bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic reorganization of the astrocyte actin cytoskeleton elicited by cAMP and PACAP: a role for phosphatidylInositol 3‐kinase inhibition
Authors: Perez Virgili , Bouschet Tristan , Fernandez Céline , Bockaert Joël , Journot Laurent
Published: January 2005

Cyclic AMP (cAMP)‐raising agents induce astrocytes grown in vitro to adopt a stellate morphology resembling their in vivo appearance, through the depolymerization of actomyosin stress fibres. The signalling pathways responsible for cAMP‐induced astrocyte stellation have thus far remained largely elusive. We showed in this study that the neurotrophic peptide PACAP (pituitary adenylate cyclase‐activating polypeptide) mimicked the effect of forskolin, a direct activator of adenylate cyclase, on the actin cytoskeleton of primary rat astrocytes. The depolymerization of stress fibres induced by PACAP or forskolin was prevented by the expression of a constitutively active mutant of RhoA, but not by a protein kinase A (PKA) blocker, indicating that cAMP‐raising agents act upstream of RhoA, in a PKA‐independent manner. In addition, PACAP and forskolin inhibited basal Akt phosphorylation, and basal and epidermal growth factor (EGF)‐stimulated phosphatidylinositol 3‐kinase (PI 3‐K) activities. Incubation with a PI 3‐K blocker resulted in the depolymerization of stress fibres. This effect was blocked by the expression of a constitutively active mutant of RhoA, indicating that PI 3‐K inhibition acted upstream of RhoA. Together, these data demonstrate for the first time that depolymerization of stress fibres, and the resulting astrocyte stellation, induced by stimulation of cAMP production involves the inhibition of the PI 3‐K–RhoA pathway.
Depolarization evokes different patterns of calcium signals and exocytosis in bovine and mouse chromaffin cells: the role of mitochondria
Authors: Alés E. , Fuentealba J. , García A. G. , López M. G.
Published: January 2005

This study was planned on the assumptions that different high‐voltage activated calcium channels and/or the ability of mitochondria to take up Ca2+ could be responsible for different cytosolic Ca2+ concentrations ([Ca2+]c) and catecholamine release responses in adrenal chromaffin cells of bovine and mouse species. Short K+ pulses (2–5 s, 70 mm K+) increased [Ca2+]c to a peak of about 1 µm; however, in bovine cells the decline was slower than in mouse cells. Secretory responses were faster in mouse but were otherwise quantitatively similar. Upon longer K+ applications (1 min), elevations of [Ca2+]c and secretion were prolonged in bovine cells; in contrast [Ca2+]c in mouse cells declined three‐fold faster and failed to sustain a continued secretion. Confocal [Ca2+]c imaging following a 50‐ms depolarizing pulse showed a similar Ca2+ entry, but a rate of [Ca2+]c increase and a maximum peak significantly higher in bovine cells; the rate of dissipation of the Ca2+ wave was faster in the mouse. The mitochondrial protonophore CCCP (2 µm) halved the K+‐evoked [Ca2+]c and secretory signals in mouse cells, but had little affect on bovine responses. We conclude that the relative densities of L (15% in bovine and 50% in mouse) and P/Q Ca2+ channels (50% in bovine and 15% in mouse) do not contribute to the observed differences; rather, the different intracellular distribution of Ca2+, which is strongly influenced by mitochondria, is responsible for a more sustained secretory response in bovine, and for a faster and more transient secretory response in mouse chromaffin cells. It seems that mitochondria near the plasmalemma sequester Ca2+ more rapidly and efficiently in the mouse than in the bovine chromaffin cell.
A recombinant multimeric immunoglobulin expressed in rice shows assembly‐dependent subcellular localization in endosperm cells
Authors: Nicholson Liz , Gonzalez‐Melendi Pablo , Van Dolleweerd Craig , Tuck Heidi , Perrin Yolande , Ma Julian K.‐C. , Fischer Rainer , Christou Paul , Stoger Eva
Published: January 2005

To investigate the role of subunit assembly in the intracellular deposition of multimeric recombinant proteins, we expressed a partially humanized secretory immunoglobulin in rice endosperm cells and determined the subcellular locations of the assembled protein and its individual components. Transgenic rice plants expressing either individual subunits or all the subunits of the antibody were generated by particle bombardment, and protein localization was determined by immunoelectron microscopy. Assembly of the antibody was confirmed by immunoassay and coimmunoprecipitation. Immunolocalization experiments showed no evidence for secretion of the antibody or any of its components to the apoplast. Rather, the nonassembled light chain, heavy chain and secretory component accumulated predominantly within endoplasmic reticulum‐derived protein bodies, while the assembled antibody, with antigen‐binding function, accumulated specifically in protein storage vacuoles. These results show that the destination of a complex recombinant protein within the plant cell is influenced by its state of assembly.
A physiological overview of the genetics of flowering time control
Authors: Bernier Georges , Périlleux Claire
Published: January 2005

Physiological studies on flowering time control have shown that plants integrate several environmental signals. Predictable factors, such as day length and vernalization, are regarded as ‘primary’, but clearly interfere with, or can even be substituted by, less predictable factors. All plant parts participate in the sensing of these interacting factors. In the case of floral induction by photoperiod, long‐distance signalling is known to occur between the leaves and the shoot apical meristem (SAM) via the phloem. In the long‐day plant, Sinapis alba, this long‐distance signalling has also been shown to involve the root system and to include sucrose, nitrate, glutamine and cytokinins, but not gibberellins. In Arabidopsis thaliana, a number of genetic pathways controlling flowering time have been identified. Models now extend beyond ‘primary’ controlling factors and show an ever‐increasing number of cross‐talks between pathways triggered or influenced by various environmental factors and hormones (mainly gibberellins). Most of the genes involved are preferentially expressed in meristems (the SAM and the root tip), but, surprisingly, only a few are expressed preferentially or exclusively in leaves. However, long‐distance signalling from leaves to SAM has been shown to occur in Arabidopsis during the induction of flowering by long days. In this review, we propose a model integrating physiological data and genes activated by the photoperiodic pathway controlling flowering time in early‐flowering accessions of Arabidopsis. This model involves metabolites, hormones and gene products interacting as long‐ or short‐distance signalling molecules.
Risk factors of parents abused as children: a mediational analysis of the intergenerational continuity of child maltreatment (Part I)
Authors: Dixon Louise , Browne Kevin , Hamilton‐Giachritsis Catherine
Published: January 2005

Background:  This study provides an exploration of factors implicated in the intergenerational cycle of child maltreatment. Families with newborns where at least one of the parents was physically and/or sexually abused as a child (AP families) were compared in terms of risk factors to families where the parents had no childhood history of victimisation (NAP families). The mediational properties of risk factors in the intergenerational cycle of maltreatment were then explored.

Methods:  Information was collected by community nurses as a part of the ‘health visiting’ service. Data was collated across 4351 families, of which 135 (3.1%) had a parent who self‐reported a history of abuse in childhood. The health visitor visited each family at home when the child was 4 to 6 weeks of age to assess the presence of risk factors.

Results:  Within 13 months after birth, 9 (6.7%) AP families were referred for maltreating their own child in comparison to 18 (.4%) NAP families. Assessments found a significantly higher number of risk factors for AP families. Mediational analysis demonstrated that the presence of three significant risk factors (parenting under 21 years, history of mental illness or depression, residing with a violent adult) provided partial mediation of the intergenerational continuity of child maltreatment, explaining 53% of the total effect.

Conclusion:  Prevention may be possible, once a history of parental childhood abuse has been identified, by offering services in priority to those families where a parent is under 21 years, has a history of mental illness/depression and/or there is a violent adult residing in the household. However, it must also be acknowledged that these factors do not provide a full causal account of the intergenerational transmission and consideration should be given to additional factors, such as parenting styles (see Part II of this mediational model, ).
Attributions and behaviours of parents abused as children: a mediational analysis of the intergenerational continuity of child maltreatment (Part II)
Authors: Dixon Louise , Hamilton‐Giachritsis Catherine , Browne Kevin
Published: January 2005

Background:  This study extends previous research () by exploring the mediational properties of parenting styles and their relation to risk factors in the intergenerational cycle of child maltreatment. Families with newborns where at least one of the parents was physically and/or sexually abused as a child (AP families) were compared, in terms of parents’ attributions and behaviour, to families where the parents had no childhood history of victimisation (NAP families).

Methods:  Information was collected from 4351 families (135 AP families) by community nurses as part of the ‘health visiting’ service. The same health visitor visited each family twice at home when the child was 4 to 6 weeks and 3 to 5 months of age, to assess behavioural indicators of positive parenting.

Results:  Within 13 months after birth, 9 (6.7%) AP families were referred for maltreating their own child in comparison to 18 (.4%) NAP families. Assessments found a significantly higher number of risk factors and measures indicating poor parenting for AP families. Mediational analysis found that intergenerational continuity of child maltreatment was explained to a larger extent (62% of the total effect) by the presence of poor parenting styles together with the three significant risk factors (parenting under 21 years, history of mental illness or depression, residing with a violent adult). The three risk factors alone were less explanatory (53% of the total effect).

Conclusion:  This study provides an explanation for why a minority of parents abused in childhood go on to maltreat their own infant, evidencing poor parenting styles and mediating risk factors. Hence, prevention may be enhanced in AP families by the promotion of ‘positive parenting’ in addition to providing additional support to young parents, tackling mental illness/depression and domestic violence problems.
Commentary hallucination in the elderly: three case reports
Authors: KOBAYASHI Toshiyuki , KATO Satoshi , OSAWA Takuro , SHIODA Katsutoshi
Published: January 2005

Three elderly females with commentary hallucinations are presented. Here, the term ‘commentary hallucination’ is used as a comprehensive term describing a condition where the subject hears voices that comment on, command, or describe the subject's actions or behavior. According to the DSM‐IV, the three cases presented here met the criteria for a psychotic disorder not otherwise specified, a schizoaffective disorder, and schizophrenia, respectively. All three cases showed no evidence of abnormalities when examined using neuroimaging techniques but might have had some senile brain changes that were under the threshold of the neuroimaging studies. Although the commentary hallucinations in the three patients were not distinctively different from the hallucinations that are characteristic of schizophrenia, the subjects were able to keep some distance from the hallucinations; in other words, the hallucinations were not ego‐invasive. The commentary hallucinations in the present patients might be explained as resulting from exhaustion caused by stressful life events, subtle senile organic brain changes, and a subsequent decline in psychological tension. These hallucinations may have originated from the pathological appearance of a background‐inner speech accompanying the patients’ behavior.
White matter lesions on magnetic resonance imaging in late‐life depression
Authors: OH Byoung Hoon , CHEON Jin Sook
Published: January 2005

Objectives: The aims of the present study were to identify the frequency and severity of white matter lesions on the magnetic resonance imaging (MRI) of major depressive disorders and depression caused by cerebrovascular diseases (CVD), to evaluate the relation with cerebrovascular risk factors, and finally to understand an important cause of late‐life depression.

Methods: The MRI films of 32 patients over 50 years of age (15 men and 17 women) with major depressive disorders, 25 patients (17 men and eight women) with depression caused by CVD who had scores over 24 on the mini‐mental state examination, and 25 controls (six men and 19 women) were analyzed for white matter lesions according to the modified Fazekas criteria. The cerebrovascular risk factors including hypertension, arteriosclerosis, obesity, smoking, diabetes mellitus, thyroid function abnormalities, EKG abnormality and stroke were also assessed.

Results: (i) The frequency of periventricular lesions or deep white matter lesions were significantly higher in patients with depression caused by CVD and major depressive disorders than in controls; (ii) the intracerebral hyperintensities or classical infarctions were prevalent in the frontal cortex (32.0%) and basal ganglia (40.0%); (iii) among cerebrovascular risk factors, stroke (P < 0.005), hypertension (P < 0.025), EKG abnormality (P < 0.005) and smoking (P < 0.05) were significantly prevalent in the patients with depression caused by CVD and major depressive disorders as compared with controls; and (iv) the severity of white matter lesions was significantly associated with the cerebrovascular risk factors (P < 0.005) in patients over 50 years of age with major depressive disorders.

Conclusions: The white matter hyperintensities on brain MRI of patients with major depressive disorders over 50 years of age were significantly associated with cerebrovascular risk factors, which suggested a vascular origin of pathogenesis of late‐life depression.
Clinical usefulness of cognitive evoked potentials to assess cognitive deficits in cerebrovascular diseases
Authors: CHEON Jin Sook , CHUNG Heung Chae , OH Byoung Hoon
Published: January 2005

Background: The aim of the present study is to evaluate the clinical applicability and usefulness of cognitive evoked potentials (CEP) to identify a cognitive deficit in patients with cerebrovascular diseases (CVD).

Methods: The P3 latencies, amplitudes and latency to amplitude ratios (LAR) of CEP were measured in 25 healthy control subjects and 35 inpatients with CVD. The association of CEP with variables including age, sex, mini‐mental state examination (MMSE) score, CVD types, loci of hemiplegic limbs, duration, education, brief psychiatric rating scale (BPRS), instrumental activities of daily living (IADL) and daily living function assessment (DLFA) was also analyzed.

Results: (i) The P3 latencies (447.87 ± 113.06 msec) and LAR (65.83 ± 43.25) were prolonged in CVD (P < 0.05), while the amplitudes (8.18 ± 2.51 µV ) were not changed; (ii) the P3 latencies (537.31 ± 101.14msec) and LAR (94.89 ± 46.44 in CVD with a MMSE score <24 were prolonged, and the amplitudes (6.45 ± 1.98 µV ) were reduced (P < 0.05, respectively); (iii) the BPRS, IADL and DLFA in CVD with a MMSE score <24 were different from MMSE ≥24 (P < 0.05); (iv) there was no difference in CEP between CVD caused by infaction and hemorrhage; (v) the P3 latencies were correlated positively with age, BPRS and IADL, while negatively with MMSE and DLFA. The amplitudes were correlated positively with MMSE and DLFA, while negatively with age, BPRS and IADL. The LAR were correlated positively with age, BPRS and IADL, while negatively with MMSE and DLFA; and (vi) on analyzing association of CEP with variables in CVD with MMSE <24, the P3 latencies were correlated positively with BPRS and DLFA, while negatively with MMSE and DLFA. The amplitudes were positively correlated with age. The LAR were positively correlated with IADL.

Conclusions: The P3 latencies and LAR of CEP seemed to be useful clinical measures to assess cognitive disorders in CVD as well as in vascular dementia.
Initial Brazilian experience with short‐duration in‐center daily hemodialysis
Authors: Lugon Jocemir R. , Andre Mauro B.
Published: January 2005

The whole initial Brazilian experience with short‐duration in‐center daily hemodialysis is summarized here. The study was performed at a time when low‐flux membrane and nonproportional dialysis represented the standard dialysis treatment in Brazil. Five patients were treated for 2 years. The subject is developed in a way to narrate the efforts to set the research project and summarize the findings, meeting presentations, and publications that derived from the project. At the end of the study, the main benefits observed consisted of alleviation of the end‐stage renal disease anemia; reduction of the frequency of complications during dialysis sessions; a lower degree of azotemia; easier blood pressure control; and improvements in acid‐base status, mineral metabolism and bone disease, nutrition, and quality of life.
Early hospital readmission was less likely for hemodialysis patients from facilities with longer median length of stay in the DOPPS study
Authors: Tadaki Futoshi , Inagaki Miho , Miyamoto Yoshiyasu , Tanaka Shin‐Iti , Tanaka Reika , Kakuta Takatoshi , Saito Akira
Published: January 2005

The length of hospital stay is considered to influence hospital readmission in general. The Dialysis Outcomes and Practice Patterns Study (DOPPS), an international prospective observational study undertaken to establish a relationship between facility practices and dialysis outcomes, started in 1996. Results suggest that the duration of hospital stay is significantly correlated with the probability of early readmission in dialysis patients. Thus, early hospital readmission was observed to be less likely for hemodialysis patients from facilities with longer median length of stay. The lengths of hospital stay for hemodialysis patients differed in the three continents studied. Although socioeconomic pressures may drive the lengths of hospital stay, the duration of hospitalization should be determined keeping in mind the safety of clinical course for each disease. In this forum, a 47‐year‐old female hemodialysis patient with severe secondary hyperparathyroidism, who had been treated with hemodialysis for 21 years, was hospitalized with severe clinical symptoms. Although the clinical symptoms disappeared 10 days after total parathyroidectomy with autotransplantion, severe hypocalcemia persisted despite large amounts of intravenous calcium gluconate. This patient was hospitalized for a long duration owing to the large calcium deficit in her body. Had the length of her hospital stay been shortened, either she could have needed rehospitalization or her condition could have worsened.
Access  High output heart failure in patients with upper arm A‐V fistulae: Diagnosis and treatment
Authors: Amerling R. , Malostovker I. , Dubrow A. , Rosero H. , Haveson S.
Published: January 2005

Purpose:
Arteriovenous fistula (AVF) is the preferred blood access for hemodialysis due to its longevity and resistance to infection. Little attention is given to the long‐term hemodynamic consequences of large left‐to‐right shunts, particularly in patients with brachial artery fistulae. Materials and Methods: We describe 9 patients (8 on dialysis, 1 post‐transplant), aged 25–73, who developed clinical heart failure, primarily due to large, upper arm AVFs. Results: 4/9 had access flows in excess of 2 liters/min, assessed by blood temperature monitoring. 6/9 had cardiac output measured by right heart catheterization, before and after shunt compression. One also underwent left heart catheterization with ventriculography. 3/9 had surgical reduction of the fistula, either by banding or by serial interposition of small caliber GoreTex graft. In 2/9 the shunt was ligated. One patient had heart failure in association with 2 large, upper arm AVFs, one of which was ligated. After years of improved cardiac symptoms, heart failure recurred in association with marked hypertrophy of his remaining AVF. Resting cardiac output in this patient was in excess of 11 liters/min. 2/9 experienced acute onset of heart failure within 1–3 days of angioplasty of a venous stenosis. One of these, with very poor baseline cardiac function, expired. Surgical revision or ligation was accompanied by clinical improvement in the 5 patients so treated. One of these expired of a stroke after two months of cardiac improvement. Conclusion: High output heart failure is under‐diagnosed in dialysis patients. Patients with large upper arm shunts are particularly at risk. Access flow should be assessed regularly and those with outputs >1.5 liters/min should be monitored closely for development of heart failure. Surgical correction is beneficial and indicated in symptomatic patients.

Patient number
Age/Sex
Access type
Years with access
Flow (liters/min)
Change CO (liters/min)
Rx
Outcome

1
37/M
AVF
 8
>2
1.7
Reduction
Improved

2
26/M
AVF
 5
>2
2.4
Band
Improved

3
73/M
AVF
 3
>2
1.5
Reduction
Improved

4
45/M
AVF
10
n/a
3.2
Reduction
Improved

5
65/M
AVF
 4
>2
2.8
Band
Improved

6
57/F
AVG
 4
1.2
1.8

7
39/F
AVF
 2
n/a
n/a
Ligate
Improved

8
66/M
AVG
 0.3
0.7
n/a
Ligate
Improved

9
69/F
AVF
 0.25
n/a
n/a

Expired
A study of 8 hour long night dialysis with the Aksys PHD dialysis system
Authors: Kjellstrand C. , Blagg C.R. , Ing T.S. , Young B.
Published: January 2005

The Aksys PHD system is designed for short quotidian dialysis employing a 52‐liter batch of ultrapure dialysate and up to 30 in situ hot water reuses of the entire extracorporeal circuit including a 40‐liter physical cleaning before each dialysis. Methods: We studied the effect of the 52‐liter tank during 108 long 5–8 hour dialysis 3.5–6 times/week in 5 patients and one 50‐liter patient simulator for 4 weeks. Phosphate (PO4), beta‐2 microglobulin (b‐2), urea (BUN), and creatinine (creat) were measured pre‐, during, and post‐dialysis 86 times and in total dialysate 74 times during long dialysis. Tank saturation, Kt/V, and monthly chemistries were also measured. Results:  Patient weight 76 ± 2 kg, QB 234 ± 23 ml/min, QD 498 ± 13 ml/min. Dialysate was recirculated 4.8 times during 8 hours.

Analyte
Short
Long dialysis
p

Pre‐BUN
   70 ± 18
   49 ± 15
<0.0001

Pre‐creat
   12 ± 3
   10 ± 2
<0.0002

Pre‐PO4
 5.2 ± 1.5
 4.1 ± 1.1
<0.003

Pre‐b‐2
34.0 ± 5.3
27.8 ± 4.5
<0.0001

All patients on 8 hrs × 5 dialyses/week stopped phosphate binders within 3 weeks. eKt/V(urea) rose to 0.5 in one hour and then slowly to 0.8 at 8 hours.

Weekly stdKt/V:

Dialyses/week/Hrs:
2
5
8

5
2.2
2.7
3.0

6
2.7
3.4
3.6

7
3.1
3.8
4.4

At 8 hrs the tank was 99 ± 8% saturated with BUN, 86 ± 12% with creat, 77 ± 18% with PO4, and only 12 ± 5% with b‐2. Total removal per dialysis increased 2 gm BUN, 0.4 gm creat, 0.4 gm PO4, and 40 mg b‐2. The decline per reuse in conductivity clearance was only 0.7 ± 1.2% during short and 1.4 ± 1.4% during long dialysis (p = 0.11). There was no change in monthly chemistries or hematologies.

Discussion: 
The data show that the Aksys PHD is very effective for long 8‐hour dialysis. The data for PO4 and b‐2 are the same as reported for conventional dialysis machines using 5 times as much dialysate, and the weekly stdKt/V if the PHD is used every night is twice the standard defined by K/DOQI. The exceptional cleanliness and biocompatibility by way of the one‐per‐month reuse should be a great advantage to patients. The full automatization saves the patient one hour every night and 30 minutes every morning. The PHD also economizes on filters and dialysate and is good for the environment.
Nocturnal dialysis: Comparing six night/week with alternate night therapy
Authors: Mahadevan K. , Pellicano R. , Reid A.B. , Kerr P.G. , Agar J.W.M.
Published: January 2005

The biochemical, haemodynamic, clinical, and nutritional benefits of nocturnal haemodialysis (NHD) compared with (c/w) 4 hr, 3/week conventional haemodialysis (CHD) are well known and accrue by increasing dialysis time and frequency either for 8 hrs alternate night/week (NHD3.5) or for 8 hrs 6 nights/week NHD (NHD6). However, there is little data yet comparing NHD3.5 with NHD6. 13 NHD6(8.15 hrs/night) were c/w 14 NHD3.5(7.8 hrs/night), all with similar demographic profiles. NHD6 had unrestricted diet and fluid intake but NHD3.5 needed some restriction. Before (b) and after (a) HD phosphate (PO4) control was ideal though bPO4 levels for NHD6 were lower (1.64 mmol/l) c/w NHD3.5(1.83 mmol/l). All NHD6 needed PO4 supplementation c/w 2/14 NHD3.5 but 5/14 NHD3.5 needed PO4 binders c/w 0/13 NHD6. Both had normal blood pressures with 3/14 NHD3.5 needing anti‐hypertensives c/w 2/13 NHD6. The bHb was 122.8 g/l (NHD6) c/w 127.7 g/l (NHD3.5) and the balbumin was 38.3 g/l (NHD6) c/w 37.7 g/l (NHD3.5). NHD6 had lower b blood urea (10.2 c/w 19.5 mmol/l) and less interdialytic urea and creatinine fluctuation. NHD6 ultrafiltration rates (UFR) and intradialytic weight gains (mean ± SEM) were significantly lower (248 ± 22.7 ml/hr and 2.03 ± 0.19 kg) c/w NHD3.5(453 ± 34.6 ml/hr and 2.85 ± 0.27 kg): UFR p < 0.10. We conclude that NHD6 offers the optimum biochemical, volume, and clinical outcome but NHD3.5 still has a clear and major advantage over CHD and a dual additional appeal to providers seeking home‐based therapy cost advantages and consumable expenditure control. A flexible dialysis program should offer all the time and frequency options of NHD but, in particular, should support NHD at a frequency sympathetic to the clinical, rehabilitation, and lifestyle aspirations of individual patients.
Ten‐year study of bacteremia in hemodialysis patients in a single center
Authors: Park J.A. , Jung H.A. , Yoon J.M. , Kim Y.O. , Yoon S.A. , Kim Y.S. , Kim S.Y. , Chang Y.S. , Bang B.K
Published: January 2005

Background: 
The incidence of infection in patients on chronic hemodialysis in higher than that of the general population. Infection is known to be a major cause of morbidity and mortality in these patients. The vascular access is important for hemodialysis, but infection through this route is the most common source of bacteremia and can be lethal to the patients. Despite the high morbidity and mortality of bacteremia in patients on chronic hemodialysis, the clinical characteristics of bacteremia in hemodialysis patients is rarely reported yet in Korea. Methods: We included 696 hemodialysis patients from January 1993 to December 2003 at Uijongbu St. Mary's Hospital. We investigated incidence, source, causative organisms, clinical manifestations, complication, and mortality of bacteremia. We compared clinical factors, morbidity, and mortality between arteriovenous fistula and central venous catheter groups. Results: Total 52 cases of bacteremia occurred in 43 patients. The major source of infection was vascular access (48%). Staphylococcus aureus was most common organism isolated. Major complications were septic shock (9.6%), pneumonia (9.6%), infective endocarditis (3.8%), and aortic pseudoaneurysm (1.9%). Nine patients died from septic shock (n = 4), aspiration pneumonia (n = 2), hypoxic brain injury (n = 1), gastrointestinal bleeding (n = 1), and rupture of aortic pseudoaneurysm. The central venous catheter group (n = 22) had higher incidences of vascular access as a source of infection (81.8% vs 23.3%, p < 0.001) and staphylococcus as a causative organism (77.2% vs 50.0%, p = 0.042) than the arteriovenous group. Conclusion:  This data shows that bacteremia causes high incidence of fatal complications and mortality. Therefore, careful management of vascular access as well as early detection of bacteremia is an important factor for the prevention of infection and proper antibiotic therapy should be started early.
Schistosomiasis could play a role in transmission of HCV infection in dialysis patients
Authors: Badawy L. , Addullah I. , EI Guinaidy M. , Aly M. , Aziz A. , Tarek A.S. , Abdel R.S.
Published: January 2005

Background: 
Both chronic HCV infection and schistosomiasis are major health problems in Egypt. The high prevalence of HCV infection in bilharzial patients had been postulated to be due to HCV transmission during past anti‐bilharzial parental therapy. The aim of the work was to study the possibility of transmission of HCV through the life cycle of schistosomiasis. Subject and Methods: The study included 180 patients divided into four groups: Group I: Included 40 patients with chronic renal failure (CRF) on regular hemodialysis (RH) with hepatic schistosmiasis (HS) and previous history of blood transfusion (BT). Group II: Included 40 patients with CRF on RH with HS and had no previous history of BT. Group III: Included 40 patients with CRF on RH with no evidence of HS and no previous history of BT. Group IV: Included 60 patients with HS with normal renal function and no previous history of BT. In addition 20 healthy persons were included as a control group. In addition to the routine investigations the patient groups were subjected to HCV Ab, HBsAg, HBcAb, HBcAg, anti bilharzial Ab, abdominal ultrasonography, rectal snip for patients positive for anti bilharzial Ab, and in‐situ hybridization (ISH) for HCV RNA and HBV DNA in the rectal snips positive for living schistosoma ova obtained from bilharzial patients positive for markers of HCV and HBV, respectively. Results: HCV Ab was detected in 92.5%, 65%, 55%, and 76.7% in groups I, II, III, IV, respectively, compared to 25% in the control group. Anti‐schistosomal Ab was detected in 75%, 50%, and 71.7% in groups I, II, and IV, respectively. A highly significant correlation was found between HCV Ab and anti‐schistosomal Ab positivity among all bilharzial groups (P < 0.01 in group I and P < 0.001 in groups II & IV). Rectal snips were positive for living schistosoma ova in 76.7%, 90%, and 81.4% of anti‐schistosomal Ab positive cases in groups I, II, and IV, respectively. Moreover, a highly significant correlation was found between HCV Ab and rectal snip positivity among the 3 bilharzial patients groups (P < 0.001 in groups I & II and P < 0.01 in group IV). On the other hand, there was no significant association between HBs Ag and either anti‐schistosomal Ab positivity or rectal snip positivity. ISH revealed HCV RNA in 26.3% of schistosomal ova‐positive rectal snips. In contrast, the examined biopsies were negative for hybridization of HBV DNA. Conclusion: Schistosomiasis might play a role in the transmission of HCV through its life cycle and this also may explain the significant association between HCV and schistosomiasis.
Spontaneous renal rupture in patients on chronic hemodialysis
Authors: Park J.A. , Jung H.A. , Yoon J.M. , Kim Y.S. , Kim Y.O. , Yoon S.A. , Kim S.Y. , Chang Y.S. , Bang B.K.
Published: January 2005

Background: 
Because of high incidence of acquired renal cyst and renal malignancy, it is suggested that spontaneous renal rupture more frequently occurs in patients receiving long‐term hemodialysis than in the general population. This study was performed to evaluate the clinical characteristics of spontaneous renal rupture in hemodialysis patients. Methods: This retrospective study enrolled 12 hemodialysis patients who developed spontaneous renal rupture. We investigated primary renal disease, duration of dialysis, clinical symptoms and signs, radiologic findings, treatment modalities, and histologic findings. Result: The mean age of the patients was 54 ± 10 years old and the number of male was 9. Primary renal disease consisted of autosomal dominant polycystic kidney disease (PCKD)(n = 5), chronic glomerulonephritis (n = 2), diabetic nephropathy (n = 1), hypertensive nephropathy (n = 1), unknown cause (n = 3). Presenting symptoms and signs were sudden onset of flank pain in 9 patients and gross hematuria with mild flank pain in 3 patients. Mean duration from initiation of hemodialysis to development of spontaneous renal rupture was 53 ± 36 months. Abdominal computed tomography showed subcapsular or perinephric hematoma in all patients. Of the 7 non‐PCKD patients, 6 patients had multiple acquired renal cysts. Surgical exploration was undertaken in 9 patients. Pathologic examination demonstrated small sized renal cell carcinoma in 2 of 9 patients. Three patients were only treated with conservative management including blood transfusion. All 12 patients recovered without recurrence. Conclusion: This study demonstrated that genetic or acquired renal cyst was an important cause of spontaneous renal rupture in hemodialysis patients and presenting manifestations were sudden onset of flank pain and gross hematuria.
Death in dialysis
Authors: Concepcion L.A.
Published: January 2005

Purpose: 
To analyze all patients who died while on hemodialysis from a single institution 1995–2004 and determine factors that influence duration on HD (months). Material and Methods: Review of the EMR from the dialysis unit for demographics, treatment parameters, cause of death, laboratory data. Two main groups those who stop dialysis (SHD) vs non stop dialysis (NSHD) data as mean and SD. Observations done at the start/mid/end of the period on dialysis by Kaplan Meier analysis. Results: 348 deaths, reported SMR for 2000–93(0.36,0.48,0.72,0.79), average comorbidity index 7.1–16.4; 49.1% male; age 67.6(12.3); 58.2% DM, 117(33.6%) stop dialysis. Detail analysis from 2000–2004; 187 deaths; 33.6% catheter, 41.1% AV graft at the time of death; 26% on no BP meds at the end, 64% 1–2 BP meds at the end.

Cause
Stop
No Stop

CV
33(28%)
145(62.7%)

Infection
10(8.5%)
 41(17.7%)

Other
74(63.5%)
 45(19.6%)

Most SHD deaths due to uremia (60%), Cancer 17%, occurred 36% CVA. SHD vs NSHD: older 70.8 (12.9) vs 65.9(12.9) p < 0.001. No difference in average months in dialysis 41.2 (38.9) vs 48.7(47.7)NS, in URR (start/end), UF during Hd, predialysis MAP (start/end: 105(15) 196(15)/95 (20) , 96(20)) albumin, phosphorous. Lower creatinine (at the end 6.2(1.5) 7.4(2.4)) higher Kt/V at end 1.47(0.4) vs 1.29(0.3). BMI lower at star/mid/end of the observation period. Conclusions: A large proportion of deaths were due to discontinuation of dialysis, older patient discontinue dialysis more frequently, the length of time on dialysis (months) is related more to nutritional factors (creatinine, BMI)
Effects of vitamin E‐coated membrane dialyzer on reduction of inflammation
Authors: Jainkiatfu K.
Published: January 2005

Objective: 
Blood‐membrane interaction during hemodialysis may contribute to inflammatory process, which accelerates the development of atherosclerosis in maintenance hemodialysis patients (MHD). Vitamin E has been widely used against oxidative stress in MHD. One of the strategies for the utilization of vitamin E in MHD patients is the usage of vitamin E‐coated membrane dialyzer. We investigated the effects of vitamin E‐coated membrane dialyzer on serum C‐reactive protein and interleukin‐6, the biomarker of inflammation, compared to polysulfone membrane dialyzer. Methods: Vitamin E‐coated membrane dialyzer (1.5‐m2 surface area) and synthetic polysulfone dialyzer (1.5‐m2 surface area) were manipulated in a crossover clinical study for 24 weeks in 10 non‐diabetic MHD patients. Run‐in and wash‐out periods (Cellulose tri‐acetate) were performed for 4 weeks before the treatment. Pre‐ and post‐dialysis blood samples were taken at the begining and the end of each dialyzer period (12 weeks). High‐sensitivity C‐reactive protein (hs‐CRP) and interleukin‐6 (IL‐6) were examined. Results: Mean age of the patients was 54.9 years old. CRP and IL‐6 levels were similarly increased after dialysis in both groups (4.8 ± 0.7 and 37.2 ± 9.4, respectively). The CRP and IL‐6 level in vitamin E‐coated membrane dialyzer treatment were lower than in polysulfone treatment (5.0 ± 1.2, p < 0.008 and 67.2 ± 12.4, p < 0.04, respectively). Serum albumin, hemoglobin level, and white blood cell count were not affected by types of dialyzer membrane. Conclusions: In our study, hemodialysis stimulated the inflammation as the previous study. Vitamin E‐coated membrane dialyzer may diminish the inflammatory process in MHD patients and may also prevent further atherosclerosis.
Acute complicating symptoms during hemodialysis sessions have well correlation with deranged blood pressure regulation
Authors: Iqbal M.M. , Hossain R.M. , Rahman H. , Das S. , Hossain J. , Salam A. , Islam M.N. , Mohsin M.
Published: January 2005

Objective: 
This observational study was undertaken to evaluate the frequency of acute complications occurring during dialysis sessions and their association with other clinical and biochemical parameters. Method: Forty‐six maintenance hemodialysis patients were selected and evaluated. Mean of the weekly evaluations of different parameters over a three‐month period is presented here. Result: Age of study subjects was 39 ± 13 years and body mass index (BMI) 21 ± 4 kg/m2. Duration of hemodialysis was 41 ± 29 months. Most of the patients were hypertensive (98%), taking multiple anti‐hypertensive drugs. Mean of the blood pressures before and at the end of dialysis sessions over the three month period were: systolic blood pressure (SBP) 159 ± 18 vs. 163 ± 22 (p < 0.05) and diastolic blood pressure (DBP) 92 ± 13 vs. 87 ± 7 mmHg (p < 0.003). Frequency of acute complicating symptoms during dialysis sessions were: headache (75%), rise in blood pressure (73%), leg cramps (67%), vomiting (60%), palpitation (58%), sweating (52%), and hypotension (35%). Raised blood pressure showed a positive correlation with headache (r = 0.50, p < 0.01) and sweating (r = 0.53, p < 0.05). Vomiting and palpitation were more frequent at low post‐dialysis blood pressure (vomiting vs. post‐SBP‐r = −0.41, p < 0.05 and palpitation vs. post‐DBP‐r = −0.48, p < 0.05), and these patients were likely to get inadequate dialysis (hypotension vs. Kt/V‐r = −0.63, p < 0.01). Pre and post dialysis weight variation was 53 ± 11 vs. 51 ± 11 kg (p < 0.001), average ultrafiltration during dialysis (UF)−2.39 (0.5–4) liter and single session Kt/V was 0.95 ± 0.38. The rising tendency of post‐dialysis blood pressure correlated positively with increasing UF (SBP vs. UF‐r = 0.36, p < 0.01 and DBP vs. UF‐r = 0.25, p < 0.05). Conclusion: From this study it may be concluded that acute complications during dialysis sessions have a significant correlation with deranged blood pressure regulation, and optimum control of blood pressure could provide better dialysis.
Results of improvement in adequacy of intermittent hemodialysis (IHD) in uremic patients
Authors: Grzegorzewska A.E. , Banachowicz W.
Published: January 2005

Increasing number of uremic patients, who need IHD, is a great challenge for every society but especially for poor and developing countries. The aim of our study is to look if small (not very expensive) increase in IHD adequacy is able to improve standard medical parameters. In 40 patients, treated with IHD for 57.5 (1–185) months, Kt/V was monitored on‐line during the middle IHD session in the week, 4 times in each of 6 consecutive months. Measurements of Kt/V based on a conductivity method. In the first month of observation Kt/V was lower (1.09 ± 0.02, p < 0.0009) than in later months, in which Kt/V was ranging from 1.13 ± 0.04 to 1.17 ± 0.01. Blood morphology was estimated every month. At the beginning of study period, after 3 months, and at the end of studies, dry body mass, BMI, the blood pH and serum concentration of calcium, phosphate, intact PTH, total protein, albumin, cholesterol, iron, ferritin, urea, and creatinine were determined. The increase in Kt/V was accompanied by rising values of Hb (99.1 ± 16.6 → 105.1 ± 12.5 g/l, p = 0.022), Hct (31.6 ± 5.2 → 33.8 ± 3.6%, p = 0.004), MCV (95.9 ± 7.7 → 100.7 fl ± 5.7, p = 0.000), iron (58.2 ± 29.6 → 73.2 ± 27.8 μg/dl, p = 0.002), blood pH before (7.26 ± 0.04 → 7.41 ± 0.04, p = 0.000) and after (7.34 ± 0.05 → 7.48 ± 0.05, p = 0.000) IHD session as well as by decreasing values of PTH [918 (38–3500)→ 420 (15–4341) pg/ml, p = 0.036]. Statistically unchanged parameters included dry body mass (70.4 ± 15.6 → 70.9 ± 16.1 kg), BMI (28.21 ± 6.73 → 28.23 ± 6.79 kg/m2), serum concentration of total protein (69.1 ± 5.7 → 70.9 ± 4.8 g/l), phosphate (5.72 ± 1.50 → 5.39 ± 2.02 mg/dl), cholesterol (203 ± 49 → 191 ± 62 mg/dl) and ferritin (740 ± 558 → 632 ± 346 ng/dl) as well as WBC (8.60 ± 3.89 → 6.52 ± 1.50 K/nl) and PLT (251 ± 91 → 195 ± 60 K/nl). There were correlations between Kt/V and serum concentrations of phosphate (r = 0.370, p = 0.019), PTH (r = 0.314, p = 0.048), ferritin (r = 0.417, p = 0.007), Hb (r = −0.376, p = 0.017), and Hct (r = 0.374, p = −0.017). Our results indicate that even a small increase in IHD adequacy leads to beneficial changes in management of uremic patients (better response on erythropoietin, diminished laboratory features of secondary hyperparathyroidism, better iron utilization). Correlation between Kt/V and examined parameters indicate that higher IHD doses were provided to patients in more advanced uremic state. It may partially explain advantages observed with incremental IHD adequacy.
External gamma radiation caused by radon in water used for home haemodialysis (HHD)
Authors: Riitta M.‐K. , Meeri K. , Jyrki H. , Tuukka T. , Hannu A. , Eero H.
Published: January 2005

Background: 
Radon is a natural radioactive element found especially in drilled water wells. It may cause problems in HHD. In this study the occurrence and prevention of radiation exposure to radon among HHD patients was examined. Material and methods: Since 1998, 103 patients have been trained for HHD and drilled wells were used in 7 patients. Apart from routine analyses, radon concentration was also determined. Results: High radon concentration was observed in three drilled wells, in one of these 2000 Bq/L. Water was conducted into the HHD‐equipment through a charcoal filter and reverse osmosis equipment. Radon concentration was less than 50 Bq/L in the purified water. It was thus considered acceptable for dialysis. As the charcoal filter adsorbs radon, its decay products build up in the filter and emit gamma radiation. Considering that the daily through‐put of water is about 375 liters, the estimated dose rate for a radon concentration of 1,000 Bq/L is 0.4 microSv/h at one‐meter distance. At this distance the annual dose would be 1.8 mSv, expecting a daily occupancy time of 12 hours. The average background gamma dose rate in Finnish dwellings is 0.1 microSv/h. National dose constraints of 3 mSv/year for adults and 1 mSv/year for children living in HHD‐households have been recommended. Conclusions: Waterborne radon must be considered when planning of HHD in households where drilled wells are used. Elevated radon concentration should always be removed from household water. In addition, external gamma radiation from charcoal filters requires appropriate restrictions in order to achieve a safe treatment.
Pediatrics  Access  Problems in hemodialysis with a permanent central venous catheter
Authors: Muscheites J. , Drueckler E. , Stolpe H.J. , Wigger M.
Published: January 2005

Hemodialysis is a common treatment of chronic renal failure, also in childhood. Due to the high standard of technique there are only few contraindications for this treatment at present. Limitations are given by the vessel access. But in the last years, hemodialysis has been made practicable by the permanent central venous catheter, however, with more problems. As an example for potential complications in the treatment with the permanent catheter we present an unusual case report about a twenty‐one‐ year‐old girl suffering from chronic renal failure due to reflux nephropathy, Prader‐Willi‐ syndrome, myelonatrophia of undetermined origin with spastic diplegia of the legs, and increasing sphincter ani dysfunction. We started the renal replacement therapy when the girl was 15 years old. It was not possible to create an AV fistula due to very small vessels. Two Gore‐Tex ® implants were clotted in absence of thrombophilia. Afterwards, the hemodialysis was performed by a permanent central venous catheter. The catheter had to be changed 15 times. The reasons for changing the catheter were problems of flow during hemodialysis due to clotting, dislocations, spontaneous removing of the catheter by herself, and infections. Altogether a sepsis occurred four times. The first transplantation failed due to a rupture of the transplanted kidney. A second transplantation was not possible because of the high BMI. Intermittently, the girl was treated with peritoneal dialysis (PD) in the hospital, because the PD couldn’t be done at home due to different reasons. Only on weekends could the girl go home. The PD had to be finished after 6 months due to a severe psychotic syndrome. The girl died at age 21, caused by a sepsis following the 15th change of the catheter. A huge problem of frequent catheter changing is the limited availability of vessel accesses – the limits of treatment by hemodialysis.
Efficacy of percutaneous angioplasty in non‐maturing Brescia‐Cimino fistulas
Authors: Kim Y.S. , Kim Y.O. , Song H.H. , Jung H.W. , Park J.A. , Yoon S.A. , Lee S.H. , Chang Y.S. , Bang B.K.
Published: January 2005

Purpose: 
To evaluate efficacy of percutaneous transluminal angioplasty (PTA) in non‐maturing Brescia‐Cimino fistulas. Methods: Between January 1997 and December 2003, we treated 22 patients with non‐maturing Brescia‐Cimino fistulas by PTA. Retrospective analysis was performed on the findings of fistulogram, techniques and success rate of PTA, and patency rate. Results: Seventeen segmental stenoses and 5 segmental occlusions of cephalic veins were identified. Sixteen stenoses and 2 occlusions were located at the cephalic vein adjacent to the anastomosis site, and 3 occlusions and 1 stenosis were seen at the proximal vein near the elbow joint. In addition to venous stenosis, a focal arterial stenosis at the anastomosis site and two accompanying accessory veins that might hamper maturation of main cephalic vein was seen in each of two patients, respectively. Simultaneous occlusion of left innominate vein as well as occlusion of cephalic vein were noted in one patient. Initial success rate of PTA was 95.5%(21/22). Overall success rate including 11 additional PTAs performed during follow‐up was 96.9%(32/33). No major complication occurred. Primary and secondary patency rates were 72% and 95% at 3 months, and 50% and 77% at 6 months, respectively. Conclusion: PTA is an effective and safe method in salvaging non‐maturing Brescia‐Cimino fistulas.