bluuebunny/crossref_metadata_2025 huggingface dataset:
Körperdysmorphe Symptome, soziale Anpassung und Motivation zu psychotherapeutischer Beratung bei ambulanten dermatologischen Patienten
Authors: Ritter Viktoria , Fluhr Joachim W. , Schliemann‐Willers Sibylle , Elsner Peter , Strauß Bernhard , Stangier Ulrich
Published: September 2016

Hintergrund und Ziele

Die Dermatologie ist zunehmend mit Patienten konfrontiert, die unter einer körperdysmorphen Störung (KDS) leiden. Die KDS ist gekennzeichnet durch die übermäßige Beschäftigung mit einem oder mehreren wahrgenommenen Defekten oder Makeln in der äußeren Erscheinung, die für andere nicht oder allenfalls minimal erkennbar sind. Bislang gibt es nur wenige Prävalenzstudien bei KDS im ambulanten dermatologischen Setting. Darüber hinaus wurde die Motivation zu psychotherapeutischer Beratung bei ambulanten dermatologischen Patienten mit körperdysmorphen Symptomen noch nicht systematisch erfasst. Ziel der vorliegenden Studie war daher, die Häufigkeit körperdysmorpher Symptome, die soziale Anpassung sowie die Motivation zu psychotherapeutischer Beratung bei ambulanten dermatologischen Patienten zu untersuchen.

Patienten und Methodik

252 ambulante Patienten einer Universitäts‐Hautpoliklinik wurden konsekutiv rekrutiert und mittels Dysmorphic Concerns Questionnaire, Soziale Aktivität Selbstbeurteilungs‐Skala sowie Veränderungsstadien‐Skala untersucht.

Ergebnisse

7,9 % der unselektierten Gesamtstichprobe erzielten Testresultate, die auf klinisch relevante körperdysmorphe Symptome hinweisen. Patienten mit klinisch relevanten körperdysmorphen Symptomen wiesen eine geringe soziale Anpassung auf. Entgegen den Erwartungen zeigten sie eine hohe Veränderungsmotivation und Bedarf an Psychotherapie.

Schlussfolgerungen

Die Ergebnisse bestätigen die bisherigen Prävalenzraten bei KDS im ambulanten dermatologischen Setting und verdeutlichen die Notwendigkeit psychotherapeutischer Beratungsangebote in der Dermatologie.
Neue Entwicklungen in der Berufsdermatologie
Authors: Diepgen Thomas L.
Published: September 2016

Berufsbedingte Hautkrankheiten nach BK‐Nr. 5101 stehen in Deutschland seit vielen Jahren an der Spitze der angezeigten Berufskrankheiten. Durch die Optimierung von Maßnahmen der primären, sekundären und tertiären Prävention können heutzutage die meisten Betroffenen im Beruf verbleiben. Zum 01.01.2015 wurde die Berufskrankheitenverordnung (BKV) novelliert und es wurde die BK‐Nr. 5103 „Plattenepithelkarzinome oder multiple aktinische Keratosen der Haut durch natürliche UV‐Strahlung“ als neue Berufskrankheit in die BK‐Liste der BKV aufgenommen. Die Definition von „multipel“ bedeutet dabei entweder mehr als fünf einzelne aktinische Keratosen innerhalb eines Zeitraums von 12 Monaten oder das Vorliegen einer Feldkanzerisierung von größer 4 cm2. Wichtige Aspekte dieser neuen Berufskrankheit werden aufgezeigt und diskutiert sowie Neuerungen bei der BK 5101 angesprochen.
Mirror neuron activation as a function of explicit learning: changes in mu‐event‐related power after learning novel responses to ideomotor compatible, partially compatible, and non‐compatible stimuli
Authors: Behmer Lawrence P. , Fournier Lisa R.
Published: September 2016

Questions regarding the malleability of the mirror neuron system (MNS) continue to be debated. MNS activation has been reported when people observe another person performing biological goal‐directed behaviors, such as grasping a cup. These findings support the importance of mapping goal‐directed biological behavior onto one's motor repertoire as a means of understanding the actions of others. Still, other evidence supports the Associative Sequence Learning (ASL) model which predicts that the MNS responds to a variety of stimuli after sensorimotor learning, not simply biological behavior. MNS activity develops as a consequence of developing stimulus‐response associations between a stimulus and its motor outcome. Findings from the ideomotor literature indicate that stimuli that are more ideomotor compatible with a response are accompanied by an increase in response activation compared to less compatible stimuli; however, non‐compatible stimuli robustly activate a constituent response after sensorimotor learning. Here, we measured changes in the mu‐rhythm, an EEG marker thought to index MNS activity, predicting that stimuli that differ along dimensions of ideomotor compatibility should show changes in mirror neuron activation as participants learn the respective stimulus‐response associations. We observed robust mu‐suppression for ideomotor‐compatible hand actions and partially compatible dot animations prior to learning; however, compatible stimuli showed greater mu‐suppression than partially or non‐compatible stimuli after explicit learning. Additionally, non‐compatible abstract stimuli exceeded baseline only after participants explicitly learned the motor responses associated with the stimuli. We conclude that the empirical differences between the biological and ASL accounts of the MNS can be explained by Ideomotor Theory.
Origins and implications of apid bees (Hymentopera: Apidae) in French Polynesia
Authors: Groom Scott V. C. , Stevens Mark I. , Ramage Thibault , Schwarz Michael P.
Published: September 2016

Island plant–pollinator networks are typically simpler than their continental counterparts and this can make them less resilient to disturbance from exotic species. French Polynesia has a very low diversity of bees, but their status as either native or introduced species has been largely speculative. We combine previous studies with new DNA sequence data to show that 11 bee species have now been recorded for French Polynesia. Haplotype variation at the ‘barcode’ region of the mitochondrial gene cytochrome c oxidase subunit I (COI) for four of these species, Ceratina dentipes Freise, Xylocopa sonorina Smith, Braunsapis puangensis (Cockerell) and Amegilla pulchra (Smith), indicates that they all represent very recent introductions. Apis mellifera Linnaeus was a purposefully introduced species, and four megachilid species probably arrived due to human‐aided dispersal through maritime activities in the Pacific. The two remaining bee species, an unidentified partial specimen of a halictid bee and the colletid bee Hylaeus (P.) tuamotuensis Michener, are collectively known from only four specimens collected in the 1930s and their provenance is uncertain. French Polynesia therefore comprises a region where recently introduced bee species greatly overwhelm any possible native bee fauna. These introductions are likely to have major ecosystem impacts, including disruptions of existing plant–pollinator networks and facilitating the spread of weedy plant species, as well as positive impacts for agriculture. Future biosecurity initiatives need to consider these potential impacts and the likely routes of dispersal to effectively control any further unintended introductions.
Volume Effects of Daily Hemodialysis
Authors: Sherman Richard A.
Published: September 2016

Daily hemodialysis appears to be well tolerated, with hypotension rarely complicating such therapy, a finding that is the subject of this review. When daily hemodialysis utilizes a shorter treatment time, this may limit the intradialytic reduction in plasma volume. This reduction is a function of treatment time, ultrafiltration rate (UFR), and plasma refilling rate (PRR). However, daily therapy may be associated with a higher UFR and lower PRR, both of which may accentuate the fall in plasma volume. The reduced frequency of intradialytic hypotension may, in part, be related to other aspects of such therapy, such as the smaller oscillations and decreased dialytic flux of hemodynamically active solutes.
Hemodialysis Systems for Intermittent, Semi‐Continuous, and Continuous Therapies in Acute Renal Failure
Authors: Clark William R. , Soltys Paul J.
Published: September 2016

As is the case in end‐stage renal disease (ESRD), both intermittent and continuous renal replacement therapies (RRTs) are employed in acute renal failure (ARF). In fact, a continuum of treatment options is available in ARF. At one end of the ARF RRT spectrum is conventional intermittent hemodialysis (IHD), in which relatively high blood and dialysate flow rates are used (typically ≥250 and 500 mL/min, respectively). Continuous renal replacement therapies (CRRTs), which employ much lower flow rates, comprise the other end of the spectrum. Finally, hybrid therapies, which combine characteristics of both IHD and CRRT, have recently been described. These therapies’ removal mechanisms for solutes over a broad molecular weight range are discussed. An understanding of these mechanisms is important when determining the amount of therapy that can be provided by any RRTs. Additional studies are required to improve the understanding of solute removal by the various RRT used in ARF.
Quantitating Dialysis in the Home Hemodialysis Patient: A Simple and Practical Approach
Authors: Coulis Nancy J. , Gray Barbara A. , Saiphoo Carl S. , Tobe Sheldon W. , Manuel M. Arif
Published: September 2016

Home hemodialysis is the most cost‐effective form of dialysis and is associated with the lowest mortality. Home hemodialysis patients are usually highly motivated, independent, and actively employed. Because of the minimal supervision they require and the fact that they are not in a controlled environment, it is easy to overlook the measurement of their dialysis adequacy. We studied 6 home hemodialysis patients and demonstrated that blood urea measured 30 min before the end of dialysis (Ct‐30) is equivalent to that measured 30 min after the end of dialysis (Ct+30). The Kt/V results using Ct‐30, Kt/V(Ct‐30), were almost equivalent to Kt/V(Ct+30) (p = 0.5). The Kt/V Kt/V(Ct) using blood urea measured at the end of dialysis (Ct) significantly overestimated Kt/V(Ct‐30) and Kt/V(Ct+30) (p = 0.007) The calculated percent reduction of urea (PRU) was about 5% less when using Ct‐30 compared with Ct (p = 0.001).

Taking blood samples 30 min before the end of dialysis for urea kinetics is more convenient for the home dialysis patients, since no other technical aspects of dialysis need their attention. The samples can be delivered to the laboratory the following day, because the blood may be stored in heparinized tubes at 4°C without deterioration of urea and creatinine concentrations. The Kt/V(Ct‐30) was almost equal to Kt/V(Ct+30), so there is no longer any concern for the errors introduced by urea rebound. The blood pump must be reduced to 80 mL/min for about 10 sec to eliminate the errors due to fistula and cardiopulmonary recirculation. A simple programmable calculator will facilitate the calculation of accurate results using the Daugirdas second‐generation formula.
Measurement of Hemodialysis Adequacy in a Changing World
Authors: Kjellstrand Carl M. , Twardowski Zbylut J.
Published: September 2016

Defining adequacy of dialysis remains an elusive goal. The application of the Kt/Vurea concept to clinical dialysis was a major improvement in trying to define a dialysis dose. Intuitively, the Kt/V concept makes a great deal of sense: the urea clearance of the dialyzer during dialysis (K), multiplied by the time (t) of dialysis, divided by the patient's urea distribution volume (V) ought to give the best number to compare the efficiency of dialyses that patients receive. There are, however, many pitfalls associated with the whole Kt/Vurea concept.
Nightly Home Hemodialysis: Fifteen Months of Experience in Lynchburg, Virginia
Authors: Lockridge Robert S. , Albert Jeanette , Anderson Helen , Barger Terry , Coffey Lisa , Craft Viola , Jennings Floyd M. , McPhatter Lesley , Spencer Maureen , Swafford Angela
Published: September 2016

What constitutes adequate dialysis has been debated in the nephrology literature over the past eight years. The mortality rate of patients on dialysis in the United States is about 20% per year. We believed that short and infrequent dialysis sessions contributed to poor outcomes. To improve the results, Lynchburg Nephrology started the nightly home hemodialysis (NHHD) program in September 1997.

Ten patients were trained in the first 15 months of the program. Patients dialyzed 7 – 9 hours, 6 nights/week, using the Fresenius 2008H machine. A standard dialysis solution with 2.0 mEq/L potassium, calcium concentration of 3.0 – 3.5 mEq/L was used. Dialysis solution flow rates were 200 – 300 mL/min. Serum phosphate levels were maintained above 2.5 mg/dL by adding 0 – 45 mL Fleet's Phosphosoda to the bicarbonate bath.

Patients had marked improvement in quality of life as measured with the SF‐36. Blood pressure was better controlled with fewer medications. All phosphate binders were eliminated. Caloric intake and protein intake increased to normal levels as measured by three‐day dietary histories pre‐NHHD, and at 3, 6, and 12 months on NHHD.

Epoetin alfa dosages were reduced by about 50%. Nightly home hemodialysis should be considered as a valuable modality option for end‐stage renal disease patients; it is potentially superior to conventional thrice‐weekly hemodialysis.
Time Needed to Improve Clinical Parameters By Daily Hemodialysis
Authors: Traeger Jules , Galland Roula , Delawari Ehsan , Arkouche Walid
Published: September 2016

Daily hemodialysis therapy (DHD), 2 hours, 6 times per week, is able to cure complications that persist on standard hemodialysis (SHD), 4 hours, 3 times per week. Cardiovascular manifestations (high blood pressure, left ventricular hypertrophy), nutritional deficient states, and postdialysis asthenia are improved during the first month of DHD therapy and are usually cured at 3 months. Daily hemodialysis may be considered as a rescue therapy. The next step will be to select which patients can return to the classical SHD therapy without recurrence of their complications.
Daily Hemodialysis versus Standard Hemodialysis: TAC, TAD, Weekly eKt/V, std(Kt/V), and PCRn
Authors: Galland Roula , Traeger Jules , Delawari Ehsan , Arkouche Walid , Abdullah Elias
Published: September 2016

Seven patients, mean age 42.57 ± 15.69 years (range 21 – 67 years), on standard hemodialysis (SHD), 4 – 5 hours, three times per week for 11.0 ± 6.63 years (range 1 – 18 years), were switched to daily hemodialysis (DHD), 2 – 2.5 hours, six times per week. For each type of treatment similar parameters were applied, and the total weekly time was the same. Mean duration of DHD was 15.4 ± 4.98 months (range 7 – 20 months). We report here our results of quantification in each method, including time‐averaged concentration (TAC), normalized protein catabolic rate (PCRn), equilibrated Kt/V (eKt/V), equivalent normalized continuous standard clearance [std(Kt/V)], equivalent renal urea clearance (eKRn), and time‐averaged deviation (TAD).

With DHD, urea TAC was reduced from 19.09 ± 3.47 to 15.16 ± 3.21 mmol/L (p = 0.026), urea TAD diminished from 4.76 ± 1.04 to 2.52 ± 0.57 mmol/L (p = 0.000 53), PCRn increased from 1.11 ± 0.23 to 1.42 ± 0.24 g/kg/day (p = 0.001), weekly eKt/V increased from 4.11 ± 0.31 to 4.74 ± 0.43 (p = 0.000 25), std(Kt/V) rose from 2.17 ± 0.06 to 4.02 ± 0.25 (p = 0.0001), and eKRn increased from 12.96 ± 0.60 to 21.7 ± 3.09 mL/min (p = 0.000 45).

On DHD the most important quantitative variation is the decrease of urea TAD (closer to that of a healthy kidney), due to the increased frequency of dialysis; std(Kt/V) practically doubled and represents 30% of that of normal renal function. These changes are probably the main explanation for the clinical improvements, but it is difficult to dissociate the effects of increased dialysis dose from the effects of decreased TAD.
Blood Flow, Negative Pressure, and Hemolysis During Hemodialysis
Authors: Twardowski Zbylut J. , Haynie Jimmy D. , Moore Harold L.
Published: September 2016

Blood flow, measured by an ultrasound flowmeter, and the extent of hemolysis were assessed during a single, routine dialysis in 100 patients. Before and after the hemodialysis session, blood was drawn for measurements of haptoglobin (HPT), hemoglobin (HGB), albumin (ALB), and lactate dehydrogenase (LDH).

The average values were as follows: pump speed 510 mL/ min, real blood flow 422 mL/min, arterial chamber pressure ‐350 mm Hg, and venous chamber pressure 279 mm Hg. Haptoglobin concentrations were higher in patients with central vein catheters compared to patients with arteriovenous access. The meaning of this finding is unclear. Mean HPT concentrations increased significantly less during hemodialysis (2.37%) than concentrations of ALB (11.3%), HGB (9.17%), and LDH (18.2%), indicating that some hemolysis is present in all dialyses. In dialyses with arterial chamber pressures more negative than ‐350 the median concentration of ALB (8.70%) increased significantly more than the median concentration of HGB (7.99%). This indicates significantly more hemolysis in dialyses with more negative pressures compared to those with less negative arterial chamber pressures. Median LDH increased more in dialyses with more negative prepump chamber pressures (16.19% vs 13.78%), but not significantly; however, LDH increases were significantly higher than either HGB or ALB, thus indicating significantly more hemolysis in dialyses with more negative pressures compared to those with less negative arterial chamber pressures. Erythropoietin dose was not significantly different in patients dialyzed with more or less negative arterial chamber pressures (17 645 ± 1226 U/week vs 16 308 ± 1506 U/week).

We conclude that dialyses with negative arterial chamber pressures greater than ‐350 mm Hg cause slightly higher hemolysis than dialyses with less negative arterial chamber pressures, but this increased hemolysis is not associated with an increased requirement of erythropoietin dose. Whether this increased hemolysis is of clinical significance is uncertain.
Telematics Service for Home and Satellite Hemodialysis
Authors: Agroyannis Basil , Fourtounas Costas , Romagnoli Gianfranco , Skiadas Marios , Tsavdaris Charalambos , Chassomeris Costas , Tzanatos Helen , Kopelias Ioannis , Lymberopoulos Dimitrios , Psarras John
Published: September 2016

Home hemodialysis (HD) for the treatment of end‐stage renal disease was first implemented about 30 years ago. In this paper the application of telematics monitoring services for supporting patients who need home HD or satellite HD is described.

Two modified HD machines were located in two renal units, and a central control station (CCS, UNIX workstation with multimedia PC terminal) was located in another room of the hospital. Bidirectional communication between the modified HD machines and the CCS was managed using ISDN (Integrated Services Digital Network) links. Nine patients had 150 HD sessions performed using these HD machines over a period of 5 months. This system, called the HOMER‐D system, provided on‐line, remote supervision of the HD machine‐related functions and the clinical condition of the patients through measurement of blood pressure, pulse rate, PO2 (pulse oxymetry), and ECG from the CCS. Any disturbances in the functioning of the HD machines were both visible and audible in the CCS, and the observer could give teleconsultation to the renal unit staff. No major dialysis‐associated complications were observed; all data and alarms were transmitted correctly; and patients received adequate HD treatment.
Blood Urea Nitrogen Stability: A Feasibility Study for Home Hemodialysis Adequacy Testing Through Mail
Authors: Case Gay L. , Pierce Lynn , Vigil Debbie
Published: September 2016

Urea kinetic modeling measures the delivered dose of hemodialysis and is used to monitor dialysis adequacy. Obtaining samples for adequacy calculations is a challenge for home hemodialysis (HHD) patients. Ideally, the urea reduction ratio (URR) should be measured at a typical dialysis session; therefore, for HHD patients test specimens should be drawn at home and transferred to a clinical laboratory. Would blood urea nitrogen (BUN) remain stable if samples were mailed to the laboratory? To answer this question, BUN was measured in pre‐ and postdialysis samples from 20 patients over 8 days of laboratory storage. While BUN values varied among the patient population, neither pre‐ nor postdialysis values showed any significant variation during the 8‐day storage time. These results suggest that BUN values are sufficiently stable for specimens to be drawn at home and mailed to a testing laboratory.
Delayed Dialyzer Reprocessing for Home Hemodialysis
Authors: Pierratos Andreas , Francoeur Robert , Ouwendyk Michaelene
Published: September 2016

Although dialyzer reuse for home hemodialysis (done by patients at home) has been in practice since the 1960s, it is now almost completely abandoned. The need for dialyzer reuse resurfaced with the renewed interest in daily/nightly forms of home hemodialysis and the associated increase in operating costs. We describe a method of dialyzer reuse based on reprocessing of dialyzers at the center, after they had been stored in a refrigerator at home for 1 week by the patient. Transportation of the dialyzers by either the patient or a transportation service was acceptable to the patients. Despite the lower number of reuses, possibly related to the delayed processing, dialyzer reuse in this setting provided significant financial benefits. Experience with this process for 3 years has not disclosed any negative effects after the initial logistical issues related to dialyzer transportation were resolved.

In summary, weekly dialyzer reprocessing at the center provides a solution to the need for dialyzer reuse for the home hemodialysis patient.
Is Hypertension Beneficial to the Conventional Hemodialysis Patient?
Authors: Salem Mahmoud M.
Published: September 2016

Hypertension is common in the conventional hemodialysis population. While hypertension in the general population has been shown to reduce survival, the issue is less clear in the dialysis population. This review focuses on recent studies showing a favorable outcome in hypertensive hemodialysis patients compared to those with lower blood pressure. Possible explanations for this paradoxical relationship are examined and practical suggestions given for the management of hypertension in the hemodialysis patient.
Does Blood Pressure Control by Gentle Ultrafiltration Improve Survival in Hemodialysis Patients?
Authors: Charra Bernard , Jean Guillaume , Hurot Jean-Marc , Chazot Charles , Vanel Thierry , Terrat Jean-Claude , Laurent Guy
Published: September 2016

Agentle ultrafiltration can be achieved using a long and slow hemodialysis. It is easier to achieve gentle ultrafiltration if the interdialytic weight intake is moderate ( i.e., if the patient maintains a low sodium diet) and if diffusion allows for a negative or nil sodium balance during the session ( i.e., dialysate sodium < 140 mmol/L). A gentle ultrafiltration allows control of blood pressure by reducing the extracellular volume to its ideal level, the “dry weight,” at the end of the session. Controlling blood pressure reduces cardiovascular mortality, which is by far the foremost cause of death in hemodialysis.

Controlling blood pressure means reducing the occurrence of both hypertension and hypotension. Hypotension has been reported to correlate with mortality in hemodialysis as much as or more than hypertension itself. This “U‐curve” phenomenon is not paradoxical. It displays two distinct facts on the same figure: an increased early mortality in hypotensive patients (hypotension is a marker of frailty or congestive heart failure, both of which cause increased mortality) and, on the other hand, the well‐established, long‐term increased mortality in hypertensive patients. Hypotension is not a mandate to undertreat hypertension.
Daily Dialysis: Toward a New Standard in Well‐Being
Authors: Piccoli Giorgina B. , Bechis Francesca , Pozzato Marco , Ettari Giorgio , Alloatti Sandro , Vischi Margherita , Mezza Elisabetta , Iacuzzo Candida , Quaglia Marco , Burdese Manuel , Anania Patrizia , Gai Massimo , Quarello Francesco , Jeantet Alberto , Segoloni Giuseppe Paolo
Published: September 2016

Daily hemodialysis (DHD) is a promising option; however, logistic obstacles and clinical perplexities limit its dissemination. Understanding the mechanisms of, and the time until, the onset of improved well‐being may help to quantify clinical advantages and to define the minimum length of a “trial” of daily dialysis. By following 30 patients treated in 4 centers, this study aimed to determine how long a period of time is needed until a patient experiences subjective improvement.

From November 1998 to November 2000, 30 patients tried at least 2 weeks of short daily dialysis in four Northern Italian centers of Piemonte and Valle d'Aosta. The DHD (2 – 3 hours; blood flow 270 – 350 mL/min; individual HCO3, Na, K) was performed at home or in a center. Motivations to try DHD, fears and concerns regarding DHD, and changes in perceived well‐being were assessed by semi‐structured interview.

The main clinical indications for a trial of DHD were poor tolerance of conventional treatment, cardiovascular disease, and hypertension or hypotension; only 6 patients had no comorbidity at start. The patients' main reasons for choosing DHD were related to job problems and the search for a better treatment. Most of the patients continued DHD because of improved well‐being; logistic reasons accounted for the drop‐outs (5 patients). The main fears were related to logistic aspects, vascular access problems, and excessive involvement of the partner on home dialysis. Improved well‐being was reported by 28 of 30 patients; 2 patients reported no difference. Subjective improvement was perceived within 2 weeks in 22 of 30 patients, and within 1 month in 28 of 30 patients.

An offer of a 2 – 4 week trial of DHD may help patients and caregivers to determine whether subjective and objective benefits outweigh logistic problems and whether a permanent transfer to DHD is worthwhile.
Surgical Revision and Early Cannulation of the Arteriovenous Fistula in Hemodialysis Patients: An Effective Technique
Authors: Lye Wai-Choong , Kour Nam-Wee
Published: September 2016

Arteriovenous fistula (AVF) dysfunction is a common problem in hemodialysis patients. After surgical revision for malfunction, we used AVFs early to avoid complications associated with central venous catheters. In this study, we report experience with surgical revisions of native AVFs with suspected arterial dysfunction as the cause of inadequate arterial inflow for dialysis. Exclusion criteria were presence of a central venous catheter as a hemodialysis access, and clinical or radiologic evidence of stenosis or thrombosis of the distal venous segment of the AVF.

We prospectively studied 50 patients (mean age 60.2 ± 10.5 years, 25 men and 25 women) with 59 revisions. The patients were followed until change in the modality of dialysis, transplant, or death. The types of AVFs revised were left wrist radiocephalic in 27 patients (54%), left forearm radiocephalic in 10 (20%), right wrist radiocephalic in 6 (12%), left antecubital brachiocephalic in 3 (6%), right antecubital brachiocephalic in 2 (4%), and right forearm radiocephalic in 2 (4%). The causes of inadequate arterial flow were juxta‐anastomotic thrombosis in 20 patients (40%), inadequate arterial anastomotic flow in 16 (32%), inadequate anastomosis in 7 (14%), and juxta‐anastomotic venous stenosis in 7 (14%). The primary surgical revision techniques were proximal neo‐anastomosis using the semiarterialized vein in 43 patients (86%), thrombectomy and re‐anastomosis in 5 (10%), and resection and repair in 2 (4%).

Technical success, defined as successful cannulation of the revised AVF for hemodialysis and avoidance of central venous catheter, was achieved in 44 of 50 patients (88%). Technical failure occurred 6 cases, the causes being inadequate arterial flow in 3 patients, failure to cannulate the veins in 2 patients, and steal syndrome in 1 patient. After primary revisions failed, 9 re‐revisions were done in 6 patients. The 1‐year, 2‐year, and 3‐year primary and overall patency rates were 76.2%, 67.6%, 65.0%, and 85.7%, 75.7%, 65.0%, respectively.

In conclusion, surgical salvage of the AVF with inadequate arterial flow is an effective approach that can be performed as an outpatient procedure and allows early cannulation of the semi‐arterialized veins, thus avoiding the use of central venous catheters.
The Clinical Impact of Increasing the Hemodialysis Dose
Authors: Panagoutsos Stelios A. , Yannatos Evangelos V. , Passadakis Ploumis S. , Thodis Elias D. , Galtsidopoulos Omiros G. , Vargemezis Vassilis A.
Published: September 2016

Good evidence suggests that improvements in dialysis efficiency reduce morbidity and mortality of hemodialysis (HD) patients. Dialysis efficiency has also been related to better control of arterial blood pressure (BP), anemia, and serum phosphorus levels, and to improvement in patients' nutritional status.

Over a 2‐year period, the present self‐controlled study of 34 HD patients (23 men, 11 women; age, 52.6 ± 14.5 years; HD duration, 55.9 ± 61.2 months) looked at the effect on clinical and laboratory parameters of increasing the delivered dialysis dose under a strict dry‐weight policy. Dialysis dose was increased without increasing dialysis time and frequency.

A statistically significant increase was seen in delivered HD dose: the urea reduction ratio (URR) increased to 60% ± 10% from 52% ± 8%, and then to 71% ± 7% (p < 0.001); Kt/Vurea increased to 1.22 ± 0.28 from 0.93 ± 0.19, and then to 1.55 ± 0.29 (p < 0.001). A statistically significant increase in hemoglobin concentration also occurred—to 10.8 ± 1.9 g/dL from 10.4 ± 1.7 g/dL, and then to 11.0 ± 1.3 g/dL (p < 0.05 as compared to baseline)—with no significant difference in weekly erythropoietin dose.

Statistically significant decreases occurred in the systolic and diastolic blood pressures during the first year; they then remained unchanged. Systolic blood pressure decreased to 131 ± 23 mmHg from 147 ± 24 mmHg (p < 0.001); diastolic blood pressure decreased to 65 ± 11 mmHg from 73 ± 12 mmHg (p < 0.001). Serum albumin increased insignificantly to 4.4 ± 0.4 g/dL from 4.3 ± 0.4 g/dL, and then significantly to 4.6 ± 0.3 g/dL (p = 0.002 as compared to both previous values). Normalized protein catabolic rate increased significantly to 1.16 ± 0.15 g/kg/day from 0.93 ± 0.16 g/kg/ day (p < 0.001), and then to 1.20 ± 0.17 g/kg/day (p < 0.001 as compared to baseline).

We conclude that the increases achieved in average Kt/Vurea per hemodialysis session by increasing dialyzer membrane area, and blood and dialysate flows, without increasing dialysis time above 4 hours, in patients hemodialyzed thrice weekly, coupled with strict dry‐weight policy, resulted in improvements in hypertension, nutritional status, and anemia.
Do Catheter Side Holes Provide Better Blood Flows?
Authors: Wachter Dirk S. De , Weijmer Marcel C. , Kaušylas Mantas , Verdonck Pascal R.
Published: September 2016

Four catheters (Ash Split Cath, Tesio, Duo‐Split, and Duo‐‐Flow; Medcomp, Harleysville, PA, U.S.A.) were tested in a temperature‐controlled in vitro setup filled with 50% aqueous glycerin solution to determine hydraulic resistance at different flow rates. All these catheters have side holes; hydraulic resistance was determined with these holes open and closed. Due to extra pressure losses near the catheter tip, the pressure–flow relationship deviates from Poiseuillian theory and is generally quadratic in nature. An equivalent diameter was derived from the data. This equivalent diameter can be used to evaluate performance using a single number.

Permanent catheters can easily deliver 300 mL/minute under optimal circumstances, but acute catheters are, in practice, limited to 200 mL/minute, and even somewhat less in the coaxial Duo‐Flow type. Permanent catheters have larger equivalent internal diameters (1.8 vs 1.45 mm). Covering the side holes does not influence hydraulic resistance to a great degree, except in the arterial limb of acute catheters.

These results indicate that, especially in acute catheters, obstruction of the side holes or fibrin sleeve/thrombus formation over the inlet holes may severely impact the available blood flow rate during dialysis. On the other hand, side holes in permanent catheters or venous limbs seem to be superfluous for performance reasons.
The Middle Molecule Hypothesis Revisited. Should Short, Three Times Weekly Hemodialysis Be Abandoned?
Authors: Charra Bernard , Scribner Belding H. , Twardowski Zbylut J. , Bergström Jonas
Published: September 2016

When the middle molecule (MM) hypothesis was formulated in 1975, no MM had yet been identified as a uremic toxin. Meanwhile, the birth and implementation of the Kt/Vurea concept gained wide acceptance and has remained the world standard for assessing dialysis adequacy. However, over the past 20 years, accumulating evidence has made it clear that MM's are important uremic toxins, and that the dose of dialysis based on removal of small molecular substances does not protect against excessive hemodialysis mortality, morbidity, or the presence of uremic signs and symptoms. These poor results are, in one way or another, linked to the accumulation of MM's and other substances behaving like MM's, such as phosphate.

Dialysis schedules yielding the best clinical results, such as longer dialysis and more frequent dialysis, favor increased removal of middle molecular substances. The observation that short daily dialysis is giving results similar to long nocturnal quotidian dialysis supports early observations that the volume from which middle molecular substances are extracted mainly by hemodialysis is small (about as large as the extracellular volume), and that transfer of MM's from cells to extracellular fluid is very slow. This behavior of MM's is markedly different from that of small molecular substances, which are more rapidly transferred from intracellular to extracellular compartments and are more readily extracted from total body water during hemodialysis.

In order to achieve even minimum adequate dialysis, it is now scientifically validated that toxic MM's must be removed in larger amounts than currently attained. This can only be accomplished by long dialysis sessions with a 3‐times per week schedule or more frequent dialyses. Five hours 3 times per week represents the absolute minimum treatment. Dialy

sis 6 to 7 times per week is the ideal schedule for patients who are willing to commit the time and effort in exchange for maximum well‐being and long survival.
Use of sigmoid colon in orthotopic neobladder reconstruction: Long‐term results
Authors: Nicita Giulio , Martini Alberto , Filocamo Maria T , Saieva Calogero , Tosto Aldo , Stomaci Niceta , Bigazzi Barbara , Villari Donata
Published: September 2016

Objectives

To present our experience with a sigmoid orthotopic neobladder.

Methods

We retrospectively evaluated the functional and oncological outcomes of 160 patients who underwent orthotopic neobladder reconstruction using a detubularized 20–25‐cm sigmoid segment at our institution. Each patient was evaluated every 3 months the first year, every 6 months for the next 4 years and annually thereafter. Urodynamic studies of all consenting patients were carried out after 6 months, and 2, 5 and 10 years. We carried out the log–rank test, and used Cox regression models and Kaplan–Meier survival analysis. The anova test was used to compare urodynamic findings over time.

Results

Mean follow up was 6.8 years (range 0.65–21.7 years). Overall survival was 58.1% at 5 years, and 47.1% at 10 years. Early complications occurred in 36 patients (22.6%); late complications in 40 (25%). Stage V chronic kidney disease developed in two patients (1.3%). Complete (daytime and night‐time) continence, defined as no need for pads or condom devices, was achieved by 45% of patients at 5 years, daytime continence was achieved by just 36% of patients; both were unchanged at 10 years. A significant difference emerged in maximal neobladder capacity and post‐void residual values between 6 months and 2 years, and between 2 and 5 years (P < 0.01 and P = 0.03, respectively).

Conclusions

Sigmoid neobladder continence and capacity significantly improve over the first 5 years, and they remain stable over the long term. Upper urinary tract function is not affected by endoluminal pressure, and the rate of metabolic imbalance is negligible.
Remittances as a Shield to Vulnerable Households in Macedonia: The Case When the Instrument is Not Strictly Exogenous
Authors: Petreski Marjan , Petreski Blagica , Tumanoska Despina
Published: September 2016

The objective of this article is to investigate whether remittances sent to Macedonia have a role to play for shielding vulnerable households, by highlighting the importance of a strictly exogenous instrument in an IV context. Results suggest that remittance‐receiving households have, on average, a 20.1 per cent lower vulnerability than non‐receiving ones. However, if one has a reasonable belief that vulnerability and the instrument are determined simultaneously, or are directly correlated due to the existence of a third unobservable factor, then the shielding effect of remittances for vulnerable households remains up to the ninth percentage of direct influence and with a reducing magnitude, and then disappears.
International Migrant Remittances and Labour Supply in Nigeria
Authors: Urama Nathaniel E. , Nwosu Emmanuel O. , Yuni Denis N. , Aguegboh Stephen E.
Published: September 2016

The study analyses how remittances to Nigeria affect the labour supply of recipients using Propensity Score Matching (PSM) and a Log‐Linear regression model, with data from the 2013 Nigerian General Household Survey. The PSM results show that for the entire sample, the difference between the average amount of labour supplied per week by those that receive remittances and the amount they would have supplied without remittances is insignificant. The marginal impact analysis also shows that, ceteris paribus, the average labour supply for all recipients is inelastic to remittances. The results from the sub‐group analysis, however, show that receiving remittances negatively affects the labour supply of the self‐employed in agriculture, teenagers and the elderly. These results led us to the recommendation that policies to increase the inflow of remittances should be encouraged but in tandem with programmes to educate farmers on the benefit of investing remittances received in their farming business.
The PAYG system and the optimal redistribution instrument in an overlapping generation model
Authors: D'Elia Vanesa Valeria
Published: September 2016

Using a two‐period overlapping generation (OLG) model, this article seeks to identify the optimal redistribution policy instrument in terms of aggregate welfare when agents differ according to their labour condition. We use five policy specifications: (i) early redistribution to the young informal generation; (ii) late redistribution to the informal old generation; (iii) a mix between early and late redistribution; (iv) redistribution from the current formal young generation to the current formal old one; and (v) a non‐redistribution scenario. With inelastic labour supply, we show that transferring to the young performs better as a redistribution policy. This result is robust across different parameter values.
Combination therapeutics in complex diseases
Authors: He Bing , Lu Cheng , Zheng Guang , He Xiaojuan , Wang Maolin , Chen Gao , Zhang Ge , Lu Aiping
Published: September 2016

The biological redundancies in molecular networks of complex diseases limit the efficacy of many single drug therapies. Combination therapeutics, as a common therapeutic method, involve pharmacological intervention using several drugs that interact with multiple targets in the molecular networks of diseases and may achieve better efficacy and/or less toxicity than monotherapy in practice. The development of combination therapeutics is complicated by several critical issues, including identifying multiple targets, targeting strategies and the drug combination. This review summarizes the current achievements in combination therapeutics, with a particular emphasis on the efforts to develop combination therapeutics for complex diseases.
D‐dopachrome tautomerase in adipose tissue inflammation and wound repair
Authors: Kim Bong‐Sung , Tilstam Pathricia V. , Hwang Soo Seok , Simons David , Schulte Wibke , Leng Lin , Sauler Maor , Ganse Bergita , Averdunk Luisa , Kopp Rüdger , Stoppe Christian , Bernhagen Jürgen , Pallua Norbert , Bucala Richard
Published: September 2016

D‐dopachrome tautomerase (D‐DT/MIF‐2) is a member of the macrophage migration inhibitory factor (MIF) cytokine superfamily, and a close structural homolog of MIF. MIF and D‐DT have been reported to be involved in obesity, but there is little known about the regulation of D‐DT in adipose tissue inflammation and wound healing. Subcutaneous adipose tissue was collected from 54 healthy donors and 28 donors with acutely inflamed wounds undergoing wound debridement. In addition, epididymal fat pads of mice were injected with lipopolysaccharide to study receptor expression and cell migration in vivo. D‐DT protein levels and mRNA expression were significantly decreased in subcutaneous adipose tissue adjacent to acutely inflamed wounds. D‐DT improved fibroblast viability and increased proliferation in vitro. While D‐DT alone did not have a significant effect on in vitro fibroblast wound healing, simultaneous addition of neutralizing MIF antibody resulted in a significant improvement of fibroblast wound healing. Interestingly, expression of the MIF and D‐DT receptor CD74 was down‐regulated while the MIF receptors CXCR2 and CXCR4 were up‐regulated primarily on macrophages indicating that the MIF‐CXCR2/4 axis may promote recruitment of inflammatory cells into adipose tissue. Our results describe a reciprocal role of D‐DT to MIF in inflamed adipose tissue, and indicate that D‐DT may be beneficial in wound repair by improving fibroblast survival and proliferation.
Sudoscan is an effective screening method for asymptomatic diabetic neuropathy in Chinese type 2 diabetes mellitus patients
Authors: Mao Fei , Liu Siying , Qiao Xiaona , Zheng Hangping , Xiong Qian , Wen Jie , Liu Lianyong , Tang Mingming , Zhang Shuo , Zhang Zhaoyun , Ye Hongying , Lu Bin , Li Yiming
Published: September 2016

Aims/Introduction

The aim of the present study was to use the sudomotor function test, Sudoscan, as a screening method for the evaluation of asymptomatic diabetic distal symmetric polyneuropathy in Chinese type 2 diabetes patients. As a result, more attention could be paid to those asymptomatic patients who could be easily neglected and underdiagnosed in everyday clinic.

Materials and Methods

A total of 394 Chinese type 2 diabetes patients were enrolled and tested for symptoms and clinical signs of neuropathy using the Neurological Symptom Score, Neuropathy Disability Score, and vibration perception threshold. Sudoscan was carried out, and the results were collected as the measurement of the electrochemical skin conductance of both hands and feet.

Results

In the present study, we found that the abnormal rate of Sudoscan results in patients with asymptomatic neuropathy was higher than those without neuropathy and those with symptomatic neuropathy. This study also showed that lower electrochemical skin conductance at the feet was significantly associated with increasing symptoms, Neurological Symptom Score (r = −0.124, P < 0.05), Neuropathy Disability Score (r = −0.3, P < 0.01) and vibration perception threshold value (r = −0.18, P < 0.05). Logistic analysis showed that age (odds ratio 1.042, 95% confidence interval 1.014−1.071, P < 0.05) and feet electrochemical skin conductance levels (odds ratio 0.98, 95% confidence interval 0.962–0.993, P < 0.01) were independently associated with diabetic distal symmetric polyneuropathy.

Conclusions

Sudoscan might be a promising tool to screen asymptomatic diabetic distal symmetric polyneuropathy in Chinese patients with type 2 diabetes mellitus.
Background review for the 2016 European guideline on Mycoplasma genitalium infections
Authors: Jensen J.S. , Cusini M. , Gomberg M. , Moi H.
Published: September 2016

Mycoplasma genitalium is a cause of 10–35% of non‐chlamydial non‐gonococcal urethritis in men and in women, and is associated with cervicitis and pelvic inflammatory disease (PID). Transmission of M. genitalium occurs through direct mucosal contact. In women, symptoms include vaginal discharge, dysuria or symptoms of PID – abdominal pain and dyspareunia. In men, urethritis, dysuria and discharge predominates. Asymptomatic infections are frequent. In this review, we present the evidence base for the recommendations in the 2016 European guideline on M. genitalium infections and describe indications for testing, recommended diagnostic methods, treatment and patient management. The guideline was prepared on behalf of the European branch of The International Union against Sexually Transmitted Infections; the European Academy of Dermatology and Venereology; the European Dermatology Forum; the European Society of Clinical Microbiology and Infectious Diseases; the Union of European Medical Specialists. The European Centre for Disease Prevention and Control and the European Office of the World Health Organisation also contributed to their development.
Magnesium sulfate for postoperative complications in children undergoing tonsillectomies: a systematic review and meta‐analysis
Authors: Xie Min , Li Xiang‐kui , Peng Yu
Published: September 2016

Objective

Previous systematical reviews showed that systemic magnesium decreased postoperative pain and reduced morphine use without any reported serious adverse effects in adults. However, studies in children yielded different results. So we conducted a systematic review to evaluate the impact of magnesium sulfate on postoperative complications in children undergoing tonsillectomies.

Methods

The PubMed, EMbase via OVID, CENTRAL, and WHO ICTRP were searched to identify randomized controlled trials that addressed the effect of magnesium for postoperative pain, agitation, and complications in children undergoing tonsillectomies. Two reviewers screened titles and abstracts for eligibility and assessed the quality of the included studies. The meta‐analysis was performed using RevMan 5.3.

Results

Ten randomized controlled trials involving 665 participates published between 2003 and 2015 were included. Eight studies showed no different effect on pain scores between MgSO4 and control groups. Two studies showed significant lower emergence agitation incidence in MgSO4 group (pooled OR = 0.18, 95% CI 0.07 to 0.48, P = 0.0006). Five studies showed rescue analgesia was reduced in MgSO4 group (RR = 0.53, 95% CI 0.31 to 0.91, P = 0.02). Laryngospasm was founded lower in MgSO4 group (OR = 0.36, 95% CI 0.13 to 0.96, P = 0.04). Postoperative nausea and vomiting was found no difference between two groups (OR = 1.23, 95% CI 0.70 to 2.18, P = 0.47).

Conclusion

Unlike the studies in adults, this review shows there is no statistically significant effect of perioperative use of magnesium in the postoperative pain control in children undergoing tonsillectomies. But it seems has benefits in reducing rescue analgesia, emergence agitation incidence, and laryngospasm.