bluuebunny/crossref_metadata_2025 huggingface dataset:
Rehabilitation Protocol for Unilateral Laryngeal and Lingual Paralysis (Tapia Syndrome): Comment About “A Challenging Case of Tapia Syndrome After Total Thyroidectomy” By Ildem Deveci, Mehmet Surmeli, and Reyhan Surmeli
Authors: De Luca Pietro , Cavaliere Matteo , Scarpa Alfonso , Savignano Luisa , Cassandro Ettore , Cassandro Claudia , Iemma Maurizio
Published: February 2020

Tapia syndrome is a rare complication after surgery, with ipsilateral paralysis of vocal cord and tongue due to extracranial involvement of recurrent laryngeal and hypoglossal nerves. Tapia’s case report is extremely interesting for both the rarity of the reported cases and for the importance of an early rehabilitation. In a previous work, we reported a case of Tapia syndrome after cardiac surgery for aortic aneurysm, and the protocol of logopedic rehabilitation adopted. In the postoperative period, he developed severe dyspnea and dysphagia that required a tracheostomy and a logopedic rehabilitation therapy that led to a fast and efficient swallowing without aspiration after 47 sessions (less than 4 months). The progressive recovery of the function suggests aprassic nerve damage. However, the logopedic therapy is recommended to limit the possibility of permanent functional deficits and quickly recover swallowing and phonation.
Hair, Hormones, and Haunting: Race as a Ghost Variable in Polycystic Ovary Syndrome
Authors: Carlin Elizabeth , Kramer Brandon
Published: February 2020

In this paper, we examine how polycystic ovary syndrome (PCOS) is racialized in biomedical research. Drawing from Star’s seminal concept of triangulation, we analyze how the diagnostic criteria for PCOS combine two different biomarkers: body hair and testosterone. Hair and hormones are both haunted by their use in eugenic research, and as clinical measures, they can carry forward powerful narratives of biological difference. PCOS researchers circulate strong claims about racial difference in hirsutism (“male-pattern” hair growth in women) as if they were established knowledge, sometimes calling for race-specific diagnostic thresholds. Tracing the links between (1) race and hirsutism, (2) hirsutism and testosterone, and (3) testosterone and race, we find that these connections are all conceptualized in ambiguous and inconsistent ways. Through triangulation, the uncertainty clouding each link is mitigated by the apparent strength of the chain as a whole. The logic linking race to disease is attenuated, allowing race to persist as a ghost variable. As PCOS is increasingly reframed as a risk factor for other conditions, racial stratification is submerged, implicit but actionable, at every stage of the life course cascade of risk.
Patterns and prediction of behavior problems during the toddler and preschool periods in preterm children
Authors: Ross Gail S. , Rescorla Leslie A. , Perlman Jeffrey M.
Published: February 2020

There are few studies of behavior problems in preterm children prior to 2 years old and the changes that occur over time. The aims of this study were to examine the patterns and prediction of behavior problems and the effects of gender and socioeconomic status (SES) on behavior problems in preterm children at the toddler and preschool periods. Parents of 124 very low birthweight preterm children completed a standardized behavior questionnaire at 18 months corrected age and 3 years old. At both times, scores were significantly higher on Attention and Withdrawn Problems than on other behavior problem syndromes. There was a significant overall increase in Externalizing and Internalizing behavior problem scores between 18 months and 3 years, particularly in Internalizing problems. Overall prediction for normal versus not-normal categorization (≥1 standard deviation) on behavior problem and broad-spectrum scales ranged from 77% to 90% and was higher for children in the normal than not-normal categories. Boys had higher Internalizing Problems at 18 months and higher Externalizing Problems at 3 years. Children from low SES families had higher Internalizing and Total Behavior problems at 18 months and higher Internalizing, Externalizing, and Total Behavior problems at 3 years. Screening preterm children for behavior problems before 2 years old appears useful for early intervention of such problems.
Whatsappsport: Using Whatsapp While Viewing Sports Events
Authors: Tamir Ilan
Published: February 2020

Viewing sports events was always qualitatively different from the viewing experience of other genres. The social experience and emotional investment of sports viewers created unique viewing habits, in which second screens and social media effectively extend the experience of the millions of concurrent sports viewers wishing to share their feelings with each other. The enormous popularity of Whatsapp groups in recent years, and especially sports-focused groups, has made this app an integral element in event viewing, and created a unique viewing dynamic. This study analyzes the discourse in Whatsapp sports groups in Israel as its members view the 2018 World Cup soccer games, in an effort to identify the new role of second screens during sports broadcasts. An analysis of group messages shared by Whatsapp sports groups whose members cover a diverse range of ages and geographic locations basically shows that, in contrast to other media genres in which second screening is not necessarily related to the content broadcast on the primary screen, sports fans demonstrate an absolute commitment to the primary broadcast when second screening. On a deeper level, this study identified four main functions of Whatsapp groups during sports broadcasts: a social agent that supervises and controls the nature and quality of the primary screen broadcast, the generator of discourse that extols viewers’ expertise and effectively challenges traditional sport hierarchies, an active role in game management as fans attempt to influence game outcomes, and a means for extending fans’ celebrations of victory beyond the boundaries of the game.
The 18th FRAME Annual Lecture, October 2019: Human In Silico Trials in Pharmacology
Authors: Rodriguez Blanca
Published: February 2020

Safety and efficacy testing is a crucial part of the drug development process, and several different methods are used to obtain the necessary data (e.g. in vitro testing, animal trials and clinical trials). Our group has been investigating the potential of modelling and simulation as an alternative approach to some of the methods used for testing drugs for cardiac effects. To achieve our goal of developing and promoting novel approaches in drug development, we formed multidisciplinary collaborations that included clinicians, computer scientists and biologists. Our in silico models are based on human data (e.g. magnetic resonance images, electrocardiogram) and on current knowledge of human electrophysiology, thus generating predictions that are directly applicable to humans. Such models are a particularly powerful tool because they encompass different sources of population heterogeneity, which is crucial for drug testing and for assessing how interindividual variability might affect clinical endpoints. Our group has shown that computer modelling can be used to predict the effects of a test drug in a virtual population or in combination with machine learning to predict different phenotypes when a drug is given to a diseased population. Furthermore, our user-friendly drug testing software is freely available and is being adopted by industry in their drug development process. We have been engaging with industry and regulators to show that our models can contribute to the replacement of animals in drug development. Our ambition is to generate models for simulation of different diseases and therapies for investigations from subcellular to whole organ.
Ex-appraisal bias: Negative illusions in appraising relationship quality retrospectively
Authors: Smyth Aidan P. J. , Peetz Johanna , Capaldi Adrienne A.
Published: February 2020

Cognitive biases are prevalent within the context of romantic relationships. The present research investigated biases about relationships after they have ended. In a longitudinal design ( N = 184), individuals reported relationship quality at two time points, as well as rated relationship quality retrospectively. Results supported an ex-appraisal bias: individuals rated their past relationship quality more negatively in retrospect than they had actually reported at the time. This bias was present across participants who stayed together and those who broke up but was three times larger for those whose relationships had ended. This bias may be a motivated cognition that helps individuals let go of their ex-partners after a breakup.
Successful resuscitation by using extracorporeal membrane oxygenation in a patient with amniotic fluid embolism: a case report
Authors: Kim Jae Won , Kim Jin Hwan , Kim Tae Woo , Ryu Keon Hee , Park Sun Gyoo , Jeong Chang Young , Choi Jin Ho , Park Dong Ho
Published: February 2020

Amniotic fluid embolism (AFE) is a rare disease, but it is a potentially fatal condition, as well as a leading cause of unpredictable maternal death in developed countries. The typical clinical symptoms of AFE include hypoxia, hypotension, and coagulopathy, and with rapid progression, it may cause cardiac arrest and death. We report a case of sudden hemodynamic instability due to amniotic fluid embolism, which was successfully treated with veno-arterial extracorporeal membrane oxygenation (ECMO). A 39-year-old woman was scheduled for delivery at 38 weeks and 2 days of gestation. During labor, sudden generalized tonic-clonic seizures developed, followed by dyspnea and cyanosis. Despite immediate cesarean section being performed, she became hypoxemic and experienced cardiovascular collapse. ECMO was promptly applied, and the patient became stable 8 days after cesarean section. ECMO appears to be an appropriate treatment option for catastrophic amniotic fluid embolism.
The regulation of nitric oxide in tumor progression and therapy
Authors: Hu Ya , Xiang Jing , Su Linlin , Tang Xi
Published: February 2020

Nitric oxide (NO) is a ubiquitous gas with free radical groups that is soluble in water, and which is involved in numerous physiological functions including inflammatory and immune responses. However, the role of NO in tumor biology is controversial and misunderstood. NO has been shown to have both anti-cancer and carcinogenic effects, which are dependent on the time, location, and concentration of NO. This duality presents a double challenge to determine the net impact of NO on cancer and to define the therapeutic role of NO-centered anti-cancer strategies. Nevertheless, it is believed that a comprehensive and dynamic understanding of the cascade of molecular and cellular events underlying tumor biology that are affected by NO will allow researchers to exploit the potential anti-tumor properties of drugs that interfere with NO metabolism.
Digitalization of work and heteronomy
Authors: Mengay Adrian
Published: February 2020

Digitalization has two very different effects on work. On the one hand, it leads to a re-Taylorization of work, de-qualification and a loss of workers autonomy. On the other hand, digitalization of work leads to new forms of indirect control and algorithmic control that can be used to manage and instrumentalize the supposed autonomy of workers to actually enable an unequal and exploitative labour process. This article discusses the questions of heteronomy related to the digitalization of work, presents central aspects of new forms of control (direct, indirect, and algorithmic) and explains why formalization, data centred decision making and flexible structures are used to control the labour process and improve heteronomy of work.
Pavement Image Datasets: A New Benchmark Dataset to Classify and Densify Pavement Distresses
Authors: Majidifard Hamed , Jin Peng , Adu-Gyamfi Yaw , Buttlar William G.
Published: February 2020

Automated pavement distresses detection using road images remains a challenging topic in the computer vision research community. Recent developments in deep learning have led to considerable research activity directed towards improving the efficacy of automated pavement distress identification and rating. Deep learning models require a large ground truth data set, which is often not readily available in the case of pavements. In this study, a labeled dataset approach is introduced as a first step towards a more robust, easy-to-deploy pavement condition assessment system. The technique is termed herein as the pavement image dataset (PID) method. The dataset consists of images captured from two camera views of an identical pavement segment, that is, a wide view and a top-down view. The wide-view images were used to classify the distresses and to train the deep learning frameworks, while the top-down-view images allowed calculation of distress density, which will be used in future studies aimed at automated pavement rating. For the wide view group dataset, 7,237 images were manually annotated and distresses classified into nine categories. Images were extracted using the Google application programming interface (API), selecting street-view images using a python-based code developed for this project. The new dataset was evaluated using two mainstream deep learning frameworks: You Only Look Once (YOLO v2) and Faster Region Convolution Neural Network (Faster R-CNN). Accuracy scores using the F1 index were found to be 0.84 for YOLOv2 and 0.65 for the Faster R-CNN model runs; both quite acceptable considering the convenience of utilizing Google Maps images.
Integration of rCF in resin transfer pressing process
Authors: Goergen C , May D , Mitschang P
Published: February 2020

A new composite manufacturing process, resin transfer pressing, is introduced in this paper. In this process, nonwoven fabrics made of recycled carbon fibers are oversaturated with thermoset resin, i.e. they contain excess resin. The oversaturated nonwoven fabrics are prefabricated and used as resin carrier in a press process, where they are placed in a heated mold together with a dry textile-based preform. During pressing, the resin is pressed out and transferred from the nonwoven into the non-impregnated preform and hence impregnates the whole reinforcement. This study examines the oversaturation of nonwoven fabrics, the resin transfer pressing laminate manufacturing and the surface quality of the laminates. The ability of a nonwoven fabric to be oversaturated with resin is defined by the saturation degree, which was determined as up to 12 for glass fiber nonwoven fabrics and up to 60 for recycled carbon fiber nonwoven fabrics. Different laminates are manufactured by resin transfer pressing, and the impregnation quality is evaluated. With an optimized stacking sequence, a pore content <1% was achieved. The use of recycled carbon fiber nonwovens in the resin transfer pressing process leads to a less wavy surface compared to a wet compression molding manufactured laminate, showing a decrease of waviness Wz25 of 11% minimum.
Decentralization of solid waste management services in rural Lebanon: Barriers and opportunities
Authors: Abed Al Ahad Mary , Chalak Ali , Fares Souha , Mardigian Patil , Habib Rima R
Published: February 2020

Rapid urbanization, closure of dumps, and insufficient infrastructure funding in Lebanon have resulted in improper municipal solid waste management (MSWM), creating a continuing trash crisis in recent years. In Beirut and Mount Lebanon, MSWM was carried out in centralized waste processing and disposal facilities operated by the government. The trash crisis and failure of the centralized system prompted several municipal authorities to decentralize MSWM by establishing local facilities, paid by the council taxes charged to beneficiary households. To study the feasibility of decentralized MSWM, a survey of 228 households in a rural village in Lebanon explored households’ willingness to pay (WTP) for a local MSWM service. For data analysis, a multivariate Tobit model was used to examine the determinants of the WTP amount. Results showed that 79% of surveyed households in the studied village were willing to support local MSWM improvements by contributing an average yearly fee of US$48, representing a 30% increase in their current council taxes. Analysis showed a significant positive association between the WTP amount and the household monthly income level, the residents perceived needs for urgency to act on solid waste management, and the households’ responsibility to be involved in MSWM. An interview with the municipality mayor later revealed that financial, technical, and land resources are lacking to enable consideration of a decentralized project for MSWM in the village. Municipalities in rural areas have limited resources and are unable to sustain a decentralized MSWM service unless adjacent towns join effort in supporting and financing MSWM initiatives.
Prevalence of Urologic Disease Among Patients Investigated for Hematuria With CT Urography
Authors: Fenwick Andrew K. C. , Sala Eric , Canales Donaldo D.
Published: February 2020

Purpose:

The current study evaluated the prevalence of urologic disease among patients with hematuria referred for computerized tomography (CT) urography to determine which patients require investigation with CT urography.

Methods:

We retrospectively reviewed radiology reports of 1046 CT urograms performed for the indication of microscopic (43.7%) or gross hematuria (56.3%). Urological findings were categorized as negative, benign, or suspicious (pathologically confirmed) for malignancy.

Results:

Of 1046 CT urograms performed, 53.5% were negative, 36.4% were benign, and 10% were suspicious for malignancy. The most common benign finding was urolithiasis (22.3%). Overall, urinary tract malignancies were present in 3.6% of patients, and the rate was significantly higher ( P < .001) for gross (5.8%) than microscopic hematuria (0.9%). CT urography identified 0.6% patients with upper urinary tract malignancies; the malignancy rate was significantly higher ( P = .038) for gross (1%) than microscopic hematuria (0%), and no significant sex ( P = 1.00; male = 0.6%, female = 0.6%) or age ( P = .600; < 50 years = 0%, ≥ 50 years = 0.7%) differences were observed. Logistic regression revealed that being male was associated with gross hematuria (odds ratio [OR] = 2.92), and that both age and gross hematuria (ORs = 1.06 and 5.13, respectively) were associated with malignancy.

Conclusions:

CT urography found no upper urinary tract malignancies in 99.4% of patients presenting with hematuria, including all patients with microscopic hematuria and those with gross hematuria <50 years old. Investigating these subgroups with CT urography may be unnecessary and result in increased patient morbidity and health-care costs.
Social Media Influence and Electoral Competition
Authors: Shmargad Yotam , Sanchez Lisa
Published: February 2020

Do social media platforms help or hinder democracy? Internet enthusiasts posit that social media could have a democratizing effect by lowering the costs of promotion, while skeptics argue that these platforms replicate or even exacerbate preexisting inequalities. We inform this debate by combining campaign finance and electoral outcome data from the Federal Election Commission with Twitter metrics of candidates who ran in the 2016 U.S. congressional elections. We find that poorer candidates, who spent less than their competitor, performed better if they had indirect influence on Twitter—getting their tweets shared by users whose own tweets are widely shared. The effect of indirect influence on election outcomes was more pronounced in races with larger financial inequities between candidates or fewer total expenses across candidates. Moreover, poorer candidates with indirect influence saw smaller vote gaps than their party’s candidate in the same district (in House races) or state (in Senate races) in 2014.
Peritoneal Membrane Transport and Hypoalbuminemia: Cause or Effect?
Authors: Margetts Peter J. , McMullin Joseph P. , Rabbat Christian G. , Churchill David N.
Published: February 2020

Objective

Peritoneal membrane transport has been associated with serum albumin and clinical outcome. We examined the relationship between serum albumin and peritoneal membrane transport status before and after the initiation of peritoneal dialysis.

Setting

Patients were followed at a tertiary-care regional nephrology program at St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada.

Methods

Incident peritoneal dialysis patients between 1 January 1995 and 31 May 1998 were eligible if there was a peritoneal equilibration test within 180 days of starting dialysis, and a serum albumin value measured within 90 days prior to, and 20 to 70 days after initiating dialysis.

Main Outcome Measures

Serum albumin, before and after the initiation of dialysis, and the presence of proteinuric renal disease were compared with the peritoneal equilibration test results.

Results

Among 67 identified patients, there were 7 high, 27 high-average, 26 low-average, and 7 low transporters and the mean serum albumin values before dialysis were 35.1, 37.4, 37.8, and 40.4 g/L, respectively ( p < 0.001). Serum albumin values prior to the initiation of dialysis correlated significantly with the 4-hour D/P creatinine ratio ( r = –0.251, p = 0.040). After initiation of dialysis, the correlation was stronger ( r = –0.447, p < 0.001). Serum albumin prior to initiation of dialysis was lower for those with proteinuric than nonproteinuric renal disease (36.4 g/L vs 38.8 g/L, p = 0.04). The trend to lower serum albumin in high transporters was seen in patients with both proteinuric and nonproteinuric renal disease.

Conclusion

The association between higher peritoneal membrane transport and lower serum albumin is present before initiation of dialysis in both proteinuric and nonproteinuric renal disease. The poor outcomes associated with low serum albumin and higher peritoneal membrane transport might be explained by other underlying factors. The contribution of inflammation, malnutrition, and fluid overload requires further study.
Influence of Initial Nutritional Status on Continuous Ambulatory Peritoneal Dialysis Patient Survival
Authors: Chung Sung Hee , Lindholm Bengt , Lee Hi Bahl
Published: February 2020

Objectives

To evaluate the influence of initial nutritional status on continuous ambulatory peritoneal dialysis (CAPD) patient survival and to identify factors determining initial nutritional status and patient mortality.

Design

Prospective single-center study.

Setting

Kidney Center, Soon Chun Hyang University Hospital.

Patients

A total of 91 consecutive CAPD patients, who underwent initial nutritional assessment at Soon Chun Hyang University Hospital, Seoul, Korea, between September 1994 and January 1999, was included in this study. All patients were assessed at a mean of 7 days after beginning CAPD (range 3 – 24 days). Forty-eight patients were male, 50 were diabetics, and their mean age was 53.9 years (range 22 – 76 years).

Methods

Nutritional status was assessed by subjective global assessment (SGA), biochemical and anthropometric measurements, fat-free edema-free (FFEF) body mass by creatinine kinetics, urea kinetic studies, and calculation of the normalized protein equivalent of total nitrogen appearance (nPNA).

Results

By SGA, 55% were classified as having normal nutrition while 45% had signs of malnutrition; 61% of female and 31% of male patients, and 54% of diabetics and 34% of nondiabetics were classified as malnourished. Initial FFEF body mass, blood urea nitrogen (BUN), serum albumin (sAlb), residual renal function (RRF), and weekly total creatinine clearance were significantly lower in the malnourished patients than in the patients with normal nutrition. On multiple regression analysis, only FFEF body mass was an independent determinant of SGA score. On 31 January 1999, 41 patients were still on CAPD, 15 patients had died, and 27 patients had been transferred to hemodialysis. Those who died during observation were older and had lower initial FFEF body mass, % lean body mass, BUN, sAlb, RRF, and SGA score. The 2-year patient survival rate was significantly lower in the malnourished than in normal patients (67.1% vs 91.7%, p = 0.02). On Cox proportional hazards analysis, initial age, malnutrition assessed by SGA, and FFEF body mass were identified as factors determining death.

Conclusion

Malnutrition was present in 45% of patients commencing CAPD when assessed by SGA. Initial FFEF body mass was a determinant of SGA score and predicted death. Malnutrition as assessed by SGA was also an independent predictor of death. Initial nutritional status, therefore, appears to exert a powerful influence on CAPD patient survival.
Discriminative Impact of Ultrafiltration on Peritoneal Protein Transport
Authors: Waniewski Jacek , Wang Tao , Heimbürger Olof , Werynski Andrzej , Lindholm Bengt
Published: February 2020

Objective

The dialysate concentration of large proteins increases, on average, linearly during the whole peritoneal dialysis dwell, and this linear pattern seems to be independent of the rate of ultrafiltration induced by dialysis fluid. However, we observed a high variability of protein kinetics in individual dwell studies. Therefore, we studied the details of the kinetic pattern of peritoneal transport.

Design and Methods

Kinetics of β2-microglobulin, albumin, and total protein was examined in 23 clinically stable continuous ambulatory peritoneal dialysis patients using Dianeal 3.86% (15 dwell studies) or Dianeal 1.36% (9 dwell studies) dialysis fluid. Dialysate volume was measured using radioisotopically labeled albumin as a volume marker, with corrections for sample volume and absorption of fluid and marker from the peritoneal cavity. The generalized version of the Babb–Randerson–Farrell model was applied to estimate diffusive mass transport coefficient (KBD) and sieving coefficient (S) for proteins and small solutes (urea, creatinine, glucose, sodium, potassium). To quantify deviations from the linear pattern of protein dialysate concentration increase, the ratio (SR) of the slope of the linear regression line for the initial 3 – 30 minutes, divided by the slope for the next 60 – 360 minutes, was evaluated for albumin.

Results

In 5 dwell studies with Dianeal 3.86% fluid, SR was lower than 1 [low albumin transport (LAT) group, median SR = 0.49, range –4.39 – 0.71], while in the other 10 dwell studies with this solution, SR was higher than 1 [high albumin transport (HAT) group, median SR = 2.77, range 1.32 – 7.56]. Clearances of albumin up to 120 minutes were higher in the HAT group than in the LAT group. The transport of fluid, β2-microglobulin, and small solutes did not differ between the LAT and the HAT groups. KBD values for proteins did not differ between the groups, but S values for albumin and total protein were lower for the LAT group than for the HAT group. A similar diversity was found in the dwell studies with Dianeal 1.36%: In three dwell studies, SR for albumin was lower than 1 (median SR = 0.95, range 0.70 – 0.97), and in six dwells it was higher than 1 (median SR = 1.55, range 1.23 – 1.98). In general, the SR values observed with Dianeal 1.36% were closer to 1 than those for Dianeal 3.86%.

Conclusions

Ultrafiltration may affect the initial kinetic patterns of large protein (such as albumin) transport in two opposing ways: ( 1 ) by slowing the increase of protein concentration in dialysate (due to a low sieving coefficient, LAT group), and ( 2 ) by speeding up the increase of protein concentration in dialysate (due to a high sieving coefficient, HAT group). The average pattern in a non-selected group of studies is, however, close to a steady (linear) increase.
Effect of Pyrazinamide and Probenecid on Peritoneal Urate Transport Kinetics during Continuous Ambulatory Peritoneal Dialysis
Authors: Spaia Sophia , Magoula Ifigenia , Tsapas George , Vayonas George
Published: February 2020

Objective

We administered pyrazinamide (PZA) and probenecid (PB) — two well-known modulators of urate transport via the proximal tubules — to evaluate their impact on urate transport through the peritoneal membrane and to clarify mechanisms affecting peritoneal transport.

Setting

A continuous ambulatory peritoneal dialysis (CAPD) unit in 2nd Hospital of IKA (Social Services Institute), Greece.

Patients

In 20 stable CAPD patients, on the study day, a 4-hour, 2-L, 1.36% glucose exchange was performed (control exchange). Pyrazinamide 3 g was given orally and another identical exchange was performed (study exchange). The same protocol was repeated with 2 g PB. Kt/V, peritoneal clearances of urea, creatinine, and urate for each exchange, and mass transfer area coefficients (MTAC) for the three solutes and their dialysate-to-plasma concentration (D/P) ratios were used to estimate peritoneal transport.

Results

Administration of PZA resulted in decreased clearances and MTAC values for the three solutes. The D/P ratio decreased significantly only for urate, indicating a more intense influence of PZA on urate. After PB administration, clearances of urea, creatinine, and urate were increased. MTAC and D/P ratio increased significantly only for urate ( p < 0.05), demonstrating an action similar to that exerted on renal tubules.

Conclusions

These findings provide evidence that unrestricted diffusion is not the only transport mechanism in the case of urate, and demonstrate the existence of an active mechanism in peritoneal urate transport with a reabsorptive and, probably, a secretive component that resembles that of renal tubule urate transport. Attention should be given in the case of CAPD patients undergoing antituberculous (PZA) treatment: it might have a negative impact on urea, creatinine, and urate peritoneal transport rates.
Normalization of Clearances in Peritoneal Dialysis Using a Formula for Body Water Derived from an End-Stage Renal Disease Population
Authors: Tzamaloukas Antonios H. , Murata Glen H. , Malhotra Deepak , Piraino Beth , Rao Panduranga , Bernardini Judith , Oreopoulos Dimitrios G.
Published: February 2020

Objective

To compare body water (V) estimates from the Chertow formula (VC), which was derived in an end-stage renal disease population, to V estimates from the Watson formulas (VW) in continuous ambulatory peritoneal dialysis (CAPD) patients. To identify CAPD patients in whom VC is preferred to VW for clearance studies.

Design

Retrospective analysis of clearance studies.

Setting

Dialysis units of four academic medical centers.

Participants

302 subjects on CAPD.

Intervention

613 clearance studies by standard methods.

Main Outcome Measures

Comparisons between VC and VW, and between urea clearance normalized by VC [(Kt/VC)ur] and VW [(Kt/VW)ur].

Results

VC exceeded VW by 3.5 ± 1.6 L ( p < 0.001), or 9.6% on average. This degree of overestimation of VW is in the range of body water estimates found in CAPD subjects with severe volume overload (> 5% of body weight) in previous studies. Total (Kt/VW)ur exceeded total (Kt/VC)ur by 8.6%. By linear regression, VC = –0.589 + (1.112 x VW), r = 0.983. VW exceeded VC in only 12 studies. Young age, short height, low body weight, and low prevalence of diabetes characterized the studies with VW > VC. Total (Kt/VW)ur was adequate (≥ 2.0 weekly) in 276 studies. Among these, 74 studies had inadequate total (Kt/VC)ur (< 2.0 weekly). By logistic regression, the predictors of inadequate (Kt/VC)ur, when (Kt/VW)ur was adequate, included the presence of diabetes, great height, and long duration of CAPD.

Conclusions

VC provides estimates of body water exceeding those provided by VW in a great majority of CAPD patients. Consequently, approximately 25% of the clearance studies that are adequate when VW is used as the normalizing parameter may be inadequate when VC is used. VC may provide a more appropriate estimate of body water than VW in CAPD patients with volume overload.
Prevalence of TT Virus in Serum and Peripheral Mononuclear Cells from a CAPD Population
Authors: Barril Guillermina , López–Alcorocho Juan M. , Bajo Auxiliadora , Ortiz–Movilla Nuria , Sánchez–Tomero Jose A. , Bartolomé Javier , Selgas Rafael , Carreño Vicente
Published: February 2020

Background

A novel virus named TT virus (TTV) has been isolated recently from patients with posttransfusional hepatitis of unknown etiology. The prevalence of TTV in several groups at risk has been reported, however, there is no information about the prevalence of TTV in patients on continuous ambulatory peritoneal dialysis (CAPD) without blood transfusions or hemodialysis antecedents.

Objective

To study the incidence of TTV in serum and peripheral blood mononuclear cells (PBMC) of CAPD patients.

Design

TTV DNA was detected by polymerase chain reaction, using primers from the open reading frames (ORF) 1 and 2, in serum and PBMC from 22 CAPD patients who had not received blood transfusions or hemodialysis therapy prior to CAPD. As controls, sera from 20 patients with chronic viral hepatitis (10 with HBV and 10 with HCV) and 20 healthy donors were included in the study.

Results

TTV DNA was detected in the serum of 5 of 22 (22.7%) CAPD patients with both sets of primers. Four of the 5 (80%) patients with TTV DNA in their serum were TTV positive in their PBMC with primers from ORF1 and ORF2. Five of 20 (25%) patients with chronic viral hepatitis (2 patients with HBV and 3 with HCV) and 4 of 20 (20%) healthy donors were TTV DNA positive in serum. No relation was found between TTV infection and the underlying kidney disease, previous surgery, and abnormal alanine aminotranferase levels.

Conclusion

We have found a relatively high prevalence of TTV that is similar to that found in healthy donors and in patients with chronic viral hepatitis.
Outcome following Staphylococcal Peritonitis
Authors: Peacock Sharon J. , Howe Paul A. , Day Nicholas P.J. , Crook Derrick W.M. , Winearls Christopher G. , Berendt Anthony R.
Published: February 2020

Objective

Staphylococcus spp predominate as the causative pathogen of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis. This study evaluated the difference in morbidity and mortality between peritonitis caused by S. aureus and coagulase-negative staphylococci (CoNS).

Design

Prospective observational study.

Setting

A single regional dialysis unit in a teaching hospital.

Patients

Thirty-seven patients had S. aureus peritonitis and 65 patients had CoNS peritonitis between July 1990 and November 1995.

Main Outcome Measures

Using the first recorded episode of peritonitis, survival analysis was performed for time to ( 1 ) death, ( 2 ) removal of peritoneal dialysis catheter, and ( 3 ) change to hemodialysis. Abdominal complications were recorded for the first and subsequent episodes.

Results

No difference in time to death was demonstrated for the two groups ( p = 0.79), although two deaths that occurred during therapy for peritonitis were attributable to S. aureus infection. In addition, 5 patients developed serious abdominal complications related to an episode of S. aureus peritonitis. Patients with S. aureus peritonitis had a shorter time to both peritoneal dialysis catheter removal ( p = 0.004) and change to hemodialysis ( p = 0.014). The change in mode of dialysis was independent of catheter loss.

Conclusion

This study highlights the serious nature of S. aureus peritonitis and confirms the need for effective preventive measures against infection by this pathogen.
The Longitudinal Effect of a Single Peritonitis Episode on Peritoneal Membrane Transport in CAPD Patients
Authors: Ates Kenan , Koç Rafet , Nergizoglu Gökhan , Ertürk Sehsuvar , Keven Kenan , Sen Arzu , Karatan Oktay
Published: February 2020

Objective

To evaluate the longitudinal effect of a single peritonitis episode on peritoneal membrane transport.

Design

A prospective longitudinal study.

Setting

Department of nephrology in a university hospital.

Patients

Eighteen continuous ambulatory peritoneal dialysis patients with peritonitis.

Methods

Peritoneal transport for low, middle, and high molecular weight (MW) solutes was evaluated by peritoneal equilibration test (PET). The first PET was performed on the day following the diagnosis of peritonitis. The test was repeated at weeks 1, 2, 4, 12, and 24 and the results were compared to baseline PET data obtained before peritonitis. In addition, dialysate CA125 concentration and leukocyte count were measured.

Results

During peritonitis there were significant increases in dialysate-to-plasma (D/P) ratios for all low, middle, and high MW solutes except potassium, and decreases in D4/D0 glucose ratio and ultrafiltration (UF) volume. Over the subsequent 2 weeks, solute transport gradually decreased to the baseline values then remained unchanged during follow-up. Although net UF volume demonstrated a similar course during the study, it did not completely return to the baseline value. No decrease in D/P sodium ratio was found at 60 minutes during the PET performed 24 weeks after peritonitis. The percent change in solute transport during peritonitis compared to baseline value was significantly correlated with a solute's MW ( r = 0.776, p = 0.014). The slope of the regression line for D/P ratios versus MW, in double logarithmic scale, before peritonitis (-0.73 ± 0.09) was steeper than the slope during peritonitis (-0.59 ± 0.08).

Conclusions

These findings indicate that a single peritonitis episode does not permanently affect peritoneal solute transport. However, the loss of net UF that accompanies peritonitis is not completely recovered, probably due to impairment of transcellular water transport. The transport changes associated with peritonitis may be due to the combined effect of increased effective peritoneal surface area and intrinsic permeability. Our findings suggest that the latter mechanism seems to be more important.
Phenotypic Alterations of Recruited Eosinophils in Peritoneal Fluid Eosinophilia
Authors: Hellman Cecilia , Lundahl Joachim , Hylander Britta , Halldén Gunilla
Published: February 2020

Objective

To characterize eosinophils and soluble factors in effluent from continuous ambulatory peritoneal dialysis (CAPD) patients and connect these findings to related conditions with eosinophilic accumulation.

Patients

Three newly started CAPD patients, two with peritoneal fluid eosinophilia (PFE) and one with bacteria-induced peritonitis. One patient with PFE was followed up for 10 visits during a 7-month period.

Methods

Leukocytes were analyzed in dialysate and peripheral blood from the patients, by flow cytometry, and soluble mediators by ELISA or CAP technique.

Results

We found an increased number of neutrophils in the effluent from the patient with bacteria-induced peritonitis; accumulation of eosinophils in combination with negative cultures was noted in the patients with PFE. Increased levels of interleukin (IL)-5 and eosinophil cationic protein, but equal levels of eotaxin, were found in effluent from the PFE patients compared to the patient with neutrophilia. Peritoneal fluid eosinophils were activated by means of EG2, CD11b, CD9, and CD69 expression. Compared to blood eosinophils, the cytokine receptors for IL-5 and granulocyte-macrophage colony-stimulating factor, but not IL-3, were down regulated.

Conclusion

The finding of activated eosinophils in combination with IL-5 and eotaxin in PFE indicates existing similarities between PFE and conditions found during recruitment of eosinophils in allergic inflammatory responses.
A Survey of CAPD Peritonitis Management and Outcomes in North and South Thames NHS Regions (U.K.): Support for the ISPD Guidelines
Authors: Kent James R. , Almond Michael K.
Published: February 2020

Objective

This survey examined the current management of continuous ambulatory peritoneal dialysis (CAPD) peritonitis and the effectiveness of the various antibiotic protocols in use.

Design

The information required was elicited via a postal questionnaire.

Setting

The questionnaire was posted to each renal dialysis unit offering CAPD throughout the North and South Thames National Health Service regions.

Patients

All patients using CAPD at each responding unit were eligible for inclusion.

Main Outcome Measures

Each unit provided details of their CAPD peritonitis episodes for 1997. Each unit's empirical treatment regimen for CAPD peritonitis was sought in addition to response rates. Also requested were numbers for peritonitis episodes, recurrences, and negative cultures, plus the peritonitis rate per patient-month.

Results

Thirteen units returned the questionnaire (87% of the survey population). Nine of the 13 units were using vancomycin regimens, with the remainder using cephalosporin regimens. The results were compared to the audit standards of the British Renal Association. Seventy percent of units reached the 80% mark for response rate; similar results were achieved with both the vancomycin and cephalosporin regimens. Ninety-two percent achieved the suggested peritonitis rate of 1 episode every 18 patient-months; 30% achieved the culture-negative rate of 10%. The average recurrence rate was 19%.

Conclusion

The units contacted achieved most of the standards suggested by the British Renal Association; however, wide variations did exist. Recent guidelines have suggested avoiding vancomycin-based regimens in order to reduce the incidence of vancomycin resistance. The suggested regimen of a cephalosporin with an aminoglycoside seems to represent a suitable alternative.
High Prevalence of Hyperparathyroidism among Peritoneal Dialysis Patients: A Review of 176 Patients
Authors: Billa Viswanath , Zhong Aimin , Bargman Joanne , Vas Stephen , Wong Pui Y. , Oreopoulos Dimitrios G.
Published: February 2020

Objectives

Parathyroid dysfunction continues to produce significant morbidity in dialysis patients. Since the introduction of low calcium dialysate for peritoneal dialysis (PD), no large studies have been done to determine the prevalence of parathyroid dysfunction in these patients. This study was done to assess the prevalence of parathyroid disease in the PD population and to determine the risk factors associated with this dysfunction.

Design

We analyzed data on 176 patients who received PD at a single center between August 1998 and February 1999. Clinical data, laboratory variables related to parathyroid function, and data pertaining to dialysis treatment and weekly drug dosing were obtained for each patient on two different occasions, approximately 3 months apart. Variables predictive of the development of parathyroid dysfunction were calculated by univariate and multivariate logistic regression analysis.

Results

Two-thirds of the patients surveyed had an abnormal intact parathyroid hormone (iPTH) level: 47% had an iPTH level more than three times normal, the mean was 54.6 ± 35.4 pmol/L; 23% had an iPTH value below the upper limit of normal, here the mean was 3.6 ± 1.8 pmol/L. Diabetic patients had lower iPTH levels (22.2 ± 28.4 pmol/L) than nondiabetics (33.9 ± 34.8 pmol/L) ( p = 0.02). On multivariate regression analysis, we found that age, duration of dialysis, Kt/V, serum bicarbonate, and serum ionized calcium levels did not significantly affect parathyroid function. Hyperphosphatemia was the only factor that was associated with the development of secondary hyperparathyroidism in this study population ( p = 0.029).

Conclusion

There is a high prevalence of hyperparathyroidism in the current PD population. Phosphate control is suboptimal and hyperphosphatemia is an independent risk factor for the development of hyperparathyroidism.
Residual Renal Function in a Large Cohort of Peritoneal Dialysis Patients: Change over Time, Impact on Mortality and Nutrition
Authors: Shemin Douglas , Bostom Andrew G. , Lambert Cynthia , Hill Connie , Kitsen Jenny , Kliger Alan S.
Published: February 2020

Objective

Residual renal function contributes importantly to total solute clearance in peritoneal dialysis (PD) patients. This study was designed to examine the progression of residual renal function over time and its impact on nutrition and mortality in PD patients in the six New England states (ME, NH, VT, CT, MA, RI) comprising End Stage Renal Disease (ESRD) Network 1.

Design

As part of the ESRD Clinical Indicators Project, data on 990 PD patients in Network 1 were abstracted from data supplied by dialysis units in the fourth quarter of 1997. This included demographic information; dose of PD in L/day; weekly renal, dialysis, and total Kt/V urea; weekly renal, dialysis, and total creatinine clearance (CCr); serum albumin level; and mortality and transplantation information. Data collection was repeated in the second and fourth quarters of 1998 and in the second quarter of 1999.

Patients

990 PD patients in Network 1.

Outcome Measures

The change in total and renal solute clearances over time, the relationship between renal clearance and mortality, and the relationship between renal clearance and nutritional status, as represented by serum albumin.

Results

Over the 2-year period, mean weekly renal Kt/V urea and weekly renal CCr dropped significantly. To examine the effect of residual renal function on mortality, patients were divided into high and low (above and below the median) weekly renal Kt/V urea and weekly renal CCr groups. Patients above the median levels of both weekly renal Kt/V urea and weekly renal CCr had a significantly decreased risk of dying during the observation period, after controlling for age, gender, serum albumin level, and diabetic status [OR for high vs low renal Kt/V urea 0.54 (CI 0.34 – 0.84), OR for high vs low renal CCr 0.61 (CI 0.40 – 0.94)]. The mean weekly renal Kt/V urea was significantly and directly correlated with the mean serum albumin level by Spearman rank correlation ( R = 0.133, p < 0.001), as was the mean weekly renal CCr ( R = 0.115, p < 0.001).

Conclusions

Residual renal function is an important contributor to total solute clearance in PD patients. Even at low levels it is linked to decreased mortality and better nutritional status.
Left Ventricular Hypertrophy and Clinical Outcome in CAPD Patients
Authors: Silaruks Songkwan , Sirivongs Dhavee , Chunlertrith Darunee
Published: February 2020

Objective

To determine the clinical outcome of left ventricular hypertrophy (LVH) (left ventricular wall diastole thickness ≥ 1.2 cm) detected by echocardiography in non-diabetic, continuous ambulatory peritoneal dialysis (CAPD) patients without dilated cardiomyopathy.

Design

A prospective, descriptive study was conducted between 1 July 1995 and 31 January 1998. Patients were followed up for 24 months.

Setting

Peritoneal dialysis unit in a medical school hospital.

Patients and Methods

Baseline and yearly echocardiograms were carried out on 66 patients receiving CAPD. Cardiac death was assessed. LVH was correlated with outcome.

Results

Of 66 nondiabetic CAPD patients without dilated cardiomyopathy, 20 had a normal echocardiogram (LV wall thickness < 1.2 cm), 21 had mild hypertrophy, and 25 severe hypertrophy (LV wall thickness > 1.4 cm in diastole). In the first two groups, 21% were admitted with congestive heart failure (CHF) after starting dialysis. The 1-year cumulative survival was 85% among those with mild hypertrophy and 91% in the normal group. In the group with severe hypertrophy, 57% were admitted at least once with CHF, and the 1-year cumulative survival was 56%. Eighty-two percent of those who died in the severe group, which accounted for the significantly worse survival ( p = 0.003), died from cardiac or cerebrovascular causes, compared with none of those with a normal echocardiogram.

Conclusions

Severe LVH was found in a third of our CAPD patients and was associated with a significantly high cardiovascular morbidity and mortality.