bluuebunny/crossref_metadata_2025 huggingface dataset:
Etiology, Prevention and Treatment of Back Pain in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis
Authors: Goodman Carol E. , Husserl Fred E.
Published: February 2020

As part of a comprehensive continuous ambulatory peritoneal dialysis (CAPD) program, the Ochsner Foundation Home Training Unit, in association with the Department of Physical Medicine and Rehabilitation, has established a preventive approach to spinal musculoskeletal problems. Because the CAPD patient is susceptible to back complaints resulting from alterations in body posture and altered bone metabolism, we have designed a special program for evaluation and prevention, which incorporates special exercises for posture correction and energy conservation. Sixteen of 32 patients have been evaluated, instructed and supervised in this program. Two patients required back supports in addition to exercises. One patient was withdrawn from CAPD because of incapacitating back pain. The remaining 15 have been able to sustain normal activity and avoid back pain with exercises alone.
Penetration of Metronidazole into Continuous Ambulatory Peritoneal Dialysate
Authors: Bush Andrew , Holt Jacquelyn E. , Sankey Michael G. , Kaye Clive M. , Gabriel Roger
Published: February 2020

Seven patients receiving continuous ambulatory peritoneal dialysis were given 400 mg of oral metronidazole every eight hours for three days. Plasma, dialysate and urine were collected during the final 24 hours and assayed for metronidazole and its two principal oxidative metabolites by a specific, high-performance, liquid-chromatographic method. Concentrations of metronidazole in plasma and dialysate were similar and were greater than the minimum inhibitory concentration for susceptible anaerobes. There was evidence of retention of both oxidative metabolites. This study shows that oral metronidazole in standard dosages achieves bactericidal concentrations in peritoneal fluid and should be effective in the treatment of peritonitis due to anaerobic bacteria.
‘Contraction’ Alkalosis during Treatment of Hypergl Ycemia in CAPD Patients
Authors: Tzamaloukas Antonios H.
Published: February 2020

Two men on CAPD for renal failure from diabetic nephropathy developed three episodes of severe hyperglycemia (blood glucose greater than 50 mmol/l), which were treated with insulin alone. During treatment, the serum bicarbonate rose; in the first patient from 27 to 31 mmol/l; in the second patient from 24 to 31 in the first episode, and from 20 to 26 mmol/1 in the second episode. Corresponding changes in arterial pH were 7.47 to 7.57, 7.48 to 7.67 and 7.47 to 7.59. Contraction of the extracellular compartment during correction of hyperglycemia could account for the total increase in serum bicarbonate in the first patient, but only for about one-half of the increase in the second patient.
Changes in Serum Inflammatory Proteins during Peritonitis in CAPD Patients
Authors: Gilmour Janet , Tymiansky Rosemary , Pierratos Andreas , Vas Stephen , Kline Michael , Khanna Ramesh , Digenis George , Cuff Sally , Oreopoulos Dimitrios G.
Published: February 2020

The serum concentrations of IgG, IgA, IgM, C3, C4, haptoglobin, tranferrin, αl-antitrypsin, αl-acid glycoprotein, and C-reactive protein were measured in 14 CAPD patients during the course of peritonitis and at one, two and three months thereafter. Of these parameters only the CRP showed consistent changes paralleling the course of the peritonitis. The CRP baseline values in CAPD patients (second and third month after peritonitis) were similar to those found in non-dialysed normal controls, suggesting that the CRP changes, which were observed, can be attributed to the peritonitis; CRP may be a valid acute phase reactant during peritonitis in PD patients.
Ketoconazole Pharmacokinetics in Continuous Ambulatory Peritoneal Dialysis
Authors: McGuire Nancy M. , Port Friedrich K. , Kauffman Carol A.
Published: February 2020

Ketoconazole, a new oral drug, has minimal toxicity and a broad spectrum of antifungal activity. To determine its usefulness in fungal peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD), we carried out nine pharmacokinetic studies in five patients on CAPD. Serum levels of ketoconazole in CAPD patients were lower than in normal controls, and some patients did not appear to absorb the drug. We did not detect ketoconazole in the peritoneal fluid of any patient, even in the presence of peritoneal inflammation. One should not use this agent in the treatment of fungal peritonitis at daily doses of 400 mg or less because such a dose achieves only poor peritoneal fluid concentrations.

Continuous ambulatory peritoneal dialysis (CAPD) has become an attractive alternative to hemodialysis for many patients with chronic renal failure. However, a major drawback with this technique is peritonitis (1). Although most of these infections are due to staphylococci (I), fungal peritonitis appears to be increasing as experience with CAPD grows (2,3). The treatment of such peritonitis is hampered by the poor penetration of amphotericin B into the peritoneal fluid (2), chemical peritonitis when amphotericin B is instilled directly into the cavity (3), and the limited spectrum of activity of flucytosine -a drug which readily penetrates into the peritoneal fluid (4).

Ketoconazole is less toxic than amphotericin B and easier to administer and it has a much broader antifungal spectrum than flucytosine. The value of ketoconazole in fungal peritonitis remains to be established, and we have only limited data concerning its penetration into the peritonal cavity (2, 5). In this study we assessed the serum and peritoneal-fluid levels of ketoconazole in patients on CAPD.
Peritonitis among CAPD Patients: Host, Agent and/or Environment?
Authors: Stegman Mary Ruth , Berger Ann M.
Published: February 2020

At the Omaha Veteran's Administration Medical Center, Omaha, Nebraska, USA the authors used the classic epidemiological model based on the interaction between host, agent and environment, and a historical-prospective design to study the risk factors for peritonitis among all continuous ambulatory peritoneal dialysis (CAPD) patients. Data were abstracted from the medical records of the patients and from questionnaires completed by the nurses who had cared for the entire population since the inception of CAPD at this hospital. Using the Cox proportional hazard regression model, they analyzed variables considered to be associated with the host, agent and environment. This survival analysis demonstrated that, when other host, agent and environmental factors are controlled, age (younger patients), low patient motivation and minimal social support are significant risk factors for peritonitis.

The literature suggests that the study of and the attempts to control peritonitis among continuous ambulatory peritoneal dialysis (CAPD) patients has not considered the host, agent and environment as a unit, but rather have centered on one element at a time. Most investigators focus upon the host as the contributing factor (1–4) and view the infectious agent as ubiquitous (5, 6). Others consider as primary the social and/or psychological environment of the host (7–9). None have undertaken an investigation which has studied all three aspects of the infectious disease model so that risk can be estimated while controlling for confounding factors.
Computerized Tomographic Scanning with Intraperitoneal Contrast Enhancement in a CAPD Patient with Localized EDEMA
Authors: Schultz Stanton G. , Harmon Thomas M. , Nachtnebel Kenneth L.
Published: February 2020

In a patient on continuous ambulatory peritoneal dialysis with localized abdominal and genital edema, the site of extraperitoneal dialysate leakage was determined by computerized tomographic scanning with intraperitoneal contrast enhancement. No adverse effects were encountered. The source of fluid leakage should be sought in CAPD patients with localized (i.e. genital) edema, because often they may have an undetected hernia or other peritoneal defect. Removal of the peritoneal dialysis catheter would not solve such a problem. In such cases, intraperitoneal contrast-enhanced CT scanning may represent an effective technique for identifying the site of dialysate leakage.

Abdominal and inguinal hernias are well-recognized complications of con tinuous ambulatory peritoneal dialysis (CAPD). Dialysate may escape from the peritoneal space through such hernias; also the development of genital edema in a CAPD patient may indicate the presence of an inguinal hernia, which otherwise may be impossible to detect clinically (I). In CAPD patients who have had multiple abdominal operations, there may be numerous possible sites of hemia development and dialysate leakage, so that it may prove difficult to identify and repair the defect. We describe a patient in whom contrast-enhanced computerized tomographic scanning was used to identify the site of extraperitoneal dialysate leakage.
Fungal Eosinophilic Peritonitis Due to AL Ternaria in a Patient on Continuous Ambulatory Peritoneal Dialysis
Authors: Horisberger Jean-Daniel , Bille Jacques , Wauters Jean-Pierre
Published: February 2020

We describe an unusual episode of fungal peritonitis, caused by an Alternaria species and associated with a persistent eosinophilia in peritoneal fluid and blood. Peritoneal and systemic eosinophilia, persisting long after catheter insertion and, associated with the signs of peritonitis, should arouse suspicion of a fungus infection.

About 5% of episodes of peritonitis in patients on CAPD are due to yeast, mainly of the Candida species (I). On rare occasions, cases have been re ported of peritoneal infections in CAPD patients caused by various filamentous fungi (2 7).

Peritoneal fluid eosinophilia in CAPD patients, a self-limited, benign condition, is a well described entity and usually occurs soon after catheter implantation (8–10).

We present an episode of a fungal peritonitis, associated with a late, longstanding eosinophilia of peritoneal fluid and peripheral blood. The responsible organism was a dematiceous filamentous fungus identified as Alternaria alternata.
An Unusual Cause of Massive Intraperitoneal Bleeding in CAPD
Authors: Zaki Joseph Shohat , Yussim Shapira Alexander , Boner Geoffrey
Published: February 2020

A 73-year-old man, who had been on CAPD for two years, presented with massive intraperitoneal hemorrhage. On laparotomy the peritoneal catheter was situated in a large pouch that was lined by fibrous tissue. The hemorrhage arose from erosion of the pouch wall -an unusual cause of intraperitoneal bleeding in the CAPD patient.

Massive intraperitoneal bleeding is a rare complication of continuous ambulatory peritoneal dialysis (CAPD). Mild to moderate bleeding, which is more common in CAPD, usually is related to disintegration of small blood vessels. In most patients the bleeding is self-limited. This paper describes an unusual cause of massive bleeding in a CAPD patient.
Cancer in Patients on CAPD
Authors: Digenis George E. , Pierratos Andreas , Ayiomamitis Anthony , Dombros Nickolas , Sombolos Kostas , Oreopoulos Dimitrios G.
Published: February 2020

Many workers have reported a high incidence of cancer in persons with uremia or on hemodialysis but there is no agreement on this point. Because the incidence of neoplasms in patients on CAPD is unknown, we reviewed the medical records of the 328 patients treated with CAPD at the TWH from 1977 to 1985. Of these, nine developed cancers, of whom three had been treated with immunosuppressive agents previously. Whether or not these three patients are included, we found no significant difference in cancer incidence between the CAPD and the control population (p = 0.12 and 0.51 respectively). In conclusion, this review found no evidence that our CAPD patients had an increased incidence of cancer.

Although an increased incidence of cancer has been reported in patients with chronic renal failure, before or while on hemodialysis, there is no agreement on the issue. The reported incidence of tumors in different studies ranged widely between 0.84 and 9.5% (I, 2). Even though an increasing number of patients have been treated on CAPD, the literature contains no information regarding the incidence of cancer in this population. The present study was undertaken to provide an answer to this question.
Usefulness of Dialysate Fibrin Degradation Products and Lactic Dehydrogenase Isoenzyme Patterns in Assessing the Clinical Course of Peritonitis
Authors: Suzuki Kazuyuki , Ishizaki Makoto , Hotta Osamu , Horigome Ikuo , Sudo Katsuhiko , Kurosawa Kousei , Taguma Yoshio
Published: February 2020

Objective

To establish the usefulness of fibrin degradation products (FDP) and lactic dehydrogenase isoenzyme patterns (LDH isoenzyme) in assessing the clinical course of peritonitis.

Design

A retrospective study of patients with peritonitis who were divided into three groups according to their clinical course.

Setting

Single dialysis unit of a general hospital.

Interventions

Patients were treated by intraperitoneal and oral antibiotics.

Patients

Twenty-six patients with 34 episodes of peritonitis were studied. Group 1 consisted of 21 patients with 26 recoveries from peritonitis; Group 2 consisted of 5 patients with 5 relapsing episodes of peritonitis, and Group 3 consisted of 3 patients with 3 persistent episodes of peritonitis.

Main Outcome Measures

Concentrations of WBCs, FDP, LDH isoenzyme and microbiological culture of the dialysate were determined.

Results

In most of Group 1, WBCs, FDP, and LDH isoenzyme returned to normal within 2 weeks. In 4 patients of Group 1, who had complications (diverticulitis, cholecystitis, cystitis, and tunnel infection), WBCs, FDP, and LDH isoenzyme returned to normal gradually within 3 weeks. In Group 2, WBCs returned to normal, but FDP remained relatively high and LDH isoenzyme did not normalize. In Group 3, WBCs, FDP and LDH isoenzyme did not normalize.

Conclusions

Failure of normalization of FDP and LDH isoenzyme suggests an incomplete recovery from peritonitis. FDP and LDH isoenzyme are useful in assessing the course of peritonitis.
The Effect of Changes in Dialysate Volume on Glucose and Urea Equilibration
Authors: Kohaut Edward C. , Waldo F. Bryson , Benfield Mark R.
Published: February 2020

Objectives

To determine the effect of changing dialysate volume on urea and glucoseequilibration curves and to determine, if dialysate volume is prescribed on the basis of body surface area, whether equilibration curves will be consistent in patients of different sizes and ages.

Design

A prospective study wherein children with acute or chronic renal failure had peritoneal equilibration studies done with dwell volumes of 30 mL/kg, 40 mL/kg, and 1200 mL/m2.

Patient Population

Twenty-two children: 7 under 3 years of age; 8 between 3 and 10 years of age; 7 older than 10 years of age.

Statistics

Student's t-test.

Results

Urea and glucose equilibrated rapidly at dwell volumes of 30 mL/kg, slower at dwell volumes of 40 mL/kg, and slowest at dwell volumes of 1200 mL/m2. Equilibration curves were similar in children of different ages when dialysate volumes of 1200 mL/m2 were infused.

Conclusion

Dialysate volumes of 1200 mL/m2 should be used when equilibration studies are being done to compare individuals of different ages and sizes.
Compatibility of Peritoneal Dialysis Fluids Containing Alternative Osmotic Agents with Cells Present in the Peritoneal Cavity
Authors: De Fijter Carola W.H. , Oe P. Liem , Donker Ab J.M. , Verhoef Jan , Verbrugh Henri A.
Published: February 2020

The success of continuous ambulatory peritoneal dialysis (CAPD) lies in preserving the peritoneum as a dialyzing membrane. Repeated infusions of nonphysiological fluids are potentially detrimental to the peritoneal membrane and its host defense. The disadvantages of the currently used peritoneal dialysis fluids (PDPs) containing glucose as an osmotic agent (short ultrafiltration profile, systemic carbohydrate load, nonphysiological composition) have stimulated the search for alternative, less toxic osmotic agents devoid of metabolic side effects and capable of sustaining ultrafiltration. PDFs containing glycerol, amino acids, or glucose polymers have had clinical usage in CAPD patients and were reviewed with regard to their compatibility with cells present in the peritoneal cavity.

Overall, glycerol appears to have no advantage over glucose-based PDFs, although it is less inhibitory for mesothelial cell proliferationin vitro. The optimum formulation of amino acid-based PDFs has not yet been established; its lactate and specific amino acid content may limit their biocompatibility. The virtually iso-osmolar glucose polymer (icodextrin)-containing PDFs were associated with improved biocompatibility compared to glucose monomer-based solutions.

Modifications of PDFs towards a more balanced salt solution with a neutral pH may further increase their compatibility with peritoneal host defense as well as with the integrity of the mesothelial membrane. Such improvement in PDF biocompatibility may result in clinical benefit, that is, enhanced resistance to infection and preservation of peritoneal ultrafiltration capacity.
Clinical Studies of New Icodextrin Formulations
Authors: Mistry Chandra D. , Bhowmick B. , Ashman Ruth , Uttley L.
Published: February 2020

The osmotic effectiveness of icodextrin as a “colloid” osmotic agent has been well established and shown to be particularly well suited for long dwell exchanges (8 12 hours). More recently, its advanced application generated the first in vivo demonstration of sustained ultrafiltration with hypo-osmolar dialysis solution (i.e., against the osmolality gradient). This led to the “novel” concept of an iso-osmolar combination of “crystalloid” and “colloid” osmotic agents to achieve a range of ultrafiltration optimized for dwell time.

In accordance with our objective of developing physiological solutions for all continuous ambulatory peritoneal dialysis (CAPD) exchanges, we tested this hypothesis by comparing an iso-osmolar combination of 2.0% -2.5% of dextrin 20 (Mw 20000 dalton; Mn 5800 dalton) and 0.68% glucose with 1.36% glucose solution in 11 CAPD patients over a 6-hour dwell. An iso-osmolar icodextrin mixture produced ultrafiltration of similar magnitude to that of a 1.36% glucose solution with less than half the calorie load. This solution, therefore, has the potential to replace all the currently used hyperosmolar exchanges with physiological solutions containing half the daily calorie load without exceeding the current safe level of maltose accumulation.

This also offers a unique potential for a combination of unrelated but compatible agents, each with its own metabolic advantages, which would offer a wider spectrum of metabolic advantages than a single agent alone.
Transformed Mesothelial Cells in Patients on CAPD for Medium to Long Term Periods
Authors: Selgas Rafael , De Castro Mercedes Fernandez , Viguer Jose Maria , Burgos Emilio , Bajo Maria Auxiliadora , Carcamo Cristina , Vara Francisco
Published: February 2020

Objective

To describe the characteristics of abnormal cells present in the peritoneal effluent of 4 continuous ambulatory peritoneal dialysis (CAPD) patients; the cells were accidentally detected in a longitudinal study of cell populations in 83 patients.

Design

Descriptive study.

Participants

Four stable CAPD patients (2 male, 2 female).

Interventions

Peritoneal cells were collected from nocturnal peritoneal effluent (NPE) by centrifugation.

Measurements

Light microscopy, ultrastructural, cytochemical, and immunohistochemical characteristics were studied.

Results

The abnormal cells were characterized by a flat appearance, large size (diameter 100 μm) -six to ten times larger than a normal macrophage, a broad acidophilic cytoplasm with rare granulations, and a low nucleus/cytoplasm ratio. The nucleus was pyknotic, with dense chromatin and sometimes appeared fragmented. Its number presented a considerable variability between the patients and was much higher in the 2 females. This number remained stable in each patient over time. These cells were negative for betaglucuronidase and positive for PAS stain with variable intensity. A very low number of flat cells were positive for vimentin with weak intensity, whereas cytokeratin and epithelial membrane antigen (EMA) were positive in a higher number of cells with medium to strong intensity. Ultrastructural studies showed numerous short surface microvilli, cytoplasm well-developed with intracytoplasmic lumina and abundant, dispersed intermediate filaments, scattered mitochondria, and stacks of rough endoplasmic reticulum were observed. Dispersed secretory vacuoles and isolated lipid vacuoles were present.

Conclusion

All these features imply that they are mesothelial in origin and are suggestive of a change known as peritoneal squamous metaplasia. To date, the clinical follow-up of our patients has shown a benign outcome; further studies are necessary to elucidate the significance of this peritoneal squamous metaplasia in CAPD patients.
The Effect of Dialysate Acidity on Peritoneal Solute Transport in the Rat
Authors: Park Min Sun , Heimbürger Olof , Waniewski Jacek , Werynski Andrzej , Lee Hi Bahl , Bergström Jonas , Lindholm Bengt
Published: February 2020

Objective

To investigate the possible effect of unphysiologically low pH in dialysis fluid on peritoneal transport.

Design

A 4-hour single-cycle experimental session of peritoneal dialysis was performed in six 5prague-Dawley rats using Dianeal 3.86% solution modified by adding 5 mmol/L of sodium hydroxide, neutral pH solution (NpH5) (pH 7.4). The intraperitoneal volume (V D) and peritoneal bulkfluid reabsorption (aa) were calculated using a marker, 1311–labeled human serum albumin (RI5A). The diffusive mass transport coefficient (KBD) as well as sieving coefficient (5) for glucose, urea, sodium, and potassium were calculated using the Babb-Randerson-Farrell model. The same study was performed in seven rats using Dianeal 3.86% solution, acidic pH solution (ApH5) (pH 5.7) to provide control values.

Results

The dialysate pH was stable with NpH5; 45 min after the infusion of ApH5 it increased rapidly and reached the physiological value 7.4. Dialysate volume and KBD values for sodium and potassium with NpH5 were significantly higher than with ApH5, while the KBD values for glucose and urea did not differ between the two solutions. 5 values for sodium and urea did not differ between the two solutions, while the values for glucose and potassium with NpH5 were significantly higher and lower, respectively, than the values with ApH5 (0.92±1.04 vs 0.04±0.63 and 0.56±060 vs 1.15±0.39, p < 0.05). The absorption of glucose from the dialysis solution expressed as a percentage of the initial amount of dialysate glucose was significantly lower with NpH5 than with ApH5 at 30 min (17.3±1.7% vs 29.7±2.0%, p < 0.05).

Conclusion

We conclude that the peritoneal transport of fluid and small solutes might to some extent be influenced by the acidity of the dialysis solution. The vasodilatory effect of acidic dialysis solution might be the most important mechanism for these differences. However, a larger KBD value and a lower 5 value for potassium and higher 5 values for glucose during dialysis with the neutral dialysis solution may indicate that transport mechanisms other than simple passive transport are involved in peritoneal transport for glucose and electrolytes.
Renal Transplantation in Patients Undergoing Chronic Peritoneal Dialysis
Authors: Perez Fontán Miguel , Rodríguez-Carmona Ana , Falcon Teresa García , Moncalián Javier , Oliver Juan , Valdés Francisco
Published: February 2020

Objective

To review the outcome of renal transplantation in a group of patients treated with chronic peritoneal dialysis and to compare the results with those of a matched population on hemodialysis.

Design

Retrospective study.

Setting

Tertiary, institutional hospital, administering to a population of two million, with 100 patients on peritoneal dialysis. Six hundred and sixty renal transplantations were performed by the end of 1993.

Patients

Fifty-six patients on chronic peritoneal dialysis who received 58 cadaveric renal allografts were compared to 58 patients on hemodialysis who received a graft from the same donor (n = 39), or the transplant next to the one performed to the corresponding patient on peritoneal dialysis (n = 19).

Results

Patients on peritoneal dialysis showed a lower rate of delayed graft function (24.1 vs 50%, p < 0.05) and a similar incidence of acute rejection than patients on hemodialysis. Also, peritoneal dialysis patients received less supplementary immunosuppression, suffered a lower incidence of late infections (0.93 vs 0.58 episodes/patient), and had a similar incidence of dialysis-related complications (0.25 vs 0.20 episodes/patient).

Conclusions

Patients on peritoneal dialysis do well after renal transplantation. The incidence of some complications, particularly delayed graft function, is lower than in patients on hemodialysis, while the incidence of dialysis-associated complications is similar in both groups.
The Fate of Leached Di(2-Ethylhexyl)Phthalate in Patients Undergoing Capd Treatment
Authors: Mettang Thomas , Thomas Stefan , Kiefer Thomas , Fischer Frank-Peter , Kuhlmann Ulrich , Wodarz Roman , Rettenmeier Albert W.
Published: February 2020

Objectives

To evaluate the degree of exposure to and the fate of di(2-ethylhexyl)phthalate (DE HP) and its major derivatives mono(2-ethylhexyl)phthalate (ME HP), 2-ethylhexanol (2-EH), and phthalic acid (PA) in patients undergoing regular continuous ambulatory peritoneal dialysis (CAPD) during a 4-hour dwell period.

Design

Prospective, controlled.

Setting

Teaching hospital, Department of Nephrology.

Participants

Seven elderly patients on stable CAPD using Fresenius instruments and dialysate and 6 agematched healthy controls.

Interventions

During a routinely performed peritoneal equilibration test (PET), blood and dialysate samples were drawn before and 120 and 240 min after the dwell was started. In addition, blood samples were taken from a group of volunteers participating in a pharmacological study.

Measurements

Quantitative analysis of DE HP and its hydrolysis products was performed by selected ion-monitoring gas chromatography/mass spectrometry, operating the mass spectrometer in a combined positive and negative ion chemical ionization mode.

Results

Serum concentrations of DE HP and PA were significantly higher in patients (median: 0.079 I1g/mL, range: 0.032 -0.210 I1g/mL; and 0.167 I1g/mL, range: 0.097 0.231 I1g/mL, respectively) than in controls [0.0195 I1g/mL, range: 0.016 -0.025I1g/mL (p = 0.0027) and 0.0120 I1g/mL, range: 0.006 -0.034I1g/mL (p = 0.0026), respectively]. Concentration of ME HP in the fluid of CAPD bags prior to use was four times higher than that of the parent compound. During the first 4 hours of dwell time, the concentrations of ME HP and 2-EH in dialysate consistently decreased from 0.177 (range: 0.137 -0.239119/ mL) to 0.022 I1g/mL (range: 0.005 -0.058 I1g/mL) (p = 0.017), and from 0.087 (range: 0.075 -0.097I1g/mL) to 0.05 I1g/mL (range: 0.023 0.064I1g/mL) (p = 0.017), respectively, while the concentration of DE HP remained stable. Remarkably high concentrations of PA (0.129 I1g/mL; range: 0.038 -0.466 I1g/mL) were found in CAPD bags prior to use, and these concentrations tended to increase during dwell time, without statistical significance, however (0.135I1g/mL; range: 0.073 -0.659I1g/mL, p = 0.062).

Conclusions

Patients on CAPD are regularly exposed to considerable amounts of phthalic ester derivatives, mainly to MEHPand PA. ME HP seems to bewellabsorbed by the peritoneal membrane. The long-term effects of this exposure remain to be elucidated.
The Pathway From Social Status to Physical Health: Taking a Closer Look at Stress as a Mediator
Authors: Cundiff Jenny M. , Boylan Jennifer Morozink , Muscatell Keely A.
Published: February 2020

Stress is often invoked as a potential contributor to disparities in physical health as a function of social status. Although there is good reason to believe that stress exposure and stress responses may be an important pathway linking lower social status to poor health, direct evidence is lacking. We summarize the evidence for this pathway and limitations of that evidence, focusing particularly on how stress is conceptualized and measured. We argue that in addition to more direct tests of mediation, the measurement of the mediator—stress—could also be improved. We also propose that measuring theory-specific stress exposures may be more fruitful than assessing general stress exposures (e.g., life events, global perceived stress) by increasing theoretical clarity and predictive utility of stress in this context.
Simulation-based medical education can be used to improve the mental health competency of emergency physicians
Authors: Coggins Andrew , Marchant Dale , Bartels Jane , Cliff Brett , Warburton Sandra , Murphy Margaret , Mitra Tatum , Ryan Christopher J
Published: February 2020

Objective:

We explored the feasibility of developing, running and evaluating a simulation-based medical education (SBME) workshop to improve the knowledge, skills and attitudes of emergency department (ED) doctors when called on to assess patients in psychiatric crisis.

Method:

We designed a four-hour workshop incorporating SBME and a blend of pre-reading, short didactic elements and multiple-choice questions (MCQs). Emergency department nurses (operating as SBME faculty) used prepared scripts to portray patients presenting in psychiatric crisis. They were interviewed in front of, and by, ED doctors. We collected structured course evaluations, Debriefing Assessment for Simulation in Healthcare (DASH) scores, and pre- and post-course MCQs.

Results:

The pilot workshop was delivered to 12 ED registrars using only existing resources of the Psychiatry and Emergency Departments. Participants highly valued both ‘level of appropriateness’ (Likert rating μ = 4.8/5.0) and ‘overall usefulness’ ( μ = 4.7/5.0) of the programme. They reported an improved understanding of the mental state and of relevant legal issues and rated the debriefings highly (participant DASH rating: n = 193; score μ = 6.3/7.0). Median MCQ scores improved non-significantly pre- and post-course (7.5/12 vs 10/12, p = 0.261).

Conclusion:

An SBME workshop with these aims could be delivered and evaluated using the existing resources of the Psychiatry and Emergency Departments.
Outside-in arthroscopic psoas release for anterior iliopsoas impingement after primary total hip arthroplasty
Authors: Moreta Jesús , Cuéllar Adrián , Aguirre Urko , Casado-Verdugo Óscar L , Sánchez Alberto , Cuéllar Ricardo
Published: February 2020

Purpose:

1 of the causes of groin pain after total hip arthroplasty (THA) is impingement of the iliopsoas tendon. The purpose of this study was to present our results with outside-in arthroscopic tenotomy for iliopsoas impingement after THA.

Methods:

We retrospectively reviewed 12 patients treated between 2009 and 2016 with a minimum follow-up of 2 years. Anterior acetabular component prominence was measured on a true lateral hip radiograph. A transcapsular tenotomy was performed near the edge of the acetabular component through an outside-in arthroscopic approach. The primary clinical outcomes evaluated were groin pain, assessed with a visual analogue scale (VAS), and the Harris Hip Score (HHS). Secondary outcomes included strength of hip flexion, measured with the Medical Research Council (MRC) scale.

Results:

All patients had groin pain improvement, though one patient continued to have moderate pain. The mean VAS score was significantly lower postoperatively (1.08) than preoperatively (6.2) ( p < 0.001). The mean HHS improved from 58.8 (range, 37–76) to 86.1 (range, 59–98) ( p  = 0.001). The average postoperative MRC Scale was 4.58. The mean anterior prominence was 7.25 mm (range 3–12 mm). In patients with <10 mm of component prominence, tenotomy provided groin pain resolution in all cases ( n  = 8). In patients with ⩾10 mm of prominence, symptoms resolved in 3 out of 4 cases.

Conclusions:

Outside-in arthroscopic iliopsoas release provided a high rate of success with no complications in this study, even in patients with moderate acetabular component prominence.
Family life cycle and preferences for a mega-sporting event package: The case of the 2018 PyeongChang Winter Olympic Games
Authors: Kim Hyesun , Baek Jooa , Choe Yeongbae
Published: February 2020

Mega-sporting events often contribute to both financial and nonfinancial aspects of a destination. Nonetheless, several problematic issues (e.g. risk/safety issues, high travel costs, and online broadcasting) require a hosting destination focusing more on marketing and promotion strategies to boost event attendance. As such, this study aims to understand the optimal bundling package strategy for a mega-sporting event by investigating the effect of customers’ life cycle stage on their preferences in purchasing an event-related package. Several event package features used in this study are important determinants of mega-sporting event participation. More important, respondents in different family life cycle stages showed different levels of sensitivity to each package attribute, thereby constructing different preferences. The result of this study would be useful information for designing more attractive mega-sporting event packages and/or target marketing strategies focusing on different life stages.
A Rare Case of Benign Luteomas of Pregnancy Masquerading as Malignancy
Authors: Devlin Kelly , Payton Amber , Rubino Jessica , Shapiro Robert
Published: February 2020

A luteoma is a benign ovarian mass that can have malignant characteristics on sonography. Pelvic sonography is used to help distinguish benign from malignant masses. The workup of adnexal masses during pregnancy may involve the use of both transabdominal and transvaginal sonography as well as Doppler imaging, magnetic resonance imaging, and serum tumor markers to identify the risk of malignancy. This study presents a case of a benign ovarian luteoma of pregnancy detected during sonography. The mass was removed during the first trimester due to malignant sonographic features. Counseling and treatment regarding ovarian masses should consist of a multidisciplinary team made up of physicians in maternal-fetal medicine, radiology, neonatology, and sonographers.
Commercial app use linked with sustained physical activity in two Canadian provinces: a 12-month quasi-experimental study
Authors: Mitchell Marc , Lau Erica , White Lauren , Faulkner Guy
Published: February 2020

Background

Top tier commercial physical activity apps rarely undergo peer-reviewed evaluation. Even fewer are assessed beyond six months, the theoretical threshold for behaviour maintenance. The purpose of this study was to examine whether a multi-component commercial app rewarding users with digital incentives for walking was associated with an increase in physical activity over one year.

Methods

This 12-month quasi-experimental study was conducted in two Canadian provinces (n = 39,113 participants). Following a two-week baseline period, participants earned digital incentives ($0.04 CAD/day) every day they reached a personalized daily step goal. Mixed-effects models estimated changes in weekly mean daily step count between the baseline period and the last two recorded weeks. Models were fit for several engagement groups and separately by baseline physical activity status within engagement groups.

Results

Nearly half of participants (43%) were categorized as physically inactive at baseline (fewer than 5000 daily steps), and 60% engaged with the app for at least six months [‘Regular’ (24–51 weeks of step data) or ‘Committed’ sub-groups (52 weeks)]. Weekly mean daily step count increased for physically inactive users regardless of engagement status (P < .0001). The increase was largest for ‘Regular’ and ‘Committed’ participants—1215 and 1821 steps/day, respectively. For physically active participants, step count increases were only observed in the ‘Committed’ sub-group (P < .0001). Effect sizes were modest-to-medium depending on the sub-group analyzed.

Conclusions

A commercial app providing small but immediate digital incentives for individualized goals was associated with an increased weekly mean daily step count on a population-scale over one year. This effect was more evident for physically inactive and more engaged participants.
Author Correction: Gut microbiome composition in the Hispanic Community Health Study/Study of Latinos is shaped by geographic relocation, environmental factors, and obesity
Authors: Kaplan Robert C. , Wang Zheng , Usyk Mykhaylo , Sotres-Alvarez Daniela , Daviglus Martha L. , Schneiderman Neil , Talavera Gregory A. , Gellman Marc D. , Thyagarajan Bharat , Moon Jee-Young , Vázquez-Baeza Yoshiki , McDonald Daniel , Williams-Nguyen Jessica S. , Wu Michael C. , North Kari E. , Shaffer Justin , Sollecito Christopher C. , Qi Qibin , Isasi Carmen R. , Wang Tao , Knight Rob , Burk Robert D.
Published: February 2020

Following publication of the original paper [1], an error was reported in the third paragraph in the section “Analysis of GMB composition and its correlates” (page 3 of the PDF). The first sentence of the text should refer to Table 2, but mistakenly refers to Table 1.
The draft genome of a new Verminephrobacter eiseniae strain: a nephridial symbiont of earthworms
Authors: Arumugaperumal Arun , Paul Sayan , Lathakumari Saranya , Balasubramani Ravindran , Sivasubramaniam Sudhakar
Published: February 2020

Purpose

Verminephrobacter is a genus of symbiotic bacteria that live in the nephridia of earthworms. The bacteria are recruited during the embryonic stage of the worm and transferred from generation to generation in the same manner. The worm provides shelter and food for the bacteria. The bacteria deliver micronutrients to the worm. The present study reports the genome sequence assembly and annotation of a new strain of Verminephrobacter called Verminephrobacter eiseniae msu.

Methods

We separated the sequences of a new Verminephrobacter strain from the whole genome of Eisenia fetida using the sequence of V. eiseniae EF01-2, and the bacterial genome was assembled using the CLC Workbench. The de novo-assembled genome was annotated and analyzed for the protein domains, functions, and metabolic pathways. Besides, the multigenome comparison was performed to interpret the phylogenomic relationship of the strain with other proteobacteria.

Result

The FastqSifter sifted a total of 593,130 Verminephrobacter genomic reads. The de novo assembly of the reads generated 1832 contigs with a total genome size of 4.4 Mb. The Average Nucleotide Identity denoted the bacterium belongs to the species V. eiseniae, and the 16S rRNA analysis confirmed it as a new strain of V. eiseniae. The AUGUSTUS genome annotation predicted a total of 3809 protein-coding genes; of them, 3805 genes were identified from the homology search.

Conclusion

The bioinformatics analysis confirmed the bacterium is an isolate of V. eiseniae, and it was named Verminephrobacter eiseniae msu. The whole genome of the bacteria can be utilized as a useful resource to explore the area of symbiosis further.
Orthologous promoters from related methylotrophic yeasts surpass expression of endogenous promoters of Pichia pastoris
Authors: Vogl Thomas , Fischer Jasmin Elgin , Hyden Patrick , Wasmayer Richard , Sturmberger Lukas , Glieder Anton
Published: February 2020

Methylotrophic yeasts such as Komagataella phaffii (syn. Pichia pastoris, Pp), Hansenula polymorpha (Hp), Candida boidinii (Cb) and Pichia methanolica (Pm) are widely used protein production platforms. Typically, strong, tightly regulated promoters of genes coding for their methanol utilization (MUT) pathways are used to drive heterologous gene expression. Despite highly similar open reading frames in the MUT pathways of the four yeasts, the regulation of the respective promoters varies strongly between species. While most endogenous Pp MUT promoters remain tightly repressed after depletion of a repressing carbon, Hp, Cb and Pm MUT promoters are derepressed to up to 70% of methanol induced levels, enabling methanol free production processes in their respective host background. Here, we have tested a series of orthologous promoters from Hp, Cb and Pm in Pp. Unexpectedly, when induced with methanol, the promoter of the HpMOX gene reached very similar expression levels as the strong methanol, inducible, and most frequently used promoter of the Pp alcohol oxidase 1 gene (PPpAOX1). The HpFMD promoter even surpassed PPpAOX1 up to three-fold, when induced with methanol, and reached under methanol-free/derepressed conditions similar expression as the methanol induced PPpAOX1. These results demonstrate that orthologous promoters from related yeast species can give access to otherwise unobtainable regulatory profiles and may even considerably surpass endogenous promoters in P. pastoris.
The revision of the categories of mood, anxiety and stress-related disorders in the ICD-11: a perspective from the Arab region
Authors: El Khoury Joseph R. , Baroud Evelyne A. , Khoury Brigitte A.
Published: February 2020

Background

The World Health Organization estimates that 75% of patients with mental and substance use disorders in low- and middle-income countries do not have access to the care needed. In the Arab World, approximately 100–140 million people suffer from at least one psychiatric disorder. One main criticism of classification systems has been their lack of cultural sensitivity. The International Classification of Diseases, 11th edition aims to improve clinical utility of psychiatric classification across cultures. Mood, anxiety and stress-related disorders are the most common psychiatric manifestations and the most impacted by cultural factors.

Main body

Relying on rigorous field testing, including in three Arab countries, clinically meaningful changes have been introduced in the International Classification of Diseases 11. These include new disorders such as complex post-traumatic stress disorder and prolonged grief disorder. In classifying mood episodes, the pattern of symptoms over time is emphasized. Disorders associated with anxiety provide the basis for a new grouping separate from obsessive-compulsive-related disorders. Lastly, culture and its impact are incorporated into each diagnostic grouping.

Conclusions

This latest version of the International Classification of Diseases prioritizes addressing gaps in the validity and reliability of psychiatric classification. The methodology adopted in this latest revision is encouraging and opens the way to truly global collaboration on refining psychiatric diagnoses and practice.
Optimizing the development and evaluation of complex interventions: lessons learned from the BetterBirth Program and associated trial
Authors: Barnhart Dale A. , Semrau Katherine E. A. , Zigler Corwin M. , Molina Rose L. , Delaney Megan Marx , Hirschhorn Lisa R. , Spiegelman Donna
Published: February 2020

Background

Despite extensive efforts to develop and refine intervention packages, complex interventions often fail to produce the desired health impacts in full-scale evaluations. A recent example of this phenomenon is BetterBirth, a complex intervention designed to implement the World Health Organization’s Safe Childbirth Checklist and improve maternal and neonatal health. Using data from the BetterBirth Program and its associated trial as a case study, we identified lessons to assist in the development and evaluation of future complex interventions.

Methods

BetterBirth was refined across three sequential development phases prior to being tested in a matched-pair, cluster randomized trial in Uttar Pradesh, India. We reviewed published and internal materials from all three development phases to identify barriers hindering the identification of an optimal intervention package and identified corresponding lessons learned. For each lesson, we describe its importance and provide an example motivated by the BetterBirth Program’s development to illustrate how it could be applied to future studies.

Results

We identified three lessons: (1) develop a robust theory of change (TOC); (2) define optimization outcomes, which are used to assess the effectiveness of the intervention across development phases, and corresponding criteria for success, which determine whether the intervention has been sufficiently optimized to warrant full-scale evaluation; and (3) create and capture variation in the implementation intensity of components. When applying these lessons to the BetterBirth intervention, we demonstrate how a TOC could have promoted more complete data collection. We propose an optimization outcome and related criteria for success and illustrate how they could have resulted in additional development phases prior to the full-scale trial. Finally, we show how variation in components’ implementation intensities could have been used to identify effective intervention components.

Conclusion

These lessons learned can be applied during both early and advanced stages of complex intervention development and evaluation. By using examples from a real-world study to demonstrate the relevance of these lessons and illustrating how they can be applied in practice, we hope to encourage future researchers to collect and analyze data in a way that promotes more effective complex intervention development and evaluation.

Trial registration

ClinicalTrials.gov, NCT02148952; registered on May 29, 2014