Biomedical subjects

Hiroyoshi Fukui

Publications and source records attributed to Hiroyoshi Fukui.

4 recordsLinked to original sources

PubMed2004

Use of ultrapure dialysate in reduction of chronic inflammation during hemodialysis.

Chronic inflammation contributes to the pathogenesis of several complications of hemodialysis therapy. It is thought that backfiltration of bacteria-derived contaminations during dialysis may induce a chronic inflammatory state. High-sensitivity C-reactive protein (hs-CRP) is one of the tools which can take a hold on such a chronic inflammatory condition. We examined the effect of ultrapure dialysate which contributes to chronic inflammation with hs-CRP and tried to reduce endotoxin (ET) levels at the end of the dialysate from 70 EU/l to <1.0 EU/l (ultrapure dialysate). Other dialysis conditions, except ET level, were fixed. We investigated the hs-CRP of 23 patients receiving regular dialysis before the use of ultrapure dialysate and 1 year after use of it prospectively. The data showed a significant decrease in the median value of the hs-CRP from 0.16 to 0.07 mg/dl (p < 0.05). The value of serum beta(2)-microglobulin decreased from 33.2 to 28.4 mg/dl (p < 0.01) and the hemoglobin level increased from 10.0 to 11.0 g/dl (p < 0.05). These results indicate that even a dialysate containing 70 EU/l of ET level may induce a chronic inflammatory state. hs-CRP is a very useful marker of chronic inflammation and the use of ultrapure dialysate is necessary to improve a chronic inflammatory state. The targeted ET level at the end of the dialysate should be set at < or = 1.0 EU/l.

Aged↗

PubMed2004

[Evaluation of thrombin in urine as a real-time indicator of clotting activation in glomerulonephritis].

When tissues are injured and bleeding occurs, blood clotting is immediately activated and fibrin clots are formed by thrombin. Afterwards, antithrombin III promptly inactivates thrombin, which restricts the clotting to the bleeding site. In inflamed sites, tissue factor is expressed on cells in the lesion by stimulation from cytokines, and produces thrombin. In this case, thrombin may survive longer because of inefficient inactivation by antithrombin III due to dilution and less perturbation in the interstitial fluid, and therefore, has a greater chance to activate thrombin receptors (protease-activated receptors: PARs) on the cells, which induces various cellular events including proliferation, migration, and shape change. Recent studies have suggested a pathophysiological association of the PAR pathway with crescentic glomerulonephritis. However, the role of thrombin in human diseases has not been fully studied, probably because of a lack of simple and reliable methods for measuring thrombin in clinical samples. To solve this problem, we developed an ELISA system for human alpha-thrombin and applied it to the measurement of thrombin in the urine of patients with glomerulonephritis. Thrombin in urine was detected in glomerulonephritic patients but not in healthy volunteers or disseminated intravascular coagulation patients, which suggests that thrombin in urine may reflect thrombin generation by clotting activation in the glomerular lesion.

Biomarkers↗

PubMed2004

Encapsulating peritoneal sclerosis in Japan: a prospective, controlled, multicenter study.

BACKGROUND: Encapsulating peritoneal sclerosis (EPS) is recognized as a rare but serious complication of peritoneal dialysis (PD). The aim of this study was to determine the incidence, clinical features, and mortality rate of EPS. METHODS: The authors requested the registration of all PD patients in facilities across Japan where more than 10 patients were treated with PD in this prospective multicenter study. During the 4-year study, the incidence of EPS was observed in the enrolled patients. RESULTS: A total of 1,958 patients who were treated with PD in 57 facilities were followed up from April 1999 through March 2003. EPS occurred in 48 patients, corresponding to an overall incidence of 2.5%. In 33 of the 48 (68.8%) patients, EPS was found after discontinuation of PD. The incidence (and mortality rate) of EPS was 0%, 0.7% (0%), 2.1% (8.3%), 5.9% (28.6%), 5.8% (61.5%), and 17.2% (100%) in patients who had undergone PD for 3, 5, 8, 10, 15, and more than 15 years, respectively. The recovery ratio with total parenteral nutrition, corticosteroids and surgical treatment were 0%, 38.5%, and 58.3%, respectively. Eighteen patients (37.5%) died, 22 (45.8%) recovered, and the status of the other 8 (16.7%) remained unchanged. CONCLUSION: The results of this prospective multicenter study showed that the incidence of EPS was 2.5% within a 4-year observation period and that two thirds of the cases were diagnosed after discontinuation of PD. Because of the current progress in diagnostic technology and therapeutic methodology, it appears that PD can be continued successfully with an acceptable, low risk for EPS for at least 8 years, whereas stricter caution is required for patients receiving PD for longer periods.

Adult↗

PubMed2003

A timesaving method to create a fixed puncture route for the buttonhole technique.

BACKGROUND: Up to now, for a successful buttonhole puncture of the vascular access vessel, the fistula should be punctured by the same experienced medical staff for 2-3 months, using sharp needles, until a fixed puncture route is established. METHODS: We developed a timesaving method to create the fixed puncture route for the buttonhole technique. In this method, after the usual haemodialysis (HD), a newly developed thumbtack-shaped polycarbonate peg is thrust toward the access vessel along the same path as the puncture needle that has just been removed. Then, at the beginning of the next HD, the peg is removed and a dull puncture needle is inserted along the track already formed by the peg left in place. These steps are repeated at each HD session for 14 days. Thereafter, the vascular access is achieved at HD sessions by inserting a dull puncture needle through the established puncture route. RESULTS: This buttonhole puncture approach was used in 37 patients for 3 months. While the polycarbonate peg was in place, patients experienced no restrictions in their normal activities of daily living, except during bathing and showering. As for puncture pain, no patient found the pain of the buttonhole technique to be greater than that of the conventional puncture technique. Moreover, no significant bleeding was noted during HD. With this buttonhole puncture approach, only one patient had enough erythema at the puncture site to suggest possible infection. After HD, the time for bleeding to stop was <10 min in 95% of patients. CONCLUSION: This study showed the new timesaving method for creating a buttonhole to be safe and useful.

Catheters, Indwelling↗