bluuebunny/crossref_metadata_2025 huggingface dataset:
Murambi de Boubacar Boris Diop: L'écriture testimoniale comme transfiguration émotive du réel?
Authors: Wattara Mamadou
Published: March 2014

Cet essai vise à analyser Murambi . Le livre des ossements de Boubacar Boris Diop comme une œuvre de témoignage inspirée du génocide des Tutsi et Hutu modérés du Rwanda en 1994. Après un crime aussi odieux, il est nécessaire de dénoncer le mal et se souvenir des victimes. Cependant un véritable travail de mémoire consécutif à un crime de masse n'est possible qu'à la faveur d'une émotion politique qui désigne sans ambigüité victimes et bourreaux Nous voudrions attirer l'attention sur le contexte socio-politique qui a abouti à la production du roman pour mieux élucider les modalités d'écriture qui s'y déploient. Nous employons à dessein l'expression transfiguration émotive du réel pour parler des dispositions textuelles dont se sert l'œuvre d'art pour rendre compte de l'indicible souffrance des victimes du génocide, ceci dans un contexte socio-historique doublement marqué par les émotions: au plan social et politique. Il s'agit à terme de dire ce qui constitue la singularité de Murambi dans le vaste corpus des témoignages sur le génocide des Tutsi du Rwanda.
L'Arabesque romanesque dibienne: Une lecture de L'Arbre à dires de Mohammed Dib
Authors: Denié-Higney Laurence
Published: March 2014

Dès les débuts du roman maghrébin d'expression française, ses auteurs en interrogent la forme et essaient de la transformer pour servir leur propre vérité. Ce renouvellement de la forme romanesque n'a cessé depuis. Cet article examine L'Arbre à dires, un texte publié en 1998 par Mohammed Dib, un de ses écrivains algériens de la première génération. L'Arbre à Dires représente une nouvelle étape dans la recherche formelle dibienne. C'est en effet un texte difficilement classable dans un genre traditionnel, puisqu'il est tout à la fois un récit de voyage, un essai, une fiction et une autobiographie. Or, une lecture à la lumière des idées de Bakhtine sur le roman et des analyses des critiques de l'art musulman révèle que ce texte est non seulement un roman mais plus précisément un roman-arabesque. La forme et le fond de L'Arbre à Dires respectent les principes de la construction de l'arabesque, répétant, tissant et retravaillant les mêmes thèmes à travers notamment la reprise, parfois verbatim, de phrases-clé.
Soul limbo féérique (Chamoiseau avec Céline)
Authors: Cornille Jean-Louis
Published: March 2014

Si la possibilité d'un lien entre Chamoiseau et Céline est quelquefois évoquée, on n'a jamais réellement cherché à l'établir dans les faits. La plupart des commentateurs de l'œuvre de Chamoiseau s'accordent à dire que l'auteur y interroge en profondeur les rapports entre l'écrit et l'oral. Mais c'est très exactement ce qu'on a pu affirmer à propos de Céline: il serait l'inventeur du "parlant" en littérature française, sa contribution majeure étant d'avoir libéré la langue de ses entraves grammaticales en l'ouvrant à des formes populaires habituellement refoulées. Aussi ne s'étonnera-t-on pas de voir Chamoiseau s'intéresser à l'œuvre de Céline, même si l'auteur antillais situe le problème sur le terrain de l'oralité fortement ritualisée du conteur. Tout le débat sur l'oralité reste cependant mal posé, tant qu'on le place sur le seul plan de la parole du conteur. Sur le plan strictement littéraire, la question est en effet de savoir comment "transposer".cette parole en termes d'écriture. Dans ce sens, on propose de rapprocher ici Solibo Magnifique de Guignol's band , avec lequel il a en commun de parodier le genre détective: à partir de là, des échos se multiplient, les uns plus étranges que les autres, sans qu'on puisse jamais trancher sur leur provenance.
Use and Functions of Spatial Planes in Catalan Sign Language (LSC) Discourse
Authors: Barberà Gemma
Published: March 2014

Although the phonological description of spatial planes that configure signing space is very detailed (Brentari 1998; Liddell and Johnson 1989; Sandler 1989), our knowledge of their use and functions at the discourse level is still very limited. This article describes the use of the spatial planes in Catalan Sign Language (LSC). It provides a unified treatment of various linguistic phenomena (e.g., hierarchical relations and locatives) that have hitherto been described separately in the sign language literature and of other aspects (e.g., encoding of specificity) that have not yet been the subject of research in LSC or other signed languages. The features found in two of the three spatial planes as described in the phonological literature are also relevant beyond the sentence level and serve well-defined discourse functions.
Art attacks and killing jokes: The graphic language of punk humour
Authors: Bestley Russell
Published: March 2014

The first part of this study, published in Punk & Post Punk 2.2, positioned punk within an historical and cultural context in relation to humour, comedy, satire, profanity and the absurd. This second part of the article places further emphasis on the visual identity of punk, post punk and hardcore groups, and on the graphic strategies employed by designers to reflect an underlying satirical core at the heart of the subculture.
Rupert Loydell interviews Andrew Poppy, August 2013
Authors: Loydell Rupert
Published: March 2014

Andrew Poppy is a composer, arranger, musician, performer, record producer, writer, creative and artistic director, teacher and mentor. An artist with a unique body of work, his collaborations mix acoustic and electronic sounds with language, visual images and performance disciplines. In the 1970s he studied music at Goldsmiths College, London University, and later attended a summer school with John Cage. He signed to Trevor Horn and Paul Morley’s maverick pop label ZTT in the mid-1980s, making three albums that evade classification. By this time his work as an arranger and orchestrator was sought after by bands and record labels. More recently this has led to remixing projects for other artists. Poppy continues to connect singers and musicians from contemporary classical music and popular culture, as in the current Shiny Floor Shiny Ceiling, a CD and staged performance with videos by Julia Bardsley, as well as Revolution Number Eight Airport for Joseph Beuys, which was presented on the South Bank by Jarvis Cocker. He is the artistic director of a number of ongoing creative projects, including The Sustaining Ensemble, Field Radio Recordings and BARDSLEY_POPPY projects. Andrew Poppy also works in arts education, developing postgraduate courses and modules, and as a mentor and workshop leader. Full CV and works list available at www.andrewpoppy.co.uk.
The Effect of Mutation and Selection on Codon Adaptation inEscherichia coliBacteriophage
Authors: Chithambaram Shivapriya , Prabhakaran Ramanandan , Xia Xuhua
Published: March 2014

Studying phage codon adaptation is important not only for understanding the process of translation elongation, but also for reengineering phages for medical and industrial purposes. To evaluate the effect of mutation and selection on phage codon usage, we developed an index to measure selection imposed by host translation machinery, based on the difference in codon usage between all host genes and highly expressed host genes. We developed linear and nonlinear models to estimate the C→T mutation bias in different phage lineages and to evaluate the relative effect of mutation and host selection on phage codon usage. C→T-biased mutations occur more frequently in single-stranded DNA (ssDNA) phages than in double-stranded DNA (dsDNA) phages and affect not only synonymous codon usage, but also nonsynonymous substitutions at second codon positions, especially in ssDNA phages. The host translation machinery affects codon adaptation in both dsDNA and ssDNA phages, with a stronger effect on dsDNA phages than on ssDNA phages. Strand asymmetry with the associated local variation in mutation bias can significantly interfere with codon adaptation in both dsDNA and ssDNA phages.
Effective Messages in Vaccine Promotion: A Randomized Trial
Authors: Nyhan Brendan , Reifler Jason , Richey Sean , Freed Gary L.
Published: March 2014

OBJECTIVES:

To test the effectiveness of messages designed to reduce vaccine misperceptions and increase vaccination rates for measles-mumps-rubella (MMR).

METHODS:

A Web-based nationally representative 2-wave survey experiment was conducted with 1759 parents age 18 years and older residing in the United States who have children in their household age 17 years or younger (conducted June–July 2011). Parents were randomly assigned to receive 1 of 4 interventions: (1) information explaining the lack of evidence that MMR causes autism from the Centers for Disease Control and Prevention; (2) textual information about the dangers of the diseases prevented by MMR from the Vaccine Information Statement; (3) images of children who have diseases prevented by the MMR vaccine; (4) a dramatic narrative about an infant who almost died of measles from a Centers for Disease Control and Prevention fact sheet; or to a control group.

RESULTS:

None of the interventions increased parental intent to vaccinate a future child. Refuting claims of an MMR/autism link successfully reduced misperceptions that vaccines cause autism but nonetheless decreased intent to vaccinate among parents who had the least favorable vaccine attitudes. In addition, images of sick children increased expressed belief in a vaccine/autism link and a dramatic narrative about an infant in danger increased self-reported belief in serious vaccine side effects.

CONCLUSIONS:

Current public health communications about vaccines may not be effective. For some parents, they may actually increase misperceptions or reduce vaccination intention. Attempts to increase concerns about communicable diseases or correct false claims about vaccines may be especially likely to be counterproductive. More study of pro-vaccine messaging is needed.
Simulation of Co-Rotating Twin Screw Extrusion Process Subject to Pressure-Dependent Wall Slip at Barrel and Screw Surfaces: 3D FEM Analysis for Combinations of Forward- and Reverse-Conveying Screw Elements
Authors: Malik M. , Kalyon D. M. , Golba J. C.
Published: March 2014

Mathematical modeling and simulation of the coupled flow, deformation, heat and mass transfer, and rate of reactions occurring in the twin screw extruder allow the optimization of process parameters and the screw and barrel geometries. In mathematical modeling of the twin screw extrusion process the conventional flow boundary condition at the screw and barrel walls is the no-slip condition. However, most complex fluids, including polymers, polymeric suspensions and blends, exhibit wall slip, with the slip behavior depending on the intrinsic properties of the materials being processed, the operating conditions, the geometries of the barrel, screw and the die, and the properties of the solid surfaces. Typically, the slip velocity is specified to be a function of temperature, stress condition at the wall and the materials of construction. However, recent investigations have further revealed that the wall slip behavior can also be significantly affected by pressure. With an objective of considering the effects of wall slip on the dynamics of twin screw extrusion, fully-intermeshing co-rotating twin screw extrusion of a concentrated suspension is analyzed using three-dimensional finite element method, FEM, subject to the wall slip boundary condition. The wall slip boundary condition is first applied systematically to barrel and screw surfaces individually followed by the application of wall slip to both surfaces simultaneously. In an integrated fashion both the forward-conveying (pressure-generating) and reverse-conveying (pressure-losing) screw sections are considered. The effects of pressure on wall slip are also analyzed and elucidated.
Preparation of Polymer-Clay Nanocomposites by Melt Mixing in a Twin Screw Extruder: Using On-Line SAOS Rheometry to Assess the Level of Dispersion
Authors: Mould S. , Barbas J. , Machado A. V. , Nóbrega J. M. , Covas J. A.
Published: March 2014

A prototype on-line rotational rheometer was fixed between a twin screw extruder and a multi-rod die of an industrial pelletization line used for the manufacture of polymer-clay nanocomposites. After diverting the required amount of melt to the device, measurements were performed in small amplitude oscillatory shear and used to estimate the level of dispersion of the organoclay in the polypropylene matrix, by means of correlations that are commonly utilized. The aim is to determine whether changes in clay type, clay content, feed rate and screw speed cause detectable alterations in the rheological response and thus in the level of dispersion, with a view to practical process monitoring and control. The analysis of the data is supported by XRD and electron (scanning and transmission) microscopy observations.
Violence makes safe in South African prisons
Authors: Lindegaard Marie Rosenkrantz , Gear Sasha
Published: March 2014

That gangs have a prominent place in South African prison violence—like in many other geographical contexts—has become increasingly clear. Based on qualitative research among South African inmates and ex-inmates, we propose that prison gangs be considered adaptation strategies to the extremely coercive and oppressive environments of prisons. We focus on the relationship between gang involvement in prison, violent acts among inmates, and the risk of being subjected to violence during incarceration. By providing emic perspectives, we aim to demonstrate how inmates negotiate three types of social roles, largely defined by their ability and willingness to use violence: franse, gangster, and wyfie. Our findings suggest that prison gangs may jeopardize the personal safety of inmates, but can also paradoxically offer some inmates the opportunity to establish a sense of safety and agency by avoiding random violence.
Caudal tramadol bupivacaine combination for postoperative pain releif in subumbilical paediatric surgery
Authors: Islam Md Shafiqul , Islam Md Tajul , Bhowmick Dilip Kumar , Hossain Moinul , Akhtaruzzaman AKM , Rahman Shafiqur
Published: March 2014

Background Regional anaesthesia in children provides the advantage of reduced requirements of other anaesthetic agents and of excellent analgesia introduction. Rational use of adjuvant with local anaesthetic in caudal route for prolonged optimal analgesia in paediatric population. Objectives To evaluate the quality and duration of postoperative analgesia in children undergoing subumbilical surgeries with caudally administered mixture of tramadol and bupivacaine. Methods Sixty children of ASA physical status I & II scheduled for elective subumbilical surgery were included in this prospective case-control study. Children were randomly assigned to receive caudal analgesia with plain bupivacaine (Group-I) and a mixture of tramadol-bupivacaine (Group-II) respectively. Blood pressure, heart rate, oxygen saturation and duration of analgesia were recorded postoperatively. Results Study revealed that mean duration of caudal analgesia in Group-I and Group-II were 245.67 ± 6.94 and 612.05 ± 16.49 minutes respectively which was significantly longer (P<0.001) in Group-II. Mean number of postoperative analgesics were 2.97±0.50 and 1.78±0.50 in Group-I and Group-II which was statistically highly significant (P=0.000). Postoperative nausea and vomiting was significantly high in Group-II (P=0.019). Conclusion Combination of tramadol with bupivacaine results in prolonged analgesia when administered in caudal route. In addition, tramadol is more useful in young children considering less respiratory depression than other opioids. DOI: http://dx.doi.org/10.3329/jbsa.v23i2.18172 Journal of BSA, 2009; 23(2): 42-46
Comparison of haemodynamic alteration with laryngeal mask airway and endotracheal tube in intermediate duration of gynaecological operation
Authors: Gafur Azizul , Kamal Mustafa , Alia Ashia , Ali Idris , Islam Amirul , Khan Abdul Kuddus
Published: March 2014

Background Laryngeal mask airway insertion causes less changes of haemodynamic parameters. As haemodynamic changes during laryngoscopy and endotracheal intubation as result of intense stimulation of sympathetic nerves system. Objective To find out the effective airway management by LMA during controlled ventilation, to avoid laryngoscopic and intubation induced haemodynamic changes and to avoid laryngospasm and bronchospasm. Method A total number of 100 patients ASA grade I & II were selected randomly as per inclusion and exclusion criteria in two groups. Fifty in each group. In group A used LMA and in group B used ETT during general anaesthesia in intermediate duration of gynaecological operation. Pulse,NIBP,SpO2 were recorded in perioperatively. Result Pulse, blood pressure were significant between the two groups (p<0.00) but in SpO2 was insignificant except in 2 min of intraoperative which was significant. (p<0.013). Conclusion LMA insertion causes less changes of haemodynamic parameters when compared with that of ET intubation. Our finding suggests that LMA can be safe and beneficial alternative to ETT. DOI: http://dx.doi.org/10.3329/jbsa.v23i2.18174 Journal of BSA, 2009; 23(2): 51-55
Postoperative analgesia after lumbar disc surgery: A comparison between ketorolac and opioid
Authors: Kamal Md Mustafa , Al Maruf Abdullah , Yeasmeen Sabina , Hye Abdul
Published: March 2014

Background Most spinal surgery is painful and good postoperative analgesia is important. Opioids are the traditional first-line treatment. Ketorolac has been used for postoperative pain relief. However, there is no data available about controlling postoperative pain with ketorolac after open lumbar discectomy or laminectomy in Bangladesah. Objective To compare the efficacy of a Parentral ketorolac with conventional opioid for management of postoperative pain after lumbar disectomy or laminectomy. Methods Sixty patients who underwent lumbar disectomy or laminectomy were randomly allocated into two groups. Group A (n = 30) patients received 30 mg intramuscular ketorolac upon surgical closure and every 6 hours for 24 hours and intramuscular pethidine 1.5 mg/kg/b.w. as needed (PRN). Group B (n = 30) patients received only intramuscular pethidine 1.5 mgkg-1/b.w. every 6 hours for 24 hours and as needed (PRN). Postoperative analgesia was assessed in both groups by Visual Analogue Scale at arrival in postoperative ward and at 6, 12 and 24 hours for 24 hours. Total postoperative narcotic consumption and side effects like post operative nausea and vomiting (PONV), dizziness, urinary retention and pruritus were also recorded. Results Baseline data were comparable between the two groups. The mean VAS almost similar and less than 3 at different reading in both groups which indicate adequate postoperative analgesia and the differences were statistically not significant. The mean total cumulative amount of pethidine administered over 24 hrs period was less in group A it was 64.31+19.13 mg where as in group B was 161.23+21.25 mg. and the difference was statistically significant (p<0.01). Incidences of side effects like PONV, urinary retention and pruritus were more in group B than group A and differences were statistically significant (p<0.01). Conclusion For postoperative pain management after lumbar spine surgery both ketorolac and traditional parental opioid found effective. Total opioid consumption is significantly less with ketorolac and side effects like PONV, dizziness, urinary retention and pruritus were more with opioid alone. DOI: http://dx.doi.org/10.3329/jbsa.v23i2.18175 Journal of BSA, 2009; 23(2): 56-61
Role of pre-emptive analgesia in post operative Pain management - a review of literature
Authors: Yasmin Rubina , Akhtaruzzaman AKM , Khan Sayed Akhter
Published: March 2014

DOI: http://dx.doi.org/10.3329/jbsa.v23i2.18176 Journal of BSA, 2009; 23(2): 62-66
Sub arachnoid block related complications - 5 years experiences
Authors: Islam Md Saiful , Ahmed SK Fariduddin , Abdullah ATM , Al Maruf Abdullah , Chowdhury Iqbal Hossain
Published: March 2014

Sub Arachnoid Block (SAB) is a frequently used popular anaesthetic technique but it is not without complications. The objectives of this retrospective descriptive study was to report and evaluate the complications of SAB in Khulna city,which occurred in a period of 5 years from January 2004 to December 2008. It was a multicentre study. Related data from anesthetic procedure records were collected for above mentioned period. Total 10829 patients were operated under SAB in those centres during the study period. Majority of patients were female (72.22%), mean age was 39 ± 9.78 years, age groups between 20 to 39 years were 72.22%, ASA physical status between I and II were 87.01%. Complications of SAB were mild hypotension 3090(28.53%), severe hypotension 83(0.76%), cardiac arrest 20(0.18%), postdural puncture headache (PDPH) 1825(16.85%), meningism 10(0.09%), cuada equina syndrome 4(0.036) and death 3(0.027%). Most common complications were simple hypotension and PDPH. Serious adverse events such as severe hypotension, cardiac arrest, cauda equina syndromes and death were were more than other western countries and may be due to shortage of adequate skilled anaesthesiologist. A prospective study with a good number of qualified anaesthesiologists can be taken in hand on ward for further evaluations. DOI: http://dx.doi.org/10.3329/jbsa.v23i2.18177 Journal of BSA, 2009; 23(2): 67-71
Anaesthetic management of a case of Treacher - Collins syndrome
Authors: Chowdhury Md Shahnewaz , Chowdhury Md Mohsinuzzaman , Chowdhury Gulshan Ara
Published: March 2014

Treacher-Collins syndrome (TCS) is a rare congenital disease known to be associated with a difficult airway and represents some of the most hazardous and difficult challenges that anaesthetists may encounter during their entire practice of anesthesia. Successful anaesthetic management of a case with Treacher-Collins syndrome posted for laparoscopic cholecystectomy under general anaesthesia is presented in this report. DOI: http://dx.doi.org/10.3329/jbsa.v23i2.18178 Journal of BSA, 2009; 23(2): 72-75
Reading Kafka Enactively
Authors: Troscianko Emily T.
Published: March 2014

I argue that understanding cognition as enactive — that is, as constituted of physical interaction between embodied minds and the environment — can illuminate the opening of Kafka's novel Der Proceß (The Trial), revealing it as cognitively realistic in this respect. I show how enactivism is relevant to this passage in several ways: in terms of enactive vision and imagination (based on the sensorimotor account of vision), enactive language (with a focus on basic-level categorization and readers' motor responses), and enactive emotion (drawing on appraisal theory). I also suggest that these cognitively realistic features might result in ambivalent reactions on the reader's part.
Workplace Bullying among Managers: A Multifactorial Perspective and Understanding
Authors: Ariza-Montes J. , Muniz R. Noel , Leal-Rodríguez Antonio , Leal-Millán Antonio
Published: March 2014

The aim of this paper is to study certain factors that may be determinant in the emergence of workplace bullying among managers—employees with a recognized and privileged position to exercise power—adopting the individual perspective of the subject, the bullied manager. Individual, organizational, and contextual factors integrate the developed global model, and the methodology utilized to accomplish our research objectives is based on the binary logistic regression model. A sample population of 661 managers was obtained from the micro data file of the 5th European Working Conditions Survey-2010 (European Foundation for the Improvement of Living and Working Conditions) and utilized to conduct the present research. The results indicate that the chance for a manager to refer to him/herself as bullied increases among women that hold managerial positions and live with children under 15 at home, and among subjects that work at night, on a shift system, suffering from work stress, enjoying little satisfaction from their working conditions, and not perceiving opportunities for promotions in their organizations. The present work summarizes an array of outcomes and proposes, within the usual course of events, that workplace bullying could be reduced if job demands were limited and job resources were increased. The implications of these findings could assist directors/general directors in facilitating, to some extent, good social relationships among managers.
Dialysate Cytokine Levels do not Predict Encapsulating Peritoneal Sclerosis
Authors: Goodlad Catriona , Tam Frederick W.K. , Ahmad Sohail , Bhangal Gurjeet , North Bernard V. , Brown Edwina A.
Published: March 2014

Background

Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of long-term peritoneal dialysis (PD). There is no well-validated method for predicting which patients will develop the condition, although known risk factors include long duration of PD, high glucose exposure and lack of residual renal function. We have investigated whether dialysate cytokines (MCP-1 (monocyte chemotactic protein-1), CCL18 (pulmonary and activation-regulated cytokine, PARC), IL-6 (interleukin-6), CCL15 (leukotactin) and angiogenin) could be used to predict the onset of EPS more effectively than known clinical risk factors.

Methods

Samples of dialysate and clinical data were prospectively collected from 151 patients at the West London Renal center between 2003 and 2010. Dialysate cytokine levels were measured using the enzyme-linked immunoabsorbant assay (ELISA) technique. Encapsulating peritoneal sclerosis subsequently developed in 17 patients during a follow-up period of 27 – 113 months. Cytokines found at higher levels in dialysate of pre-EPS patients were investigated as candidate predictors of EPS using logistic regression analysis.

Results

Dialysate IL-6, MCP-1 and CCL15 were significantly higher in patients who subsequently developed EPS; however, a logistic regression model using dialysate cytokines to predict EPS was no better than a model using well-recognized clinical markers (length of time on PD and membrane transport status).

Conclusions

Although MCP-1, IL-6 and CCL15 were found at higher levels in the dialysate of patients who subsequently developed EPS, dialysate levels of these cytokines do not improve prediction of future EPS above a model using known clinical risk factors.
Comparing the Incidence of Catheter-Related Complications with Straight and Coiled Tenckhoff Catheters in Peritoneal Dialysis Patients—a Single-Center Prospective Randomized Trial
Authors: Ouyang Chu-Jun , Huang Feng-Xian , Yang Qiong-Qiong , Jiang Zong-Pei , Chen Wei , Qiu Yagui , Yu Xue-Qing
Published: March 2014

♦Objectives

We aimed to prospectively compare the incidence of catheter-related complications and catheter survival for straight (SCs) and coiled (CCs) Tenckhoff catheters in peritoneal dialysis (PD) patients.

♦Methods

This open prospective randomized trial recruited 189 PD patients with end-stage renal disease from the department of nephrology, The First Affiliated Hospital of Sun Yat-sen University from 6 November 2007 to 27 August 2008. The patients were randomized to a SC ( n = 99) or a CC ( n = 90) and were then followed for 2 years. All catheter placements were performed by two designated experienced nephrologists who used a standardized institutional placement protocol. The primary study outcomes were catheter-related complications and catheter survival at 1 and 2 years.

♦Results

We observed no significant differences in clinical and demographic characteristics between the groups at baseline. The overall incidence of catheter dysfunction was higher in the CC group than in the SC group (17.8% vs 7.1%, p = 0.03), and most of the events occurred 4 weeks or more after the catheters were implanted. Catheter tip migration and omental wrapping were the most common causes of catheter dysfunction. Surgical catheter rescue was more common in patients with CCs than in patients with SCs (9 vs 3 patients respectively, p = 0.05). No significant differences were observed in other catheter-related complications, including dialysate leaks, hernias, and PD-related infections (peritonitis, exit-site, and tunnel infections). Catheter survival rates in the SC and CC groups were similar at 1 year (96.7% ± 1.9% vs 96.5% ± 2.0%, p = 0.98) and at 2 years (95.3% ± 2.3% vs 92.4% ± 3.6%, p = 0.76).

♦Conclusions

The incidence of PD catheter–related complications is probably higher with CCs than with SCs. The results of our study suggest that a SC is the better option to reduce subsequent catheter complications.
Effect of Body Mass Index on Outcomes of Peritoneal Dialysis Patients in India
Authors: Prasad Narayan , Sinha Archana , Gupta Amit , Sharma Raj Kumar , Bhadauria Dharmendra , Chandra Abhilash , Prasad Kashi Nath , Kaul Anupama
Published: March 2014

Objectives

We studied the effect of body mass index (BMI) at peritoneal dialysis (PD) initiation on patient and technique survival and on peritonitis during follow-up.

Methods

We followed 328 incident patients on PD (176 with diabetes; 242 men; mean age: 52.6 ± 12.6 years; mean BMI: 21.9 ± 3.8 kg/m2) for 20.0 ± 14.3 months. Patients were categorized into four BMI groups: obese, ≥25 kg/m2; overweight, 23 – 24.9 kg/m2; normal, 18.5 – 22.9 kg/m2 (reference category); and underweight, <18.5 kg/m2. The outcomes of interest were compared between the groups.

Results

Of the 328 patients, 47 (14.3%) were underweight, 171 (52.1%) were normal weight, 53 (16.2%) were overweight, and 57 (17.4%) were obese at commencement of PD therapy. The crude hazard ratio (HR) for mortality ( p = 0.004) and the HR adjusted for age, subjective global assessment, comorbidities, albumin, diabetes, and residual glomerular filtration rate ( p = 0.02) were both significantly greater in the underweight group than in the normal-weight group. In comparison with the reference category, the HR for mortality was significantly greater for underweight PD patients with diabetes [2.7; 95% confidence interval (CI): 1.5 to 5.0; p = 0.002], but similar for all BMI categories of nondiabetic PD patients. Median patient survival was statistically inferior in underweight patients than in patients having a normal BMI. Median patient survival in underweight, normal, overweight, and obese patients was, respectively, 26 patient–months (95% CI: 20.9 to 31.0 patient–months), 50 patient–months (95% CI: 33.6 to 66.4 patient–months), 57.7 patient–months (95% CI: 33.2 to 82.2 patient–months), and 49 patient–months (95% CI: 18.4 to 79.6 patient–months; p = 0.015). Death-censored technique survival was statistically similar in all BMI categories. In comparison with the reference category, the odds ratio for peritonitis occurrence was 1.8 (95% CI: 0.9 to 3.4; p = 0.086) for underweight patients; 1.7 (95% CI: 0.9 to 3.2; p = 0.091) for overweight patients; and 3.4 (95% CI: 1.8 to 6.4; p < 0.001) for obese patients.

Conclusions

In our PD patients, mean BMI was within the normal range. The HR for mortality was significantly greater for underweight diabetic PD patients than for patients in the reference category. Death-censored technique survival was similar in all BMI categories. Obese patients had a greater risk of peritonitis.
Increased Levels of Modified Advanced Oxidation Protein Products are Associated with Central and Peripheral Blood Pressure in Peritoneal Dialysis Patients
Authors: Xu Hong , Cabezas-Rodriguez Ivan , Qureshi Abdul Rashid , Heimburger Olof , Barany Peter , Snaedal Sunna , Anderstam Björn , Helin Ann-Christin Bragfors , Carrero Juan Jesus , Stenvinkel Peter , Lindholm Bengt
Published: March 2014

♦Background and Aims

Oxidative stress plays an important role in the pathogenesis of cardiovascular disease (CVD). Central blood pressure (BP) is thought to be more relevant than peripheral BP for the pathogenesis of CVD. Advanced oxidation protein products (AOPP) are markers of oxidative stress. This study investigated the relationship between AOPP and central BP in peritoneal dialysis (PD) patients.

♦Methods

In a cross-sectional study of 75 PD patients (67% men), we analyzed two oxidative stress markers, AOPP (modified assay, mAOPP, correcting for the impact of triglycerides) and pentosidine, three inflammation markers, interleukin-6 (IL-6), tumor necrosis factor (TNF), and high-sensitivity C-reactive protein (hs-CRP). All patients underwent measurement of central systolic blood pressure (SBP) and diastolic blood pressure (DBP) by applanation tonometry.

♦Results

Patients with mAOPP levels above the median had a higher central SBP and DBP than those below the median values. In univariate analysis, the levels of mAOPP associated with central SBP and central DBP. Multiple regression analysis, adjusting for age, gender, diabetes, CVD, protein-energy wasting (PEW), hs-CRP and extracellular water by multi-frequency bioimpedance or N-terminal prohormone of brain natriuretic peptide (NT-proBNP), confirmed independent associations between mAOPP and central SBP and central DBP respectively.

♦Conclusions

The mAOPP level is independently associated with the central SBP and DBP in PD patients. This finding suggests that oxidative stress may be involved in the pathogenesis of hypertension or that hypertension itself or factors associated with hypertension such as fluid overload may have an additional effect on oxidative stress in PD patients.
Anthropometrics Identify Wasting in Patients Undergoing Surgery for Encapsulating Peritoneal Sclerosis
Authors: Campbell Rosalind , Augustine Titus , Hurst Helen , Pararajasingam Ravi , van Dellen David , Armstrong Sheilagh , Bartley Carol , Birtles Linda , Summers Angela
Published: March 2014

♦Introduction

Encapsulating peritoneal sclerosis (EPS) is a serious complication of peritoneal dialysis in which gastrointestinal (GI) symptoms reduce appetite and dietary intake. Adequate nutrition is important, especially if surgery is required. Although the incidence of EPS is low, the present report is able to detail preoperative nutrition status and treatment in a large cohort of patients from a national EPS referral center.

♦Methods

Of 51 patients admitted to this EPS specialist center hospital for their first peritonectomy in the study period, 50 had a preoperative dietetic assessment, and 49 underwent upper-arm anthropometry.

♦Results

Mean body mass index (BMI) was 20.6 kg/m2. Mean weight loss was 14% of body weight in the preceding 6 months, with 35 of 50 patients losing more than 10%. On anthropometry, 25 of 49 patients were below the 5th percentile for mid-arm circumference (MAC), 17 of 49 were below for triceps skinfold thickness (TSF), and 21 of 49 were below for mid-arm muscle circumference (MAMC). Mean handgrip strength (HGS) was 60% of normal, with 43 of 49 patients being below 85% of normal. Appetite was poor in 21 of 50 patients, and 37 of 50 had upper and 40 of 50 had lower GI symptoms. By subjective global assessment, 27 of 51 patients were graded as severely malnourished, and 5 of 51, as well-nourished. Mean serum albumin was 28 g/L and did not correlate with BMI, MAC, TSF, MAMC, or HGS. In most patients, C-reactive protein was elevated (mean: 111 mg/L). Preoperative parenteral nutrition was given to 46 of 51 patients for a mean of 21 days.

♦Discussion

Our findings demonstrate the poor nutrition status of patients admitted for EPS surgical intervention. Anthropometrics reveal depleted fat and lean body mass in EPS patients, which might be a result of anorexia and inflammation, and the reason that albumin was not an accurate marker of nutrition. Poor nutrition status is likely to negatively affect outcome in this patient group.

♦Conclusions

Early recognition of GI symptoms may herald a diagnosis of EPS. Optimization of preoperative nutrition status with intensive nutrition support is needed.
Kocuria Species Peritonitis: Although Rare, we Have to Care
Authors: Dotis John , Printza Nikoleta , Stabouli Stella , Papachristou Fotios
Published: March 2014

Kocuria species are found in the environment and on human skin. These micro-organisms are generally considered to be nonpathogenic saprophytes, rarely causing infection. However, the peritoneum has been reported to be a site of Kocuria infection. We reviewed all cases of peritonitis in peritoneal dialysis (PD) patients caused by Kocuria species that were reported in the worldwide literature. In total, 12 episodes of Kocuria species peritonitis have been reported in 9 PD patients. The median age of the patients was 62 years (range: 8 – 78 years). In the reported episodes, 4 different Kocuria species were isolated, with K. varians being the predominant species (41.7%). The most common initial symptom was abdominal pain (83.3%), followed by turbid effluent (75%) and fever (33.3%). Intraperitoneal first-generation cephalosporins and glycopeptides were the most-used antibiotics, with first-generation cephalosporins being more often preferred as first-line therapy. The median duration of treatment was 14 days, and in 2 episodes, the Tenckhoff catheter was removed. Although Kocuria peritonitis in PD patients is rare, it should be promptly treated because relapses can occur, especially with K. varians episodes.
The Risk Factors and the Impact of Hernia Development on Technique Survival in Peritoneal Dialysis Patients: A Population-Based Cohort Study
Authors: Yang Shang-Feng , Liu Chia-Jen , Yang Wu-Chang , Chang Chao-Fu , Yang Chih-Yu , Li Szu-Yuan , Lin Chih-Ching
Published: March 2014

Objectives

There is a lack of consensus on the risk factors for hernia formation, and the impact on peritoneal dialysis (PD) survival has seldom been studied.

Methods

This was a population-based study and all collected data were retrieved from the National Health Insurance Research Database of Taiwan. Patients who commenced PD between January 1998 and December 2006 were screened for inclusion. Multiple logistic regression and Cox proportional hazards models were applied to estimate the predictors for hernia formation and determine the predictors of PD withdrawal.

Results

A total of 6,928 PD patients were enrolled and followed until December 2009, with 631 hernia events and 391 hernioplasties being registered in 530 patients (7.7%). The incidence rate was 0.04 hernias/patient/year. Longer PD duration (per 1 month increase, hazard ratio (HR) 1.019) and history of mitral valve prolapse (MVP) (HR 1.584) were independent risk factors for hernia formation during PD, and female gender (HR 0.617) was a protective factor. On the other hand, there were 4,468 PD withdrawals, with cumulative incidence rates of 41% at 1 year, 66% at 3 years, and 82% at 5 years. Independent determinants for cumulative PD withdrawal included hernia formation during PD (HR 1.154), age (per 1 year increase, HR 1.014), larger dialysate volume (per 1 liter increase, HR 0.496), female gender (HR 0.763), heart failure (HR 1.092), hypertension (HR 1.207), myocardial infarction (HR 1.292), chronic obstructive pulmonary disease (COPD) (HR 1.227), cerebrovascular accident (CVA) (HR 1.364), and history of MVP (HR 0.712)

Conclusions

Prolonged PD duration was a risk factor for hernia formation, and female gender was protective. Hernia formation during PD therapy may increase the risk of PD withdrawal.
Development and Testing of Self-Management Scale for PD Patients
Authors: Wang Xiao-hua , Pang Jian-hong , Lin Lu , Xu Yi , Jiang Qing , Wang Qi , Lu Guo-yuan , Wang Nian-song
Published: March 2014

Objectives

To develop and evaluate the self-management scale for peritoneal dialysis (PD) patients.

Methods

The item pool was formulated based on literature reviews and in-depth interviews. An initial scale containing five factors and 44 items was constructed through two rounds of Delphi expert consultation and a preliminary test. A total of 313 PD patients from the Jiangsu-Zhejiang-Shanghai area were surveyed to test the reliability and validity of the scale.

Results

Five factors, namely solution bag replacement, troubleshooting during operation, diet management, complication monitoring, emotion management and return to social life, were extracted by exploratory factor analysis: the 28 items could explain 64.567% of the total variance; the content validity index was 0.963; the Cronbach's α coefficient and split-half coefficient were 0.926 and 0.960 respectively; and test-retest reliability was 0.937.

Conclusion

The scale has been proved to be a reliable and valid tool which allows PD nurses to evaluate the self-management ability of PD patients. The evaluation outcomes can serve as a basis for individualized nursing plans and interventions so as to provide highly effective nursing care.
Oxidative Dna Damage and Mortality in Hemodialysis and Peritoneal Dialysis Patients
Authors: Xu Hong , Watanabe Makoto , Qureshi Abdul Rashid , Heimbürger Olof , Bárány Peter , Anderstam Björn , Eriksson Monica , Stenvinkel Peter , Lindholm Bengt
Published: March 2014

Background and Aims

Increased oxidative stress in dialysis patients is thought to contribute to increased mortality; however, confirmatory data are scarce. We analyzed the serum concentration of 8-hydroxy-2'–deoxyguanosine (8-OHdG), a marker of oxidative stress, in relation to mortality in hemodialysis (HD) and peritoneal dialysis (PD) patients.

Methods

Serum 8-OHdG, interleukin 6 (IL-6), other biochemical markers, Davies comorbidity score, and protein-energy wasting (PEW) were assessed in 303 prevalent patients treated with HD (n = 220; age: 63 ± 14 years) or PD (n = 83; age: 64 ± 14 years). Mortality was assessed after a median follow-up of 31 months.

Results

The median (25th - 75th percentile) concentration of 8-OHdG was higher in HD than in PD patients: 1.3 ng/mL (0.9 - 1.8 ng/mL) versus 0.5 ng/mL (0.4 - 0.6 ng/mL), p < 0.001. The HD modality (standard β = 0.57, p < 0.001) and dialysis vintage (standard β3 = 0.12, p = 0.02) were independent predictors of serum 8-OHdG in a multivariable linear regression model including age, sex, body mass index, dialysis modality (HD or PD), preceding time on dialysis (dialysis vintage), PEW, comorbidity score, IL-6, and use of angiotensin converting-enzyme inhibitors or angiotensin II receptor blockers or statins. During follow-up, 107 patients died. In multivariable Cox regression models including all 303 patients and adjusted for age, sex, body mass index, dialysis modality, dialysis vintage, and comorbidity score, 8-OHdG was significantly associated with all-cause mortality (adjusted hazard ratio: 1.40; 95% confidence limits: 1.05, 1.87 for 1 standard deviation increase of 8-OHdG). In subgroup analyses according to dialysis modality, 8-OHdG was associated with mortality in HD patients but not in PD patients.

Conclusions

Oxidative stress as assessed by 8-OHdG is an independent predictor of all-cause mortality in dialysis patients. This association was seen in HD patients, but no such association could be demonstrated for PD patients.
Isocyanide-based multicomponent reactions towards cyclic constrained peptidomimetics
Authors: Koopmanschap Gijs , Ruijter Eelco , Orru Romano VA
Published: March 2014

In the recent past, the design and synthesis of peptide mimics (peptidomimetics) has received much attention. This because they have shown in many cases enhanced pharmacological properties over their natural peptide analogues. In particular, the incorporation of cyclic constructs into peptides is of high interest as they reduce the flexibility of the peptide enhancing often affinity for a certain receptor. Moreover, these cyclic mimics force the molecule into a well-defined secondary structure. Constraint structural and conformational features are often found in biological active peptides. For the synthesis of cyclic constrained peptidomimetics usually a sequence of multiple reactions has been applied, which makes it difficult to easily introduce structural diversity necessary for fine tuning the biological activity. A promising approach to tackle this problem is the use of multicomponent reactions (MCRs), because they can introduce both structural diversity and molecular complexity in only one step. Among the MCRs, the isocyanide-based multicomponent reactions (IMCRs) are most relevant for the synthesis of peptidomimetics because they provide peptide-like products. However, these IMCRs usually give linear products and in order to obtain cyclic constrained peptidomimetics, the acyclic products have to be cyclized via additional cyclization strategies. This is possible via incorporation of bifunctional substrates into the initial IMCR. Examples of such bifunctional groups are N-protected amino acids, convertible isocyanides or MCR-components that bear an additional alkene, alkyne or azide moiety and can be cyclized via either a deprotection–cyclization strategy, a ring-closing metathesis, a 1,3-dipolar cycloaddition or even via a sequence of multiple multicomponent reactions. The sequential IMCR-cyclization reactions can afford small cyclic peptide mimics (ranging from four- to seven-membered rings), medium-sized cyclic constructs or peptidic macrocycles (>12 membered rings). This review describes the developments since 2002 of IMCRs-cyclization strategies towards a wide variety of small cyclic mimics, medium sized cyclic constructs and macrocyclic peptidomimetics.
Treatment of Asymptomatic Hyperuricemia and Prevention of Vascular Disease: A Decision Analytic Approach
Authors: Akkineni Roopa , Tapp Stephanie , Tosteson Anna N.A. , Lee Alexandra , Miller Katherine L. , Choi Hyon K. , Zhu Yanyan , Albert Daniel A.
Published: March 2014

Objective.

Elevated serum urate may be associated with an increase in cardiovascular (CV) disease. Treating asymptomatic hyperuricemia with urate-lowering drugs such as allopurinol may reduce CV events. We designed a model to simulate the effect of allopurinol treatment on reducing frequency of CV events in individuals with elevated serum urate.

Methods.

A Markov state-transition model was constructed to assess occurrence of vascular events (VE) for 2 treatment strategies: treat all asymptomatic individuals with allopurinol (Treat All) and treat only if symptomatic (Treat Symptomatic). The model simulated a hypothetical cohort of 50-year-old men with different serum urate concentrations (6–6.9 and 7–7.9 mg/dl) followed over 20 years. Age and sex subgroups were analyzed. Model inputs were derived from current literature. The main outcome measures were mean number of VE and mean number of deaths from VE.

Results.

For 50-year-old men with serum urate 6.0–6.9 mg/dl, individuals in the Treat All strategy have a 30% reduction in the mean number of VE compared to those in the Treat Symptomatic strategy (mean VE: 0.078 vs 0.11), and a 39% reduction in mean number of deaths from VE. At higher serum urate concentrations, treatment is more effective in reducing the mean number of VE and mean number of deaths from VE (38% event, 54% death). Results for women show similar trends. As the cohort ages, treatment has less effect on reducing VE. The number needed to treat to prevent 1 event is 20 (men, 7.0–7.9 mg/dl).

Conclusion.

The model predicts that treating asymptomatic hyperuricemia with allopurinol is most effective in preventing VE at a serum urate above 7.0 mg/dl in men and 5.0 mg/dl in women.