bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathogenesis of Peritoneal Sclerosis
Authors: Pollock C.
Published: January 2018

Peritoneal sclerosis is an almost invariable consequence of peritoneal dialysis. In most circumstances it is “simple” sclerosis, manifesting clinically with an increasing peritoneal transport rate and loss of ultrafiltration capacity. In contrast, encapsulating peritoneal sclerosis is a life threatening and usually irreversible condition, associated with bowel obstruction, malnutrition and death. It is unknown whether common etiological factors underlie the development of these 2 clinically and pathologically distinct forms of peritoneal sclerosis. The majority of studies to date have investigated factors that contribute to “simple” sclerosis, although it remains possible that similar mechanisms are amplified in patients who develop encapsulated peritoneal sclerosis. The cellular elements that promote peritoneal sclerosis include the mesothelial cells, peritoneal fibroblasts and inflammatory cells. Factors that stimulate these cells to promote peritoneal fibrosis and neoangiogenesis, both inherent in the development of peritoneal sclerosis, include cytokines that are induced by exposure of the peritoneal membrane to high concentrations of glucose, advanced glycation of the peritoneal membrane and oxidative stress. The cumulative exposure to bioincompatible dialysate is likely to have an etiological role as the duration of dialysis correlates with the likelihood of developing peritoneal sclerosis. Indeed peritoneal dialysis using more biocompatible fluids has been shown to reduce the development of peritoneal sclerosis. The individual contribution of the factors implicated in the development of peritoneal sclerosis will only be determined by large scale peritoneal biopsy registries, which will be able to prospectively incorporate clinical and histological data and support clinical decision making.
A Trial of Detecting Impending Access-graft Failure by Simplified Weekly Flow Monitoring
Authors: Vilkomerson D. , Chilipka T. , Rafi H. , Homel P. , Ghadari G. , Eisen T. , Finkelstein F. , Kuhlmann M. , Levin N.
Published: January 2018

Access graft failure is a major problem in hemodialysis. Monitoring the flow through the access so that impending failure can be detected and prevented seems reasonable, but recent clinical trials have failed to show any benefit of such monitoring. Described here are plans for a clinical trial of a new flow monitoring procedure that measures access flow weekly instead of monthly and, being performed before dialysis, avoids the dialysis-induced changes in graft flow that may have affected earlier trials. The planned trial is to be carried out in two stages, the first to establish the sensitivity and specificity of the new method, and the second (if the results of the first stage warrant it) a controlled trial comparing access-costs and hospitalization days between a monitored group and a matched standard care control group. It is hoped that this trial of the new method will establish it as an effective means of extending access-graft life.
Early Results of Valved Bovine Jugular Vein Conduit for Right Ventricular Outflow Tract Reconstruction
Authors: Mert M. , Cetin G. , Turkoglu H. , Ozkara A. , Akcevin A. , Saltik L. , Paker T. , Gunay I.
Published: January 2018

Objective

Many congenital cardiac anomalies present with accompanying severe right ventricular outflow tract (RVOT) obstruction or interruption requiring surgical correction. RVOT reconstruction by means of a conduit is often necessary in the majority of these patients in the early years of life and there are several proposed conduits for this purpose.

Methods

Fourteen patients with different congenital cardiac pathologies underwent RVOT reconstruction with the newly developed bovine valved jugular vein conduit (The Contegra conduit). The function of the conduit is observed by echocardiographic examinations at the hospital discharge and at follow-up visits with special attention to the function of the venous valve and to any gradient on the RVOT.

Results

There were two perioperative mortalities. All the surviving patients are followed for a mean period of 8.07 months (range 2 to 33 months). The function of the venous valve was determined, in 4 patients (33.33%) as without regurgitation, in 7 patients (58.3%) as mild regurgitation and in 1 patient (8.33%) as mild-to-moderate regurgitation. The reconstructed RVOT was free of any significant gradient at the hospital discharge (mean 10.83 ±10.18 mmHg) and at the follow-ups (mean 12.916 ±12.33 mmHg). There was not a trend towards an increase in the gradients following discharge.

Conclusion

The early results of the Contegra valved conduit are very satisfactory. This graft can be a good alternative for RVOT reconstruction, particularly in the neonatal and infant patient group. These patients can be managed by homograft replacement of their conduit in later years.
Effectiveness of Aluminum Hydroxide Timing Administration in Relation to Meals in Controling Hyperphosphatemia in Dialysis Patients
Authors: Katopodis K.P. , Andrikos E. , Pappas M. , Siamopoulos K.C.
Published: January 2018

Phosphate binder compounds contribute to the control of hyperphosphatemia in hemodialysis (HD) patients. However, the most effective schedule of administration of phosphate binders in relation to meals is not well documented. We examined the effectiveness of aluminum hydroxide intake as the sole phosphate binder in relation to meals. Eighty-five patients on regular HD (45 male, 40 female), age 21–72 years, with a duration of 6–216 months HD participated in the study. In all patients, phosphate binders were discontinued for a one month period. Thereafter, and according to the protocol, all patients were advised to take aluminum hydroxide [Al(OH)3] 30 min before, during and 30 min after meals for 3 periods of one month each, in a random order. One month washout period preceded the periods of Al(OH)3 ingestion. When Al(OH)3 was administered 30 min prior to the meals, serum phosphate decreased by 7.0% (0.59 mg/dL), while when administrated with or 30 min after meals, it decreased statistically significantly by 28.5% (2.08 mg/dL), and 16% (1.29mg/dL) respectively.

Our results suggest that the efficacy of Al(OH)3 to bind phosphate salts and thus to prevent the hyperphosphatemia in HD patients is higher when this drug is taken with meals.
Engrafting Periodontal Fibroblasts with New 3-Dimensional Polylactide Foams
Authors: Poll B. , Buttler P. , GräBer H.G. , Lampert F. , Becker C.
Published: January 2018

In clinical periodontics, “tissue engineering” techniques have been developed to guide the regenerative process following periodontal disease. We explored a new shaped biomaterial in order to promote cellular adhesion, proliferation and migration of periodontal cells. Granules of poly-D,L-lactide were foamed in specially designed moulds by a controlled gas-loading process. Explant cultures of periodontal tissue were seeded at different densities on the 3-dimensional scaffolds following analysis of cytotoxicity, cell proliferation and differentiation. The moulding procedure led to porous structures with predetermined tubes for cellular locomotion. Cells adhered to and populated the material's surface and inner cavities while retaining fibroblastic phenotype. An optimal ratio between cellular proliferation and mortality rate was achieved at a seeding density of > 106 cells/cm3 scaffold. We designed modified polylactide scaffolds capable of acting as a stent and a cell carrier matrix. The foaming process is easy, cheap and suitable for commercial production.
Soft Tissue Response to a New Austenitic Stainless Steel with a Negligible Nickel Content
Authors: Tschon M. , Fini M. , Giavaresi G. , Borsari V. , Lenger H. , Bernauer J. , Chiesa R. , Cigada A. , Chiusoli L. , Giardino R.
Published: January 2018

This study evaluates the soft tissue response to a new austenitic stainless steel with a low nickel content (P558) in comparison with a conventional stainless steel (SSt) and a titanium alloy (Ti6Al4V). Previous findings showed its in vitro biocompatibility by culturing P558 with healthy and osteoporotic osteoblasts and its in vivo effectiveness as bone implant material. Regarding its use as a material in osteosynthesis, P558 biocompatibility when implanted in soft tissues, as subcutis and muscle, was assessed. Disks and rods of these metals were implanted in rat subcutis and in rabbit muscle, respectively. Four and twelve weeks post surgery implants with surrounding tissue were retrieved for histologic and histomorphometric analysis: fibrous capsule thickness and new vessel formation were measured. Around all implanted materials, light microscopy highlighted a reactive and fibrous capsule formation coupled with ongoing neoangiogenesis both in rats and in rabbits. Histomorphometric measurements revealed a stronger inflammatory response, in terms of capsule thickness, surrounding SSt implants (9.8% Ni content) both in rat subcutis and in rabbit muscle independently of shape and site of implantation. A progressive decrease in capsule thickness around P558 (<0.02% Ni content) and Ti6Al4V, respectively, was seen. Regarding new vessel density, the data showed a different response dependent on the site of implantation. However, in the light of the previous and present studies, P558 is a good material, instead of titanium alloys, in orthopedic research.
Rheotherapy for Vascular Disorders
Authors: Valbonesi M. , Carlier P. , Giannini G. , Ruzzenenti M.R.
Published: January 2018

Patients with vascular disorders are seldom offered apheresis in the management of their symptoms.

In this article we review the different apheretical techniques used in these situations.
Extracorporeal Blood Oxygenation and Ozonation (EBOO): A Controlled Trial in Patients with Peripheral Artery Disease
Authors: Di Paolo N. , Bocci V. , Salvo D.P. , Palasciano F. , Biagioli M. , Meini S. , Galli F. , Ciari I. , Maccari F. , Cappelletti F. , Di Paolo M. , Gaggiotti E.
Published: January 2018

Background

Since 1990 our group has been using extracorporeal circulation to ozonate blood by an original method, known as extracorporeal blood oxygenation and ozonation (EBOO), with the aim of amplifying the results observed with ozone autohemotherapy.

Objective

To verify the hypothesis that EBOO improves the skin lesions typical of peripheral artery disease (PAD) patients.

Methods

Twenty-eight patients with PAD were randomized to receive EBOO or intravenous prostacyclin in a controlled clinical trial. The primary efficacy parameters were regression of skin lesions and pain, and improvement in quality of life and vascularisation.

Results

Patients treated with EBOO showed highly significant regression of skin lesions with respect to patients treated with prostacyclin. Other parameters that were significantly different in the two groups of patients were pain, pruritus, heavy legs and well-being. No significant differences in vascularisation of the lower limbs before and after treatment were found in either group. No side effects or complications were recorded during the 210 EBOO treatments.

Conclusion

EBOO was much more effective than prostacyclin for treating skin lesions in PAD patients and also had a positive effect on patient general condition without any apparent change in arterial circulation. This suggests other mechanisms of action of EBOO.
Modern Strategies in the Prevention of Implant-Associated Infections
Authors: Von Eiff C. , Kohnen W. , Becker K. , Jansen B.
Published: January 2018

The application of medical devices either for temporary or permanent use has become an indispensible part of almost all fields of medicine. However, foreign bodies are associated with a substantial risk of bacterial and fungal infections. Implant-associated infections significantly contribute to the still increasing problem of nosocomial infections.

To reduce the incidence of such infections, specific guidelines providing evidence-based recommendations and comprising both technological and nontechnological strategies for prevention have been established. Strict adherence to hygienic rules during insertion or implantation of the device are aspects of particular importance. Besides such basic and indispensable aspects, the development of new materials which could withstand microbial adherence and colonization has become a major topic in recent years. Modification of surface by primarily physico-chemical methods may lead to a change in specific and unspecific interactions with microorganisms and, thus, to a reduction in microbial adherence. Medical devices made out of a material that would be ideally antiadhesive or at least colonization-resistant would be the most suitable candidates to avoid colonization and subsequent infection. However, it appears impossible to create a surface with an absolute “zero”-adherence due to thermodynamical reasons and due to the fact that a modified material surface is in vivo rapidly covered by plasma and connective tissue proteins. Therefore, another concept for the prevention of implant-associated infections involves the impregnation of devices with various antimicrobial substances such as antibiotics, antiseptics, and/or metals.

In fact, already commercially available materials for clinical use such as antimicrobial catheters have been introduced, in part with considerable impact on subsequent infections. However, future studies are warranted to translate the knowledge on the pathogenesis of device-associated infections into applicable prevention strategies.
Influence of Sub-Inhibitory Concentrations of Antimicrobial Agents on Biofilm Formation in Indwelling Medical Devices
Authors: Henriques M. , Cerca N. , Azeredo J. , Oliveira R.
Published: January 2018

Biofilms of Staphylococcus epidermidis and Candida spp. are two of the most frequent factors of infections associated with the use of indwelling medical devices. Several strategies have been proposed and/or developed to prevent infection. The aim of this study was to compare the effect of sub-inhibitory concentrations of anti-microbial agents on biofilm formation.

Biofilms of three strains of S. epidermidis and two of both Candida albicans and Candida dubliniensis were formed in the presence of three antibiotics and two antifungal agents respectively. Based on the control samples, the percentage of biofilm formation inhibition by the different agents was determined and compared.

The results showed that the influence of the antibacterial and antifungal agents tested is strain dependent, with the effect of the different agents also varying among strains, even though they have the same mechanism of action.
A Comparison of Two Citrate Anticoagulation Regimens for Continuous Veno-Venous Hemofiltration
Authors: Egi M. , Naka T. , Bellomo R. , Cole L. , French C. , Trethewy C. , Wan L. , Langenberg C.C. , Fealy N. , Baldwin I.
Published: January 2018

Aims

To assess the safety and efficacy of two different commercial citrate containing pre-filter replacement fluids during continuous veno-venous hemofiltration (CVVH) in patients with frequent filter clotting. Setting: Four intensive care units. Patients: Sixty-three critically ill patients with acute renal failure (ARF). Design: Prospective observational study.

Methods

We used a commercial citrate fluid (citrate: 11 mmol/L - fluid A) as predilution replacement for CVVH. We then changed to a new commercial citrate fluid (citrate: 14 mmol/L-fluid B) as replacement fluid and performed statistical comparisons. Replacement fluid rate was fixed at 2,000 ml/hour.

Results

Filter life was 12.2 hour with fluid A compared with 17.1 hour with fluid B on average (p=0.0001). Mean post filter ionized calcium concentration was 0.52 mmol/L with fluid A compared with 0.40 mmol/L with fluid B (P&0.0001). Citrate intolerance led to cessation of treatment in one patient with fluid A and one patient with fluid B. Overall ionized calcium levels were higher (A: 1.18 vs B: 1.13 mmol/L; P&0.0001) and bicarbonate was lower (A: 22.4 vs B: 24.5 mmol/L; P&0.0001) during treatment with fluid A. Alkalemia was seen in 10 patients treated with fluid A and 16 patients treated with fluid B (NS).

Conclusions

We have developed a simple approach to regional citrate anticoagulation for CVVH using a commercial citrate-containing fluid as replacement fluid. Increasing citrate concentration from 11 to 14 mmol/L increased filter life while maintaining relative safety and simplicity.
Life-Threatening Complications of Extracorporeal Treatment in Patients with Severe Eosinophilia
Authors: Gwinner W. , Menne J. , Lonnemann G. , Bahlmann F. , Koch K.-M. , Haller H.
Published: January 2018

We report three patients with massive eosinophilia of different etiology who developed bronchoconstriction, hypotension, and shock shortly after dialysis or leukapheresis had been begun. In two cases, ethylene oxide-free materials had been used ruling out an allergic reaction related to this compound. Degranulation of eosinophils with release of eosinophil peroxidase may have caused the observed adverse reactions, as suggested by in vitro experiments with blood from the three patients. Our observations draw attention to the fact that extracorporeal therapies may initiate life-threatening complications in patients with severe eosinophilia.
A Mechanical Model Lung for Hydraulic Testing of Total Liquid Ventilation Circuits
Authors: Bagnoli P. , Vismara R. , Fiore G.B. , Costantino M.L.
Published: January 2018

A new model lung (ML), designed to reproduce the tracheal pressure vs. fluid flow relationship in animals undergoing total liquid ventilation (TLV) trials, was developed to be used as a mock bench test for neonatal TLV circuits.

The ML is based on a linear inertance-resistance-compliance (LRC) lumped-parameter model of the respiratory system with different resistance values for inspiration (Rinsp) or expiration (Rexp). The resistant element was set up using polypropylene hollow fibres packed inside a tube. A passive oneway valve was used to control the resistance cross-section area provided for the liquid to generate different values for Rinsp or Rexp, each adjustable by regulating the active length of the respective fibre pack. The compliant element consists of a cylindrical column reservoir, in which bars of different diameter were inserted to adjust compliance (C). The inertial phenomena occurring in the central airways during TLV were reproduced by specifically dimensioned conduits into which the endotracheal tube connecting the TLV circuit to the ML was inserted. A number of elements with different inertances (L) were used to simulate different sized airways.

A linear pressure drop-to-flow rate relationship was obtained for flow rates up to 5 l/min. The measured C (0.8 to 1.3 mL cmH2O−1 kg−1), Rinsp (90 to 850 cmH2O s l−1), and Rexp (50 to 400 cmH2O s l −1) were in agreement with the literature concerning animals weighing from 1 to 12 kg. Moreover, features observed in data acquired during in vivo TLV sessions, such as pressure oscillations due to fluid inertia in the upper airways, were similarly obtained in vitro thanks to the inertial element in the ML.
Our Nine-Year Experience with the Self-Locating Catheter: Comparison of Malfunction Rate with Other Tenckhoff Catheter Variants
Authors: Lanuza M. , Minguela J.I. , Rodado R. , Muriel J. , Ruiz-De-Gauna R.
Published: January 2018

Objective

To evaluate catheter-related complications among self-locating and other variants of Tenckhoff catheters.

Patients and Methods

We studied all self-locating catheters implanted in our hospitals from May/97 to Dec/05. We extended the follow-up to Jun/05. We collected demographic data, causes of catheter withdrawal and dropping of PD. We studied data about technique and catheter related complications.

Results

We included 328 catheters in 285 patients. There were 258 self-locating, 55 straight and 15 curled. There was a higher rate of catheter withdrawal due to malfunction in patients with straight or pig-tail catheters than in self-locating ones (log-rank, p<0.001).

Conclusion

In our patients, self-locating catheters have a lower malfunction rate than other variants of Tenckhoff catheters.
Effects of High-Volume Continuous Hemofiltration on Experimental Pancreatitis Associated Lung Injury in Pigs
Authors: Yan X.-W. , Li W.-Q. , Wang H. , Zhang Z.-H. , Li N. , Li J.-S.
Published: January 2018

Objective

To investigate the effect of high-volume continuous hemofiltration on experimental pancreatitis associated lung injury (PALI) in pigs.

Methods

Animals had severe acute pancreatitis (SAP) induced by intraductal injection of sodium taurocholate and trypsin and were randomly assigned to three groups: 1) Controls, 2) Low-volume (LV) (20 ml/kg/h) continuous venovenous hemofiltration (CVVH) and 3) High-volume (HV) (100 ml/kg/h) CVVH at the onset of the induction of SAP. Systemic and pulmonary hemodynamic index were monitored intermittently. At the same time, arterial oxygen tension (PaO2), cytokines and activated NF-κB levels of peripheral blood mononuclear cell were measured. After the animals died, the degree of microscopic lung injury was judged and scored.

Results

The median survival times of control, low-volume and high-volume groups were respectively 41 h, 50 h and 65 h. Temperatures in high-volume CVVH group were more steady than in control and LV CVVH groups (p<0.01). MPAP was significantly decreased by 4–5 mmHg in the HV CVVH group after 12 h of treatment. PaO2 was significantly higher in HV group than in LV group at 6 h, 12 h, 24 h and 48 h (p<0.01). HV CVVH resulted in significant reductions not only in interstitial edema and atelectasis but also hemorrhages, hyaline membranes, microthrombi and total lung injury histology score. Plasma cytokines in the high-volume group were significantly lower than in the LV and control groups. In the HV group, the expression of NF-κB activation at 6 h, 12 h and 24 h was lower than in the control and LV groups respectively.

Conclusion

CVVH can reduce pulmonary edema and the severity of PALI in pigs with high-volume CVVH being significantly better than low-volume CVVH. The beneficial effects of CVVH on arterial oxygenation and pulmonary function may be connected with improvements in systemic hemodynamics, reduction in plasma cytokine concentration and decreased activity of NF-κB in peripheral blood mononuclear cells.
Biofilm Formation in Medical Device-Related Infection
Authors: Mack D. , Rohde H. , Harris L.G. , Davies A.P. , Horstkotte M.A. , Knobloch J.K.-M.
Published: January 2018

Medical device-associated infections, most frequently caused by coagulase-negative staphylococci, especially Staphylococcus epidermidis, are of increasing importance in modern medicine. Regularly, antimicrobial therapy fails without removal of the implanted device. The most important factor in the pathogenesis of medical device-associated staphylococcal infections is the formation of adherent, multilayered bacterial biofilms. There is urgent need for an increased understanding of the functional factors involved in biofilm formation, the regulation of their expression, and the interaction of those potential virulence factors in device related infection with the host. Significant progress has been made in recent years which may ultimately lead to new rational approaches for better preventive, therapeutic, and diagnostic measures.
Virulence Factors in Enterococcal Infections of Orthopedic Devices
Authors: Baldassarri L. , Creti R. , Recchia S. , Pataracchia M. , Alfarone G. , Orefici G. , Campoccia D. , Montanaro L. , Arciola C.R.
Published: January 2018

Enterococci are opportunistic pathogens which today represent one of the leading causes of nosocomial infections. We have examined a collection of 52 Enterococcus faecalis isolated from orthopedic infections to determine if they were characterized by a specific pattern of virulence factors. The isolates were evaluated for biofilm formation, presence of genes coding the enterococcal surface protein (esp) and gelatinase (gelE), as well as for gelatinase production. While the rate of esp-positive isolates was comparable to that found among strains from other clinical sources, we found a significantly higher rate of strong biofilm formers and gelatinase producers. Particularly high was the rate of gelE-carrying strains expressing the gene. Data suggest that these two factors in particular may play an important role in enterococcal infections associated with biomaterials.
Microbially-Influenced Corrosion: Damage to Prostheses, Delight for Bacteria
Authors: Beech I.B. , Sunner J.A. , Arciola C.R. , Cristiani P.
Published: January 2018

In natural and man-made environments, microbial communities thrive as biofilms on living (e.g. tissue) and inanimate (e.g. plastic, metal, wood, mineral) surfaces. Biofilms are found in a wide range of aqueous habitats, including physiological fluids. Numerous types of microorganisms are able to colonize catheters, implants, prosthetics, and other medical devices manufactured from different metallic and non-metallic materials dwelling within a human body. The development of biofilm is facilitated by the production of extracellular polymeric substances (EPS).

Biofilms formed on surfaces of metallic materials may alter interfacial electrochemical processes, which can lead to increased corrosion of the colonized substratum. Deterioration of metallic materials in the presence of a biofilm is termed biocorrosion or microbially-influenced corrosion (MIC). In the field of biomaterials, “biocorrosion” is commonly used when describing the effect of host tissue on the corrosion of implant metals and alloys. Therefore, to avoid confusion, we will here use the term MIC as a reference to biofilm-influenced corrosion.

It is important to realise that although most metals are prone to microbial colonization, i.e. to biofouling, this does not imply that they are susceptible to MIC. For example, a metal such as titanium, accumulates biofilm, however, it still demonstrates excellent resistance against MIC.

Corrosion is, by definition, an electrochemical process, therefore, electrochemical techniques are frequently employed to determine and measure the rate of abiotic, as well as biologically driven corrosion reactions. This communication addresses the use of electrochemical techniques for monitoring (i) biofilm formation on and (ii) MIC of implant metals and alloys.
New Surfaces with Hydrophilic/Hydrophobic Characteristics in Relation to (No)Bioadhesion
Authors: Legeay G. , Poncin-Epaillard F. , Arciola C.R.
Published: January 2018

The possibility of biosurfaces with high or low adhesiveness for protein, bacteria or eukaryotic cells is discussed.

At the interface surface object/biological milieu, biocompatibility, (no) bioadhesion and (no) biocontamination are shown to be correlated with physico-chemical surface characteristics. First consequence is the (no) possibility of biofilm formation.

Substrates with low surface energy could interact only with hydrophobic biomolecules. On substrates with high surface energy, a water monolayer spontaneously formed. Modification of a surface by plasma techniques is a way for engineering biomaterials. Plasma techniques are dry processes and more suitable for biomedical applications. In the field of biomaterial medical devices, in hygienic prevention of nosocomial diseases, in food packaging, the use of substrates with a very hydrophilic character may help to prevent the proliferation of cells and bacteria. Such a technique is so efficient that antibiotic molecules are not necessary. Therefore, surface engineering is a tool for modifying and adapting materials to specific biological applications.
Wireless Patient Monitoring System for a Moving-Actuator Type Artificial Heart
Authors: Nam K.W. , Chung J. , Choi S.W. , Sun K. , Min B.G.
Published: January 2018

In this study, we developed a wireless monitoring system for outpatients equipped with a moving-actuator type pulsatile bi-ventricular assist device, AnyHeart™. The developed monitoring system consists of two parts; a Bluetooth-based short-distance self-monitoring system that can monitor and control the operating status of a VAD using a Bluetooth-embedded personal digital assistant or a personal computer within a distance of 10 meters, and a cellular network-based remote monitoring system that can continuously monitor and control the operating status of AnyHeart™ at any location.

Results of in vitro experiments demonstrate the developed system's ability to monitor the operational status of an implanted AnyHeart™.
Prognostic Implications of Plasma Myoglobin Levels in Patients with Chronic Kidney Disease
Authors: Lenglet Aurélie , Liabeuf Sophie , Desjardins Lucie , Neirynck Nathalie , Glorieux Griet , Lemke Horst-Dieter , Vanholder Raymond , Brazier Michel , Choukroun Gabriel , Massy Ziad A.
Published: January 2018

Purpose

Poor cardiovascular outcomes in chronic kidney disease (CKD) patients have prompted nephrologists to look for biomarkers that may improve risk stratification in this population. The objective of this study was to evaluate plasma myoglobin (Mb) levels according to the CKD stage and to determine whether they are associated with overall, cardiovascular (CV) mortality, CV events, and renal outcomes.

Methods

Plasma Mb levels were determined in 140 CKD patients at different stage (mean ± SD age: 67 ± 12; males: 61%) who were prospectively monitored for overall and CV mortality, CV events and CKD progression. Twenty-seven healthy subjects served as controls.

Results

Plasma Mb levels were higher in CKD patients than in controls and progressively increased as the glomerular filtration rate fell. Hemoglobin levels, CKD stage, the aortic calcification score and brain natriuretic peptide levels were associated with plasma Mb concentrations. In a multivariate analysis, only CKD stage was associated with Mb levels. During follow up (mean duration: 968 ± 374 days), 44 patients died and 63 had a cardiovascular event. In a crude analysis, plasma Mb >73.8 μg/l predicted overall and cardiovascular mortality and the occurrence of cardiovascular events (p = 0.01, 0.05 and 0.01, respectively). However, this association was lost after adjustment for other prognostic factors for mortality. Plasma Mb was not a significant predictor of the progression of CKD either.

Conclusions

Plasma Mb levels were significantly higher in predialysis or dialyzed CKD patients than in healthy controls. However, we could not identify a relevant clinical outcome associated with this elevation. Larger studies are needed to confirm the present results.
The Prevalence of Persistent Intradialytic Hypertension in a Hemodialysis Population with Extended Follow-Up
Authors: Van Buren Peter N. , Kim Catherine , Toto Robert D. , Inrig Jula K.
Published: January 2018

Background

Intradialytic hypertension, a phenomenon where blood pressure increases during hemodialysis, is associated with increased mortality in hemodialysis patients. The proportion of patients in which intradialytic hypertension persists over time is unknown.

Methods

In a retrospective cohort study, we studied all patients from our outpatient hemodialysis units that received ≥1 month of treatments during the period from January to August 2010. We reviewed all pre- and post-hemodialysis blood pressure and weight measurements from 22,955 treatments during this study period. We defined intradialytic hypertension as an increase in systolic blood pressure ≥10 mmHg from pre- to post-hemodialysis. Individual patients were defined as having persistent intradialytic hypertension if the change in blood pressure from pre- to post-hemodialysis, when averaged throughout the study period, was ≥+10 mmHg. We calculated weight changes between and during hemodialysis and defined ultrafiltration rate per treatment as ultrafiltration volume divided by minutes on hemodialysis. We compared patients with and without persistent intradialytic hypertension using chi-square analysis and mixed linear models.

Results

The prevalence of intradialytic hypertension was 21.3 per 100 treatments. The median percentage of intradialytic hypertension treatments per patient was 17.8% (9–31.3%, interquartile range). The prevalence of persistent intradialytic hypertension was 8 per 100 patients. Patients with persistent intradialytic hypertension had lower ultrafiltration rate compared to other patients (10.4 vs. 12.2 ml/min, p = 0.02).

Conclusions

Intradialytic hypertension is a persistent phenomenon in a subset of hemodialysis patients. Ultrafiltration rate was the only volume-related variable that differed between patients with and without persistent intradialytic hypertension.
‘I see what you mean’
Authors: Reid Anna , Koglbauer René
Published: January 2018

This article reports on the use of a visual methods approach to collecting and analysing data in relation to the area of leadership curriculum development. The focus of the study is the structure of the current leadership curriculum for the National Professional Qualifications (NPQs) in England. In particular, the authors explore the extent to which a visual method of data collection enhances their understanding of underlying structures of the NPQs, and the extent to which they can adopt findings from the study to influence the planning and preparation of future programmes. Participants in the study volunteered to attend an international conference workshop on leadership, management and administration. This was the forum for data collection. Purposive sampling ensured a prior knowledge of the theoretical framework underpinning our work and objectivity in that none of the participants were involved in the delivery of NPQ programmes in England. Findings suggest that the current NPQ programme structure lacks the flexibility required in order to provide a meaningful professional development experience. In relation to the theoretical underpinnings of this study, findings also highlight areas to be addressed when undertaking new NPQ programme development and delivery.
Using Sherman–Morrison theory to remove the coupled effects of multi-transducers in vibration test
Authors: Zhu Rui , Fei Qingguo , Jiang Dong , Hang Xiaochen
Published: January 2018

Modal parameter identification is adversely affected by the mass loading of the transducer in experiments, especially when multi-transducers are arranged on the lightweight structure. In order to remove the coupling effects of transducers on each measurement point, a hierarchical multi-transducers eliminations method based on Sherman–Morrison theory is investigated. The method consists of two steps: (1) Decomposition: multiple elimination is decomposed into multi-levels, the relationship of the frequency response functions between each level is illustrated in the tree diagram; (2) Elimination: according to the relationship between each level, the measured frequency response functions are modified level by level. Numerical simulation is conducted by employing a three-degrees-of-freedom spring-mass system and the robustness is verified in the noise case. Experimental investigations are undertaken by employing a lightweight cantilever beam: Laser Doppler vibrometer is adopted to obtain measured frequency response functions without transducer mass loading effect, which are regarded as the target data. The initial frequency response functions are obtained in the case, in which multi-accelerometers are arranged and the effects should be removed. The result shows that the method can effectively decouple the frequency response functions due to transducers. In the elimination process, it is necessary to delete duplicate information (frequency response functions), which can greatly reduce the amount of calculation. And the effects of multi-transducers mass can be removed and the corrected frequency response functions are in quite good agreement with the target values.
A brain impact stress analysis using advanced discretization meshless techniques
Authors: Marques Marco , Belinha Jorge , Dinis Lúcia Maria JS , Natal Jorge Renato
Published: January 2018

This work has the objective to compare the mechanical behaviour of a brain impact using an alternative numerical meshless technique. Thus, a discrete geometrical model of a brain was constructed using medical images. This technique allows to achieve a discretization with realistic geometry, allowing to define locally the mechanical properties according to the medical images colour scale. After defining the discrete geometrical model of the brain, the essential and natural boundary conditions were imposed to reproduce a sudden impact force. The analysis was performed using the finite element analysis and the radial point interpolation method, an advanced discretization technique. The results of both techniques are compared. When compared with the finite element analysis, it was verified that meshless methods possess a higher convergence rate and that they are capable of producing smoother variable fields.
Comparative experimental investigation of preheated thumba oil for its performance testing on a CI engine
Authors: Kumar Shashi , Yadav Apurv
Published: January 2018

Petroleum-based fuels are continuously depleting and will vanish in the coming years. Among the biomass sources, vegetable oils and animal fats have attracted much attention as a potential renewable resource for production of an alternative for petroleum-based diesel fuel. In the present work, preheated thumba oil is used to prepare three different concentration blends with diesel, B20, B40, and B60 to run a single cylinder CI engine. The results of the engine parameters when blends are used as a fuel are compared to the results with pure diesel. The brake thermal efficiency of B20 blend was found to be higher than diesel and other blends. Brake-specific fuel consumption and brake-specific energy consumption of B20 were less than other blends but slightly more than diesel. By combining the effect of all the parameters, B20 blend was found to be a suitable alternative for diesel fuel.
Seeking the gravediggers of capitalism in China
Authors: Cao Shixiong , Yu Zhongqi
Published: January 2018

More than 150 years ago, Marx predicted that the working class would become “the gravedigger of capitalism,” a seemingly prescient prediction as socialism flourished between the two World Wars. However, traditional capitalist countries are thriving, while many socialist countries have collapsed during the past quarter-century. Nonetheless, capitalism is revealing its flaws both in the developed world (e.g. recent financial crises) and in rapidly developing countries (e.g. ecological damage), leading to social unrest that is making Marx’s prediction relevant once more. Considering this situation from a broader historical perspective suggests that new social groups often evolve to fill niches left open by more traditional groups and can support the evolution of new social systems during the establishment of new industries, technologies, and institutions. Thus, they play a crucial role in initiating and guiding fundamental institutional change. Although capitalism has been surprisingly long-lived by historical standards for such systems, new systems may be evolving to push it aside. China’s rapid socioeconomic changes in recent decades provide an opportunity to watch new social groups emerge and begin to play an important role in changing social institutions. The institutional diversity created and sustained by these groups may be important for humanity’s long-term survival.
Clinical validation of nuclear factor kappa B expression in invasive breast cancer
Authors: Agrawal Anil Kumar , Pielka Ewa , Lipinski Artur , Jelen Michal , Kielan Wojciech , Agrawal Siddarth
Published: January 2018

Breast cancer is the most commonly diagnosed cancer in Polish women. The expression of transcription nuclear factor kappa B, a key inducer of inflammatory response promoting carcinogenesis and cancer progression in breast cancer, is not well-established. We assessed the nuclear factor kappa B expression in a total of 119 invasive breast carcinomas and 25 healthy control samples and correlated this expression pattern with several clinical and pathologic parameters including histologic type and grade, tumor size, lymph node status, estrogen receptor status, and progesterone receptor status. The data used for the analysis were derived from medical records. An immunohistochemical analysis of nuclear factor kappa B, estrogen receptor, and progesterone receptor was carried out and evaluation of stainings was performed. The expression of nuclear factor kappa B was significantly higher than that in the corresponding healthy control samples. No statistical difference was demonstrated in nuclear factor kappa B expression in relation to age, menopausal status, lymph node status, tumor size and location, grade and histologic type of tumor, and hormonal status (estrogen receptor and progesterone receptor). Nuclear factor kappa B is significantly overexpressed in invasive breast cancer tissues. Although nuclear factor kappa B status does not correlate with clinicopathological findings, it might provide important additional information on prognosis and become a promising object for targeted therapy.
Making two plus two equal five
Authors: Sharp Anne
Published: January 2018

This paper examines ways in which internal data can be used in the evaluation research through data matching. It illustrates this through two case studies involving a three-year longitudinal and a cross-sectional evaluation of two large-scale Australian assistance programs. Discussion centres around ways in which internal data were used to assist the interview process, identify areas where ‘claimed’ (what the respondent says) and ‘actual’ (what the internal data show) data differ, and identify non-response issues.

The paper also examines how internal data can be used as an intermediate platform against which the results of two independent surveys can be reconciled. This is useful as many surveys do not use the same measurement scales or cover the same topics. The use of internal data can provide some commonality between the two, again adding value in the overall evaluation process and allowing the organisation to better utilise existing data.
Corporate governance in the wake of contemporary corporate collapses: Some agenda items for evaluators
Authors: Sarre Rick
Published: January 2018

The number and scope of corporate collapses in recent times clearly illustrate that corporate accountability practices are failing to match the rhetoric of managers responsible for business probity. The malaise has continued even though regulatory enforcement is empowered by federal and state law and enforced by criminal penalties and civil sanctions. Research is now revealing that regulatory creativity may offer considerable potential for bringing about good corporate governance. New regulatory options are thus becoming increasingly sought after, especially given the inefficiencies of the current legal frameworks and the inadequacies of the traditional official line which suggests that the best response to malfeasance is (simply) more law. This paper reviews some current research agendas and evaluative findings. It sets out some evaluative questions that now need to be explored.
Development of program evaluation in Australia and the Australasian Evaluation Society – the early decades
Authors: Sharp Colin A.
Published: January 2018

The year 2003 marks the 21st year of the series of National Evaluation Conferences (NECs) and international conferences, as well as the sixteenth year of the AES. This paper is not intended as a full history, nor as a dossier of the AES per se; that is for another time and place. Rather, it seeks both to reflect on whether there is a distinctive flavour of public sector program evaluation in the antipodes, and to give an overview of how evaluation developed in Australia, and to a lesser extent New Zealand. This will require the opening up and examination of the historical roots of program evaluation in Australia and of some aspects of current practice.
‘A Balancing Act’: Resolving Multiple Stakeholder Interests in Program Evaluation
Authors: Markiewicz Anne
Published: January 2018

Attempting to balance multiple stakeholder interests in program evaluation presents many challenges. The views of different stakeholders as part of a reference group, or multiple stakeholder voices within a sector, are often diverse and reflect different political and organisational interests. In order to ensure that the evaluation product is widely accepted, and thereby utilised, these differences need to be recognised, and mediated.

To work effectively with multiple stakeholders in this manner, the evaluator requires well developed negotiation skills. This paper argues that negotiation is an essential component to the planning stage of an evaluation, and that strategic steps need to be taken early in the evaluation process to ensure consensus is developed in stakeholder expectations regarding methodology and outcomes from the evaluation.

This article will put forward a number of negotiation principles for evaluation practice which view the evaluator as enabling stakeholders to appreciate all positions, including that of the evaluator, with consensus emerging from increased understanding and consciousness raising.
Evaluation for management and development
Authors: Bost Jeff
Published: January 2018

This article examines an evaluation currently being undertaken in Papua New Guinea. The evaluation is designed to assist an organisation (comprising a donor agency, a recipient government department and a managing contractor) with the management and further development of an aid program set in the education sector.

The challenge facing the organisation has been how to devise and implement a comprehensive managerial approach that will enable improvement of the existing program, the subsequent design of a new program and, at the same time, support a third objective of creating an ongoing culture of evaluation.

In responding to that challenge the organisation has committed to the use of structured evaluation processes. Specifi cally, it has decided to implement a range of ‘front end’ evaluative approaches-developmental, evaluability assessment and program logic-drawn from the interactive and clarifi cative forms presented in Owen's (1999) conceptual framework.

The article outlines the interventions that have been undertaken and assesses progress to date. Examples of completed activities are outlined and some innovative monitoring evaluative tools are introduced, such as the ‘capacity scale’ and the monitoring and evaluation (M&E) template. The paper concludes with some thoughts on the role of evaluation for management and development for achieving continuous improvement.
Reconciling tensions between principles and practice in Indigenous evaluation
Authors: Scougall John
Published: January 2018

The expectations placed on an evaluator working in an Indigenous context are often great. The ideal is someone in close relationship with the community, employing culturally sensitive methods, fostering broad community involvement, transferring evaluation skills and contributing to a process of empowerment and positive social change. The hard reality is that evaluators are most often outsiders with limited resources and precious little time to spend in the field. By ‘outsider’ I mean someone not of the people, culture and place. They are typically short on contextual understandings and need to work across many project sites. This precludes the possibility of any real bonding with the participants. Furthermore, outsiders often struggle to ‘hear’ correctly and to elicit meaningful information from Indigenous people due to cultural barriers and poor rapport. Perhaps only a handful of locals will choose to become more than peripherally involved in an evaluation. These are major impediments that give rise to very real tensions between evaluation principles and practice. This paper reflects on these tensions in the context of the national evaluation of the Australian Government's Stronger Families and Communities Strategy (‘the Strategy’).