bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic structuring in Andean landlocked populations of Galaxias maculatus: effects of biogeographic history
Authors: Zattara Eduardo E. , Premoli Andrea C.
Published: December 2004

Aim  To test whether the genetic diversity of diadromous and landlocked populations of the small puyen Galaxias maculatus (known as jollytail in Australia and inanga in New Zealand) follow the same structuring patterns observed for migratory and non‐migratory species of the genus Galaxias. This work also aimed to test whether the genetic structuring of a group of populations could be predicted from differences in the geomorphologic history of the region they inhabit.

Location  Eight landlocked populations were sampled from cold‐temperate lakes in north‐western Patagonia. The study area could be split latitudinally into two sectors that differed in their geomorphology, each of them hosting four populations. The southern sector shows evidence of a higher degree of glacial coverage, and the lakes are probably remnants of a big proglacial palaeolake. Lakes in the northern sector, on the other hand, suggest no common origin.

Results  Significant genetic structuring was found among the studied populations (Θ = 0.188), being the highest value reported to date for the species. Significant correlation was found between genetic diversity and lake area and perimeter. Diversity also showed a slight latitudinal variation suggesting the presence of genetically distinct groups of populations. The comparison of populations from the two geographical sectors showed that those from the north had a higher diversity, more private alleles and strong structuring, while those from the south were less diverse and much more homogeneous.

Main conclusions  Non‐migratory populations of G. maculatus show much higher values of genetic structuring than those reported for diadromous populations. This follows the pattern seen when comparing migratory and non‐migratory species of Galaxias. This agrees with population genetics theory which predicts that restricted gene flow would result in greater among‐population divergence. Also, differences between northern and southern populations agreed with what was predicted by the geomorphologic history of the study area. During the Last Glacial Maximum ice cover in that region may have reduced the habitat of G. maculatus to a refuge with an impoverished gene pool. When the ice receded, leaving a great proglacial lake, that former population expanded and became fragmented after water levels descended. This resulted in present day lakes harbouring homogeneous populations with reduced diversity. The northern sector, in contrast, was less affected by glaciers, resulting in more geomorphologically stable lakes holding genetically diverse populations.
Metastasis of lung cancer to the finger: a report of two cases
Authors: Nakamura Hiroyuki , Shimizu Tadamichi , Kodama Kazuo , Shimizu Hiroshi
Published: December 2004

Case 1  A 73‐year‐old man complained of a 2‐month history of an asymptomatic nodule on the left thumb. The nodule had enlarged gradually and was accompanied by tenderness. The nodule on the tip of the left thumb was about 1 cm in diameter, well demarcated, fleshy, and reddish, with a granulomatous appearance (Fig. 1a). Histopathologic findings of the digital nodule revealed a dense dermal infiltration of cells with a marked nuclear atypicality, cell keratinization, and intercellular bridges (Fig. 1b). Because the diagnosis of a metastatic carcinoma of the skin was suspected, subsequent systemic examination was considered. Computed tomography revealed the presence of a primary carcinoma in the left lung, which was diagnosed as squamous cell carcinoma, T4N0M1, stage IV, and there were multiple metastases. The histopathologic finding of the digital nodule was similar to that of the lung lesions. The patient underwent radiation therapy for the digital tumor, and systemic chemotherapy which was stopped because of adverse side‐effects. The patient died 6 months after identification of the tumor.

(a) Clinical appearance of Case 1. Tumor on the tip of the left thumb. (b) Histopathology of the tumor of Case 1 showing dense dermal infiltration of the cells, with marked nuclear atypicality, cell keratinization, and intercellular bridges (hematoxylin and eosin staining; original magnification, × 40)

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Case 2  A 71‐year‐old man presented with a nodule on the left ring finger 1 month after operation for cancer of the left lung. Pathologic findings of the lung revealed a moderate or highly differentiated squamous cell carcinoma with cell keratinization, pT2N1M0, stage II. The finger tumor gradually enlarged in size. Physical examination showed an approximately 2 cm in diameter, elastic, hard, relatively well‐demarcated, and hyperkeratotic tumor on the tip of the left ring finger (Fig. 2a). The lesion was accompanied by erosions in its center and a dark, erythematous swelling at the surrounding edges. A skin biopsy of the digital tumor was taken. Histologic examination revealed a dense dermal infiltration with marked nuclear atypicality and a tendency to keratinize. Squamous cell carcinoma with moderate or high cell differentiation was pathologically diagnosed (Fig. 2b), the same as recognized in the lung cancer specimen. This case was diagnosed as metastatic carcinoma to the finger, associated with primary lung cancer.

(a) Clinical appearance of Case 2. Tumor on the tip of the left ring finger with an erosion at its center and an erythematous swelling at the surrounding edges. (b) Skin biopsy from the nodule of Case 2 showing the proliferation of marked atypical squamous cells in the dermis and keratinization of the cells (hematoxylin and eosin staining; original magnification, × 40)

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Becker's melanosis: A report of 12 cases with atypical presentation
Authors: Alfadley Abdullah , Hainau Bo , Al Robaee Ahmed , Banka Nusrat
Published: December 2004

Becker's melanosis is a distinct clinical entity. It usually presents in adolescence as a unilateral, hyperpigmented, hairy cutaneous hamartoma. We report herein 12 cases of Becker's melanosis that differ in their presentation from classical Becker's melanosis, and we believe that such presentations are not uncommon.
Lachlan Orogen subduction–accretion systematics revisited
Authors: SPAGGIARI C. V. , GRAY D. R. , FOSTER D. A.
Published: December 2004

Geological and Ar–Ar data provide a link between the formation of mélange, now preserved in the Howqua River region (Governor Fault Zone, central Lachlan Orogen), and ca 450–420 Ma east‐directed subduction that contributed to formation of the Tabberabbera Zone. These data support a previously presented model comprising three accretionary subduction zones to explain closure of a marginal ocean basin. An additional, west‐dipping subduction zone at ca 470 Ma has recently been suggested for the central and western Lachlan Orogen boundary, but is not required to explain the field relationships and chronology.
Neurocognitive functioning and quality of life among dually diagnosed and non‐substance abusing schizophrenia inpatients
Authors: Herman Michael
Published: December 2004

ABSTRACT:  The aim of this study was to compare the domains of intellectual, memory and executive functions of persons with schizophrenia who concurrently have substance abuse disorders (the dually diagnosed) with a group of non‐substance‐abusing patients with schizophrenia and to ascertain if there were differences between the two groups in their perceptions of quality of life. Neuropsychological and quality of life data of 46 dually diagnosed and 43 non‐substance‐abusing patients with schizophrenia was analysed retrospectively. All subjects were inpatients of a state psychiatric hospital. Selected subtests of the Wechsler Adult Intelligence Scale − III and the Wechsler Memory Scale − III constituted the intellectual and memory measures whilst the measures of executive functioning were the Stroop Color Word Test, the FAS version of the Controlled Oral Word Association Test, and the Trail Making Test (Trails A & B). Perceptions of quality of life were evaluated using the World Health Organization Quality of Life measure. The two groups did not differentiate on intellectual and memory domains, however, the dually diagnosed showed a significantly better facility with tasks of executive functions. In addition, the dually diagnosed expressed higher levels of satisfaction with their quality of life compared to the non‐substance‐abusing patients with schizophrenia. These results have implications for interventions.
Carcinosarcoma of the bladder diverticulum and a review of the literature
Authors: CHENG CHI WAI , NG MAN TAT , CHEUNG HO YUEN , SUN WAI HO , CHAN LUNG WAI , WONG WAI SANG , LAI FERNAND MAC‐MOUNE
Published: December 2004

Abstract  We report a carcinosarcoma within a bladder diverticulum together with a review of 18 previously reported cases of intradiverticular sarcomas and carcinosarcomas with respect to their clinical features, treatments and outcomes. Frequent deaths with intra‐abdominal recurrences suggest the need for total cystectomy, rather than diverticulectomy.
Low‐cycle fatigue of 1Cr–18Ni–9Ti stainless steel and related weld metal under axial, torsional and 90° out‐of‐phase loading
Authors: CHEN X. , AN K. , KIM K. S.
Published: December 2004

The fatigue behaviour of base metal and weld joints of 1Cr–18Ni–9Ti stainless steel has been studied under uniaxial, torsional and 90° out‐of‐phase loading. A significant degree of additional hardening is found for both base metal and weld metal under 90° out‐of‐phase loading. Both base metal and weld metal have the same cyclic stable stress–strain relationship under torsional cyclic loading and 90° out‐of‐phase cyclic loading. Base metal exhibits higher cyclic stress than weld metal under uniaxial loading, and Young's modulus and yield stress of weld metal are smaller than those of base metal. Weld metal exhibited lower fatigue resistance than base metal under uniaxial and torsional loading, but no significant difference was found between the two materials under 90° out‐of‐phase loading. A large scatter of fatigue life is observed for weld metal, perhaps because of heterogeneity of the microstructure. The Wang–Brown (WB) damage parameter and the Fatemi–Socie (FS) damage parameter, both based on the shear critical plane approach, were evaluated relative to the fatigue data obtained.
Validity of bolt‐removal and gap‐insertion techniques to experimentally simulate the vibration of a cracked rotor
Authors: KEINER H. , GADALA M. S. , TANG C. W.
Published: December 2004

Experimental studies of the vibration of a cracked rotor are essential in the development of vibration monitoring techniques. The greatest difficulty in conducting experimental parameter studies is the extensive amount of work required when placing a fatigue crack (FC) of known size and location in the structure. Two alternative techniques, the bolt‐removal method (BRM) and the gap‐insertion method (GIM), have been suggested to provide an easy mechanism to experimentally simulate the behaviour of a breathing crack. This study aims to qualitatively and quantitatively evaluate these methods and compare them with the results from a grown FC in a slow rotating drum specimen. Deflection results show good agreement, particularly in the vertical direction. For the horizontal direction the two simulation techniques overestimate the deflection from the FC for large crack sizes. However, overall GIM and BRM provide close enough results to support the usage in experimental parameter studies at significantly lower cost.
Application of the Dang‐Van criterion for life determination under uniaxial random tension–compression with different mean values
Authors: KLUGER K. , ŁAGODA T.
Published: December 2004

In this paper the experimental fatigue lives of specimens made of 10HNAP steel with the lives calculated with the Goodman and Gerber methods of cycle amplitude transformation and the Dang Van criterion for uniaxial loading are compared. Cycles were counted with the rain flow algorithm and damage was accumulated according to the Palmgren–Miner hypothesis. This paper includes comparison of the results for constant amplitude loading with a non‐zero mean value and for random loading with zero or non‐zero mean values. It has been shown that for 10HNAP steel the algorithm of fatigue life calculations using the Dang Van criterion gives satisfactory results.
Fatigue crack growth under non‐proportional mixed‐mode loading in ferritic‐pearlitic steel
Authors: DOQUET V. , POMMIER S.
Published: December 2004

Mode II fatigue crack growth tests as well as tests in sequential mode I and then mode II were performed on ferritic‐pearlitic steel. For ΔKII ranging from 7 to , bifurcation occurs after 12–450 μm of coplanar growth at a decreasing speed. By contrast, hundreds of micrometres of constant speed coplanar growth were obtained under sequential mode I and then mode II loading, for and ΔKI ranging from 0.25 to 1.0 ΔKII. The crack growth rate is a simple sum of the contributions of each mode for ΔKI= 0.25 ΔKII but above this value a synergetic effect is found. The mechanism of this fast‐propagation mode is discussed in the light of strain range maps ahead of the crack tip obtained by digital SEM image correlation and elastic–plastic finite element calculations. The stability of the crack path according to the maximum growth rate criterion is demonstrated.
Cyclic tearing and crack growth in circumferentially cracked straight pipes
Authors: KUMAR D. VENU , MURTHY D. S. RAMACHANDRA , SEETHARAMAN S. , GUPTA S. K. , BHASIN V. , VAZE K. K. , KUSHWAHA H. S.
Published: December 2004

Earthquake load, which is cyclic in nature and of short duration, is the main design basis accident load for designing the primary heat transport (PHT) piping components of Nuclear Power Plants. Adequate protection of piping components from the effects of earthquake requires detailed knowledge of strength and deformation characteristics of the components and assemblies making up the piping system. Fracture behaviour of 23 pipes was studied by conducting cyclic tests under four‐point bending. Fifteen pipes were of carbon steel (SA333 Grade 6) of 219 mm, 324 mm and 406 mm ODs and eight pipes were of stainless steel (AISI Type 304LN) of 168 mm OD with through‐wall circumferential crack. Six pipes were tested under displacement control and the rest under load control. The effect of various parameters such as location and size of initial crack in base metal and weld metal, cyclic load range and displacement increment on crack growth and number of cycles for failure was investigated. The investigations showed significant reduction in the fracture resistance under cyclic loading conditions. Crack growth equations have been proposed for carbon steel pipes with and without weld under cyclic tearing.
The behavioural dynamics of fishers: management implications
Authors: Salas Silvia , Gaertner Daniel
Published: December 2004

In pursuing their livelihood, fishers develop strategies when faced with changes in regulations and other fishery conditions. Changes involve each individual in a decision‐making process governed by his/her own goals or constraints. Despite this reality, the complex dynamics of fishing has usually been ignored in designing management initiatives, which has contributed to management failures in many parts of the world. Fishers have generally been treated as fixed elements, with no consideration of individual attitudes based on their operating scales (geographical, ecological, social and economic) and personal goals. We review existing research on the social, economic and behavioural dynamics of fishing to provide insight into fisher behaviour and its implications for fisheries management. Emphasis is placed on fisher perception, and how fishers develop dynamic fishing tactics and strategies as an adaptive response to changes in resource abundance, environmental conditions and market or regulatory constraints. We conclude that knowledge of these dynamics is essential for effective management, and we discuss how such information can be collected, analysed and integrated into fisheries assessment and management. Particular emphasis is placed on small‐scale fisheries, but some examples from industrial fleets are provided to highlight similar issues in different types of fisheries.
Changing the tune: the structure of the input affects infants’ use of absolute and relative pitch
Authors: Saffran Jenny R. , Reeck Karelyn , Niebuhr Aimee , Wilson Diana
Published: December 2004

Sequences of notes contain several different types of pitch cues, including both absolute and relative pitch information. What factors determine which of these cues are used when learning about tone sequences? Previous research suggests that infants tend to preferentially process absolute pitch patterns in continuous tone sequences, while other types of input elicit relative pitch use by infants. In order to ask whether the structure of the input influences infants’ choice of pitch cues, we presented learners with continuous tone streams in which absolute pitch cues were rendered uninformative by transposing the tone sequences. Under these circumstances, both infants and adults successfully tracked relative pitches in a statistical learning task. Implications for the role played by the structure of the input in the learning process are considered.
The role of speech rhythm in language discrimination: further tests with a non‐human primate
Authors: Tincoff Ruth , Hauser Marc , Tsao Fritz , Spaepen Geertrui , Ramus Franck , Mehler Jacques
Published: December 2004

Human newborns discriminate languages from different rhythmic classes, fail to discriminate languages from the same rhythmic class, and fail to discriminate languages when the utterances are played backwards. Recent evidence showing that cotton‐top tamarins discriminate Dutch from Japanese, but not when utterances are played backwards, is compatible with the hypothesis that rhythm discrimination is based on a general perceptual mechanism inherited from a primate ancestor. The present study further explores the rhythm hypothesis for language discrimination by testing languages from the same and different rhythmic class. We find that tamarins discriminate Polish from Japanese (different rhythmic classes), fail to discriminate English and Dutch (same rhythmic class), and fail to discriminate backwards utterances from different and same rhythmic classes. These results provide further evidence that language discrimination in tamarins is facilitated by rhythmic differences between languages, and suggest that, in humans, this mechanism is unlikely to have evolved specifically for language.
Can Social Systems be Autopoietic? Bhaskar's and Giddens’ Social Theories
Authors: MINGERS JOHN
Published: December 2004

The theory of autopoiesis, that is systems that are self‐producing or self‐constructing, was originally developed to explain the particular nature of living as opposed to non‐living entities. It was subsequently enlarged to encompass cognition and language leading to what is known as second‐order cybernetics. However, as with earlier biological theories, many authors have tried to extend the domain of the theory to encompass social systems, the most notable being Luhmann. The pur‐pose of this paper is to consider critically the extent to which the theory of autopoiesis, as originally defined, can be applied to social systems‐that is, whether social systems are autopoietic. And, if it cannot, whether some weaker version might be appropriate. It addresses this question by considering whether autopoiesis can be applied to the theoretical conceptions of Giddens and Bhaskar. It follows an earlier paper that evaluated Luhmann's autopoietic social theory.
Increased incidence of dementia with Lewy bodies in patients carrying the ɛ4‐allele of apolipoprotein E
Authors: AKATSU Hiroyasu , KAMINO Kouzin , YAMAGATA Hidehisa , ISOJIMA Daisuke , KONDO Ikuko , YAMAMOTO Takayuki , KIDA Tomoyuki , TAKEDA Masatoshi , MIKI Tetsuro , KOSAKA Kenji
Published: December 2004

Background:  The apolipoprotein ∈4 (APOE4) allele is a risk factor for Alzheimer's disease, but it remains undetermined whether this allele is related to the pathological development of neurofibrillary tangles (NFT) and the formation of Lewy bodies.

Methods:  In the present study, we examined the relationship between these changes and the APOE4 allele in 255 consecutive neuropathologically diagnosed cases. APOE genotyping was carried out by the polymerase chain reaction–restriction fragment length polymorphism method.

Results:  Nearly all our cases of dementia with Lewy bodies (DLB) showed the common form, having numerous senile plaques in the cerebral cortex and NFT in the parahippocampal and hippocampal regions and were also associated with the APOE4 allele. Limbic neurofibrillary tangle dementia (LNTD), characterized by the presence of NFT in limbic areas as well as the absence of senile plaques, did not appear to be associated with the APOE4 allele.

Conclusions:  The APOE4 allele is a risk factor for DLB as well as Alzheimer's disease and cerebral amyloid angiopathy, but not for LNTD.
Problems family caregivers encounter in home care of patients with frontotemporal lobar degeneration
Authors: KUMAMOTO Keigo , ARAI Yumiko , HASHIMOTO Naoki , IKEDA Manabu , MIZUNO Yutaka , WASHIO Masakazu
Published: December 2004

Aim:  Frontotemporal dementia (FTD) is a degenerative dementia in which primary degeneration of the frontal region of the brain occurs. Because of the behavioral symptoms, the care of FTD patients has numerous problems. However, little has been clarified with regard to the actual care situation, especially in a family care setting. The aim of the present study was to elucidate the caregiver burden and problems associated with the care of FTD patients in home care settings.

Methods:  Two patients were diagnosed with FTD on the basis of the Lund and Manchester group criteria at the clinic for outpatients of a hospital located in Aichi Prefecture, Japan. Semi‐structured interviews were conducted with the family caregivers of the FTD patients. The content of the interview covered the patient course and any problems encountered in the home setting regarding activities of daily living (ADL), behavioral disorders and cognitive function.

Results:  These FTD patients had abnormal eating behaviors such as cramming of food into one's mouth and the abnormal manner of eating. They had to be fed bit by bit with total caregiver assistance. They were also overactive, restless and distractable, which subsequently caused problems with ADL‐assistance including extreme uncooperativeness toward their caregivers. Other behavioral symptoms associated with FTD, e.g., stereotypic behavior, distractability and high impulsivity, were also considerably burdening to the caregivers.

Conclusion:  The behavioral symptoms peculiar to FTD pose huge problems and heavy burden to the family caregiver. More resources should be allocated to specific needs of the FTD patients and their families.
Daily (quotidian) nocturnal home hemodialysis: Nine years later
Authors: Pierratos Andreas
Published: December 2004

Daily nocturnal home hemodialysis was developed to satisfy the need for a highly effective, smooth, and cost‐effective home dialysis therapy. It combines the benefits of the following dialysis methods: long, frequent, and home hemodialysis. It provides a high dialysis dose for small, as well as large, molecules including β2‐microglobulin; improves quality if life; and leads to control of hyperphosphatemia without the need for phosphate binders, as well as dissolution for extraosseous calcifications. Furthermore, it controls blood pressure often without medications, is associated with regression of left ventricular hypertrophy, improves cardiac function, improves anemia as well as nutrition, allows an unrestricted diet, and corrects sleep apnea. Finally, it decreases the overall cost of patient care and improves cost utility when compared to conventional hemodialysis. The main obstacle to its wider utilization is the structure of the current reimbursement system. Along with short daily hemodialysis, long intermittent dialysis, and the convective dialysis techniques, daily nocturnal hemodialysis promises to improve dialysis outcomes.
Effect of long‐term increase in the frequency and/or prolongation of dialysis duration on certain clinical manifestations and results of laboratory investigations in patients with chronic renal failure
Authors: Twardowski Zbylut
Published: December 2004

The effects of dialysis frequency increase by one weekly and prolongation of dialysis duration by a mean of 17.5% on certain clinical manifestation and results of laboratory investigations were studied in a group of 14 patients treated with haemodialyses because of chronic renal failure caused by isolated renal diseases.

Haemodialyses were carried out using a RSP Travenol artificial kidney and Ultra Flo 145 dialysers. The blood flow was always 200 ml/min and the flow of dialysing fluid was 500 ml/min. One dialyser was used repeatedly during 3 weeks in the same patients. After increasing the frequency or duration of dialyses the patients were not given transfusions of blood donors. The mean length of observation after increasing the frequency of dialyses was 6.4 months and after increasing their duration this length was 6.9 months. The change in the mode of dialysis had no significant effect on the concentration of urea and creatinine before as well as after dialysis. The increase in the frequency of dialyses caused a significant rise in the value of haematocrit by nearly 4%, a rise in the serum albumin concentration by a mean of 0.45 g/100 ml; a mean rise in the velocity of nerve conduction by over 6% of the lower normal range, and a mean rise in dry body weight by nearly 3.5 kg. Prolongation of dialysis time caused a significant mean rise in the haematorcrit value by over 1% before dialysis and in the serum albumin level by a mean of 0.30 g/100 ml. Both, the increase in the frequency and in the duration of dialyses caused a fall in the arterial blood pressure in hypertensive patients. The very favourable effects of increased frequency of dialyses on the clinical state of patients and on important laboratory parameters suggests that in near future the basic form of treatment of chronic renal failure may be daily short‐lasting haemodialysis.
Significance of Measurement for Colloid Osmotic Pressure during Hemodialysis
Authors: Yoshimoto A. , Matsushima Y. , Sakaji I. , Yoshikawa M. , Nitta T. , Okuno M. , Ishida Y. , Kasahara M. , Suzuki T.
Published: December 2004

Background and Purpose:  Colloid osmotic pressure (COP) in plasma rises by ultrafiltration during hemodialysis, and it consequently causes plasma refilling in which water moves from interstitial tissue to capillary space. Although hemodynamic stability is one of the important factors for good dialysis outcome, no informative and convenient indicators are available other than monitoring of blood pressure. Thus, we measured COP during hemodialysis whether COP can be used as an indicator for the hemodynamic status in comparison with hematocrit (Ht). Plasma osmolality, ultrafiltration volume, and the alteration of blood pressure were also measured to examine whether COP is associated with them.

Method:  Sixteen patients hospitalized in this hospital were examined. Amongst them, 10 patients underwent both dialysis and ultrafiltration, while 4 patients received only dialysis and 2 patients were with ultrafiltration only by extracorporeal ultrafiltration method. Ultrafiltration was performed with constant speed to the dry weight for 4 h. The measurements of COP, plasma osmolality, Ht levels, and blood pressure were performed at 30 min (12.5% of the total water removal), 1 h (25%), 2 h (50%), and 3 h (75%) after the start of hemodialysis and also at the end of dialysis (100%).

Result:  COP markedly rose by 26.0% (±13.3%) in the patients who received both dialysis and ultrafiltration, whereas Ht rose by only 13.6% (±5.21%). And the curve for COP increase was sigmoid shape, whereas that for Ht showed linear change. On the other hand, in the patients whose Ht levels showed low values, the curves for both COP and Ht showed similar pattern.

Conclusion:  These results suggest that COP is a more sensitive indicator to be monitored for the hemodynamic status than Ht during hemodialysis.
Low Serum Parathyroid Hormone Is a Predictor of Early Death after Hip Arthroplasty in Hemodialysis Patients
Authors: Nakai T. , Masuhara K. , Yamasaki S. , Fuji T. , Kanbara N.
Published: December 2004

A high mortality rate after hip arthroplasty has been reported in hemodialysis patients; however, there has been no previous study on predictors of mortality after hip arthroplasty so far.

Objectives:  The purpose of the present study was to identify any risk factors associated with early death in hemodialysis patients undergoing hip arthroplasty.

Methods:  We retrospectively reviewed 34 patients on hemodialysis who underwent hip arthroplasty between 1994 and 2001. The average age was 60 years, and the average hemodialysis duration was 116 months at the time of operation. Body mass index (BMI), operating time, and total blood loss were reviewed. Serum levels of albumin (Alb), calcium (Ca), phosphorus (P), alkaline phosphatase (Alp), and intact parathyroid hormone (PTH) were measured preoperatively.

Results:  Of these 34 patients, 9 died (26%). There were 2 perioperative deaths and 7 during follow‐up period between 2 and 19 months. No significant difference was found with respect to patient age, hemodialysis duration, Alb, Ca, P, Alp, operating time, and total blood loss. Patients with lower BMI and PTH levels had an earlier mortality than patients with higher BMI and PTH levels (p < 0.05 and p < 0.01).

Conclusion:  We conclude that despite an intensive care directed to our hemodialysis patients, the incidence of early death after hip arthroplasty is still high. If low BMI and serum levels of low PTH were detected before operation, we should pay special attention to early mortality after hip arthroplasty.
Clinical Characteristics of Upper Gastrointestinal Bleeding in Hemodialysis Patients
Authors: Bang B.K. , Kim Y.O. , Kim Y.S. , Shin Y.S. , Chae H.S. , Shin Y.S. , Yoon S.A. , Yang C.w. , Kim Y.s. , Chang Y.S.
Published: December 2004

Upper gastrointestinal bleeding (UGIB) frequently occurs in hemodialysis (HD) patients. But, clinical characteristics of UGIB in HD patients are not well reported yet.

Objective:  This study was designed to compare the clinical characteristics of UGIB between HD patients and normal population with intact renal function.

Methods:  This study enrolled 24 HD patients with UGIB. Age‐ and sex‐matched 26 patients with UGIB and normal renal function were selected as control group during the same period. Of the cases with UGIB, esophageal variceal bleedings due to liver cirrhosis were excluded in this study. We investigated the results of treatment and UGIB‐associated mortality for 3 months after the event and then compared previous gastrointestinal (GI) symptoms (Sx), endoscopic findings, treatment results, and mortality between HD patients and control.

Results:  The results are summarized in the table.

HD patients (n = 24)
Control (n = 26)
p value

Age (years)
60±11
61±11
0.702

Sex [male/female (%)]
62.5/37.5
53.8/46.2
0.536

Previous GI Sx   [asymptomatic/  symptomatic (%)]
33.3/66.7
65.3/34.7
0.024

Endoscopic diagnosis   [vascular ectasia/others (%)]
45.8/54.2
15.3/84.7
0.020

Primary treatment   [endoscopic/medical (%)]
70.8/29.2
61.5/38.5
0.488

Results of treatment

 Success/rebleeding (%)
75.0/25.0
92.4/7.6
0.095

 Patient survival/UGIB‐

  related death (%)
83.3/16.7
100/0
0.046

Conclusion:  Previous gastrointestinal symptoms were less frequent in HD patients than normal population with intact renal function. In contrast, HD patients had higher incidence of vascular ectasia and mortality than normal population with intact renal function.
Pre‐ and Post Hemodialysis Procalcitonin Levels and Their Relationships with Immunoregulatory, Proinflammatory Cytokines in Chronic Hemodialysis Patients
Authors: Karayaylali I. , Seyrek N. , Balal M. , Paydas S. , Cetiner S. , Yaman A.
Published: December 2004

Background/Aims:  Procalcitonin (PCT) has been described as a new marker of severe infection and sepsis. In this study, we investigated the serum levels of PCT during the hemodialysis (HD) in chronically hemodialyzed patients and whether the PCT levels were correlated with other cytokines.

Methods:  We measured pre‐ and post‐HD PCT, interleukin (IL‐1), IL‐2, IL‐6, IL‐10, tumor necrosis factor‐α (TNF‐α) concentrations in 24 stable patients undergoing chronic HD [11 males and 13 females; age 41.2 ± 18.0 years, 12 h/week, with a Kt/V of 1.41 ± 0.35, polysynthane (PSN) membrane being used in all patients, without reuse]. Pre‐ and post‐HD PCT concentrations were compared with cytokines such as IL‐1, IL‐2, IL‐6, IL‐10, TNF‐α, and clinical parameters including age, blood pressure, leukocyte, hemoglobin levels, C‐reactive protein (CRP), epoetin (EPO) doses, BUN, creatinine, parathormone (PTH), ferritin, and transferrin levels.

Results:  Pre‐ and post‐HD serum PCT levels were similar (0.77 ± 0.40 and 0.83 ± 0.61 ng/mL), and higher than upper normal level of 0.5 ng/mL. The levels of IL‐2 and IL‐10 decreased and the levels of IL‐1 and TNF‐α increased. Post‐HD PCT correlated with PTH, IL‐1, IL‐2, and IL‐10.

Conclusion:  About 60% of patients had elevated PCT levels, HD with low‐flux PSN membrane did not change serum PCT and IL‐6. While IL‐1 and TNF‐α increased, IL‐2 and IL‐10 decreased by PSN membrane during HD. So that PCT levels can be measured just after HD as do prior to start of HD. Is there any relationship between PCT and PTH? PCT may be important in uremic bone disease.
The Effect of Frequent and Occasional Dialysis‐Associated Hypotension on Survival of Patients on Hemodialysis
Authors: Tislér A. , Akócsi K. , Borbás B. , Fazakas L. , Ferenczi S. , Görögh S. , Kulcsár I. , Nagy L. , Sámik J. , Szegedi J. , Tóth E. , Wágner G. , Kiss I.
Published: December 2004

Frequent or occasional symptomatic intradialytic hypotension during hemodialysis may influence patients' well being, but its effects on survival, independent of comorbidities, have not previously been investigated.

Objective:  To assess the effect of frequent (f‐IDH) or occasional (o‐IDH) dialysis‐associated hypotension on survival.

Methods:  During the run in period in 1998, 77 patients with f‐IDH (≥10 hypotensive events/10 months, responding only to medical intervention) and 101 patients with o‐IDH (1 or 2 events/10 months) were identified among all 958 prevalent chronic hemodialysis patients of a network. Eighty‐five patients who had no hypotensive episodes (no‐IDH) served as controls. Patients were followed for a median of 27 months (range 0.3–37), and survival of patients was compared by log‐rank test. Independent association of f‐IDH and o‐IDH on survival, compared to no‐IDH, was assessed by proportional hazards model that included patient's demographics, laboratory data, comorbidity as well as medications.

Results:  Forty‐five patients (58%) with f‐IDH, 47 (47%) with o‐IDH, and 33 (39%) with no‐IDH died during the follow up that represents mortality rates of 37 (p = 0.013 vs. no‐IDH), 26 (p = 0.375 vs. no‐IDH), and 21 deaths/100 patient years in the three groups, respectively. In multivariate proportional hazards regression, where age, sex, time on dialysis, CHD, diabetes, Kt/V, albumin level, use of beta‐blockers, calcium‐channel blockers, and long‐acting nitrates have been adjusted for, neither f‐IDH nor o‐IDH was associated with survival.

Conclusion:  Mortality in patients with f‐IDH is significantly higher than in those without such events. Our data, however, did not provide evidence that f‐IDH, independent of age and comorbidities, contributes to mortality in these patients.
Heparin Use in Daily Hemodialysis
Authors: Hynes J. , McComb T. , Young B.
Published: December 2004

More frequent dialysis is thought to be associated with increased heparin requirements; however, limited data are available which compare heparin requirements of conventional to daily dialysis.

Objectives:  To determine differences in heparin dose during conventional thrice‐weekly dialysis (CHD) compared to daily hemodialysis (DHD).

Methods:  All patients within the daily home hemodialysis at the Northwest Kidney Centers were evaluated for heparin dose both pre‐ and post initiation of daily hemodialysis. Patients on DHD received an initial bolus of heparin, without a continuous heparin drip, and supplemental heparin midway through the dialysis run as needed to maintain adequate activated clotting times (ACTs). CHD patients received a heparin bolus, followed by initiation of heparin drip as needed to maintain adequate ACTs.

Results:  Of the 1117 patients who dialyze at the NKC, 55% were Caucasian, 21% African‐American, 20% Asian/Pacific Islander, and 35% were of other ethnicity. The majority of patients were greater than 60 years (56%), while 36% ranged from 40–60 years and 13% ranged from 20–40 years. Male patients constituted 54% of patients. Diabetes was the primary cause of renal disease (36%), followed by hypertension (21%) and glomerular disease (18%). Of those patients in the home hemodialysis program (n = 45), 10 patients started daily home hemodialysis using the Aksys daily home hemodialysis system. Of those, the majority was male (100%), Caucasian (78.8%) with an average age of 46.7 ± 18 years. Glomerulonephritis was the primary cause of end‐stage renal disease (40%), while the percentages of other diseases were similar [Alport's syndrome (20%), hypertension (20%) and diabetes (10%)]. Compared to initial DHD heparin requirements (10,111 ± 2219 units), CHD heparin dose requirements (6833 ± 2715 units) were significantly lower (p = 0.045); however, total heparin needs were similar between groups (10,166 ± 4380 units vs. 10,778 ± 2959 units) (p = 0.324).

Conclusion:  Although patients initiating DHD have greater initial heparin requirements than when on CHD, total heparin doses remain similar to those required on conventional thrice‐weekly hemodialysis. Greater initial heparin doses required during short daily dialysis appear safe compared to those of conventional dialysis.
Survival Advantage of Tailored Dialysis
Authors: Mezza E. , Salomone M. , Burdese M. , Soragna G. , Gai M. , Motta D. , Consiglio V. , Jeantet A. , Segoloni G.P. , Piccoli G. , Piccoli G.B.
Published: December 2004

Survival has been defined as an index of adequacy of dialysis. These hard data are the basis for comparing results obtained by different schedules or policies. The aim of the study was to assess mortality rate recorded within a system of tailored dialysis (1–6 dialysis per week in out‐of‐hospital settings: home hemodialysis, self‐ and limited care dialysis). Data recorded in a single center (1998–2003) were compared with data gathered in the Registry of Dialysis and Transplantation in the whole Region (1998–2000).

Methods:  Out‐of‐hospital dialysis unit is active since 1971, in which a new program integrating self‐ and limited care and home dialysis started since 1998.

Patients:  Incident dialysis patients starting renal replacement therapy within the program and all further patients starting dialysis in the Region in the same period were compared in an historical prospective cohort study.

Results:  55 patients in the Unit and further 1443 patients in the whole Region started RRT since 1998. Main features of 55 patients were 32 males 23 females; median age 51 years, range 20–76; 72.7% displaying at least 1 comorbid factor. Throughout the period gross mortality rate was 4/125 patient‐years in the Center. Kaplan–Meier curves showed a 1‐year survival of 100% vs. 91%, respectively, in the Center and in the whole Region, and a 2‐year survival of 95.5% vs. 76.6%, respectively, in the Center and in the whole Region (p = 0.001). The main demographic features were remarkably different in both settings (for the whole Region median age 66 years, range 2.2–101, at least 1 comorbidity in 56.9% of patients). In an attempt to correct for the different baseline characteristics, a multivariate Cox regression analysis was performed. The whole model resulted in statistically significant value (p = 0.000) and an increasing mortality risk resulted for age at starting dialysis, diabetes, and collagenopathy. In conclusion, tailored, high‐efficiency dialysis policy may allow superior survival results. A longer follow up is needed to confirm our approach; in larger cohorts, the finding of a low mortality rate in a relatively young population with high comorbidity may underline the need to review our current concepts on dialysis adequacy.
What Influences Cardiovascular Instability and Discomfort during Daily Hemodialysis?
Authors: Kjellstrand C.M. , Twardowski Z.J. , Bower J. , Blagg C.R.
Published: December 2004

Background:  Daily hemodialysis (DHD) markedly ameliorates cardiovascular instability (CVI) and discomfort (DIS) during dialysis, but patients continue to have some of these problems during DHD. We studied what contributed to these problems during 4445 DHD in 23 patients.

Methods:  Dependent variables were increase in pulse rate (PR), maximal (MAX) and overall (OV) fall of systolic blood pressure (BP), and a subjective score of patients' overall evaluation of the quality of dialysis (OEQ), adding a score of 14 symptoms (0 best, 40 worst). Independent variables were ultrapure dialysate and biocompatible dialysis (UP) (1626 dialyses) vs. conventional dialysis (CONV) (2819 dialyses), ultrafiltration (Uf) as percentage of body weight (BW), pre–post BUN (ΔBUN), time on dialysis (T), speed of dialysis (K/V in mL min−1 kg BW−1), and target −post‐dialysis BW (Ta‐Po BW). Relations were analyzed by backward multiple regression analysis.

Results:  PR increased by 1.6 ± 13/min; MAX BP fall was 25 ± 20 mmHg; OV BP fall was 13 ± 22 mmHg; OEQ = 0.6 ± 1.2. In multiple stepwise backward regression analysis, independents in order of importance:

PR = ΔBUN × 0.12 + Ta‐Po BW   × 1.8 + K/V × 1.1 − 5
r = 0.13, p < 0.0001

MAX BP = CONV × 8 + T × 0.2 − Ta‐Po BW

   × 6 + Uf × 2.7 −13
r = 0.33, p < 0.0001

OV BP = CONV × 11 + Uf × 4 − Ta‐Po BW

  × 4 + ΔBUN × 0.3 − 9
r = 0.35, p < 0.0001

OEQ = K/V × 0.3 − Ta‐Po BW × 0.1 − 0.2
r = 0.20, p < 0.0001

Conclusion:  To minimize drop in BP and hypotensive crashes, use of ultrapure dialysate and a biocompatible membrane (UP) was by far the most important factor, followed by slowing dialysis. To avoid post‐dialysis tachycardia and discomfort during dialysis, slow dialysis was most important. Overall, “fast” dialysis and use of “impure” regular dialysate appear to be the major dialysis factors causing CV instability and discomfort during daily hemodialysis.
Effect of Vitamin E Dialyzer Membrane on Anemia in Hemodialysis Patients
Authors: Kirmizis D. , Papagianni A. , Belechri A.M. , Alexopoulos E. , Memmos D.
Published: December 2004

Red blood cell (RBC) survival in patients on chronic maintenance hemodialysis (HD) has been reported to be shortened due to the oxidative damage of RBC membrane. The use of antioxidants might help in the control of anemia and reduce the erythropoietin (EPO) dose needed.

Objective:  The objective was to determine the effects of vitamin E‐bonded dialyzer membrane (VEM) on anemia and EPO requirements in chronic HD patients.

Patients and methods:  We prospectively studied 19 stable patients on HD (8 males, age 58.47, range 31–76 years) who were shifted from other dialyzer membranes to VEM for 6 months. At baseline they were given a mean dose of EPO of 90.6 ± 51 U kg–1 BW–1 week–1. Clinical data, dry body weight corrected pre‐dialysis RBC, hemoglobin, reticulocytes, serum iron and ferritin, complete biochemistry, iPTH, and CRP were studied at 3 and 6 months, while therapy scheme was reevaluated monthly.

Results:  A significant rise, compared to the baseline, was found in hemoglobin and in RBC at 3 months of treatment (12.44 ± 1.16 g/dL vs. 11.2 ± 1.2 g/dL, p = 0.002; and 4.01 ± 0.53 × 106/μL vs. 3.64 ± 0.5 × 106/μL, p < 0.05) and at the end of follow‐up (12.17 ± 1.33 g/dL vs. 11.2 ± 1.2 g/dL, p < 0.05; and 4.03 ± 0.53 × 106/μL vs. 3.64 ± 0.5 × 106/μL, p < 0.05). No significant change in serum iron and ferritin, reticulocytes, EPO dose used, iPTH, Kt/V, or CRP was found at the end of follow‐up compared to the baseline (68.8 ± 17 mg/dL vs. 67.9 ± 18 mg/dL, p = NS; 421 ± 296 mg/dL vs. 478 ± 359 mg/dL, p = NS; 3.76 ± 0.89 × 104/μL vs. 3.82 ± 0.78 × 104/μL, p = NS; 90.2 ± 53 U kg–1 BW–1 week–1 vs. 90.6 ± 51 U kg–1 BW–1 week–1, p = NS; 157 ± 43 pg/dL vs. 148 ± 56 pg/dL, p = NS; 1.21 ± 0.22 vs. 1.2 ± 0.17, p = NS; 7.15 ± 5.42 mg/L vs. 15.38 ± 29.8 mg/L, p = NS, respectively).

Conclusions:  Despite the small number of patients and the short time interval of treatment, an antioxidant effect of VEM apparently achieved early a better control of anemia in HD patients.
Estimation of Internal Filtration Flow Rate in a Dialyzer by a Doppler Ultrasonography
Authors: Mineshima M. , Sato Y. , Akiba I.i.t , Sunohara T. , Masuda T.
Published: December 2004

Several types of dialyzers with enhanced internal filtration have been introduced in order to increase solute clearance, especially in relatively larger molecular solutes. In these dialyzers, enhanced internal filtration increased convective transport of the solute in addition to diffusive transport. The internal filtration flow rate (QIF) has not, however, been measured in clinical situations, because none of monitoring techniques can measure this value. Herein, the QIF value was estimated during an experimental and an analytical study. Namely, we measured blood flow velocity in a cross‐sectional plane of the dialyzer by pulse Doppler ultrasonography. An in vitro study with bovine blood was carried out to determine the local blood flow velocity profile with a newly designed probe slider that enables parallel movement of the probe along the dialyzer. Furthermore, an analytical model was newly introduced to calculate changes in flow rate and pressure of blood and dialysate streams and solute concentrations along the dialyzer. The QIF value could be estimated by a simulation analysis to the experimental data using the analytical model.