bluuebunny/crossref_metadata_2025 huggingface dataset:
Vehicle Locking System Using an Electronic Breathalyzer and Notification by Mobile Communication
Authors: Brito Geovanni , Salazar Franklin W. , Lema Edwin O. , Sánchez Andrea P. , Pérez Hugo Vinicio , Buele Jorge
Published: February 2020

This paper presents the implementation of a prototype to lock/unlock the vehicle ignition system. It involves the adaptation of an opto-isolated relay, which has been equipped with a wireless interface of the MQTT protocol. The relay activation is controlled by an embedded board Raspberry
Pi 3; it acts as the main unit of the proposed system. The executed control actions are given depending on the information received by radiofrequency from an implemented electronic breathalyzer. This device evaluates the alcohol level and humidity in the driver’s breath using the MQ-3
and DHT11 sensors. In addition, a mobile communication platform compatible with Android smartphones is provided to inform the enabling/disabling of the vehicle’s ignition system, its geographical location by GPS coordinates and a front facial photograph of the driver. All these features
are incorporated by a wireless local network (WiFi) for the elements that make up the prototype. This work also presents the transmission of information to mobile terminals compatible with the Telegram instant messaging system through the UMTS network. In order to validate this proposal, the
corresponding tests are carried out and their comparison with a commercial device.
Voice Conversion System Based on Deep Neural Networks
Authors: Naveena V. , Vekkot Susmitha , Jeeva Priya K.
Published: February 2020

The paper focuses on usage of deep neural networks for converting a person’s voice to another person’s voice, analogous to a mimic. The work in this paper introduces the concept of neural networks and deploys multi-layer deep neural networks for building a framework for
voice conversion. The spectral Mel-Frequency Cepstral Coefficients (MFCCs) are converted using a 10-layer deep network while fundamental frequency (F0) conversion is accomplished by logarithmic Gaussian normalized transformation. MFCCs are subjected to inverse cepstral filtering
while changes in F0 are incorporated using Pitch Synchronous OverLap Add (PSOLA) algorithm for re-synthesis. The results obtained are compared using Mel Cepstral Distortion (MCD) for objective evaluation while ABX-listening test is conducted for subjective assessment. Maximum
improvement in MCD of 13.87% is obtained for female-to-male conversion while ABX-listening test indicates that female-to-male is closest to target with an agreement of 76.2%. The method achieves reasonably good performance compared to state-of-the-art using optimal resources and avoids requirement
of highly complex computations.
Analysis of Regional Palliative Care Strategies: Do Health Policies Influence the Development of Assistance Coverage?
Authors: Sánchez-Gutiérrez María Elena , Sanz Rubiales Álvaro , Flores Pérez Luis Alberto , Del-Valle Rivero María Luisa , Simó-Martínez Rosa María
Published: February 2020

In Spain, health competencies are decentralized, and each autonomous community implements its own plans. Our aim is to determine if the existence of regional palliative care plans implies an improvement in health care coverage. We reviewed regional palliative care plans published in Spain and analyzed the following variables: number and profile of palliative care resources, guidelines and objectives of implementation of resources of these plans, and compliance with European standards. The publication of regional plans is associated with an increase in specific resources in the following years. From 2004 to 2009, the implementation of plans in 6 autonomous communities was associated with an increase in palliative care resources compared to those without a strategy (odds ratio: 1.58, P = .02) or with a settled plan (odds ratio: 1.40, P = .07). The same phenomenon was observed between 2009 and 2015 in 4 autonomous communities and 2 autonomous cities compared with those without a strategy (odds ratio: 2.49, P = .001) and those that implemented a plan before 2009 (odds ratio: 2.62, P < .001). Updating and evaluating these regional plans are also associated with the growth of palliative care resources.
Notched tensile response and damage mechanism of the GLARE laminate
Authors: Xie Botao , Gao Liang , Jiang Shuai , Zhang Shangda , Wu Chen , Ran Xu
Published: February 2020

Glass laminate aluminum reinforced epoxy, as an attractive material for advanced aerospace applications, is most likely to face the challenge of various blunt notched damages. In this paper, the tensile tests of the glass laminate aluminum reinforced epoxy with circular and square blunt notches are conducted. The effects of notch geometry, such as notch diameter, notch corner radius, and off-axis angle, on the laminated tensile behaviors of glass laminate aluminum reinforced epoxy laminate are explored. A characteristic distance function representing the damage-affected region of notch is empirically constructed to predict the residual strength of the circular notched glass laminate aluminum reinforced epoxy based on a modified point stress criterion. For the square notched laminate, the strength is almost equal to that of the laminate with its circumscribed circle notch. Furthermore, the variation of two fracture patterns observed with the notch geometry is studied, and the evolution of the interlaminar delamination damage is analyzed after the metal chemical removal.
A Study of the Effectiveness of Blended Learning Program for Enhancing Entrepreneurial Skills Among Women in Maharashtra
Authors: Tupe Navnath
Published: February 2020

The article emphasizes the effects of blended learning program for enhancing entrepreneurial skills among women in Maharashtra with special reference to Pune district. The present study results in the creation of the entrepreneurial skill matrix that explores the necessary skills for creative entrepreneurs. Performing the entrepreneurial skill assessment is an extremely important and foremost a step of the instructional design. A significant difference was observed in posttest and pretest scores of women students, which seemingly shows that the experimental group has increased the level of entrepreneurial skills reasonably much more in posttest compared with pretest because of blended learning interventions.
mHealth Apps for Older Adults: A Method for Development and User Experience Design Evaluation
Authors: Kirkscey Russell
Published: February 2020

This study details a method for mHealth app development and user experience design (UX) evaluation, which generates a comprehensive list of stakeholder-users, acknowledges UX barriers, advocates multiple methods, and argues that developers should address the UX needs of each stakeholder-user in a complex health-care system. A case study of a research project on an mHealth app for women who are considering prevention of or treatment for osteoporosis assists to elaborate and define the method. To find any measure of success, a fully functional app for older users should be integrated into the entire health-care system.
Complications After Distal Biceps Tendon Repair: A Systematic Review
Authors: Amarasooriya Melanie , Bain Gregory Ian , Roper Tom , Bryant Kimberley , Iqbal Karim , Phadnis Joideep
Published: February 2020

Background:

Distal biceps tendon injuries typically occur in the dominant arm of men in their fourth decade of life. Surgical repair restores flexion and supination strength, resulting in good functional outcome. The complication profile of each surgical approach and fixation technique has not been widely studied in the literature.

Purpose:

To report the rate of complications after repair of complete distal biceps ruptures, to classify them according to surgical approach and fixation technique, and to analyze risk factors and outcomes of the individual complications.

Study Design:

Systematic review.

Methods:

Studies published in English on primary repair of the distal biceps between January 1998 and January 2019 were identified. Data on complications were extracted and classified as major and minor for analysis. A quantitative synthesis of data was done to compare the complication rates between (1) limited anterior incision, extensile anterior incision, and double incision and (2) 4 fixation methods.

Results:

Seventy-two articles including 3091 primary distal biceps repairs were identified. The overall complication rate was 25% (n = 774). The major complication rate was 4.6% (n = 144) and included a 1.6% (n = 51) rate of posterior interosseous nerve injury; 0.3% (n = 10), median nerve injury; 1.4% (n = 43), rerupture; and a 0.1% (n = 4), synostosis. Brachial artery injury, ulnar nerve injury, compartment syndrome, proximal radius fracture, and chronic regional pain syndrome occurred at a rate of <0.1% each. The majority of nerve injuries resolved with an expectant approach. The minor complication rate was 20.4% (n = 630). The most common complication was lateral cutaneous nerve injury (9.2%, n = 283). An extensile single incision was associated with a higher rate of superficial radial nerve injury when compared to limited single incision(6% vs 2.1%, P = .002). Limited anterior single incision technique had a higher rate of lateral antebrachial cutaneous nerve injury compared to extensile single incision. (9.7% vs 5.2%, P = .03). Synostosis occurred only with double incision. Fixation technique had no significant effect on rerupture rate and posterior interosseous nerve injury rate.

Conclusion:

This is the largest analysis of complications after distal biceps repair, indicating a major complication rate of 4.6%. This study provides valuable data with regard to the choice of technique, surgical approach, and rate of complications, which is essential for surgical planning and patient consent.

Registration:

CRD42017074066 (PROSPERO).
Thrombin Suppresses Matrix Metalloproteinase 2 Activity and Increases Tissue Inhibitor of Metalloproteinase 1 Synthesis in Cultured Human Peritoneal Mesothelial Cells
Authors: Haslinger Bettina , Mandl–Weber Sonja , Sitter Thomas
Published: February 2020

Objective

Recently, high levels of intraperitoneally generated thrombin were found in the effluent of patients treated with continuous ambulatory peritoneal dialysis (CAPD). The aim of the present study was to investigate in human peritoneal mesothelial cells (HMCs) the effect of thrombin on the activity and synthesis of matrix metalloproteinases (MMPs), which regulate the degradation of basement membrane collagen.

Methods

Cultured HMCs were isolated from omental tissue and used at confluence for the experiments. Conditioned media were obtained by incubating cells with serum-free M199 containing the relevant doses of thrombin. Activity of MMP-2 and MMP-9 were determined by an activity assay system. The antigen levels of MMPs and of the specific tissue inhibitor of metalloproteinases 1 (TIMP-1) were measured by ELISA. Northern blot analysis was applied to analyze mRNA expression of MMP-2 and TIMP-1.

Results

Incubation of HMCs with increasing doses of thrombin resulted in a concentration- and time-dependent suppression of MMP-2 activity. No changes in MMP-9 activity were seen. After a 48-hour stimulation period with thrombin (5 U/mL), MMP-2 activity decreased to 53% of that seen in control conditions. Antigen measurements revealed that this decrease was paralleled by a slight reduction in MMP-2 levels, which became significant at a thrombin dose of 5 U/mL [50.65 ± 7.5 ng/105 cells (48 hours, 5 U/mL) vs 64.6 ± 10.1 ng/105 cells (control)]. Under the same conditions, TIMP-1 levels were considerably increased [3.9 ± 0.46 μg/105 cells (48 hours, 5 U/mL) vs 1.2 ± 0.14 μg/105 cells (control)]. Hirudin (10 U/mL) completely inhibited the thrombin-induced effects on MMP-2 and TIMP-1 synthesis. These results were also reflected by Northern blot hybridization, where a slight decrease in MMP-2 and an increase in TIMP-1 mRNA expression were observed in response to thrombin.

Conclusions

Our results suggest that high thrombin levels suppress MMP-2 activity through decreased MMP-2 and increased TIMP-1 synthesis. Thus, thrombin may promote the accumulation of basement membrane collagen. In addition to fibrin formation, this mechanism may represent a further contribution by thrombin to peritoneal thickening during CAPD.
Emodin Ameliorates Glucose-Induced Morphologic Abnormalities and Synthesis of Transforming Growth Factor β1 and Fibronectin by Human Peritoneal Mesothelial Cells
Authors: Yung Susan , Liu Zhi-Hong , Lai Kar-Neng , Li Lei-Shi , Chan Tak-Mao
Published: February 2020

♦ Objective

Excessive synthesis and deposition of matrix proteins by peritoneal mesothelial cells can lead to structural and functional changes in the peritoneal membrane, jeopardizing the long-term efficacy of peritoneal dialysis (PD). Prolonged exposure to high glucose concentrations in PD fluid has been implicated as a major stimulus to matrix accumulation, through the induction of transforming growth factor β1 (TGFβ 1). This study investigated the effect of emodin (3-methyl-1,6,8-trihydroxyanthraquinone) on TGFβ 1 and fibronectin (FN) synthesis in human peritoneal mesothelial cells (HPMCs) under high glucose concentration.

♦ Design

The HPMCs were preconditioned in either 5 mmol/L or 30 mmol/L d-glucose for 2 weeks prior to the addition of emodin. Cell viability was assessed by MTT assay and lactate dehydrogenase (LDH) release. Morphology of HPMCs was studied by phase-contrast microscopy. Modulation of TGFβ 1 and FN synthesis at transcription and translation were investigated by reverse transcriptase polymerase chain reaction (RT-PCR), ELISA, and Western blot analysis.

♦ Results

When cultured under 30 mmol/L d-glucose, HPMCs demonstrated increased cell volume, multi-nucleation, and denudation of the monolayer, as compared with cells cultured under a physiologic (5 mmol/L) glucose concentration. High glucose concentration induced TGFβ 1 synthesis by HPMCs (217.17 ± 14.88 pg/mL at 5 mmol/L d-glucose vs 370.33 ± 20.67 pg/mL at 30 mmol/L d-glucose, p < 0.0001), and FN synthesis was induced at transcription and translation. Mannitol at 30 mmol/L did not affect HPMC morphology; matrix synthesis was also unaltered. Administration of emodin together with 30 mmol/L d-glucose resulted in amelioration of cell enlargement and exfoliation, and abrogation of TGFβ 1 induction (370.33 ± 20.67 pg/mL for 30 mmol/L d-glucose alone vs 260.50 ± 17.89 pg/mL for 30 mmol/L d-glucose + emodin, p < 0.0001). Synthesis of FN induced by high glucose was also reduced by 40% in the presence of emodin.

♦ Conclusions

These findings provide the first evidence that emodin can ameliorate high glucose–induced matrix synthesis in HPMCs by suppression of TGFβ 1. Emodin may thus be useful in preserving peritoneal integrity in PD.
Bisphosphonates in Dialysis and Transplantation Patients: Efficacy and Safety Issues
Authors: Rodd Celia
Published: February 2020

Bisphosphonates are an old class of compounds. They were used in the 1930s as antiscaling and anticorrosion agents in washing powders and water to prevent the deposition of calcium crystals. Those basic functions were later utilized in an attempt to prevent ectopic calcifications in humans. The early studies demonstrated that bisphosphonates had a strong affinity for bone. That property was first exploited when the compounds were used for “bone scans.”

Currently, the drugs are used for treatment of hypercalcemic conditions, abnormal bone remodelling, Paget disease, malignancy, and osteoporosis. Bisphosphonates have several important toxicities: acute renal failure, worsening renal function, reduced bone mineralization, and osteomalacia. For those reasons and others, this class of drugs has not yet been approved for use in children or in patients with severe renal insufficiency.

The present review covers several aspects of bisphosphonates: molecular structure, routes of administration, pharmacology, mechanisms of action, toxicities, and exceptional uses in children with renal disease.
Accumulation of Omental Mast Cells during Peritoneal Dialysis
Authors: Zareie Mohammad , Hekking Liesbeth H.P. , Driesprong Bas A.J. , Ter Wee Piet M. , Beelen Robert H.J. , van den Born Jacob
Published: February 2020

Objective

New vessel formation has been reported in various tissues during peritoneal dialysis (PD). In that line, mast cells can produce factors such as tryptase, chymase, or basic fibroblast growth factor that might contribute to the formation of new vessels. In the present study, the association of mast cells with neovascularization during PD was investigated.

Methods

Rats received daily 10 mL infusions of conventional 3.86% glucose-containing PD fluid over a 10-week period. The infusions were delivered through a subcutaneously implanted mini access port that was connected by catheter to the peritoneal cavity. Untreated rats served as a control group. The number of blood vessels and of mast cells in the omentum were counted. Also, the number of peritoneal mast cells was determined.

Results

Chronic exposure to PD fluid resulted in an increased number of mast cells in the omentum. However, no clear correlation was found between the elevated number of omental blood vessels and the number of mast cells in the omentum or in the peritoneal cavity.

Conclusions

Omental mast cells accumulated dramatically upon exposure to PD fluid. The actual role of accumulated omental mast cells in the induction of angiogenesis during PD should, however, be further investigated.
Expression of Aquaporin-1 in the Peritoneal Tissues: Localization and Regulation by Hyperosmolality
Authors: Ota Tomoko , Kuwahara Michio , Fan Shuling , Terada Yoshio , Akiba Takashi , Sasaki Sei , Marumo Fumiaki
Published: February 2020

Objective

The purpose of this study was to determine the localization of the aquaporin-1 (AQP1) water channel in peritoneal tissues and the effect of hyperosmolality on the peritoneal expression and function of AQP1.

Methods

Immunohistochemical localization of AQP1 was identified in rat peritoneal tissues. Cultured rat peritoneal mesothelial cells (RPMCs) were exposed to hyperosmolality by adding 4% glucose to the culture medium. After 1 hour, 4 hours, 24 hours, and 48 hours, AQP1 was identified by semiquantitative immunoblot and immunocytochemistry. Osmotic water permeability was measured using a light-scattering method.

Results

Immunohistochemistry of rat peritoneal tissues showed the presence of AQP1 in mesothelial cells, venular endothelial cells, and capillary endothelial cells, but not in arteriole and interstitial cells. Semiquantitative immunoblot revealed that exposure to hyperosmolality significantly increased AQP1 expression after 24 hours in whole RPMC lysates (3.3-fold at 24 hours and 3.9-fold at 48 hours). Consistent with the immunoblot, osmotic water permeability of RPMC was augmented 1.7-fold and 2.7-fold after 1 hour and 24 hours, respectively, in a hyperosmotic environment. In RPMC membrane fractions, AQP1 expression was significantly increased after 1 hour of exposure to hyperosmolality (3.9-fold at 1 hour, 7.1-fold at 4 hours, and 8.7-fold at 24 hours). Immunocytochemistry of RPMCs showed that AQP1 was gradually redistributed from the perinuclear area to the peripheral cytoplasm, and then to the plasma membrane after a 1-hour hyperosmotic challenge, suggesting hyperosmolality-induced translocation of AQP1. Upregulation of AQP1 was also observed in the omentum of rats loaded intraperitoneally with hyperosmotic dialysate every day for 10 weeks.

Conclusion

AQP1 is widely distributed in the peritoneal cavity and may provide the major aqueous pathway across the peritoneal barrier. In addition, our findings suggested that hyperosmolality increases AQP1-dependent water permeability in peritoneal tissues by regulating the translocation and synthesis of AQP1 protein.
Semipermeability Imparted by Surface-Active Phospholipid in Peritoneal Dialysis
Authors: Chen Yi , Burke John R. , Hills Brian A.
Published: February 2020

Objective

It has previously been demonstrated that a lining of surface-active phospholipid (SAPL) is reversibly bound (adsorbed) to normal peritoneal mesothelium. The lining acts as a boundary lubricant and release (anti-stick) agent preserving mechanical integrity of the epithelial surface. In a review of clinical trials on the use of SAPL (akin to “surfactant”) to restore ultrafiltration (UF) in patients on peritoneal dialysis (PD), speculation is that, by adsorption, the SAPL lining might also be imparting the semipermeability vital for UF.

Design

To evaluate the hypothesis, SAPL harvested from the spent dialysate of 5 patients with normal UF was deposited onto a porous, inert medium, and the resulting 7 “membranes” were clamped in an Ussing chamber used as an osmometer.

Results

With every “membrane,” a clinical concentration of glucose (2.5%) was able to induce a statistically significant osmotic pressure when dialyzed against saline. We also demonstrated how synthetic SAPL—in the form of dipalmitoyl phosphatidylcholine (DPPC) and an admixture of DPPC with phosphatidylglycerol (PG) called artificial lung-expanding compound (ALEC)—imparts greater osmotic pressure in proportion to an increasing glucose gradient. Our findings prove that human peritoneal SAPL has the physical capability to impart semipermeability when adsorbed to a surface.

Comment

As a lipid lining, adsorbed SAPL could also explain the high permeability of the natural membrane to lipophilic substances in PD. Administered as a very fine powder or as a solution in a lipid solvent, ALEC offers a potential treatment for restoring UF, if applied during the interdialytic interval. In various physical forms, ALEC and DPPC have both been widely used for two decades with complete safety in the treatment of respiratory distress syndrome in newborns. The question of formulation of exogenous SAPL in restoring UF is discussed as a complex physicochemical compromise between the higher surface activity of saturated phosphatidylcholine and its lower solubility in water.
Association of Anion Gap with Thyroid Dysfunction and Nodular Goiter in Capd Patients
Authors: Lin Chih Ching , Yang Wu Chang , Ng Yee Yung , Chou Yi Hong , Tarng Der Cherng , Chen Tzen Wen
Published: February 2020

Objective

To investigate the association of clinical parameters and serum anion gap with thyroid dysfunction and nodular goiter in continuous ambulatory peritoneal dialysis (CAPD) patients.

Design

Cross-sectional study.

Setting

Single dialysis unit and outpatient clinic.

Patients

This study included 89 uremic patients on CAPD. Gender ratio was 50 males to 39 females (M/F = 1.28); mean age was 54.8 years.

Main Outcome Measures

We investigated the prevalence of nodular goiter and thyroid dysfunction with a 10-MHz high-frequency ultrasound scanner and immunoassay kits.

Results

Nodular goiter was detected in 52.8% (47/89) of the CAPD patients. Patients with nodular goiter were older than those without goiter (57.7 vs 51.5 years, p < 0.05). Nodular goiter was found more frequently in females than in males (66.7% vs 44.0%, p < 0.05). Patients with nodular goiter had longer duration of CAPD than patients without goiter (51.6 ± 42.9 vs 31.0 ± 28.1 months, p < 0.02). In addition, CAPD patients with goiter had a higher serum anion gap (AG) (16.8 ± 3.3 vs 14.0 ± 4.5 mEq/L, p < 0.02) and a lower weekly creatinine clearance (55.9 ± 12.6 vs 64.6 ± 21.1 L/week/1.73 m2, p < 0.05) than patients without goiter. As serum AG gradually increased, significant alteration of thyroid parameters developed in the following sequence: ( 1 ) reduction of total T3 level at an AG level of 15, ( 2 ) elevation of thyrotropin (TSH) and increased prevalence of goiter at an AG of 18, and ( 3 ) reduction of free T4 and total T4 levels and elevation of TSH, with further increased frequency of goiter at an AG of 20 mEq/L.

Conclusion

According to this study, age, gender, dialysis duration, serum AG, and weekly creatinine clearance are correlated with prevalence of goiter in CAPD patients. Sequential alteration of thyroid function and increasing frequency of nodular goiter correlated with higher serum AG. There are two explanations for this correlation: the level of serum AG may be an indirect index of the level of serum goitrogens, and higher serum AG and increased frequency of nodular goiters might be a reflection of loss of residual renal function. Therefore, thyroid function screening and goiter detection using ultrasound should be considered when examining CAPD patients with progressively elevating serum anion gap.
Low Calcium Dialysate Increases Cardiac Relaxation in CAPD Patients
Authors: Tuncer Murat , Ermiş Cengiz , Süleymanlar Gültekin , Yakupoglu Gülşen , Ersoy F. Fevzi
Published: February 2020

Objective

To establish whether changes in serum calcium affect left ventricular (LV) function in continuous ambulatory peritoneal dialysis (CAPD) patients.

Methods

This study was conducted on 28 clinically stable CAPD patients (11 females, 17 males). Left ventricular relaxation and systolic function were echocardiographically examined in all patients during standard dialysate (containing 1.75 mmol/L calcium) treatment. All patients were then changed to low calcium dialysate (1.25 mmol/L calcium) for 1 month and all patients were re-examined echocardiographically. Decrement in isovolumic relaxation time (IVRT) and deceleration time (DT), and increment in the ratio of peak early to peak late diastolic velocities (E/Amax) were admitted as indexes showing improvement in LV relaxation. 17 age- and sex-matched controls were also echocardiographically examined.

Results

Deceleration time, interventricular septal thickness at systole (IVSTS) and diastole (IVSTD), and posterior wall thickness at systole (PWS) and diastole (PWD) were higher in CAPD patients using standard dialysate than in normal controls. With the use of low calcium dialysate, DTs were similar but IVSTS, IVSTD, PWS, and PWD values remained higher. In normal controls, E/Amax values were higher than those in CAPD patients using standard dialysate ( p < 0.001) and low calcium dialysate ( p = 0.009). Serum intact parathyroid hormone level, weight, clinical volume status, and blood pressure were similar throughout the study period. Serum ionized calcium levels were decreased significantly during low calcium dialysate treatment. The changes in IVRT, DT, and E/Amax suggest improvement in LV relaxation during low calcium dialysate treatment.

Conclusion

Left ventricular relaxation is increased with the use of low calcium dialysate compared with standard dialysate treatment. The idea of possible beneficial effects of increment in LV relaxation on cardiovascular morbidity and mortality deserves further studies.
Intranasal Mupirocin does not Prevent Exit-Site Infections in Children Receiving Peritoneal Dialysis
Authors: Araki Yoshinori , Hataya Hiroshi , Ikeda Masahiro , Ishikura Kenji , Honda Masataka
Published: February 2020

← Objective

Exit-site infections (ESI) in patients receiving peritoneal dialysis (PD) often progress to tunnel infections and peritonitis, sometimes requiring PD catheter removal. Staphylococcus aureus (SA) is the commonest cause of ESI. In this study, we evaluated the efficacy of mupirocin nasal ointment in preventing ESI in children receiving PD.

← Design

A single-center study.

← Setting

Tokyo Metropolitan Kiyose Children's Hospital.

← Patients

47 outpatients [33 males; age 11.7 ± 4.9 years (mean ± SD)] participated in this study between April 1998 and March 1999 at Tokyo Metropolitan Kiyose Children's Hospital. The total study period comprised 399 patient-months. Nasal cultures were performed every month. Nasal carriers of SA applied intranasal mupirocin ointment twice per day for 7 days. We compared the incidence of ESI in the intervention group to 77 historical controls (48 males; age 7.6± 5.1 years); the total control period comprised 2802 patient-months.

← Results

32 patients were identified as SA nasal carriers on one or two occasions (32/47 or 68%). The total period of SA nasal carriage was 95 patient-months (95/399 or 24%). The incidence of ESI caused by SA among all ESI cases was 20/28 (71%) in the study group and 115/151 (76%) in the control. There was no significant difference. The incidence of peritonitis caused by SA among all peritonitis cases was 3/6 (50%) in the study group and 17/42 (40%) in the control group, showing no significant difference. There was no significant difference in the overall incidence of ESI, peritonitis, or replacement of PD catheters between the study group and the control group.

← Conclusion

Intranasal mupirocin ointment did not prevent ESI. Further study is needed to develop an effective method of preventing ESI in pediatric PD patients.
Viability of Home Peritoneal Dialysis: Experience with 100 Patients from an Arab Population
Authors: Al-Hilali Nabieh , Nampoory Mangalathillam R.N. , Ninan Thomas V. , Ali Jaber H. , Gawish Alaa , Johny Kaivilayil V.
Published: February 2020

Background

The viability of home peritoneal dialysis (HPD) is being debated in Arab countries. We therefore undertook the present study to assess the viability of HPD in the Arab culture.

Patients and Methods

A total of 100 patients with end-stage renal failure were treated with HPD during the period January 1996 to October 2001.

Results

Continuous ambulatory peritoneal dialysis (CAPD) was performed in 81 patients (81%), and nightly intermittent peritoneal dialysis (NIPD) in 19 patients (19%). The patient group included 54 men (54%) and 46 women (46%) with a mean age of 54.94 ± 14.58 years. They were followed for a total of 2118.3 patient–treatment months and had a mean dialysis duration of 21.2 ± 9.97 months. Peritonitis occurred at the rates of 1 episode every 18.5 patient–treatment months (Bieffe L3 double-bag system: Bieffe Medital, Grosotto, Italy), 1 episode every 22.5 patient–treatment months (ANDY Plus system: Fresenius Medical Care, Bad Homburg, Germany), and 1 episode every 23.7 patient–treatment months (NIPD system Fresenius PD-Night: Fresenius Medical Care, Bad Homburg, Germany). Recurrent peritonitis was the main reason (70.6%) for transfer to hemodialysis. A good level of social well-being and rehabilitation was achieved in 49 patients on CAPD (60.5%) and 13 patients on NIPD (68.4%).

Conclusions

We conclude that HPD is a viable modality of renal replacement therapy in Arab countries. By adopting a strict training model, the peritoneal dialysis team can train even patients or caregivers with limited education, preventing peritonitis and promoting the general well-being of patients.
Transmigration of Blood Leukocytes into the Peritoneal Cavity is Related to the Upregulation of ICAM-1 (CD54) and MAC-1 (CD11b/CD18) Adhesion Molecules
Authors: Liberek Tomasz , Chmielewski Michal , Lichodziejewska–Niemierko Monika , Lewandowski Krzysztof , Rutkowski Boleslaw
Published: February 2020

Background

Migration of blood leukocytes into the peritoneal cavity of patients treated with peritoneal dialysis appears to be an important mechanism to prevent and fight peritonitis. To study the role of adhesion molecules in the process of leukocyte transmigration, we compared the expression of several adhesion receptors between peripheral blood monocytes and macrophages isolated from overnight dwell effluents.

Methods

The study was performed in 12, stable, infection-free patients treated with continuous ambulatory peritoneal dialysis (CAPD) and in 9 patients during peritonitis. In another set of experiments, we analyzed the expression of these molecules on blood leukocytes in 10 predialysis chronic renal failure (CRF) patients and 9 healthy controls. Peritoneal cells from an 8-hour dwell were isolated by centrifugation. Expression of adhesion receptors CD11a, CD11b, CD18, CD49d, and CD54 on blood and peritoneal leukocytes was measured using flow cytometry.

Results

In macrophages from the uninfected effluents, expression of both subunits of Mac-1 integrin receptor (CD11b and CD18) and intercellular adhesion molecule (ICAM)-1 receptor (CD54) was upregulated compared to peripheral blood monocytes from the same patients. The median value of mean fluorescence intensity in blood and effluent was 760.3 versus 1085.8 for CD11b ( p = 0.013), 288.8 versus 448.6 for CD18 ( p = 0.003), and 186.1 versus 365.7 for CD54 ( p = 0.001). The same adhesion receptors were also significantly upregulated on peritoneal macrophages and neutrophils during peritonitis compared to blood leukocytes. Blood leukocytes from CAPD and CRF patients showed higher expression of CD54 and CD49d molecules compared to leukocytes from healthy controls.

Conclusions

These data suggest that transmigration of blood leukocytes into the peritoneal cavity during uncomplicated dialysis and in peritonitis is related to selective upregulation of ICAM-1 (CD54) and Mac-1 (CD18/CD11b) receptors.
Comparing the Incomparable: Hemodialysis versus Peritoneal Dialysis in Observational Studies
Authors: Foley Robert N.
Published: February 2020

A randomized trial comparing survival in hemodialysis and peritoneal dialysis remains a utopian aspiration. Dialysis is still relatively rare on a population basis, and a natural tension exists between desirability and feasibility in terms of quality of evidence. In practice, it is very difficult to perform prospective comparisons with large groups of contemporary representative subjects, and much of the literature comes from retrospective national registries. This article considers several questions to address when trying to compare the outcomes of peritoneal dialysis and hemodialysis.

Prognostic similarity at baseline is a fundamental issue. Traditionally, adjustment for known prognostic factors has been used in an attempt to minimize the bias caused by nonrandom treatment assignment. Propensity scores have been suggested to be superior, and matched-case analysis may also be a useful method for comparison. Other questions include, when, in relation to starting dialysis, to start the observation clock; the definition and handling of switches of dialysis therapy; and the decision to censor at transplantation.

Finally, comparisons are complicated by hazards ratios that vary over time, and time-segmented analysis is obligatory. Many types of analytical approaches are needed to begin to appreciate outcome disparities between dialysis therapies.
Ossification of the Peritoneal Membrane
Authors: Di Paolo Nicola , Sacchi Giovanni , Lorenzoni Paola , Sansoni Enrico , Gaggiotti Enzo
Published: February 2020

Background

Peritoneal dialysis (PD) patients rarely develop sclerosing peritonitis (SP), a severe, life-threatening condition of unknown pathogenesis. Ossification of the peritoneum (PO) is a rare occurrence, which has, however, been reported in PD patients with SP.

Objective

To investigate etiopathogenetic correlations between PO and SP by histopathological examination.

Method

We examined biopsy specimens, obtained by laparoscopy or during surgery from 36 patients with SP, from all parts of Italy in the past 8 years for evidence of peritoneal calcification or ossification. Other studies were performed on a sample of dense white material found under the parietal peritoneum of 1 patient during laparoscopy.

Results

Ossification of the peritoneum was found in 4/16 patients with calcifications. In addition to PO, we also found bone marrow in two specimens and arterial ossification in one case. In specimens with calcifications, and especially those with ossification, there was evidence of peritoneal inflammation with infiltration of lymphocytes, multinuclear giant cells, macrophages, and mast cells. The chemical composition of the whitish material was 85% calcium chloride and 15% hydroxyapatite.

Conclusions

Calcifications alone were found in 33% (12/36) of cases of SP; 11% of SP cases were complicated by both peritoneal calcification and ossification (4/36), which indicates great availability of calcium under conditions of inflammation. Where does this calcium come from? In 1 patient with PO, the quantity of calcium was enormous and its unusual composition suggested a link with the calcium contained in dialysis solution.
Acute Systemic Inflammation is Associated with an Increase in Peritoneal Solute Transport Rate in Chronic Peritoneal Dialysis Patients
Authors: Kim Soon Bae , Chang Jai Won , Lee Sang Koo , Park Jung Sik
Published: February 2020

Background

This study was performed to evaluate the effects of acute systemic inflammation on peritoneal solute transport rate (PSTR) in chronic peritoneal dialysis (CPD) patients.

Methods

A baseline standard peritoneal equilibration test (PET) was performed on each patient every 6 months, and blood concentration of high-sensitivity C-reactive protein (hs-CRP) was assayed every 2 months in our peritoneal dialysis clinic. Acute systemic inflammation was defined as a greater than 10-fold increase in hs-CRP concentration compared with baseline value, in the absence of peritonitis, and returning to baseline level in 2 months. In patients with acute systemic inflammation, PET and hs-CRP concentration assays were performed during inflammation and after recovery. Ten patients with acute systemic inflammation were enrolled in the inflammation group and 42 other patients served as controls.

Results

There were no significant changes in hs-CRP and dialysate-to-plasma ratio of creatinine (D/Pcreat) in the control group during the study period. In the inflammation group, median hs-CRP levels at baseline, during acute inflammation, and at recovery were 2.3 mg/L (range 0.3 – 4.5 mg/L), 39.2 mg/L (range 15.1 – 117.4 mg/L), and 3.7 mg/L (range 0.9 – 8.9 mg/L), respectively. Median D/Pcreat increased significantly from baseline (0.64; range 0.55 – 0.98) to time of acute inflammation (0.72; range 0.60 – 0.96) ( p < 0.05). The D/Pcreat at recovery was 0.67 (range 0.52 – 0.94), which decreased significantly from time of acute inflammation ( p < 0.05). There was no correlation between changes in log (hs-CRP) and changes in D/Pcreat.

Conclusion

We have shown here that acute systemic inflammation is associated with a temporary increase in PSTR in CPD patients.
Superior Patient Survival for Continuous Ambulatory Peritoneal Dialysis Patients Treated with a Peritoneal Dialysis Fluid with Neutral pH and Low Glucose Degradation Product Concentration (Balance)
Authors: Lee Ho Yung , Park Hyeong Cheon , Seo Bo Jeung , Do Jun Young , Yun Sung Ro , Song Hyun Yong , Kim Yeong Hoon , Kim Yong Lim , Kim Dae Joong , Kim Yong Soo , Ahn Curie , Kim Moon Jae , Shin Sug Kyun
Published: February 2020

Background

In recent years, laboratory and clinical research has suggested the need for peritoneal dialysis fluids (PDFs) that are more biocompatible than the conventional PDFs commonly used today. Bioincompatibility of PDF has been attributed to low pH, lactate, glucose, glucose degradation products (GDPs), and osmolality. PDFs with neutral pH and low GDPs are now available commercially. In vitro and early clinical studies suggest that these solutions are indeed more biocompatible but, as of now, there is no evidence that their use improves patient outcome.

Methods

Using a dedicated database of over 2000 patients treated with PD in Korea, we were able to conduct a retrospective observational study comparing outcomes for incident continuous ambulatory PD patients treated with a standard, conventional, heat-sterilized PDF to the outcomes for patients treated with a novel, low GDP, neutral-pH PDF prepared in a dual-compartment, double-bag PD system (Balance; Fresenius Medical Care, St. Wendel, Germany). In an intention-to-treat analysis, patient and technique survival, peritonitis-free survival, and peritonitis rates were compared in 611 patients treated with Balance for up to 30 months and 551 patients with a standard PDF (stay·safe; Fresenius Medical Care) treated in the same era and with equivalent follow-up.

Results

The patients were well matched for most relevant characteristics except older age distribution for the patients treated with the standard PDF. Patients treated with Balance had significantly superior survival compared to those treated with the standard PDF (74% vs 62% at 28 months, p = 0.0032). In a multivariate Cox regression model including age, diabetes, and gender, the survival advantage persisted (relative risk of death for Balance 0.75, 95% confidence interval 0.56 – 0.99, p = 0.0465). Modality technique survival was similar in Kaplan–Meier analysis for both PDFs. No differences were detected in peritonitis-free survival or in peritonitis rates between the two solutions.

Conclusion

This study, for the first time, suggests that treatment with a novel biocompatible PDF with low GDP concentration and neutral pH confers a significant survival advantage. The exact mechanisms for such a survival advantage cannot be determined from this study. The usual criticisms of observational studies apply and the results reported here strongly warrant the undertaking of appropriately designed, randomized, controlled clinical trials.
Nephrologists Should Voluntarily Divulge Survival Data to Potential Dialysis Patients: A Questionnaire Study
Authors: Fine Adrian , Fontaine Bunny , Kraushar Maryann M. , Rich Beverly R.
Published: February 2020

Background

For many dialysis patients, survival is no different than with certain cancers. Yet, it appears that most nephrologists do not give detailed information about survival prior to obtaining informed consent for chronic dialysis. There are no published data on whether patients wish to be so informed.

Objective

To assess whether patients would want voluntary disclosure by their physician of their survival should they need dialysis, and if so, why?

Method

A questionnaire was completed by 100 general nephrology patients during their first visit to a nephrologist.

Results

The vast majority of patients (97%) would want to be given life-expectancy information, and for the physician to do so without having to be prompted. Furthermore, the majority of patients would want as much information as possible, both good and bad.

Conclusions

Virtually all patients want, and therefore should receive from their physician, prognostic information about dialysis to facilitate informed decision-making. This is in accordance with current practice guidelines.
Characterizing Comorbidity in Dialysis Patients: Principles of Measurement and Applications in Risk Adjustment and Patient Care
Authors: Miskulin Dana
Published: February 2020

Comorbid conditions are highly prevalent in dialysis patients and are significant predictors of mortality and other adverse outcomes. Accordingly, it is important to account for differences in comorbid illness burden among groups of dialysis patients being compared. At present, there is no consensus on what conditions matter, how each should be defined, and what weights each carries when defining an individual's risk or case-mix severity. A number of comorbidity instruments, generic or disease specific, have been employed in dialysis populations. They differ by the representation and definition of conditions as well as instrument scoring. No instrument has been found to be superior to another in terms of predictive accuracy for mortality, and accuracy across the board is low. Further studies are needed to determine whether improvements would be found with the use of more specifically defined items and through assignment of item weights based on relationships for outcomes specifically in a dialysis population. The roles of other factors in risk prediction, such as markers of nutritional status, inflammation, or other physiological parameters, relative to comorbid conditions also need to be defined. Outcomes other than mortality are likely to identify different factors and/or different relationships than those noted for mortality, which also require study.

Comorbidity is important for risk adjusting comparative analyses in nonrandomized trials and quality of care assessments and may, in future, influence payment for dialysis services. Efforts to improve the management of comorbid illnesses are needed. Comorbid conditions must be documented accurately and uniformly in all dialysis patients to enable these applications.
When to Start Dialysis Treatment: Where Do We Stand?
Authors: Korevaar Johanna C. , van Manen Jeannette G. , Boeschoten Elisabeth W. , Dekker Friedo W. , Krediet Raymond T. ,   The NECOSAD Study Groupa, Apperloo A.J. , Barendregt J.N.M. , Birnie R.J. , Boekhout M. , Boer W.H. , Büller H.R. , de Charro F.T. , Doorenbos C.J. , Fagel W.J. , Franssen C.F.M. , Frenken L.A.M. , Geerlings W. , Gerlag P.G.G. , Gorgels J.P.M.C. , Grave W. , Huisman R.M. , Jager K.J. , Jie K. , Koning–Mulder W.A.H. , Koolen M.I. , Kremer Hovinga T.K. , Lavrijssen A.T.J. , Mulder A.W. , Parlevliet K.J. , Rosman J.B. , Schonk M.J.M. , Schuurmans M.M.J. , Stevens P. , Tijssen J.G.P. , Valentijn R.M. , van Bommel E.F.H. , van Dorp W.T. , van Es A. , van Geelen J.A.C.A. , van Saase J.L.C.M. , Vastenburg G. , Verburg C.A. , Verstappen V.M.C. , Vincent H.H. , Vos P.
Published: February 2020

♦ Background

Since the publication of opinion-based guidelines regarding the timing of dialysis treatment, there has been a trend toward earlier initiation.

♦ Objective

In this review, the existing guidelines and the currently published studies that evaluate them are discussed.

♦ Results

These studies could not demonstrate a clear benefit on survival or quality of life for patients who started with relatively higher renal function.

♦ Conclusion

Early start of dialysis treatment should not be confused with early referral to the nephrologist. It is concluded that initiation of dialysis should not depend on a predefined magnitude of renal function, but should be tailored to the individual patient.
The Clinical and Epidemiological Aspects of Vascular Mortality in Chronic Peritoneal Dialysis Patients
Authors: Li Philip Kam-Tao , Chow Kai Ming
Published: February 2020

This article reviews the clinical aspects of and epidemiological links between vascular mortality and the dialysis population, and emphasizes areas that warrant further clarification. In particular, we highlight potential pitfalls in interpretation of published observational and clinical studies, notably some of the issues related to reverse epidemiology of risk factors for cardiovascular disease. Recent published data from our own center in the Prince of Wales Hospital relating to the significance of residual renal function, inflammation, valvular calcification, as well as left ventricular hypertrophy were highlighted. Actions are needed to tackle both the traditional and the nontraditional factors for cardiovascular disease in order to treat this problem causing the highest mortality in peritoneal dialysis patients.
Encapsulating Peritoneal Sclerosis—A Clinician's Approach to Diagnosis and Medical Treatment
Authors: Nakamoto Hidetomo
Published: February 2020

Encapsulating peritoneal sclerosis (EPS) is recognized as a serious complication of continuous peritoneal dialysis. A preliminary diagnosis of EPS is usually based on clinical signs and symptoms, which commonly include abdominal pain, nausea, vomiting, anorexia, abdominal fullness, an abdominal mass, bowel obstruction, and radiologic findings, including abdominal roentgenogram, contrast studies, ultrasound studies, and computed tomography. The diagnosis is confirmed by laparoscopy or laparotomy showing the characteristic gross thickening of the peritoneum enclosing some or all of the small intestine in a cocoon of opaque tissue.

A variety of therapeutic approaches to EPS have been reported. This review discusses medical treatment of EPS and includes an overview of the clinical features and diagnostic aspects of the condition.