 5th hospital day. Pulmonary oedema induced by suffocation has been reported only rarely. The possible mechanisms by which pulmonary oedema might form after the relief of airway obstruction are discussed.
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Affiliation(s)
- K Nishi
- National Defense Medical College, 3-2 Namiki Tokorozawa, Saitama, Japan
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Matsuyama S, Taniguchi M, Tsukioka J, Goto K, Nishi K. Genus identification of toxic plant by DNA. Forensic Science International: Genetics Supplement Series 2009. [DOI: 10.1016/j.fsigss.2009.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Nakamura S, Hashimoto Y, Igawa S, Kajino M, Nishi K, Takahashi H, Mizumoto T, Iizuka H. Childhood generalized pustular psoriasis treated by preprandial ciclosporin administration: serum cytokine pattern during the course of the disease. Clin Exp Dermatol 2009; 34:e1023-4. [DOI: 10.1111/j.1365-2230.2009.03702.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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