Long-term effects of urokinase on the preservation of renal function in patients with diabetic nephropathy were evaluated. Twenty-nine adult patients with non-insulin-dependent diabetes mellitus and overt proteinuria were randomly divided into two groups. One group was treated with daily oral administration of dipyridamole or dilazep dihydrochloride and weekly intravenous administration of urokinase; the other group was treated with dipyridamole alone. There was a significant decrease in the amount of proteinuria in the first group after 3 months of the treatment compared with the second group. There was also a significant preservation of renal function in the first group after three years of treatment compared with the second group. It was concluded that continuous administration of urokinase in addition to antiplatelet agents is useful in the treatment of patients with diabetic nephropathy.

Diabetes Mellitus, Type 2↗

PubMedDate not supplied

Overexpression of low density lipoprotein receptor on Chinese hamster ovary cells generates foam cells.

The atherosclerotic lesion is characterized by the presence of cholesterol-loaded foam cells. Chinese hamster ovary (CHO) cells do not normally store cholesteryl esters because low density lipoprotein (LDL) receptors are suppressed by exposure of these cells to LDL cholesterol. We transfected LDL receptor cDNA linked to the simian virus 40 early promoter into CHO cells (CHO 29) and found that LDL receptor binding in these cells was not suppressed by an excess amount of LDL cholesterol, indicating no regulation of the LDL receptor in CHO 29 cells. Furthermore, CHO 29 cells showed a high activity of LDL uptake and intracellular accumulation of cholesteryl esters. Light-microscopic examination demonstrated the resulting formation of foam cells in CHO 29 cells in the presence of 5 micrograms LDL/ml. These results demonstrated that foam cell changes in atherosclerotic lesions can be reproduced in CHO cells, whose LDL receptor activity is overexpressed, through the mechanism of LDL receptor-mediated endocytosis of native LDL.

Animals↗

PubMedDate not supplied

Hospice care in Japan.

Hospice care was introduced in Japan in the 1970s. There are currently an estimated 21 programs, which are primarily hospital-based. This paper provides an overview of the history, current state, and future trends of hospice care in Japan. Four programs are described, including staffing information, length of stay, and prognoses of patients. Hospice care in Japan is compared to hospice care in the United States and major differences are described. Lastly, the concept of "truth telling" is explored within the context of the Japanese culture. The discussion is based on a review of the literature and a mailed survey completed by 16 Japanese hospice programs during July 1992. The paper is in four sections: An overview of Japan. The history, current state, and future trends of hospice care in Japan. The major differences between hospice care in Japan and the United States. An exploration of "truth telling" within the context of the Japanese culture.

Culture↗

PubMedDate not supplied

Combination of nifedipine and carteolol compared to nifedipine alone in diurnal blood pressure variation and exercise blood pressure in patients with essential hypertension.

A combination of nifedipine (40 mg twice daily) plus carteolol (10 mg twice daily) was compared with nifedipine monotherapy in ten patients with essential hypertension. Ambulatory blood pressure (BP) monitoring over 24 hours and treadmill exercise testing were performed before treatment with nifedipine (but after the placebo period), after four weeks of nifedipine treatment, and after four weeks of nifedipine+carteolol combination therapy. At the end of nifedipine monotherapy, 24-hour average ambulatory BP, minimum ambulatory BP during sleep, maximum ambulatory BP, and casual BP all decreased significantly (P less than 0.01). However, the standard deviation (SD) of the ambulatory BP was not affected. The change in systolic BP response to treadmill exercise increased. After a four-week period of nifedipine+carteolol combination therapy, average ambulatory BP and maximum ambulatory BP were further decreased (P less than 0.01). The SD of the ambulatory BP and the change in BP response to exercise were significantly decreased (P less than 0.01), but the minimum ambulatory BP was not affected. These findings suggest that nifedipine and carteolol differ in their influence on diurnal BP variation and on exercise-induced BP elevation. Carteolol may mainly attenuate stress-induced BP elevation and have little influence on nocturnal BP decline. In contrast, nifedipine may affect the BP profile uniformly over the entire day. Nifedipine+carteolol combination therapy may be superior to nifedipine monotherapy because carteolol has a minimal effect on nocturnal BP and decreases stress-induced BP elevation.

Blood Pressure↗

PubMedDate not supplied

A new treatment strategy using both intermittent short dialysis and continuous ambulatory hemofiltration.

The authors devised a new treatment strategy using continuous ambulatory hemofiltration (CAHF) in between short hemodialyses (short HD). For CAHF, a small wearable hemofilter (0.1 m2) was developed using a membrane permeable to low molecular weight proteins. During short HD, no body water was removed, but saline, equivalent to 3% body weight, was administered at a constant rate. During CAHF, 1 L of replacement fluid was administered intravenously after every meal to increase the replacement volume. Switch from the conventional to new strategy resulted in far more stable blood pressure during short HD, a decrease in time averaged body weight, and a decrease in a decrease in time averaged blood urea nitrogen and plasma beta 2-m levels.

Ambulatory Care↗

PubMedDate not supplied

Change in sympathetic activity before, during, and after dialysis-induced hypotension.

During the hemodialyses of eight patients with end-stage renal failure, who often had sudden-onset dialysis-induced hypotension, catecholamine (CA) levels were measured in the ultrafiltrate obtained by a mini-filter placed in series upstream of the dialyzer. The water evaporation rate from the skin (reflecting the perspiration rate) was also monitored. Results showed a temporary elevation in CA levels in the ultrafiltrate before hypotension occurred. This rise did not continue for long, returning to baseline when hypotension actually occurred. The temporary elevation may reflect transient compensation by the sympathetic nervous system for the decrease in vascular wall tension. It was also found that there was considerable water evaporation from the skin during hypotension. Because sweat gland activity is reflexively modulated by the baroreceptor, perspiration after a drop in blood pressure may reflect the normal diminiution in baroreceptor activity.

Adult↗

PubMedDate not supplied

A new wearable system for continuous monitoring of arteriovenous fistulae.

A wearable system to constantly monitor the bruit generated by an AV fistula at times other than during dialysis was developed, and provided early detection of rapidly developing thrombi that cause occlusion of the fistular vessels. The system consists of a downsized microphone that continuously monitors the bruit generated, a warning device worn like a wristwatch, and a wire running down from the microphone to the emergency warning device. The microphone converts the bruit into an electrical signal and outputs it to the warning device. The emergency warning is then sounded whenever the input signal from the tiny microphone is weaker than a preset level. The warning device was set off in 4 of 21 long-term dialysis patients with arteriovenous fistulas, and within several hours all 4 developed an occlusion. One of the 14 patients with a graft had the device go off while sleeping, but it was a false alarm due to positioning that resulted in compression of the fistula arm.

Aged↗