bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of a Pulsatile Blood Pump and a Peristaltic Roller Pump During Hemoperfusion Treatment in a Canine Model of Paraquat Poisoning
Authors: Lee Jung Chan , Park Chan Young , Choi Seong Wook , Kim Jeong Chul , Lim Ki Moo , Kim Kyuseok , Jung Sung Koo , Kwak Young Ho , Shin Sang Do , Jo Ik Joon , Suh Gil Joon , Min Byoung Goo
Published: July 2008

Abstract:  This study examined the treatment efficacy and the damage to the blood during hemoperfusion for treating paraquat poisoning using two blood pump mechanisms. Paraquat‐poisoned animal models were prepared. A conventional hemodialysis machine, AK90, with a peristaltic roller pump and a cardiopulmonary support system, T‐PLS, with a pulsatile blood pump were used during the animal experiments. A total of 12 dogs were treated with hemoperfusion using a charcoal column. Six dogs were treated with hemoperfusion and T‐PLS, and the other six were treated with AK90. A paraquat dose of 30 mg/kg was administrated by an intravenous injection. Both pumps maintained blood flow rates of 125 mL/min measured by an ultrasonic flowmeter. For anticoagulation, heparin was administrated by an initial bolus (250 IU/kg) and a continuous injection (100 IU/kg/h). During the experiments, T‐PLS and AK90 showed a similar toxin removal efficacy. Both devices decreased the plasma paraquat concentration to 10% of the initial dose within 4‐h hemoperfusion. The two pumps showed similar hemolysis properties with acceptable levels. Although T‐PLS was developed as a cardiopulmonary bypass system, it can also be used as a hemoperfusion treatment device.
A New Synthetic Dialyzer With Advanced Permselectivity for Enhanced Low‐molecular Weight Protein Removal
Authors: Krieter Detlef H. , Lemke Horst‐Dieter , Wanner Christoph
Published: July 2008

Abstract:  Optimizing solute removal at minimized albumin loss is a major goal of dialyzer engineering. In a prospective, randomized, crossover study on eight patients (age 63 ± 14 years) on maintenance hemodialysis, the new Baxter Xenium 170 high‐flux dialyzer (BX), which contains a 1.7‐m2 PUREMA H dialysis membrane, was compared with two widely used reference high‐flux dialyzers currently available for hemodialysis in North America, the Fresenius Optiflux 180 NR (FO) and the Gambro Polyflux 170 H (GP). Solute removal and biocompatibility were assessed in hemodialysis for 240 min at blood and dialysate flow rates of 300 and 500 mL/min, respectively. Additional ex vivo experiments detecting the interleukin‐1beta (IL‐1b) generation in recirculated donor blood were performed to demonstrate the pyrogen retention properties of the dialyzers. The instantaneous plasma clearances were similar for the three dialyzers except for cystatin c (cysc), for which a lower clearance was measured with FO as compared with BX and GP after 30 and 180 min of hemodialysis. The reduction ratios (RRs) corrected for the hemoconcentration of beta2‐microglobulin and cysc were lower in FO (44 ± 9 and 35 ± 9%, respectively) versus BX (62 ± 6 and 59 ± 7%, respectively) and GP (61 ± 7 and 56 ± 8%, respectively). The RRs of the cytokine tumor necrosis factor alpha and interleukin‐6 were not different between the dialyzers. The albumin loss was <300 mg for all filters. No differences between the dialyzers were found in the biocompatibility parameters showing very low leukocyte and complement activation. The ex vivo recirculation experiments revealed a significantly higher IL‐1b generation for GP (710 ± 585 pg/mL) versus BX (317 ± 211 pg/mL) and FO (151 ± 38 pg/mL). BX is characterized by a steep solute sieving profile with high low‐molecular weight protein removal at virtually no albumin loss and an excellent biocompatibility. This improved performance may be regarded as a contribution to optimal dialysis therapy.
Laboratory Performance Testing of Venous Cannulae During Inlet Obstruction
Authors: Simons Antoine P. , Ganushchak Yuri , Wortel Pieter , Van Der Nagel Theo , Van Der Veen Frederik H. , De Jong Dick S. , Maessen Jos G.
Published: July 2008

Abstract:  Venous cannulae undergo continuous improvements to achieve better and safer venous drainage. Several cannula tests have been reported, though cannula performance during inlet obstruction has never been a test criterion. In this study, five different cannulae for proximal venous drainage were tested in a mock circulation that enabled measurement of hydraulic conductance after inlet obstruction by vessel collapse. Values for hydraulic conductance ranged from 1.11 × 10–2 L/min/mm Hg for a Thin‐Flex Single Stage Venous Cannula with an open‐end lighthouse tip to 1.55 × 10–2 L/min/mm Hg for a DLP VAD Venous Cannula featuring a swirled tip profile, showing a difference that amounts to nearly 40% of the lowest conductance value. Excessive venous drainage results in potentially dangerous high‐negative venous line pressures independent of cannula design. Cannulatip design featuring swirled and grooved tip structures increases drainage capacity and enhances cannula performance during inlet obstruction.
Oxygen Therapy Influences Episodic Cluster Headache and Related Cutaneous Brush and Cold Allodynia
Authors: Huber Gerald , Lampl Christian
Published: July 2008

Cluster headache (CH) is characterized by a series of sudden attacks of short‐lasting severe headache pain with ipsilateral autonomic features, including lacrimation, rhinorrhea, localized sweating, eyelid edema, and partial or complete Horner's syndrome. Just like in migraine, brush allodynia has been described for CH and for short lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) syndrome. Administration of normobaric oxygen is part of the standard therapy for CH attacks. Here, we describe a young male with a first CH attack and the influence of oxygen on pain and concomitant cutaneous allodynia.
Chronic Alcohol Consumption Generates a Vulnerable Immune Environment During Early SIV Infection in Rhesus Macaques
Authors: Marcondes Maria Cecilia G. , Watry Debbie , Zandonatti Michelle , Flynn Claudia , Taffe Michael A. , Fox Howard
Published: July 2008

Background:  Alcohol consumption is a common problem in HIV‐infected individuals, and the effects of alcohol may alter the efficiency of the immune response, potentially aggravating the disease as well as affecting end organs, such as the brain. However, the elements of the virus‐host interaction that are modulated by ethanol are poorly dissected.

Methods:  Ethanol intake was conditioned in rhesus macaques prior to SIV infection, in order to mimic this common human behavior, and allow the evaluation of aspects of the virus‐immune system interactions during acute time‐points, when important facets of the infection are set up and when virus reproducibly enters the brain.

Results:  Although ethanol had a limited effect on the acute plasma viral load, it resulted in reduced circulating memory CD4+ T cells and increased levels of monocytes expressing the viral coreceptor CCR5. In organs, ethanol consumption impacted immune cells in the liver as well as lymphoid and other nonlymphoid tissues, where CD4+ T cells were predominantly affected.

Conclusion:  Overall, the consumption of alcohol causes immune cell alterations that can contribute to the generation of a disease susceptible environment upon SIV infection.
Hazardous Drinking: Prevalence and Associations in the Finnish General Population
Authors: Halme Jukka T. , Seppä Kaija , Alho Hannu , Pirkola Sami , Poikolainen Kari , Lönnqvist Jouko , Aalto Mauri
Published: July 2008

Background:  Hazardous drinking, defined as consuming alcohol on a risky level and not meeting the diagnostic criteria of alcohol use disorders (AUDs), has been suggested for a new complementary nondependence diagnosis. This study aimed to investigate the prevalence and associations of hazardous drinking in comparison to AUDs, moderate drinking, and abstinence.

Methods:  A national representative sample of Finns was examined in the Health 2000 Survey. For 4477 subjects aged 30 to 64 years (76%, 2341 females), both the quantity frequency data about alcohol consumption and Composite International Diagnostic Interview (CIDI) data concerning AUD diagnoses were available. The nationally recommended limits for hazardous dinking were used (males: 24 drinks, females: 16 drinks/wk). Logistic regression models were used to analyze associations.

Results:  The prevalence of hazardous drinking was 5.8%. Hazardous drinking was more prevalent among males than females (8.5% vs. 3.1%). It was most prevalent among the subjects aged 40 to 49 years (7.3%), divorced or separated (8.3%), unemployed (8.2%) and subjects living in the southern (Helsinki) region (7.5%). AUDs versus hazardous drinking were more likely to be in males versus females and in the unemployed versus employed. Subjects aged 40 and over had higher odds for hazardous drinking versus AUDs. The odds for hazardous versus moderate drinking were higher for males versus females (adjusted odds ratio = 3.24), for subjects aged over 40 years, unemployed versus employed and cohabiting, divorced/separated or unmarried subjects versus married subjects.

Conclusion:  The high prevalence of hazardous drinking makes it an important public health concern. Hazardous drinkers have different sociodemographic characteristics as compared to people in other alcohol use categories.
Relationship Between Medication Adherence and Treatment Outcomes: The COMBINE Study
Authors: Zweben Allen , Pettinati Helen M. , Weiss Roger D. , Youngblood Marston , Cox Christine E. , Mattson Margaret E. , Gorroochurn Prakash , Ciraulo Domenic
Published: July 2008

Background:  Within the alcoholism field, there is mounting evidence supporting an important relationship between medication adherence and drinking outcomes. Little is known however, about the complex relationships between medication and treatment variables and drinking outcomes. The present paper reports on the differential impact of medication adherence and treatment factors on drinking outcomes. Data derived from the COMBINE Study was used to investigate the interrelationships between medication adherence, combination treatments and drinking outcomes.

Methods:  Twelve hundred and twenty‐six patients were randomized to 1 of 8 different combination treatments involving 2 medications—naltrexone and acamprosate and placebo, and 2 behavioral treatments—medical management (MM) and combined behavioral intervention (CBI). Two primary drinking outcomes were percent days abstinent (PDA) and time to first heavy drinking day. Medication adherence was defined as a proportion that reflects the number of pills taken by the maximum number of pills expected to be taken over the course of the trial. A generalized linear mixed model was used to estimate the effects of adherence on PDA while proportional hazards model was used to examine similar co‐variate effects on time to first heavy drinking day.

Results:  Concerning time to first heavy drinking day, a significant three‐way interaction was found between medication adherence, CBI and naltrexone (p = 0.0160). Within the MM only plus placebo group (no CBI), significant differences were found in “recovery” (i.e., no heavy drinking days) rates between adherers and nonadherers (40% vs. 10%, p < 0.0001). Such differences became nonsignificant (p = 0.12) when CBI was introduced into the relationship. CBI did not add any such advantage to naltrexone‐treated patients.

Conclusions:  CBI might serve a protective function for nonadherers in the placebo group; the median relapse time was reduced when these nonadherers were exposed to the alcohol specialty intervention. CBI offered little additional benefit to nonadherers in the naltrexone group. Among nonadherers in the naltrexone group, relapse rates appear to be more a function of inadequate exposure to the active medication and less influenced by CBI.
One‐per‐Occasion or Less: Are Moderate‐Drinking Postmenopausal Women Really Healthier Than Their Nondrinking and Heavier‐Drinking Peers?
Authors: Tivis Laura J. , Tivis Rick D.
Published: July 2008

Background:  While some reported benefits of moderate drinking are thought to be the direct results of physiological mechanisms associated with consumption, other effects may be attributable to mediating factors. Both explanations suggest that moderate drinkers may be healthier than nondrinking and heavier‐drinking peers. The purpose of this study was to determine whether moderate‐drinking postmenopausal women report healthier dietary and exercise patterns, and whether they demonstrate better physiological functioning compared with peers. This study also aimed to describe patterns of relationships between alcohol and measures of general health functioning in postmenopausal women.

Methods:  One‐hundred and fifteen women aged 50 to 65 participated. Participants completed alcohol interviews, diet and exercise questionnaires, and bone density examination. Blood pressure, height, and weight were assessed, and blood was collected to conduct basic chemistry and complete blood count tests.

Results:  Postmenopausal moderate drinkers failed to demonstrate healthier dietary or exercise habits, and did not exhibit significantly better health‐functioning compared with peers. They did evidence positive associations between drinking and healthy behavior, and between drinking and cardiovascular health. Relationships between alcohol and blood analytes differed between drinking groups, some of which suggested possible negative health consequences for higher‐end drinkers in both drinking groups.

Conclusions:  These data suggested that moderate‐drinking postmenopausal women are not significantly healthier than their non‐ or heavier‐drinking peers, but may drink as part of a larger effort to take care of their health. Despite this, even 1‐drink‐per‐drinking‐day moderate drinkers may have tendencies toward unhealthy conditions. Limitations include small sample size, inability to assess specific cardiac risk and socioeconomic status, small number of correlations, and clinical relevance of analyte values.
Impact of nucleic acid testing for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus on the safety of blood supply in Italy: a 6‐year survey
Authors: Velati Claudio , Romanò Luisa , Fomiatti Laura , Baruffi Lorella , Zanetti Alessandro Remo ,   the SIMTI Research Group
Published: July 2008

BACKGROUND: Nucleic acid testing (NAT) for hepatitis C virus (HCV) and human immunodeficiency virus (HIV) has been implemented in several European countries and in the United States, while hepatitis B virus (HBV) NAT is still being questioned by opinions both in favor and against such an option, depending on the HBV endemicity, health care resources, and expected benefits.

STUDY DESIGN AND METHODS: This survey was aimed to assess the NAT impact in improving the safety of blood supply in Italy, 6 years after implementation. The study involved 93 Italian transfusion centers and was carried out in 2001 through 2006. A total of 10,776,288 units were tested for the presence of HCV RNA, 7,932,430 for HIV RNA, and 3,405,497 for HBV DNA, respectively.

RESULTS: Twenty‐seven donations or 2.5 per million tested were HCV RNA–positive/anti‐HCV–negative; 14 or 1.8 per million units tested were HIV RNA–positive/anti‐HIV–negative; and 197 or 57.8 per million donations tested were HBV DNA–positive/hepatitis B surface antigen–negative. Of the latter, 8 (2.3/106) were collected from donors in the window phase of infection and 189 (55.5/106) from donors with occult HBV. Sixty‐eight percent of the latter donors had hepatitis B surface antibody, 74.5 percent of whom with concentrations considered protective (≥10 mIU/mL).

CONCLUSION: NAT implementation has improved blood safety by reducing the risk of entering 2.5 HCV and 1.8 HIV infectious units per million donations into the blood supply. The yield of NAT in detecting infectious blood before transfusion was higher for HBV than for HCV or HIV. However, the benefit of HBV NAT in terms of avoided HBV‐related morbidity and mortality in blood recipients needs to be further evaluated.
Balance between vasoconstriction and enhanced oxygen delivery
Authors: Cabrales Pedro , Tsai Amy G. , Intaglietta Marcos
Published: July 2008

BACKGROUND: Hemoglobin (Hb) solutions are potential alternatives to blood transfusion when native oxygen (O2)‐carrying capacity is lacking. Polymerized bovine Hb (PBH) solutions are characterized by its vasoactivity, low O2 affinity, oncotic effect, prolonged shelf life, and stability. Responses to facilitated O2 transport, after exchange transfusion with PBH, were studied in the hamster window chamber model during acute extreme anemia to determine how PBH affects microvascular perfusion and tissue oxygenation.

STUDY DESIGN AND METHODS: An anemic state was induced by hemodilution with a plasma expander (70‐kDa dextran). After hemodilution, animals were randomly assigned to exchange transfusion groups based on the concentration of PBH used, namely, PBH at 13 gHb per dL (PBH13), PBH diluted to 8 or 4 gHb per dL in albumin solution at matching colloidal osmotic pressure (COP; PBH8 and PBH4), and no PBH only albumin solution at matching COP (PBH0). Measurement of systemic variables, microvascular hemodynamics, capillary perfusion, and intravascular and tissue O2 levels was performed at 11 percent Hct.

RESULTS: Restitution of O2‐carrying capacity with PBH13 restored higher arterial pressure and triggered vasoconstriction, low perfusion, and higher peripheral resistance. Groups PBH4 and PBH0 had lower arterial pressures than Group PBH13. Groups PBH4 and PBH8 maintained higher perfusion and functional capillary density than Groups PBH13 and PBH0. In all groups, blood gas variables and acid‐base balance were recovered proportional to microvascular perfusion. Arterial O2 tensions were improved for Groups PBH4 and PBH8 by preventing O2 precapillary release and increasing O2 reserve.

CONCLUSION: Further studies to establish acellular Hb optimal dosage, efficacy, safety, and effects on outcome are indicated before these solutions are implemented in routine practice.
Lung transplantation complicated by graft‐versus‐host disease and confounded by incidental transfusion‐associated macrochimerism
Authors: Pavenski Katerina , Kamel‐Reid Suzanne , Wei Cuihong , Cserti‐Gazdewich Christine M.
Published: July 2008

BACKGROUND:Passenger lymphocyte–mediated graft‐versus‐host disease (GVHD) in solid organ transplantation (SOT‐GVHD) is considered a rare complication, particularly among recipients of lung allografts. The risk of transfusion‐associated GVHD (TA‐GVHD) in solid organ transplants is also considered rare. The suspicion of either may be heralded by signs and symptoms of GVHD in the company of a population of passenger lymphocytes in excess of 1 percent (microchimerism). This case report illustrates the challenge of a patient who presented with macrochimerism both from the lung transplant allograft and from transfusions.

STUDY DESIGN AND METHODS:Chimerism assessments of the pre‐ and posttransplant donor lung, and the recipient's aplastic marrow, were made using DNA‐based polymerase chain reaction testing.

RESULTS:Macrochimerism was observed in both the posttransplant aplastic host marrow and the engrafted donor lung, with the former predominantly consisting of lung donor lymphocytes and the latter a mixture of lung and presumably transfusion source donor lymphocytes. The pretransplant donor lung exhibited no GVHD‐like pathology.

CONCLUSION:This case demonstrates SOT‐GVHD, with the unusual feature of concomitant macrochimerism from transfusions. SOT‐GVHD likely predisposed this patient to the observed transfusion‐associated macrochimerism. However, the dissociation between transfusion‐attributable macrochimerism and attributable pathology is intriguing. Furthermore, the risk spectrum of transfusion‐associated macrochimerism and TA‐GVHD in solid organ transplant recipients with and without the complication of SOT‐GVHD is unknown and warrants further study.
Validation of HLAMatchmaker algorithm in identifying acceptable HLA mismatches for thrombocytopenic patients refractory to platelet transfusions
Authors: Brooks Erin G. , MacPherson Bruce R. , Fung Mark K.
Published: July 2008

BACKGROUND: HLAMatchmaker (HLAMM) is an algorithm that determines donor‐recipient histocompatibility based on HLA type. This study determines the effectiveness of HLAMM in identifying suitable platelet (PLT) donors for refractory patients.

STUDY DESIGN AND METHODS: Data from a previous prospectively randomized multicenter study comparing cross‐reactive group (CREG)‐matched versus serologic crossmatch‐selected PLT transfusions in refractory patients were analyzed. By use of HLAMM, the compatibility of donor‐recipient pairings was determined as the number of donor triplet mismatches (TMMs) and eplet mismatches (EMMs) and compared against the posttransfusion PLT corrected count increment (CCI). The data included 73 patients who received up to two CREG‐matched and crossmatch‐selected PLT transfusions each (214 transfusions analyzed).

RESULTS: TMM and EMM values correlated well with CREG match grade. A and BU matches had TMM and EMM values of 0; BX matches had TMMs and EMMs of 4 and 6 respectively; and C and D matches had TMMs of 10 to 21 and EMMs of 13 to 24. Fewer mismatches (TMM or EMM) predicted better transfusion outcomes (p < 0.05). The median 1‐hour CCI was 8000 with TMMs of not more than 9 versus 6000 with TMMs of more than 9. The median 1‐hour CCI was 7954 with EMMs of not more than 11 versus 6356 with EMMs of more than 11. The positive predictive value of the different methods in producing a 1‐hour CCI of more than 7500 were comparable: TMM, 56 percent; EMM, 54 percent; CREG, 50 percent; and crossmatching, 45 percent (p > 0.05).

CONCLUSIONS: HLAMM (both TMM and EMM) successfully identified donors associated with good transfusion outcomes in refractory recipients and represents an acceptable method of choosing donors for refractory patients.
Starch from the Sago (Metroxylon sagu) Palm Tree—Properties, Prospects, and Challenges as a New Industrial Source for Food and Other Uses
Authors: Karim A.A. , Tie A. Pei‐Lang , Manan D.M.A. , Zaidul I.S.M.
Published: July 2008

ABSTRACT:  The common industrial starches are typically derived from cereals (corn, wheat, rice, sorghum), tubers (potato, sweet potato), roots (cassava), and legumes (mung bean, green pea). Sago (Metroxylon sagu Rottb.) starch is perhaps the only example of commercial starch derived from another source, the stem of palm (sago palm). Sago palm has the ability to thrive in the harsh swampy peat environment of certain areas. It is estimated that there are about 2 million ha of natural sago palm forests and about 0.14 million ha of planted sago palm at present, out of a total swamp area of about 20 million ha in Asia and the Pacific Region, most of which are under‐ or nonutilized. Growing in a suitable environment with organized farming practices, sago palm could have a yield potential of up to 25 tons of starch per hectare per year. Sago starch yield per unit area could be about 3 to 4 times higher than that of rice, corn, or wheat, and about 17 times higher than that of cassava. Compared to the common industrial starches, however, sago starch has been somewhat neglected and relatively less attention has been devoted to the sago palm and its starch. Nevertheless, a number of studies have been published covering various aspects of sago starch such as molecular structure, physicochemical and functional properties, chemical/physical modifications, and quality issues. This article is intended to piece together the accumulated knowledge and highlight some pertinent information related to sago palm and sago starch studies.
Dietary Lycopene: Its Properties and Anticarcinogenic Effects
Authors: Singh Preeti , Goyal G.K.
Published: July 2008

ABSTRACT:  Lycopene is the principal pigment of the carotenoids naturally found in tomatoes and is important not only because of the color it imparts but also because of the recognized health benefits associated with its presence. Red tomatoes typically contain about 95% of their lycopene as the all‐trans isomer, the most stable form. In tangerine tomatoes, on the other hand, the lycopene is present as tetra‐cis‐lycopene, a geometric isomer of all‐trans lycopene. Lycopene is a major component found in blood serum. This carotenoid has been extensively studied for its antioxidant and cancer‐preventing properties. Prevention of heart disease has been shown to be another antioxidant role played by lycopene because it reduces the accumulation of platelets that eventually lead to blood clots, heart attacks, and strokes. In contrast to many other food phytonutrients whose effects have only been studied in animals, lycopene from tomatoes has been repeatedly studied in humans and found to be protective against several cancers, which now include colorectal, prostate, breast, lung, and pancreatic cancers. This review outlines the background information dealing with lycopene and presents the most comprehensive and current understanding of its potential functional role in human health.
The International Quotidian Dialysis Registry: Annual report 2008
Authors: NESRALLAH Gihad E. , SURI Rita S. , MOIST Louise M. , OFSTHUN Norma J. , HAKIM Raymond , MCDONALD Stephen P. , MARSHALL Mark R. , CARTER Shannon T. , LINDSAY Robert M.
Published: July 2008

Alternative hemodialysis (HD) schedules, including short‐daily and nocturnal HD, continue to proliferate, with the hope of offering improved patient outcomes. Three nights per week and every other night, nocturnal HD are now being provided to more patients worldwide, both at home and in‐center. However, alternative HD schedules are still experimental in most centers, and studies establishing the efficacy of these therapies with respect to major clinical outcomes are needed. Endorsed by the National Institutes of Health, the International Quotidian Dialysis Registry is an international collaboration that was established in 2002 to prospectively study large numbers of patients treated with alternate HD schedules. The Registry will ultimately allow alternate HD modalities to be compared to conventional thrice‐weekly HD with respect to clinical endpoints, including mortality, using a prospective cohort study. To date, the Registry has enrolled 182, 1193, and 740 subjects from Canada, the United States, and Australia, respectively. This report is the fourth annual update and describes recruitment progress, baseline characteristics of enrolled patients, and worldwide prescription patterns.
Practical guidance for dialyzing a hemodialysis patient following acute brain injury
Authors: DAVENPORT Andrew
Published: July 2008

The incidence of acute brain injury in chronic hemodialysis patients is increasing, as the dialysis population is becoming increasingly older, often hypertensive, at risk of ischemic and/or hemorrhagic stroke, and subdural hemorrhage. Standard intermittent hemodialysis treatments typically lead to an increase in cerebral swelling, which can exacerbate underlying cerebral damage. In critically ill patients, continuous modes of renal replacement therapy may be required, but depending upon the clinical condition, simple modifications to standard intermittent therapies may suffice, and allow effective delivery of renal replacement therapy, but ensure that patient outcomes both in terms of mortality and residual functional brain damage is no different between those with normal renal function and those on the chronic dialysis program.
Severe jaw enlargement associated with uremic hyperparathyroidism
Authors: TARRASS Faissal , BENJELLOUN Meryem , BENSAHA Tarik
Published: July 2008

Marked enlargement of the jaws is a rare complication of renal osteodystrophy. This report describes a localized enlargement of the mandible due to a brown tumor in a patient undergoing chronic hemodialysis. Literature on jaw involvement in secondary hyperparathyroidism is reviewed.
Interdialytic blood pressure obtained by ambulatory blood pressure measurement and left ventricular structure in hypertensive hemodialysis patients
Authors: MOMINADAM Siddig , OZKAHYA Mehmet , KAYIKCIOGLU Meral , TOZ Huseyin , ASCI Gulay , DUMAN Soner , ERGIN Pinar , KIRBIYIK Sait , OK Ercan , BASCI Ali
Published: July 2008

Unlike in subjects with normal renal function, the relationship between hypertension and cardiovascular morbidity and mortality in dialysis patients is still being debated. In order to clarify this issue, we performed 44‐hour ambulatory blood pressure measurements (ABPM) during the interdialytic period in a group of 164 hypertensive patients, the blood pressure (BP) control based on conventional antihypertensive strategy previously, on chronic hemodialysis treatment in the Mediterranean region of Turkey. These results were then compared with their echocardiographic data. This is a cross‐sectional analysis. The mean ABPM during 44 hours was close to the manually measured predialysis value, but there was a gradual increase in the ABPM values in the interdialytic period. When divided into a group with mild or no left ventricular hypertrophy (LVH) (45 patients) and severe LVH (119 patients), the latter had significantly higher BP levels in all separate periods, while the difference in predialysis BP was not significant. Patients with severe LVH had larger left atrium and left ventricular diameters, and consumed more antihypertensive drugs. Systolic BP during the night before dialysis showed the strongest relation to LVH, but interdialytic weight gain was also independently related to LVH. Yet, 56% of the patients with systolic BP <135 had severe LVH. There is not only an association between BP and presence of LVH, but it is shown that volume expansion is also an important independent determinant of LVH. This may explain the difficulty in identifying hypertension as a cardiac risk factor in these patients.
Factors affecting anemia management in hemodialysis patients: A single‐center experience
Authors: SPIEGEL David M. , GITLIN Matthew , MAYNE Tracy
Published: July 2008

The difficulty maintaining hemoglobin (Hgb) within the targets recommended by KDOQI is widely recognized. While factors responsible for erythropoietin resistance have been widely studied, factors responsible for the marked fluctuations and the inability to maintain Hgb within the target range have only begun to be investigated. This study was a cross‐sectional review of anemia management in hemodialysis patients. The purpose was to evaluate factors responsible for Hgb decreases of 0.5 or 1.0 g/dL and to determine the primary factors responsible for Hgb decreases below 11 g/dL. Hgb values and clinical events were extracted from patient management databases between January 1, 2005 and November 30, 2006. Isolated events were defined as events that occurred at least 30 days after any previous event and had Hgb measurements within 2 weeks before and after the event. Increasing hospital length of stay and surgical access intervention were the most common events that resulted in a decrease in Hgb. The most common factor present in patients with Hgb decreases below 11 g/dL was the withholding of recombinant human erythropoietin (rHuEPO) within the preceding 2 months. This was the only explanation for the decrease in Hgb to <11 g/dL in 38.5% of such events. The ability to maintain dialysis patients' Hgb in the target range is complicated by intervening acute events that require hospitalization or surgical access interventions. The withholding of rHuEPO appears to be a major factor in Hgb decreases below 11 g/dL.
Effect of an ethanol/trisodium citrate hemodialysis catheter locking solution on isolates of Candida albicans
Authors: MAHARAJ Anil R. , ZELENITSKY Sheryl A. , VERCAIGNE Lavern M.
Published: July 2008

We conducted an in vitro study to assess the effect of a 30% ethanol/4% trisodium citrate (TSC) catheter locking solution on isolates of Candida albicans. Twelve isolates obtained from human blood cultures were tested in control solutions composed of broth and normal saline, and a test solution of 30% ethanol, 4% TSC, and broth. Colony counts were determined for control and test solutions at baseline and after 1, 24, and 48 hours of exposure. After 48 hours, the remaining test solution was filtered through a sterile filter funnel and rinsed with 10 mL of sterile water. Filters were aseptically transferred to agar plates and incubated for 24 hours. Control solutions grew well over the incubation period, as expected. In contrast, no viable growth was observed in test solutions 1 hour after instillation of the ethanol/TSC locking solution, or throughout the 48‐hour study duration. Additionally, filters from test solutions displayed no growth. We conclude that a 30% ethanol/4% TSC catheter locking solution eradicated all isolates of C. albicans within 1 hour of exposure in this in vitro study, and shows promise as a new hemodialysis catheter locking solution.
Tissue plasminogen activator as a hemodialysis catheter locking solution
Authors: McGILL Rita L. , SPERO Joel A. , SYSAK Joshua C. , SANDRONI Stephen E. , MARCUS Richard J.
Published: July 2008

Tunneled hemodialysis catheters require a “locking solution” between treatments to prevent catheter thrombosis. Heparin locks can be unsafe in patients with life‐threatening bleeding diathesis because of unintentional anticoagulation. This study was designed to define the hematologic consequences of using tissue plasminogen activator (t‐PA) as an alternative locking solution after heparin‐free hemodialysis (HF‐HD). Following HF‐HD, t‐PA 2 mg was instilled into each lumen of the dialysis catheter in 10 patients. Euglobulin clot lysis time (ECLT), fibrinogen, D‐dimer, and fibrin degradation products were measured during the last hour of dialysis, and repeated 15 and 30 minutes after catheter locking. Dialysis catheter performance was reassessed at the time of the next hemodialysis. Fibrinogen, D‐dimer, and fibrin degradation products were elevated at all time points, but did not change after t‐PA. ECLT decreased significantly from baseline 15 minutes after catheter locking (217±64 vs. 132±75 min, p=0.016). ECLT values had returned to baseline (202±56 minutes) by 30 minutes. No episodes of bleeding or catheter thrombosis occurred, and catheter performance did not deteriorate. A 2 mg t‐PA locking solution preserved dialysis catheter performance. ECLT decreased at 15 minutes, but normalized by 30 minutes, and did not enter the range in which bleeding would be likely. No clinical events were seen during this transient increase in systemic fibrinolysis.
Effects of parenteral iron on inflammation and the myocardium in hemodialysis patients
Authors: SOOD Manish M. , OUDIT Gavin Y. , MOHAMMADI Hanif , HUANG Hong , LOK Charmaine E.
Published: July 2008

Inflammation is a nontraditional cardiovascular risk factor in hemodialysis patients. This pilot study tested the hypothesis that intravenous iron adds to this inflammation by increasing oxidative stress. Secondly, we described the association between iron indices and myocardial structure and function. Thirteen hemodialysis patients from a teaching hospital were recruited for this descriptive study and divided into 3 groups according to their iron profile (high, low, and intermediate). Oxidative stress was determined in vivo by mass spectroscopy with measurement of malondialdehyde (MDA), hexanal, and nonenal. Cardiac magnetic resonance imaging and 2‐dimensional echocardiography were used to study any structural or functional changes, respectively. A strong correlation was found between iron indices and oxidative stress (MDA and ferritin r=0.95; p<0.001; MDA and transferrin saturation r=0.80, p<0.01). Magnetic resonance imaging measurements showed a weak correlation with iron indices while no correlation was found between iron indices and echocardiographic measurements. Iron indices are positively correlated with functional oxidative stress. Larger studies are needed to determine the association between inflammation and structural or functional dysfunction of the myocardium.
Home hemodialysis in Australia: Current perspective
Authors: KERR Peter G. , POLKINGHORNE Kevan R. , McDONALD Stephen P.
Published: July 2008

Home hemodialysis (HD) in Australia represents 11% of the dialysis population. This percentage has declined over the last 20 years but the absolute number of home HD patients has increased since 2001. The major reason for this resurgence has been the institution of nocturnal HD at home. Predominantly, this has been as a strictly alternate day exercise, although 5–6 times per week dialysis is also practised. Short‐daily HD is uncommon in Australia. Nocturnal HD now comprises 30% or more of all home HD. Most home HD in Australia is practiced without remote monitoring, using simple machines with separate reverse osmosis units. Patients tend to self‐needle and not all have a “partner.” The enthusiasm for nocturnal HD in particular has been fuelled by ANZDATA Registry data demonstrating a survival advantage for patients dialyzing alternate days compared with 3 times per week; and for patients dialyzing for >18 hours per week compared with 12 or 15 hours per week.
What happened in Finland to increase home hemodialysis?
Authors: HONKANEN Eero O. , RAUTA Virpi M.
Published: July 2008

Finland is geographically a rather large country with a relatively sparse population (5.3 million). Home hemodialysis (HHD) was started in Helsinki 40 years ago and in the early years it was only used in selected patients. However, by the late 1980s HHD almost disappeared owing to the advent of CAPD and new HD centers. Towards the end of the 1990s, it became evident that PD had limitations and new ways had to be found to individualize HD, improve the outcome, increase capacity, and limit the growth of costs of HD. After careful planning, HHD was reinstituted at the Helsinki University Hospital in 1998 and since then the program has grown steadily. By December 31, 2007, altogether 163 patients had started at home. This has required changes in the predialysis program where the “home first” policy was adopted. Other important features include close cooperation with other nephrological centers as well as centralized HHD training that also supports more remote hospitals. Since then this therapy has been started in several other academic and in some smaller hospitals, and at the end of last year about 4% of all Finnish dialysis patients (n=1.600) were on HHD (prevalence 11.8/million). In the Helsinki metropolitan area this treatment is the most economical modality (estimated annual global costs €37.000), comparable to self‐care satellite HD and CAPD. A successful HHD program requires a well‐organized predialysis program, a highly motivated multidisciplinary team, and well‐developed training networks.
The ideal home hemodialysis machine
Authors: KJELLSTRAND Carl M. , KJELLSTRAND Per
Published: July 2008

Daily home hemodialysis (HD) patients have a much superior survival rate than patients on regular, 3 times a week in‐center HD or on peritoneal dialysis. Present‐day HD machines are unsuitable for use at home by patients. We present our concept of the ideal home HD machine that allows daily short and long HD, does all the work preparing for and cleaning up after dialysis, has an intravenous infusion system controlled by the patient, needs no systemic anticoagulation, and teaches and interacts with the patient during dialysis. To fulfill these functionalities, the dialyzer and blood tubing must be integrated with the machine and replaced less often than monthly, the machine must be capable of at least 200 L/week of hemodiafiltration, prepare all fluids necessary between and during dialyses, and all the components and fluids must be much beyond ultrapure.
Role of peritoneal dialysis in the era of the resurgence of home hemodialysis
Authors: BURKART John
Published: July 2008

In recent years, there has been a resurgence of home hemodialysis (HHD) therapies. Given the small percentage of prevalent patients in the United States currently on home dialysis, an appropriate question is: What is the role of peritoneal dialysis (PD) in this era? Data suggest that in centers that are promoting the growth of HHD, their PD programs also tend to be very active. Furthermore, our experience and other data suggest that one should not worry about cannibalizing PD in order to grow HHD. Most HHD patients come from in‐center hemodialysis or those patients transitioning from PD to another therapy. In fact, data suggest that in order to promote the growth of HHD, a certain minimal infrastructure is needed in terms of staff. An active PD program not only supports a robust infrastructure that allows for HHD growth but also fosters profitability of a home program.
The International Quotidian Hemodialysis Registry: Rationale and challenges
Authors: LINDSAY Robert M. , CARTER Shannon , AWARAJI Christian , SURI Rita S. , NESRALLAH Gihad
Published: July 2008

Outcomes from conventional thrice‐weekly hemodialysis (CHD) are disappointing for a life‐saving therapy. The results of the HEMO Study show that the recommended minimum dose (Kt/V) for adequacy is also the optimum attainable with CHD. Interest is therefore turning to alternative therapies exploring the effects of increased frequency and time of hemodialysis (HD) treatment. The National Institutes of Health have sponsored 2 randomized prospective trials comparing short hours daily in‐center HD and long hours slow nightly home HD with CHD. An International Registry has also been created to capture observational data on patients receiving short hours daily in‐center HD, long hours slow nightly home HD, and other alternative therapies. Participation by individual centers, other registries and the major dialysis chains is growing and currently data from nearly 3000 patients have been collected. Pitfalls in data collection have been identified and are being corrected. A matched cohort (patients in other registries) study is planned to obtain information regarding hard outcomes expected from these therapies. The Registry may become the most important source of information required by governments, providers, and the nephrological community in assessing the utility of such therapies.
Identification of pY19‐caveolin‐2 as a positive regulator of insulin‐stimulated actin cytoskeleton‐dependent mitogenesis
Authors: Kwon Hayeong , Jeong Kyuho , Pak Yunbae
Published: July 2008

Mitogenic regulation by caveolin‐2 in response to insulin was investigated. Insulin triggered phosphorylation of caveolin‐2 on tyrosine 19. Insulin increased the interaction between pY19‐caveolin‐2 and phospho‐ERK, and that interaction was inhibited by a MEK inhibitor U0126. Insulin‐induced interaction of caveolin‐2 with phospho‐ERK was prevented when tyrosine 19 is mutated to alanine. Insulin relocalized phospho‐ERK and pY19‐caveolin‐2 to the nucleus and their nuclear co‐localization was impaired by U0126. Down‐regulation of caveolin‐2 by caveolin‐2 siRNA arrested the insulin‐induced nuclear localization of ERK with no change in the insulin‐stimulated ERK activation. Of consequence, the caveolin‐2 siRNA attenuated the ERK‐mediated c‐Jun and cyclinD1 expression and DNA synthesis by insulin. In addition, actin cytoskeleton influenced the nuclear translocation of caveolin‐2‐ERK complex. Collectively, our findings underscore the importance of pY19‐caveolin‐2 with the spatial coordination by insulin in ERK‐mediated mitogenic regulation of insulin signalling and indicate that the phosphorylation of pY19‐caveolin‐2 is required for actin cytoskeleton‐dependent ERK nuclear import.
microRNA expression in lymphoid malignancies: new hope for diagnosis and therapy?
Authors: Lawrie Charles Henderson
Published: July 2008

Introduction

microRNAs in lymphocyte development

microRNAs in lymphoid malignancy

microRNA: a new class of diagnostic and therapeuti agents for lymphoma?

microRNAs are a newly discovered class of short (∼22 nt) naturally occurring single‐stranded RNA molecules that regulate the expression of target genes post‐transcriptionally. Despite only being discovered 7 years ago, microRNAs have been implicated as key regulatory molecules in nearly every biological process examined so far and abnormal expression of microRNAs have been linked to many forms of disease including cancer where they can function as both tumour‐suppressors and oncogenes. So why are microRNAs causing so much excitement? And will this excitement translate into new medical breakthroughs? This review attempts to answer these questions in the wider context of cancer, focusing on the role that microRNAs play in normal lymphoid development and malignancy.
Surface morphology and mechanical properties of fibroblasts from scleroderma patients
Authors: Reich Adam , Meurer Michael , Eckes Beate , Friedrichs Jens , Muller Daniel J.
Published: July 2008

Overproduction of extracellular matrix components by fibroblasts plays a key role in the pathogenesis of scleroderma. To investigate whether these functional alterations are accompanied by changes in the mechanical properties and morphology of fibroblast, atomic force microscopy was applied to dermal fibroblasts derived either from scleroderma patients or from healthy donors. No significant morphological differences could be observed among the different cell strains showing long cytoskeleton fibres similar in length and irregularly distributed protrusions on the cell surface. In contrast, significant differences in cellular stiffness of dermal fibroblasts derived from scleroderma lesions were detected. Compared to fibroblasts from healthy donors, diseased cells were characterized by a reduced elastic constant both when the global and local mechanical properties were probed. The altered stiffness of scleroderma fibroblasts may be important in the pathogenesis of the disease as it could lead to the abnormal response of fibroblasts to mechanical stimuli.
Receptor tyrosine and MAP kinase are involved in effects of H2O2 on interstitial cells of Cajal in murine intestine
Authors: Choi Seok , Yeum Cheol Ho , Kim Young Dae , Park Chan Guk , Kim Man Yoo , Park Jong‐Seong , Jeong Han‐Seong , Kim Byung Joo , So Insuk , Kim Ki Whan , Jun Jae Yeoul
Published: July 2008

Hydrogen peroxide (H2O2) is involved in intestinal motility through changes of smooth muscle activity. However, there is no report as to the modulatory effects of H2O2 on interstitial cells of Cajal (ICC). We investigated the H2O2 effects and signal transductions to determine whether the intestinal motility can be modulated through ICC. We performed whole‐cell patch clamp in cultured ICC from murine intestine and molecular analyses. H2O2 hyperpolarized the membrane and inhibited pacemaker currents. These effects were inhibited by glibenclamide, an inhibitor of ATP‐sensitive K+ (KATP) channels. The free‐radical scavenger catalase inhibited the H2O2‐induced effects. MAFP and AACOCF3 (a cytosolic phospholipase A2 inhibitors) or SC‐560 and NS‐398 (a selective COX‐1 and 2 inhibitor) or AH6809 (an EP2 receptor antagonist) inhibited the H2O2‐induced effects. PD98059 (a mitogen activated/ERK‐activating protein kinase inhibitor) inhibited the H2O2‐induced effects, though SB‐203580 (a p38 MAPK inhibitor) or a JNK inhibitor did not affect. H2O2‐induced effects could not be inhibited by LY‐294002 (an inhibitor of PI3‐kinases), calphostin C (a protein kinase C inhibitor) or SQ‐22536 (an adenylate cyclase inhibitor). Adenoviral infection analysis revealed H2O2 stimulated tyrosine kinase activity and AG 1478 (an antagonist of epidermal growth factor receptor tyrosine kinase) inhibited the H2O2‐induced effects. These results suggest H2O2 can modulate ICC pacemaker activity and this occur by the activation of KATP channels through PGE2 production via receptor tyrosine kinase‐dependent MAP kinase activation.