No abstract

Background: Diastolic heart failure is the most common clinical form of heart failure. Tissue Doppler imaging (TDI) is often used to quantitate left ventricular (LV) diastolic function. The purpose of this study was to identify the determinant(s) of diastolic dysfunction in patients with end-stage renal disease on hemodialysis (HD), using the TDI method. Methods: The study subjects were 53 patients with end-stage renal disease and preserved LV systolic function on maintenance HD. LV function was assessed by conventional echocardiography. The ratio of early trans-mitral flow velocity to early mitral annular velocity (E/e′) was measured by TDI. Patients were stratified into two groups based on E/e′ value (≤15 and >15 groups). Arterial stiffness was evaluated by pulse wave velocity and cardio-ankle vascular index. Results: Patients of the E/e′ >15 group were older (p = 0.025). There were no significant differences in blood pressure, ejection fraction, E/A, deceleration time, and pulse wave velocity between the E/e′ >15 and E/e′ ≤15 groups. However, there were significant differences in LV mass index (LVMI; p < 0.001) and cardio-ankle vascular index (p = 0.048) between the two groups. Multiple regression analysis identified that LVMI was an independent determinant of E/e′ (p = 0.003). Conclusions:Our findings suggest that LVMI is an independent determinant of LV diastolic dysfunction in patients on HD.

Studies on the reproductive endocrinology of koalas have been performed mainly by using blood samples; however, in practice it is difficult to collect blood periodically because koalas are easily stressed. The purposes of the present study were to establish a noninvasive endocrine monitoring technique and to investigate the reproductive physiology of female koalas. Feces were collected from female northern and southern koalas, and progestagen was extracted from lyophilized fecal samples and determined by enzyme immunoassay. In nonpregnant northern and southern koalas, fecal progestagen markedly increased after copulation and remained high for 36.3 +/- 2.5 days and 38.9 +/- 1.4 days (luteal phase, mean +/- SEM), respectively. Mean (+/-SEM) progestagen levels (6.34 +/- 0.49 microg/g) during the luteal phase in northern koalas were significantly higher than in southern koalas (4.19 +/- 0.24 microg/g). Fecal progestagen in parturient northern koalas remained high for 36.2 +/- 1.9 days (gestation period, 34.1 +/- 0.3 days). In northern koalas, the mean levels and profiles of progestagen during pregnancy (6.44 +/- 0.37 microg/g) were consistent with those during nonpregnancy after copulation (6.34 +/- 0.49 microg/g). The duration of behavioral estrus in northern koalas was 13.5 +/- 0.9 days without copulation. In contrast, when estrous females mated, the estrous sign disappeared just after copulation. The mean (+/-SEM) length of the estrous cycle in northern koalas, as determined by behavioral estrus intervals, was 33.5 +/- 2.2 days without the luteal phase and 69.2 +/- 7.6 days with the luteal phase. Fecal progestagen analysis is a helpful and noninvasive tool to monitor ovulatory activity in northern and southern koalas and could help us to understand the reproductive activity of koalas by the combination approach with behavioral estrus.

Regardless of histological severity, intensive therapeutic intervention that includes strict inflammatory control and optimal control of hypertension may change the histology-predicted prognosis of RA-associated renal AA amyloidosis.

We herein report a case of Epstein-Barr virus (EBV)-associated T-cell lymphoma that developed within a month after a kidney transplantation. The recipient was a 37-year-old man who had evidence of a previous EBV infection. Cyclosporine, methylprednisolone, and azathioprine were used for immunosuppression, and acute rejection was treated with high-dose methylprednisolone. The lactate dehydrogenase level started to increase on day 24 and thereafter peaked on day 37 while also demonstrating progressive jaundice and a bleeding tendency. A transplant nephrectomy was done on day 37; however, the patient could not recover and eventually died of respiratory failure as a result of diffuse pulmonary edema. A pathological examination of the resected kidney revealed a diffuse proliferation of large atypical lymphoid cells in the parenchyma. Immunohistochemically, the tumor cells were positive for CD45 and T-cell marker, CD45RO, but negative for B-cell markers. EBV-encoded RNA was demonstrated within the neoplastic cells by in situ hybridization.