bluuebunny/crossref_metadata_2025 huggingface dataset:
Sobre a linguagem como fio condutor das reflexões de Giorgio Agamben
Authors: Brum Neto Benjamim
Published: February 2020

O artigo pretende abordar a linguagem como motor fundamental das reflexões de Giorgio Agamben, sejam elas pertinentes à filosofia, teologia, direito ou política. Para isso o artigo se divide em duas partes. Na primeira, pretendemos mostrar, sobretudo a partir de textos anteriores à serie Homo sacer, especialmente os presentes na coletânea A potência do pensamento, de que forma o pensamento sobre a linguagem influencia a compreensão de Agamben sobre o conceito de filosofia, de teologia e de tradição. Já na segunda parte pretendemos explorar de que forma, de acordo com Agamben, a operação jurídico-política fundamental de nossa tradição está vinculada à forma como pensamos até hoje a relação do homem com o logos. Para Agamben, estrutura de exceptio corresponde à estrutura originária do acontecimento de linguagem
A Eloquência do caso singular
Authors: Galé Pedro Fernandes
Published: February 2020

O texto pretende aproximar dois autores fundamentais do século das luzes: Winckelmann e Diderot. Encontrando similaridades nos modos de se abordar a natureza em Diderot e a arte em Winckelmann o artigo intenta demonstrar a proximidade dos expedientes das ciências da vida e da estética em um momento em que ambas se desenvolvem na direção de uma recusa em relação ao racionalismo clássico.
A perfectibilidade segundo Rousseau
Authors: Arco Júnior Mauro Dela Bandera
Published: February 2020

O homem do puro estado de natureza começa sua existência “por funções puramente animais”. De fato, o esforço de Rousseau na primeira parte do Discurso sobre a desigualdade consiste em quase “animalizar” o ser humano, tornando-o incapaz de realizar certos tipos de operações que o homem social ou socializado (dotado de um aparelho mental já desenvolvido) pode efetuar. No entanto, apesar de animalizado, o homem conserva sua dignidade própria e sua natureza exclusiva. O autor jamais reduz o comportamento humano ao animal. O objetivo do presente artigo é investigar o caráter desta natureza exclusiva e mostrar que, ao contrário do que sustentam alguns intérpretes, a perfectibilidade (signo de distinção humano) já atua no puro estado de natureza. Nesse sentido, não podemos encará-la como uma simples virtualidade nem como uma faculdade em potência.
O chamado
Authors: Vivan Filho Gerson Tadeu Astolfi
Published: February 2020

Este artigo pretende desafiar interpretações tradicionais sobre o papel da idéia de trabalho nos argumentos lockeanos para a apropriação privada, explorando em textos secundários as raízes religiosas e morais da noção. Conclui que não se resume a esforço físico, nem à produção de valor de troca no mercado, mas diz respeito a um ideal robusto e exigente de florescimento humano, de dimensão material e intelectual, que traz implicações ambíguas ao argumento central e coloca em cheque sua capacidade de justificar arranjos específicos de propriedade.
Filosofia da diferença e a questão política da identidade racial
Authors: Rodrigues Matheus Barbosa
Published: February 2020

O presente artigo investiga a relação entre a filosofia da diferença de Gilles Deleuze e a questão política da identidade racial. Em um primeiro momento, desenvolvemos a crítica da filosofia da diferença em biologia ao conceito de raça. Em seguida, com base em Achille Mbembe, demonstramos como fenômenos do mundo contemporâneo, a despeito da negação de fundamentos biológicos de discriminação, reorganizam-se ao longo de hierarquias racialmente determinadas. A partir daqui, visando o caso particular do Brasil, defendemos que a aposta na filosofia como porta voz de uma igualdade superior, sem o saber e à sua revelia, traduz uma posição política regressiva, isto é, induz à reafirmação do valor positivo depositado no mito da democracia racial. Por fim, buscamos apontar as direções iniciais para um reajuste das relações da filosofia da diferença com a questão racial.
Expediente
Authors: Carvalho Lauro
Published: February 2020

Expediente do número
Editorial
Authors: Magalhães Gildo
Published: February 2020

Editorial.
Ranunculus kangmaensis (Ranunculaceae), a new synonym of Halerpestes tricuspis var. variifolia

Authors: ZHANG MENG , ZENG YOU-PAI , YANG QIN-ER
Published: February 2020

Ranunculus kangmaensis (Ranunculaceae) was recently described from Kangmar (= Kangma) in Xizang (Tibet), China. Based on critical observations on herbarium specimens and living plants in the wild, together with evidence from achene surface morphology and karyology, we demonstrate that it does not belong to the genus Ranunculus but is identical with Halerpestes tricuspis var. variifolia. We therefore place R. kangmaensis in synonymy with H. tricuspis var. variifolia herein.
Diversity and abundance of Lepidoptera populations in the Theniet El Had National Park (Algeria)
Authors: SAMIRA KACHA , MALIKA DJERBAOUI , FAIZA MARNICHE , WILLY DE PRINS , MOHAMMED RAMDANI , FLOWER ROGER , RIADH MOULAÏ
Published: February 2020

An inventory of Lepidoptera in the Theniet El Had National Park (PNTEH), Algeria, revealed 86 taxa, both butterflies and moths. The specimens were collected in 68 localities distributed over ten cantons within the park in the period 2015–2017. A preliminary faunistic list is compiled as a base-line contribution to the study of adult Lepidoptera in this park. In total, 3139 specimens were collected. The moths are clearly well diversified, with 14 families and 49 species obtained from a total of 1485 adult specimens. The butterflies are represented by 5 families with 37 species and 1654 specimens. A total of 8 families are reported for the first time from this park, in order of abundance: Zygaenidae, Hesperiidae, Crambidae, Alucitidae, Heterogynidae, Sesiidae, Oecophoridae, and Cossidae. Also 61 species are recorded here for the first time for the park. The most diverse family is Nymphalidae with 15 taxa (23% of the total species). On the other hand, the Erebidae are represented by 894 specimens (28.5% of the total number of specimens. Within the Erebidae, the genus Catocala contains the highest number of individuals (794 specimens). The canton of Pré-Ben Chouhra is quantitatively the best represented with 625 specimens (19.9% of the total number of specimens collected) and the Nursery canton as the richest in lepidopteran species with 72 species observed. The diversity indices (H’ and Hmax.) and the equitability index (E), calculated for the 10 cantons indicate that lepidopteran species are diverse in each station.
Two new species of the armored spider genus Tetrablemma O. P.-Cambridge, 1873 from northern South America (Araneae: Synspermiata: Tetrablemmidae)
Authors: MARTÍNEZ LEONEL , FLÓREZ D EDUARDO , BRESCOVIT ANTONIO DOMINGOS
Published: February 2020

Two new species of the armored spider genus Tetrablemma O. P.-Cambridge, 1873 from Colombia and Venezuela are herein described and illustrated: Tetrablemma tatacoa sp. nov. from Huila department, Colombia and T. mochima sp. nov. from Sucre state, Venezuela. These species represent the second record of the genus in the New World. Specimens of these new species were collected in pristine ecosystems, which suggests a natural Gondwanan distribution of the genus. Additionally, a distribution map of the Tetrablemma species in America is herein included.
Stenarella domator (Poda) [Hymenoptera: Ichneumonidae], a newly introduced species to the Nearctic, and a summary of adventive Nearctic species of Ichneumonidae
Authors: WAHL DAVID B. , GREEN NATHANIEL
Published: February 2020

The western Palaearctic ichneumonid Stenarella domator (Poda) is newly recorded for the Nearctic. Photographs and a new key to the genera of Nearctic Osprynchotina (Cryptinae: Cryptini) are provided. Like other species in the Osprynchotina, S. domator is an ectoparasitoid of aculeate Hymenoptera which use mud/earth in their nests. The 25 species of adventive Nearctic ichneumonids are reviewed, and the implications of their biologies for Nearctic host ranges are discussed.
A Comparative Analysis on Nastaliq Style Urdu Character Recognition
Authors: Yasin Mehvish , Gondhi Naveen Kumar
Published: February 2020

Optical Character Recognition (OCR) has emerged as an interesting research field. Lot of work has been declared in Urdu script based on various approaches and diverse methodologies have been put forward on Nastaliq font style to get the desired output. The paper presents a survey on
different techniques of OCR and ends up with the comparative analysis of Urdu character recognition based on accuracy and other performance parameters. This exploration directly implies that the nonpresence of Urdu OCR has restricted the idea on advanced Urdu library and thus, drives a pathway
for enormous research in this field.
Hybridized Particle Swarm Optimization on Constrained Economic Dispatch Problem
Authors: Chopra Namarta , Brar Y. S. , Dhillon J. S.
Published: February 2020

The hybridization of particle swarm optimization (PSO) with simplex search method (SSM) is presented on the problem of economic dispatch in the thermal plants so as to minimizes the overall operating fuel cost while subjected to various constraints. This hybridization of stochastic
with deterministic optimization method helps the global optimum solution to further refine by the local search. It also overcome some of the drawbacks of conventional PSO like premature convergence and stagnation in the solution if the number of iterations are increased. This proposed optimization
method is used to get the overall minimum cost of fuel by including transmission line losses and valve point loading effect (VPLE) in the classical problem of economic dispatch, so as to have the more practical impact in the case considered. The validness of the suggested algorithm is tested
using small scale and large scale system and the analogy of results obtained are done with existing algorithms cited in the literature, showing improvement of 29.3% in small scale system and 6.4% in large scale system, which proves the robustness of the suggested approach.
A Hybrid Approach for Fast 3D Segmentation of Brain Tumor
Authors: Biswas Ankur , Debnath Nitai , Datta Debasish , Das Sushanta , Bhattacharya Paritosh
Published: February 2020

Brain tumor segmentation and its study are tricky assignments of medical image processing due to complexity and variance of tumors however, forms a decisive factor for quantitative exploration of the spatial data in magnetic resonance imaging of human brain. In that mode, this modality
of image has developed into a valuable investigative means in medicinal domain for detecting irregularity and discrepancy in human brain. The accuracy of segmentation method relies on its capability to discriminate different tissue, classes, discretely. Consequently there is an essential need
to evaluate this capability prior to employing the segmentation method on medical images. In this paper, a semi-automatic segmentation technique is proposed to carry out the analysis and study of proficient pathologies of brain tumor of human brain. The task of segmentation is carried out
integrating region growing with active contour methodologies. The evaluation of proposed methodology has been carried out on multislice image of MRI data and compared with other semi automatic and automatic techniques. It is observed by the experimental results that proposed system has the
ability to accomplish fast segmentation and exact modeling of tumors in brain with a gratifying accuracy in order to support future treatment planning.
An Evolutionary Computing Approach to Solve Object Identification Problem in Image Processing Applications
Authors: Sree Katamneni Vinaya , Jeyakumar G.
Published: February 2020

In the given image identifying the existence of a required object is the concern of the object detection process. This is quite natural for Human without any effort, however making a machine to detect an object in image is tedious. To make machines to recognize the objects, the feature
descriptor algorithms are to be implemented. The general object detection approaches use collection of local and global descriptors to represent an image. Difficulties arise during this process when there is variation in lightening, positioning, rotation, mirroring, occlusion, scaling etc.,
of the same object in different image scenes. To overcome these difficulties, we need combination of features that detects the object in the image scene. But there exist lot of descriptors that can be used. Hence, finding the required number of feature descriptors for object detection is a
crucial task. The question that comes out here is how to select the optimum number of descriptors to achieve optimum accuracy? The answer for the question is an optimization algorithm, which can be employed to select the best combination of the descriptors with maximum detection accuracy.
This paper proposing an Evolutionary Computation (EC) based approach with the Differential Evolution (DE) algorithm to find the optimal combination of feature descriptors to achieve optimal object detection accuracy. The proposed approach is implemented and its superiority is verified with
four different images and results obtained are presented in this paper.
Effects of fretting wear on porous Ti materials by using rice husk as hold space
Authors: Wang Xinsheng , Lu Zhen Lin , Lei Jia
Published: February 2020

A comparative analysis of the friction coefficient of pure and porous titanium was carried out through wear tests conducted both in dry friction conditions and using a bovine serum lubricant friction conditions. The microstructure, wear mechanism and three-dimensional topography of
the two specimens were studied. In pure and porous titanium, the results show that the friction coefficient, wear volume and roughness were higher in dry friction than in the presence of lubrication for both pure and porous titanium. However, in dry friction and bovine serum lubricant tested,
the resistance of pure titanium was higher than that of porous titanium.
Development of cationic polymer-based nanoplatform for insulin delivery and diabetes treatment
Authors: Tong Tong , Lou Qi , Zhao Meng , Mou Lisha
Published: February 2020

Due to the high molecular weight, hydrophilicity, and pH/enzyme sensitivity of proteins, effectively delivery of therapeutic proteins remains many difficulties. In this study, a novel nanoplatform for insulin delivery was established, in which a kind of tunable cationic polymer based
on arginine was chosen as the nanocarrier. The nanocomplexes were formed with the cationic polymers and insulin under the electrostatic reactions. Then the relationship between the chemical structure of polymers and physicochemical properties of nanocomplex was systematically investigated
among the particle size, surface charge, cytotoxicity, cellular internalization ability and finally therapeutic effects. It was confirmed that the structure of polymers affected their hydrophobicity, subsequently influencing the physicochemical properties of nanocomplex and further the therapeutic
effects of nanocomplex. The in vivo results also proved that the suitable polymer with an optimal weight ratio of materials and proteins could obtain a promising therapeutic effect on Type 1 diabetes.
The Editor’s Note: A profession in process
Authors: Heller Rafael
Published: February 2020

When PDK’s leaders created Kappan, in 1915, they saw the publication of this magazine as an essential means of building and sustaining their profession. By reading, writing about, and discussing the problems facing public education, schoolteachers and administrators determine their shared values, beliefs, principles, practices, and norms. In this month’s issue, contributors offer a similar prescription for the teaching profession today: What’s needed now are more opportunities for educators to engage in serious and ongoing conversation about their work and how to improve it.
Putting employers to work in economic development in the Atlantic provinces of Canada
Authors: Pascoe-Deslauriers Rachelle
Published: February 2020

The Atlantic provinces of Canada – New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland and Labrador – face persistent social and economic challenges, including low labour productivity, high levels of public debt and a declining workforce. There are persistent issues of low wages and high levels of underemployment and seasonal/part-time work. The policy responses proposed to tackle these challenges have focused on innovation clusters in science and technology fields, the attraction and retention of skills and unskilled immigrants to the region, and some upskilling of the local workforce. Absent is a consideration of the role of employers and businesses, and the quality of jobs available in addressing these challenges. Decent jobs have implications for individual, societal and organizational outcomes, including innovative work behaviours. This article argues that there is a need to consider job quality and how good quality jobs can support organizational and business innovation outcomes, as part of these policy debates for local economic development.
Students With Specific Difficulties in Geometry: Exploring the TIMSS 2011 Data With Plausible Values and Latent Profile Analysis
Authors: Chen Jinsong , Li Liangfang , Zhang Dake
Published: February 2020

This study analyzed the Trends in International Mathematics and Science Study 2011 data on fourth-grade U.S. students’ mathematics performance to answer four research questions: (a) How did U.S. students’ geometry performance compare with their performance on the other mathematics subscales? (b) What were the patterns of student achievement among the mathematics subscales? (c) Was there a group of students who demonstrated specific difficulties in geometry only? and (d) Which demographic variables contributed to students’ classification in the group with geometry difficulties? We found that (a) U.S. students’ performance was poorer on the Geometry subscale than on other mathematics subscales; (b) using latent profile modeling, we identified a group of students with the lowest scores across all three mathematics subscales who showed a significant discrepancy between Geometry and the other subscales that did not exist within the high-achieving and average-achieving groups; and (c) gender, age, home language, race, and preference for mathematics and science significantly influenced the probability of being classified in the group with the lowest performance and the largest gap between Geometry and other mathematics subscales. Implications for educational theory and practice are discussed.
Phyllodes Tumors—The Predictors and Detection of Recurrence
Authors: Lim Robert S. , Cordeiro Erin , Lau Jaqueline , Lim Andrew , Roberts Amanda , Seely Jean
Published: February 2020

Background:

Phyllodes tumors are rare breast neoplasms and the histopathological grade and surgical margins help guide treatment and follow-up. The traditional surgical teaching is resection with ≥10 mm margins, but are narrower surgical margins acceptable? The purpose of our study was to identify predictors of local recurrence.

Methods:

A retrospective analysis was performed to identify patients with phyllodes tumors who underwent surgery between 2002 and 2014 using a regional pathology database. Electronic medical records were used to identify surgical management, pathological characteristics, and follow-up encounters.

Results:

A total of 150 phyllodes tumors were included: 110 of 150 (73%) benign, 21 of 150 (14%) borderline, and 19 of 150 (13%) malignant. At initial surgery, 29 specimens had a positive margin and 15 (56%) underwent re-excision. Seventy tumors had a surgical margin of ≤1 mm, 40 had a margin of 2 to 9 mm, and 11 had a margin of ≥10 mm. There were 11 of 150 (7.3%) locally recurrent tumors: 5 of 11 (45%) benign, 3 of 11 (27%) borderline, and 3 of 11 (27%) malignant. In total, 10 of 11 locally recurrent tumors had a positive margin or ≤1 mm margin at initial surgery.

Conclusions:

Phyllodes tumors can have a personalized treatment approach based on histopathological grade and surgical margins. Borderline and malignant phyllodes tumors with a positive or ≤1 mm surgical margin have an increased risk of recurrence. In benign phyllodes tumors, an optimal narrow negative margin may exist but the traditional ≥10 mm excisional margin is not necessary. Local recurrence rates may be sufficiently low in benign phyllodes tumors that imaging can be performed on the presence of clinical symptoms.
Clinical Characteristics of Moyamoya Angiopathy in a Pediatric Cohort
Authors: Pines Andrew R. , Rodriguez Dan , Bendok Bernard R. , Dhamija Radhika
Published: February 2020

Moyamoya angiopathy is a rare cerebral vasculopathy characterized by a progressive stenosis of the terminal portion of the internal carotid arteries and the development of abnormal collateral vessels. Children with moyamoya angiopathy become symptomatic because of cerebral ischemic complications, and many patients eventually need revascularization. In most pediatric patients with this disease, the etiology is likely genetic. We aim to report clinical characteristics of a single-center cohort of pediatric patients with moyamoya. We performed a retrospective chart review of patients <18 years with angiographically confirmed moyamoya disease evaluated at our institution. An in-house text search tool, Advanced Cohort Explorer, was used to filter electronic medical records for patients with a diagnosis of moyamoya angiopathy from January 1999 to December 2018. The inclusion criteria were age <18 years at the time of onset of disease and a diagnosis confirmed at Mayo clinic. Fifty-one patients met the inclusion criteria. Fifty-five percent of our cohort were male, and the median age was 9 years. Three patients had a family history of moyamoya disease. Approximately half of our patients had bilateral disease. Sixteen patients had a genetic or chromosomal diagnosis (Down syndrome and NF1 being most common). Congenital anomalies like heart defects and renal dysplasia were also noted. This study is unique in that it was a large study on pediatric patients with moyamoya angiopathy. It also highlights the importance of considering genetic syndromes as an underlying cause when moyamoya angiopathy starts early in life.
Total Lymphocyte Count: A Promising Prognostic Index of Mortality in Patients on CAPD
Authors: Carvounis Christos P. , Manis Thomas , Coritsidis George , Dubinsky Maria , Serpente Patricia
Published: February 2020

Objective

In view of the limitations of albumin in peritoneal dialysis (PD), we set out to evaluate whether total lymphocyte counts (TLC) could serve as a better prognostic indicator. We were also interested in how these parameters might differ between PD and hemodialysis (HD) patients.

Design

In a retrospective study, we reviewed 113 charts from our dialysis unit. All laboratory analyses were performed by the Department of Clinical Pathology of the Nassau County Medical Center, using standard procedures. Intact parathyroid hormone (PTH) was sent out to Nichols Laboratories.

Setting

All patients originated from the renal clinic at Nassau County Medical Center, a 612 bed public hospital.

Patients

The 38 PD and 75 HD patients selected had been receiving dialysis for at least 12 months and up to 3 years. The PD patients received either continuous ambulatory and/or cycler PD. For the survivors, the averages of their routine chemical analyses were considered their representative values. For the nonsurvivors, the most recent laboratory values prior to their end point were considered.

Main Outcome Measures

Mortality or apparent malnutrition leading to transfer to HD represented the end points for PD patients. Mortality alone was used as the end point for HD patients.

Results

Within the PD population, serum albumin was not significantly lower in nonsurvivors compared to survivors, while the TLC was significantly lower in nonsurvivors (1277 ± 146/mm3 vs 2249 ± 236/mm3, p = 0.0036). The HD population demonstrated a significant difference in both TLC and serum albumin levels between its two prognostic groups; albumin was the better discriminator. Nonsurvivors had a 20% lower serum albumin than did the survivors (27.0 ± 1.6 g/L vs 34.0 ± 0.5 g/L, p = 0.0001). Patients on PD had a higher TLC than those on HD ( p = 0.0001).

Conclusions

In the HD population, but not in the PD population, both serum albumin and TLC were significantly higher in the group that survived. Serum albumin is a more powerful discriminator of mortality in the HD population, while TLC is a better discriminator of mortality in the PD population. For uncertain reasons, PD patients have a higher TLC than those on HD.
Marked Variation in Peritoneal Insulin Absorption in Peritoneal Dialysis
Authors: Fine Adrian , Parry David , Ariano Robert , Dent William
Published: February 2020

Objective

To assess both peritoneal insulin absorption and adsorption of insulin to the plastic delivery system, and to assess whether variation in peritoneal absorption is related to transport status.

Design

Eight insulin-dependent diabetic patients on continuous ambulatory peritoneal dialysis were studied. Insulin was added to the dialysate. The amount adsorbed by the bag tubing was determined; peritoneal absorption was measured by complete spent dialysate collection.

Results

Only 14% ± 5% of added insulin was adsorbed onto the dialysate delivery system. Marked variation in peritoneal absorption occurred (38% ± 14%, range 17% – 66%). Variations in membrane transport status did not account for variation in absorption.

Conclusion

Marked variation in peritoneal absorption of insulin occurs, accounting for some of the variation in intraperitoneal insulin requirements. This is not related to membrane transport status.
The Choice of Dialysis Solutions in Pediatric Chronic Peritoneal Dialysis: Guidelines by An AD HOC European Committee
Authors:   on behalf of the European Paediatric Peritoneal Dialysis Working Group, Schröder Cornelis H.
Published: February 2020

Objective

To provide guidelines on choosing dialysis solutions for children on chronic peritoneal dialysis (PD).

Setting

European Paediatric Peritoneal Dialysis Working Group.

Data Source

Literature on the application of PD solutions in children ( Evidence), and discussions within the group ( Opinion).

Conclusions

Glucose is the standard osmotic agent for PD in children ( Evidence). The lowest glucose concentration needed should be used ( Opinion). Low calcium solution (1.25 mmol/L) should be applied, wherever possible, with careful monitoring of parathyroid hormone levels ( Opinion). The use of amino acid-containing dialysis fluids can be considered in malnourished children, although aggressive enteral nutrition is preferred ( Opinion). There is insufficient evidence documenting the efficacy of intraperitoneally administered amino acids ( Evidence). When ultrafiltration and/or solute removal are insufficient, poly-glucose solutions are a welcome addition to the treatment of children on nocturnal intermittent PD ( Evidence). However, in the absence of any reported long-term experience with children, their use must be closely monitored ( Opinion). Bicarbonate would appear to be the preferred buffer for PD in children, but more in vivo studies are required before it replaces the present lactate-containing solutions ( Evidence/Opinion).
In Vivo Peritoneal Chamber: Linking Structure and Transport Function
Authors: Flessner Michael F.
Published: February 2020

Objective

The present study aimed to develop an animal model of chronic peritoneal exposure that directly links transport with the tissue involved.

Methods

Daily, rats were intraperitoneally infused through subcutaneous ports with 20 mL of these solutions: isotonic Krebs (K), K + 2.5% mannitol (M), K + 2.5% N-acetylglucosamine (NAG). Controls included catheter-only (CC) and age-control rats (AC). After 2 months, each rat was anesthetized and a plastic chamber was affixed to the abdominal wall serosa to isolate a portion of the peritoneum for transport studies. In the first 90 minutes, a hypertonic solution (approximately 500 mosm/kg) containing 14C-mannitol was placed in chamber. The volume and 14C concentration were measured to determine the rate of osmotic flux (flow/Areachamber) into the chamber and the flux of mannitol from the chamber to the tissue. At 90 minutes, fluorescein isothiocyanate conjugate (FITC)–albumin was given intravenously. The rate of appearance of that substance in the chamber was measured over a period of 180 minutes and divided by Areachamber to determine the average flux. After the rat was humanely killed, the tissue under the chamber was collected for analysis of its hyaluronan concentration ([HA]).

Results

All data are given as mean ± standard error: Group Osmotic (μL/cm2) Flux per hour Mannitol (/cm2) Albumin (/cm2) [HA] (μg/g dry) AC 69.9±14.0 0.043±0.004 0.0114±0.0012 1247±136 CC 65.5±8.0 0.040±0.013 0.0105±0.0027 1360±157 K 47.0±11.5 0.067±0.015 0.0116±0.0027 1134±160 M 101±20 0.044±0.017 0.0300±0.0120 1146±157 NAG 72.6±11.4 0.052±0.006 0.0188±0.0144 1240±157

Conclusions

In the present pilot study, no significant correlations were observed, but the number of animals in each group was small ( n = 3 – 4). Nevertheless, the results demonstrate the ability of the chamber technique to determine transperitoneal transport of water, small solutes, and protein, and to link those values directly to the structure of the tissue lying below the chamber. Thus, chronic treatment can be directly correlated with peritoneal structure and transport function.
Laparoscopic Tenckhoff Catheter Implantation in Children
Authors: Daschner Markus , Gfrörer Stefan , Zachariou Zacharias , Mehls Otto , Schaefer Franz
Published: February 2020

Objective

To assess the suitability of a laparoscopic Tenckhoff catheter implantation (TCI) technique in children.

Design

Prospective nonrandomized controlled study.

Setting

Laparoscopic and conventional TCIs in children were performed in a tertiary-care hospital.

Patients

Between 1998 and 2001, 25 laparoscopic and 23 conventional TCIs were performed in 42 children. Patients in unstable clinical conditions were excluded. The laparoscope was inserted via transumbilical incision, and a forceps by percutaneous puncture. After catheter insertion, the tip was positioned in the Douglas space, and the inner cuff placed adjacent to the peritoneum, without sutures. Peritoneal dialysis was initiated immediately after surgery.

Main Outcome Measures

Catheter-related complications during the first 4 weeks after TCI.

Results

After laparoscopic TCI, dialysate leakage occurred in 2 of 25 cases, one of which could be managed conservatively. In 1 patient in whom dwell volume was increased immediately after laparoscopic TCI, subcutaneous leakage occurred at the site of forceps insertion. In 2 patients with severe pre-existing intra-abdominal adhesions, outflow obstruction persisted after laparoscopic TCI. Simultaneous herniotomy was performed in 2 male infants. After conventional TCI, dialysate leakage occurred in 5 of 23 cases, 1 of which could be managed conservatively. Outflow obstruction occurred in 2 cases.

Conclusion

Laparoscopic TCI is feasible in children of all age groups, with at least equivalent functional results compared to conventional TCI. An additional advantage is the option to identify and eliminate anatomical risk factors, such as intra-abdominal adhesions or preformed inguinal hernias in male infants.
Pattern of Peritoneal Permeability in Continuous Ambulatory Peritoneal Dialysis Patients in Brunei
Authors: Dwarakanathan Ranganathan , Yaakob Hjh Zarah , Hadi Hasnani
Published: February 2020

Objective

Peritoneal permeability may be dissimilar in different populations. The present study identified the pattern of peritoneal permeability in continuous ambulatory dialysis (CAPD) patients treated at the Department of Renal Medicine, RIPAS Hospital, Brunei Darussalam.

Methods

Data were collected from patients on CAPD in 2001 ( n = 65). Four children were excluded from the study. The remaining 61 patients underwent a 4-hour peritoneal equilibration test (PET) as prescribed by Twardowski et al. For those patients, adequacy of dialysis (Kt/V) was estimated. A retrospective analysis of the peritoneal membrane characteristics of those CAPD patients was also conducted. The membrane characteristics were compared with the urea clearance results.

Results

Of the 61 patients, 40 were non diabetic, and 21 (34.43%) were diabetic. More than half of our patients (55.74%) had membranes classified as high-average, followed by low-average (22.95%), high (18.03%), and low (3.28%). When the patient population was grouped separately into non diabetic and diabetic patients, peritoneal permeability differed between the groups ( p = 0.000585). No relationship was observed between weekly Kt/V and transport characteristics in the group with diabetes ( p = 0.219306), the group without diabetes ( p = 0.74179), or the entire patient population ( p = 0.376832)

Conclusion

We conclude that peritoneal permeability among Bruneian CAPD patients is probably different from that among patients from other regions of Asia (more than half of our Bruneian patients had a peritoneal membrane classified as high average). We believe that the observed difference may be related to a difference in ethnicity. In general, patients with diabetes have a highly permeable membrane. Adequacy of dialysis had no correlation to PET results in our study. A larger prospective study is required to confirm our findings.
Peritoneal Equilibration Test Using a Radiopharmaceutical: Diethylenetriaminepentaacetate
Authors: Sharma Raj K. , Jeloka Tarun , Gupta Amit , Senthilnathan Musuvathy S. , Pradhan Prasant K. , Das Birendra K.
Published: February 2020

Background

The inherent characteristics of the peritoneal membrane determine the peritoneal dialysis (PD) prescription. Membrane characteristics are also an important variable affecting patient outcome. The peritoneal equilibration test (PET) described by Twardowski and colleagues in 1987 is the most commonly used test for determination of peritoneal membrane characteristics. A need exists to have simpler and more definitive tests of peritoneal membrane characteristics. In a pilot study, we used a radiopharmaceutical [99Tc-diethylenetriaminepentaacetate (99Tc-DTPA)] to determine membrane characteristics.

Patients and Methods

We injected 99Tc-DTPA (370 MBq) intravenously into 20 patients at the end of peritoneal instillation of 2.5% glucose-containing PD fluid as in a standard PET. After a 4-hour dwell, a dialysate sample was collected, and excretion of 99Tc-DTPA into the dialysate fluid was calculated as a percentage of the injected dose. Depending on the excretion of the radiopharmaceutical into the effluent after intravenous injection, patients were categorized into high, high-average, low-average, and low transporters. An analysis of standard PET characteristics was also conducted for 75 consecutive patients.

Results

Excretion of the radiopharmaceutical was found to vary between 8% and 17% of the injected dose, depending on membrane characterization. The patients were categorized into four groups depending on the percentage excretion of the radiopharmaceutical: excretion > 15%, high transporter; 12% – 15%, high-average transporter; excretion 10% – 12%, low-average transporter; and excretion < 10%, low transporter. Standard PET characteristics for 75 patients showed 32% to be high transporters, 40% to be high-average transporters, 23% to be low-average transporters, and 5% to be low transporters. The nuclear PET in 20 patients showed 40% to be high transporters, 35% to be high-average transporters, 15% to be low-average transporters, and 10% to be low transporters. Correlation with the standard PET was good (correlation coefficient: 0.64; p = 0.002).

Conclusions

The nuclear PET could be an alternative to the standard PET for assessing peritoneal membrane characteristics. It is reproducible and may have the added advantages of simplicity and a possibility of measuring total clearance (PD + renal) in the same sitting.
Factors that Might Adversely Affect Short-Term Survival of Patients Starting Peritoneal Dialysis and use of those Factors to Predict Outcome—A Single-Center Experience
Authors: Yeoh Lee Ying , Sivaraman Pary
Published: February 2020

Objective

Patients initiated on peritoneal dialysis (PD) have significant morbidity and mortality. It would be important to know which factors have an adverse impact on outcome in the first 6 months of PD and whether those factors could be used to predict patient outcome.

Methods

We identified 64 PD patients from a prospectively collected database of all consecutive patients with end-stage renal failure (ESRF) seen at our tertiary referral center between January 2000 and June 2001. The patients were divided into two groups according to whether they were still living or had died by 6 months after the start of PD. Two patients defaulted on follow-up. In the remaining 62 patients, we compared multiple parameters and identified factors that we then evaluated as prediction tools.

Results

Significant differences were noted between the groups (died vs still living) with respect to race (non Chinese: 35.3% vs 13.3%), ischemic heart disease (IHD: 70.6% vs 62.2%), two-dimensional echo ejection fraction (EF: 42% ± 19% vs 53% ± 17%), regional wall motion abnormality (RWMA: 53% vs 22%), serum albumin 28 ± 1 g/L vs 31±5 g/L), alkaline phosphatase (ALP: 140 ± 118 U/L vs 101 ± 36 U/L). No differences were observed with respect to age, sex, cause of ESRF, diabetes status, hypertension, hyperlipidemia, stroke, hemoglobin, or intact parathyroid hormone. As expected, patients in the group that had died by 6 months spent a higher total number of days in hospital (66 ± 47 days vs 43 ± 29 days) and had more cardiovascular events (58.8% vs 6.6%); however, no difference was observed with respect to septic events. The utility of IHD, albumin, ALP, EF, and RWMA as predictors of short-term mortality either singly or in combination were analyzed. We found that those factors were neither sensitive nor specific at predicting mortality in this group of patients.

Conclusions

Race (non Chinese), prior IHD, two-dimensional echo abnormalities (EF and RWMA), low serum albumin, and high serum ALP are factors that affect short-term survival in PD patients. However, it is not possible to predict patient outcome using those factors.
Methods to Determine Drain Volume for Peritoneal Dialysis Clearances
Authors: Bernardini Judith , Florio Tracey , Bender Filitsa , Fried Linda , Piraino Beth
Published: February 2020

Objective

To compare the accuracy and convenience of 3 methods for measuring drain volume for peritoneal dialysis (PD) clearance studies.

Design

Prospective comparison of both automated PD (APD) and continuous ambulatory PD (CAPD) clearance study methods.

Setting

Adults ≥18 years old at 2 dialysis clinics.

Patients

28 PD patients with 43 clearance studies, 15 on CAPD and 28 on APD.

Interventions

None.

Main Outcome Measures

Drain volume was determined by 3 methods for each study: ( 1 ) graduate-measured volume using a 2-L graduated cylinder; ( 2 ) weighed volume, with and without bag weight, using a digital floor scale or spring scale; ( 3 ) cycler-measured volume using the initial drain and ultrafiltration indicated by the cycler, plus the prescribed inflow volume without the last fill.

Results

There was no statistically significant difference in volumes using the 3 methods studied (all p > 0.89 for APD, all p > 0.97 for CAPD). Effluent volume was more accurate with the weight of the bag subtracted.

Conclusion

The most convenient and a precise method for APD is to determine the effluent drain volume using the prescription and total ultrafiltration and initial drain, as measured by the cycler. For CAPD, using the weight of drained bags is accurate but the weight of the empty bag must be subtracted. These approaches have the least risk of exposing staff to body fluids.
Temperature: The Single Most Important Factor for Degradation of Glucose Fluids during Storage
Authors: Kjellstrand Per , Erixon Martin , Wieslander Anders , Lindén Torbjörn , Martinson Evi
Published: February 2020

Objective

Bioincompatible glucose degradation products (GDPs) develop during heat sterilization of peritoneal dialysis (PD) fluids. However, degradation may also take place during storage. Consequently, storage may add to the bioincompatibility caused by heat sterilization. The aim of the present study was to investigate how different factors such as the sterilization procedure, pH, glucose concentration, and temperature influence GDP production during storage.

Design

Degradation in glucose solutions was followed by pH and UV absorbance at 228 nm and 284 nm over 2 years of storage. Different sterilization times, storage temperatures, pH, and glucose concentrations were included in the study. Peritoneal dialysis fluids were also used in the experiment. Bioincompatibility was estimated through inhibition of cell growth in L-929 fibroblasts, and GDPs through UV absorption and liquid chromatography.

Results

The most important factor determining the rate of GDP production during storage was temperature. The GDPs created by heat sterilization promoted further degradation of glucose during subsequent storage. A pH of around 3.2 protected glucose from degradation during both heat sterilization and storage. At a storage temperature of 20°C and a pH of 3.2, degradation was almost negligible. Heat sterilization produced considerable amounts of GDPs absorbing at 228 nm. During initial storage, these 228 nm-absorbing GDPs almost disappeared. After reaching a nadir, absorbance at 228 nm again started to increase. Contrary to this, absorbance at 284 nm [caused mainly by 5-hydroxymethyl-2-furaldehyde (5-HMF)] increased during the whole storage period. After 2 years at 40°C, the concentrations of GDPs produced during storage were of the same magnitude as those caused by heat sterilization. Inhibition of cell growth of L-929 fibroblasts correlated well with the part of the absorbance at 228 nm not caused by 5-HMF in glucose solutions that were heat sterilized under a wide range of conditions. This part of 228 nm absorbance (denoted 228corr) was caused almost entirely by 3,4-dideoxyglucosone-3-ene (3,4-DGE).

Conclusions

Temperature is the single most important factor for glucose degradation during storage. The concentrations of bioincompatible GDPs produced may, under improper conditions, be as high as those produced during sterilization. High concentrations of glucose and low pH protect glucose from being degraded during both sterilization and storage. A good estimate of 3,4-DGE concentration in the fluids can be obtained correcting the UV absorbance at 228 nm for the influence from 5-HMF (and, when appropriate, for lactate). The 228corr may thus be used as a simple quality control for the fluids.
Better Preservation of the Peritoneum in Rats Exposed to Amino Acid-Based Peritoneal Dialysis Fluid
Authors: Zareie Mohammad , van Lambalgen Anton A. , Ter Wee Piet M. , Hekking Liesbeth H.P. , Keuning Eelco D. , Schadee–Eestermans Inge L. , Faict Dirk , Degréve Bart , Tangelder Geert-Jan , Beelen Robert H.J. , van den Born Jacob
Published: February 2020

Background

Glucose-containing peritoneal dialysis fluids (PDF) show impaired biocompatibility, which is related partly to their high glucose content, presence of glucose degradation products, low pH, and lactate buffer, or a combination of these factors. In a rat chronic peritoneal exposure model, we compared effects of an amino acid-based PDF (AA-PDF) with a glucose-containing PDF on the peritoneal microcirculation and morphology.

Method

Two groups of rats received 10 mL of either fluid daily for 5 weeks via peritoneal catheters connected to implanted subcutaneous mini vascular access ports. Leukocyte–endothelium interactions in the mesenteric venules were investigated by intravital microscopy. Quantification of angiogenesis and fibrosis and inspection of the mesothelial cell layer were performed by light and electron microscopy.

Results

Daily exposure to glucose-containing PDF resulted in a significant increase in the number of rolling leukocytes in mesenteric venules, whereas instillation of AA-PDF did not change the level of leukocyte rolling. Glucose-containing PDF evoked a significantly higher number of milky spots in the omentum, whereas this response was significantly reduced in animals exposed to the AA-PDF ( p < 0.02). Chronic instillation of glucose-containing PDF induced angiogenesis in various peritoneal tissues, accompanied by fibrosis in the mesentery and parietal peritoneum. Quantitative morphometric evaluation of omentum and mesentery showed a clear trend toward less angiogenesis after treatment with the AA-PDF compared to the glucose-containing PDF, which reached statistical significance in the parietal peritoneum ( p < 0.04). Instillation of AA-PDF resulted in approximately 50% reduction of fibrosis in the mesentery ( p < 0.04) and approximately 25% reduction in the parietal peritoneum ( p < 0.009) compared to glucose-containing PDF. Glucose-containing PDF damaged the mesothelial cell layer, whereas the mesothelium was intact after AA-PDF treatment, as evidenced by electron microscopy.

Conclusion

Our data in a rat chronic peritoneal exposure model clearly demonstrate reduced immune activation (evidenced by decreased number of rolling leukocytes and decreased induction of omental milky spots) and reduced neoangiogenesis, fibrosis, and mesothelial damage of the peritoneal membrane after treatment with AA-PDF compared to glucose-containing PDF.
The Japanese Health-Care System and Reimbursement for Dialysis
Authors: Naito Hidemune
Published: February 2020

Like most countries, Japan is facing constraints on expansion of health system financial resources. There are almost 250000 Japanese patients with end-stage renal disease and almost all are managed by chronic dialysis. Hospital hemodialysis is the modality used by 96% of these patients.

The Japanese health-care system has tended to support resource-intensive treatments because the fee-for-service remuneration system has rewarded their utilization. This has benefited hemodialysis at the expense of peritoneal dialysis. However, this may now be changing. Case management and global budget-related approaches are being more widely introduced, as are incentives to reward more efficient treatment options. The relative costs of dialysis modalities are difficult to appreciate, as center-based services, such as hospital hemodialysis, are dependent upon fixed resources, while home-based options, such as peritoneal dialysis, are dependent upon variable resources.

The aim of this review is to reconcile various sources of information relevant to end-stage renal disease funding in Japan. The review will suggest that modifying the approach to modality selection could lead to more efficient allocation of future dialysis-related resources and so reduce the strain on Japan's health-care budget.