bluuebunny/crossref_metadata_2025 huggingface dataset:
P1313CHANGES IN VASCULAR ACCESS AND HEALTH-RELATED QUALITY OF LIFE
Authors: Chen Chen , Jiao Yue , Winter Anke , Larkin John , Usvyat Len A , Stauss-Grabo Manuela , Maddux Franklin
Published: June 2020

Background and Aims

The patient’s reported perception of their health-related quality of life (HRQOL) are important patient-centered metrics that associate with outcomes in hemodialysis (HD) populations. Patients using an arteriovenous (AV) access (fistula or graft) tend to report better HRQOL compared with those dialyzing via a catheter (Wasse et al. 2007; Moura et al. 2014). However, these differences might be due to distinct characteristics of patients who have an AV access placed, or not. For example, catheter-dependent patients are typically older and have more comorbidities than those with an AV access. We considered a different way to evaluate the impact of vascular access on HRQOL in HD patients by assessing whether a change from a catheter to an AV access, and vice versa, associates with changes in HRQOL.

Method

We used data from adult in-center HD patients (age ≥18 years) treated at a large dialysis organization in the United States from 2016-2017. Patients who had one vascular access conversion and used the corresponding access for at least 12 months before and after the conversion were included in the analysis. HRQOL was assessed by Kidney Disease Quality of Life (KDQOL-36) surveys (0-100 scale) performed over the 12 months preceding and following the change. We computed the mean score for each of the five KDQOL domains in each time period and compared the score differences between pre- and post-access change using Student’s t-tests for each conversion type.

Results

A total of 1088 HD patients (mean age 59.2 years, 52.6% male, and 59.3% white race) switched from a catheter to an AV access and 3427 patients (mean age 61.8 years, 47.8% male, and 50.7% white race) switched from an AV access to a catheter over the analysis period. After conversion from a catheter to an AV access, patients reported significantly higher physical component summary (+0.5, p<0.05), mental component summary (+0.8, p<0.001), symptoms and problems of kidney disease (+0.7, p<0.05), and effects of kidney disease (+1.2, p<0.05) scores (Figure 1). No significant difference was observed for four out of the five domains following the change from an AV access to a catheter, except for physical component summary, where the score dropped by 1.2 points (p<0.01) (Figure 2).

Conclusion

Our results suggest switching from a catheter to an AV access may associate with patients perceiving an improved physical and mental HRQOL. In contrast, changing from an AV access to a catheter might associate with a diminished perception of physical HRQOL. Albeit distinctions in HRQOL are statistically significant, absolute differences were below two points and the clinical meaning needs to be assessed in further adjusted analyses considering the underlying reasons for vascular access conversions. Nonetheless, these findings may be of importance to provide more patient focused care.
P1317THE PREVALENCE OF CENTRAL VENOUS CATHETERS AND LOWER ARM ARTERIOVENOUS FISTULAS DEPENDS ON DIFFERENT VASCULAR ACCESS MANAGEMENT POLICIES: A MULTICENTER ITALIAN STUDY
Authors: Finocchiaro Pietro , Alberti Antonino , Tripepi Rocco , Versace Maria Carmela , Garozzo Maurizio , Milone Filippo , Battaglia Giovanni Giorgio , La Rosa Sandra , Maccarrone Rosario , Granata Antonio , Sessa Concetto , Pocorobba Barbara , Musso Salvatore , Bolignano Davide , Pazzano Dario , Volpe Pietro , Mallamaci Francesca
Published: June 2020

Background and Aims

According to local resources, different vascular access (VA) procedures are employed in every country. In Italy, high variability exists in VA management among different dialysis units. In 2018, the DOPPS 5 study showed a declining prevalence of lower arm arteriovenous fistulas (AVF) in Europe with an increasing tendency of making upper arm AVFs and placing central venous catheters (CVCs). Accordingly, an Italian Survey in 2013 confirmed an increasing trend in CVCs use among different Italian regions.

Hence, we made an epidemiologic, multicenter study to evaluate a possible relation between this trend and the variability of local VA management policies.

Method

VA data from 236 patients of prevalent patients were collected from five dialysis centers in the South of Italy. The prevalence of the various types of VAs was analyzed in relation to the following different VA surgery policies adopted in the participant centers:

Results

Age of patients was comparable among all centers while dialysis vintage was higher in center A (P<0.001). The prevalence of lower arm AVFs was significantly reduced In Center A (50.6%) and the prevalence of CVCs (25.8%) was significantly increased as compared to the Centers D-E. On the contrary the Centers D-E had the highest prevalence of lower arm AVF (70.8%) and the lowest of CVCs (12.3%), with a statistically significant difference as compared to Center A (Table 1 ). Conversely, no differences were noticed when comparing data from Centers B-C vs. Center A and vs. Centers D-E, although the prevalence of lower arm AVFs was slightly higher, but the difference was not significant, and that of CVCs was slightly lower as compared to Center A ,fully supported by the vascular surgeon (Figure 1 ).

Conclusion

The reduced tendency of lower arm fistulas and the increasing prevalence of CVCs showed by the DOPPS 5 study might not be applicable to all Italian regions. In our study of 5 dialysis units in the South of Italy, the stability of the nephrologist’s surgical activity probably played a crucial role in explaining the observed decreased use of CVCs with a steadily high prevalence (over 70%) of the lower arm fistulas, regardless of aging.
P1734INFORMATION AND COMMUNICATION TECHNOLOGY-BASED CENTRALIZED MONITORING SYSTEM TO INCREASE ADHERENCE TO IMMUNOSUPPRESSIVE MEDICATION IN KIDNEY TRANSPLANT RECIPIENTS: A RANDOMIZED CONTROLLED TRIAL
Authors: Jung Hee-Yeon , Jeon Yena , Seong Sook Jin , Seo Jung Ju , Choi Ji-Young , Cho Jang-Hee , Park Sun-Hee , Kim Chan Duck , Yoon Young-Ran , Yoon Se-Hee , Lee Jong Soo , Kim Yong-Lim
Published: June 2020

Background and Aims

Innovative strategies to promote adherence to immunosuppressants in kidney transplant recipients (KTRs) is imperative. This study aimed to evaluate the efficacy and stability of the information and communication technology (ICT)-based centralized monitoring system in increasing medication adherence in Korean KTRs.

Method

A prospective, multicenter, randomized controlled study was conducted (ClinicalTrials.gov Identifier: NCT03136588). All KTRs were randomized into the ICT-based centralized monitoring or the control group and had follow-up visits every 4 weeks during 6 months. The ICT-based centralized monitoring system alerted both patients and medical staff with texts and pill box alarms if there was a dosage/dosing time error or a missed dose. Medication adherence and transplant outcomes were compared between the two groups, and patient satisfaction on the ICT-based monitoring system was evaluated.

Results

Among enrolled 114 KTRs, 57 patients were assigned to the ICT-based centralized monitoring group and 57 patients to the control group. Mean adherence at each follow-up visit was not significantly different between groups. No differences in intrapatient variability of tacrolimus and mycophenolic acid levels, renal function, and adverse transplant outcomes were observed between the intervention and control groups, as well as between the intervention group with feedback generation and the intervention group without feedback generation. Overall patient satisfaction with the ICT-based centralized monitoring system was high and significantly improved during the study period (P = 0.012).

Conclusion

Although the ICT-based centralized monitoring system did not maximize mediation adherence or enhance transplant outcomes in Korean KTRs due to high baseline adherence, patient satisfaction with the system was high. We identified the future possibility that the ICT-based centralized monitoring system could be successfully applied in clinical trials targeting other disease groups with impaired adherence.
P0168FRUCTOSE IS A CAUSE OF CALCIUM PHOSPHATE UROLITHIASIS IN RATS
Authors: Flisiński Mariusz , Brymora Andrzej , Skoczylas-Makowska Natalia , Stefańska Anna , Manitius Jacek
Published: June 2020

Background and Aims

Excessive consumption of fructose (Fr) leads to obesity, metabolic syndrome and insulin resistance, which are known risk factors for kidney stones. Along with the epidemic of obesity and diabetes there is also a growing incidence of kidney stones in both adults and children. The epidemiological studies have shown that the relative risk of nephrolithiasis significantly increases with fructose intake in diet.

The aim of the study was to assess the effect of high-fructose diet on kidney tubules disorders and predisposition to the development of kidney stones.

Method

Male Wistar rats were assigned for 8 weeks to 3 groups differing in the content of Fr in the diet: RD - regular diet with a fructose content <3%; F10 - regular diet with an addition of 10% Fr in drinking water; F60 - 60% Fr as a solid feed. Serum concentration of Fr, creatinine (Cr), insulin (Ins), triglycerides (Tg), homocysteine (Hcs), uric acid (UA), calcium (Ca), phosphorus (P), magnesium (Mg) were measured. Based on a 24-hour urine collection the following tests were performed: urine pH, proteinuria (PCR), excretion of N-Acetyl-(D)-Glucosaminidase (NAG), monocyte chemoattractant protein (MCP-1), uric acid (UAE), phosphorus (PE), calcium (CaE), magnesium (MgE) and sodium (NaE). The creatinine clearance (CrCl) was calculated. Calcium deposits in kidney sections were examined using H+E and von Kossa staining. Statistical analysis was performed using one-way analysis of variance ANOVA. Statistical significance was considered as p<0,05.

Results

The results are presented in table as mean ± SD.

The rats did not differ in total calories intake in their diet.

Conclusion

The high-fructose diet, in a dose-dependent manner, exacerbated inflammation and induced damage to the proximal tubules. Both F10 and F60 led to hypouricosuria, hypercalciuria and hyperphosphaturia. Those disturbances, in turn, caused precipitation of calcium phosphate deposits in kidney tubules and parenchyma.
P0179ECULIZUMAB USE IN A TERTIARY CARE NEPHROLOGY CENTER
Authors: Aigner Christof , Stemer Gunar , Gaggl Martina , Haninger-Vacariu Natalja , Prohaszka Zoltán , Sunder-Plassmann Raute , Kain Renate , Alice Schmidt , Sunder-Plassmann Gere
Published: June 2020

Background and Aims

Practice patterns of Eculizumab use in patients with thrombotic microangiopathies (TMA) and C3-glomerulopathy (C3G) are not well described.

Method

We used the “Vienna TMA cohort” and the hospital pharmacy database at the Medical University of Vienna to identify adult patients with a history of eculizumab use between 2012 and 2019. We describe clinical characteristics, details of eculizumab use, and outcomes of patients with complement gene variant mediated TMA (cTMA), secondary TMA (sTMA) and C3G.

Results

As of December 2019, 212 individuals were enrolled in the Vienna TMA cohort comprising 51 cTMA, 144 sTMA, and 17 TTP patients. We included also our cohort of 14 patients with C3G for this analysis. 47 patients (22 TMA and 2 C3G, 23 other indications, i.e. paroxysmal nocturnal haemoglobinuria) received at least one dose of eculizumab at the Medical University of Vienna (Figure 1). Table 1 indicates demographic and clinical details of 15 cTMA (29.4% of all cTMA), 7 sTMA (4.9% of all sTMA) and 2 C3G (14.3% of all C3G) patients treated with eculizumab. 60% of cTMA patients showed a rare complement gene variant, while sTMA was ruled out in the remaining 40%. Causes of sTMA were bone marrow transplantation (BMT) (n=2), malignant hypertension, malignoma, systemic lupus erythematodes, antiphospholipid syndrome and lung transplantation (each n=1). One sTMA patient, a BMT recipient, had a donor with a thrombomodulin gene variant. Patients with cTMA had a greater delay from first diagnosis to treatment with eculizumab than the other groups and received maintenance therapy for a longer period of time. More female patients received eculizumab as compared to male patients. Chronic kidney disease stage improved in 60% and 43% of cTMA and sTMA patients, respectively. TMA relapses did not occur during administration of eculizumab. The 2 patients with C3G didn’t respond to eculizumab in our center. Eculizumab therapy was stopped in 66% of patients with cTMA and in all patients presenting with sTMA or C3G. In general, eculizumab was well tolerated and we did not observe life threatening infections of our patients. Three adverse drug reactions included exanthema, liver injury, and hypertensive emergency. Two patients died during therapy with eculizumab (1 cTMA, 1 C3G,) and two after cessation of eculizumab therapy (1 cTMA, 1 sTMA) resulting in a mortality of 16.7%.

Conclusion

Improvement of CKD stage was achieved in 60% of patients with cTMA and in 43% of patients with sTMA. In our patients with C3G, eculizumab did not improve kidney function. In general, therapy with eculizumab was well tolerated.
P1129PERITONEAL DIALYSIS TECHNIQUE FAILURE IN A LARGE POPULATION IN COLOMBIA
Authors: Vesga Jasmin , Rodriguez Nelcy , Rivera Angela , Sanabria Mauricio
Published: June 2020

Background and Aims

Peritoneal dialysis (PD) is a renal replacement therapy widely used in the world; about 197,000 patients use it. The main limitation of the use is related to technique failure. Extending time free of technique failure remains a long-term challenge in PD.

To estimate the incidence of technique failure in PD and, describe the main reasons for failure.

Method

A historical, multicenter, observational cohort study of all adult patients starting PD between January 1, 2010, and December 31, 2015, with follow-up until December 31, 2018, at Renal Therapy Services (RTS) network. The definition of technique failure applied when a patient was switched to Hemodialysis (HD) for at least 30 days. Socio-demographic and clinical characteristics of all patients were summarized descriptively by PD modality. We estimate the failure rate with an analysis of Kaplan Meier and analysis that incorporate competing risks as death and transplant.

Results

6452 patients met the inclusion criteria for data analysis, 67% were in CAPD modality. The mean age was 59 years, 54% were male, and 53.7% had a history of diabetes, see Table 1. There were 1462 technique failures events with a rate of 10.67 events per 100 patients-year [95% CI, 10.14 – 11.24]. The median technique survival time was 5.8 years [ 95% CI: 5.11 to 5.45]. Technique failure rates did not differ by PD modality (Wilcoxon test = 0.4986), Figure 1.

In the presence of competing events, the cumulative incidence of technique failure for the first year was 6.9 events per 100 persons-risk [95% CI: 6.27 to 7.56], Table 2. The most common causes of technique failure were catheter complications, followed by psychological and medical indications, Table 3.

Conclusion

The incidence of PD technique failure is around ten events per 100 patient-year, and this is lower than the previous cohort reports in the literature. Catheter problems remain the leading cause of technique failure
P1130A CELLULAR MODEL OF HUMAN MESOTHELIUM TO STUDY OF WATER TRANSPORT DURING PERITONEAL DIALYSIS AND THE BIOCOMPATIBILITY OF INNOVATIVE GLUCOSE-SPARING SOLUTIONS.
Authors: Piccapane Francesca , Caroppo Rosa , Arduini Arduino , Corciulo Roberto , Russo Roberto , Divino Jose Carolino , Bonomini Mario , Gerbino Andrea , Carmosino Monica , Svelto Maria , Procino Giuseppe
Published: June 2020

Background and Aims

The three pore model postulates that the endothelium of peritoneal capillaries is the major limiting barrier regulating water transport across peritoneal membrane during peritoneal dialysis (PD).

We hypothesize that the mesothelium may represent an additional selective barrier to water diffusion in PD. We previously demonstrated that the water channel AQP1 is expressed in vivo by mesothelial cells.

Here, we characterized an immortalized cell line of human mesothelium (HMC) to study the functional role of the water channel AQP1 in mediating water transport during PD and also to test the biocompatibility of glucose-sparing PD solutions (Xylocore), containing xylitol and L-carnitine as the main osmotic agents.

Method

Cells were grown onto porous cell culture inserts to achieve polarization. Polarization was demonstrated by expression of the tight junction markers Zo-1 and occludin. Transepithelial water transport was measured by TEA+-sensitive microelectrodes.

HMC cell monolayers were exposed to PD solutions at the apical side for 8 hours.

The biocompatibility of conventional versus innovative PD solutions was evaluated by MTT-test, measurement of transepithelial electrical resistance (TEER) and production of pro-inflammatory cytokines by by Luminex xMAP technology.

Results

HMC cells showed polarized expression of Na+/K+-ATPase and tight junctions markers but no endogenous expression of AQP1.

HMC showed a low TEER (40Ω/cm2) compared to renal cells not expressing AQP1(1000Ω/cm2). However, the transepithelial water transport was comparable between the two cell types.

Experiments in HMCs transfected with AQP1 cDNA, suggested that the water permeability of HMC was increased by two-fold in the presence of AQP1.

Biocompatibility assays indicated that in conventional dialysis solutions glucose concentration decreased cell viability in a dose-dependent manner. Glucose concentration also strongly decreased the TEER, suggesting reduction of the barrier integrity, and increased pro-inflammatory cytokines production.

Interestingly, substitution of part of the glucose with xylitol and L-carnitine minimized these effects.

Conclusion

These results suggest that the mesothelium may represent an additional selective barrier regulating water transport through the water channel AQP1 in PD. Importantly, we also demonstrate that the formulation of glucose-sparing PD solutions containing xylitol and L-carnitine better preserve mesothelial cells viability and may represent a useful means to prolong the dialysis life of patients undergoing peritoneal dialysis.
P1131STEADY CONCENTRATION PERITONEAL DIALYSIS INCREASES ULTRAFILTRATION AND SODIUM REMOVAL COMPARED TO CAPD
Authors: Carlsson Ola , Johansson Ann-Cathrine , Heimbürger Olof , Martus Giedre , Wilkie Martin , Hegbrant Jörgen , Johansson Ann , De Leon Charlotte
Published: June 2020

Background and Aims

Fluid and sodium removal may be a challenge during glucose-based PD, leading to increased use of high glucose solutions to maintain sufficient fluid removal. This may in turn lead to increased sodium sieving, resulting in a decreased sodium removal.

Carry Life® UF uses Steady Concentration PD (SCPD), where the infusion of glucose compensates for glucose uptake and maintains the intraperitoneal glucose concentration at a sufficient level providing a continuous ultrafiltration throughout the dwell. The present study investigated the effect of Carry Life UF compared to a standard CAPD dwell regarding ultrafiltration, sodium removal and glucose absorption.

Method

Eight stable PD patients were included in the study. Subjects were treated with 5-hour Carry Life UF treatments using three different glucose doses (11, 14, 20 g/h). An initial fill with 1500 ml, 13.6 g/l glucose PD solution was used. A small volume of dialysate was drained hourly to avoid overfill. A standard 4-hour Peritoneal Equilibration Test (PET) (2000 ml, 22.7 g/l glucose) was used as control. Data expressed as mean ± SD, statistical analysis using one-way ANOVA.

Results

Ultrafiltration was significantly increased during the Carry Life UF treatments compared to PET (646±256, 739±312, 863±380 ml for 11 g/h, 14 g/h and 20 g/h, respectively, vs. 162±242 ml for PET, p<0.01). Sodium removal increased significantly during Carry Life UF treatments (86±27, 92±33, 110±37 mmol/dwell for 11, 14, and 20 g glucose/h) compared to PET (22±33 mmol/dwell, p<0.001). Figure a shows that the intraperitoneal glucose concentration increased during the first hours of the Carry Life UF treatments and remained stable during the remainder of the treatments. During PET the glucose concentration decreased gradually during the treatment. The maximum intraperitoneal glucose concentration did not exceed 26 g/l (144 mmol/l) during the Carry Life UF treatments. The UF volume per gram of glucose uptake was significantly higher for the two lower Carry Life UF glucose doses compared to PET (Figure b).

Conclusion

SCPD performed with Carry Life® UF maintained a stable intraperitoneal glucose concentration during the 5-hour treatment which generated significantly higher UF volumes compared to 4-hour PET. During the Carry Life UF treatments glucose was used more efficiently, particularly for the two lowest doses, in comparison to PET. The increased sodium removal with Carry Life® UF enables a better balance between UF volume and sodium removal than for example during APD. In summary, SCPD using Carry Life® UF increases the efficiency of PD compared to standard, glucose-based CAPD with respect to ultrafiltration and sodium removal.
P1799GENOTYPE-PHENOTYPE CORRELATION IN A PEDIATRIC ADPKD COHORT
Authors: Van Giel Dorien , De Rechter Stéphanie , Breysem Luc , Hindryckx An , Janssens Peter , Decuypere Jean-Paul , Bammens Bert , Corveleyn Anniek , Férec Claude , Vennekens Rudi , Audrezet Marie-Pierre , Harris Peter , Mekahli Djalila
Published: June 2020

Background and Aims

The correlation between genotype and phenotype is well described in ADPKD adults. PKD2 is milder than PKD1 disease, with end stage kidney disease (ESKD) occurring on average 20 years later, and patients with PKD1 truncating mutations having a more severe outcome than PKD1 non-truncating mutations. Still, large differences in outcome occur even within families carrying the same gene variation. Only a few cases series reported the genetic profile of severely affected ADPKD children and suggest an additional effect of hypomorphic genes. We therefore aim to analyse the geno-phenotype profile in a well characterized pediatric ADPKD cohort.

Method

Clinical, familial, biological and imaging data were collected longitudinally in children diagnosed with ADPKD. Genotypic analysis was done using a custom Agilent SureSelect gene panel containing 136 ciliopathy-associated genes, including PKD1 and PKD2. Mutations and/or variants identified were individually evaluated for pathogenicity.

Results

57 ADPKD children from 44 families were diagnosed at a mean (± SD) age of 4.1 (±4.8) years. ADPKD diagnosis was made in 32 children (56%) because of asymptomatic screening as requested by the family; 7 (12%) due to presenting symptoms (6 due to urinary tract infection and 1 due to post-traumatic macroscopic hematuria); 9 (16%) due to a coincidental finding of renal cysts on US performed for another reason and in 9 cases (16%) a prenatal diagnosis was performed. Twenty-nine children (51%) met the definition of very-early onset (VEO) disease.

We identified pathogenic mutations in 100% of our patients, in which the prevalence of PKD1 truncating, PKD1 non-truncating, PKD2 and GANAB mutations was 75%, 19%, 4%, and 2%, respectively. Four cases (7%) were due to a de novo mutation. Interestingly, in 29 patients (51%) the germline mutation was the only identified mutation. However, in the rest of the subjects additional variants were identified in other ciliopathy-associated genes. In 12 cases (21%) the additional identified variants found in either the PKD, PMM2, HNF1B, DNAJC1, CEP290, NEK1, MKKS, NPHP4 or PKHD1 genes were scored to have a potential phenotypic effect, which will be evaluated by continued follow-up of this cohort.

Conclusion

We report the first large cohort of genotyped ADPKD children, including an extensive panel of ciliopathy genes next to the PKD genes. Interestingly, we found a high prevalence of additional and potentially modifying variants in this young population.
Therapeutic enhancement of blood–brain and blood–tumor barriers permeability by laser interstitial thermal therapy
Authors: Salehi Afshin , Paturu Mounica R , Patel Bhuvic , Cain Matthew D , Mahlokozera Tatenda , Yang Alicia B , Lin Tsen-Hsuan , Leuthardt Eric C , Yano Hiroko , Song Sheng-Kwei , Klein Robyn S , Schmidt Robert , Kim Albert H
Published: June 2020

Background

The blood–brain and blood–tumor barriers (BBB and BTB), which restrict the entry of most drugs into the brain and tumor, respectively, are a significant challenge in the treatment of glioblastoma. Laser interstitial thermal therapy (LITT) is a minimally invasive surgical technique increasingly used clinically for tumor cell ablation. Recent evidence suggests that LITT might locally disrupt BBB integrity, creating a potential therapeutic window of opportunity to deliver otherwise brain-impermeant agents.

Methods

We established a LITT mouse model to test if laser therapy can increase BBB/BTB permeability in vivo. Mice underwent orthotopic glioblastoma tumor implantation followed by LITT in combination with BBB tracers or the anticancer drug doxorubicin. BBB/BTB permeability was measured using fluorimetry, microscopy, and immunofluorescence. An in vitro endothelial cell model was also used to corroborate findings.

Results

LITT substantially disrupted the BBB and BTB locally, with increased permeability up to 30 days after the intervention. Remarkably, molecules as large as human immunoglobulin extravasated through blood vessels and permeated laser-treated brain tissue and tumors. Mechanistically, LITT decreased tight junction integrity and increased brain endothelial cell transcytosis. Treatment of mice bearing glioblastoma tumors with LITT and adjuvant doxorubicin, which is typically brain-impermeant, significantly increased animal survival.

Conclusions

Together, these results suggest that LITT can locally disrupt the BBB and BTB, enabling the targeted delivery of systemic therapies, including, potentially, antibody-based agents.
Characteristics and Outcomes of Staphylococcus aureus Bloodstream Infection Originating From the Urinary Tract: A Multicenter Cohort Study
Authors: Grillo Sara , Cuervo Guillermo , Carratalà Jordi , Grau Immaculada , Llaberia Mariona , Aguado José María , Lopez-Cortés Luis Eduardo , Lalueza Antonio , Sanjuan Rafael , Sanchez-Batanero Ana , Ardanuy Carmen , García-Somoza Dolors , Tebé Cristian , Pujol Miquel
Published: June 2020

Background

Staphylococcus aureus bloodstream infection (SABSI) arising from a urinary tract source (UTS) is poorly understood.

Methods

We conducted a retrospective analysis in 3 major teaching hospitals in Spain of prospectively collected data of hospitalized patients with SABSI. SABSI-UTS was diagnosed in patients with urinary tract symptoms and/or signs, no evidence of an extra-urinary source of infection, and a urinary S. aureus count of ≥105 cfu/mL. Susceptibility of S. aureus strains and patient mortality were compared between SABSI from UTS (SABSI-UTS) and other sources (SABSI-other).

Results

Of 4181 episodes of SABSI, we identified 132 (3.16%) cases of SABSI-UTS that occurred predominantly in patients who were male, had high Charlson comorbidity scores, were dependent for daily life activities, and who had undergone urinary catheterization and/or urinary manipulation before the infection. SABSI-UTS was more often caused by MRSA strains compared with SABSI-other (40.9% vs 17.5%; P < .001). Patients with SABSI-UTS caused by MRSA more often received inadequate empirical treatment compared with those caused by susceptible strains (59.7% vs 23.1%; P < .001). The 30-day case fatality rate was lower in patients with SABSI-UTS than in those with SABSI-other (14.4% vs 23.8%; P = .02). Factors independently associated with mortality were dependence for daily activities (aOR, 3.877; 95% CI, 1.08–13.8; P = .037) and persistent bacteremia (aOR, 7.88; 95% CI, 1.57–39.46; P = .012).

Conclusions

SABSI-UTS occurs predominantly in patients with severe underlying conditions and in those who have undergone urinary tract manipulation. Moreover, it is frequently due to MRSA strains and causes significant mortality.
Secondary Bacterial Infections in Critical Ill Patients With Coronavirus Disease 2019
Authors: Fu Yiqi , Yang Qing , Xu Min , Kong Haishen , Chen Hongchao , Fu Yajie , Yao Yake , Zhou Hua , Zhou Jianying
Published: June 2020

Secondary bacterial infections occurred in 13.9% (5 of 36) of critical ill patients with coronavirus disease 2019. All 5 patients had been admitted to intensive care unit and received mechanical ventilation before developing bacterial infection. Active surveillance of culture should be performed for critically ill patients. Prevention of nosocomial infection should to be taken seriously.
Incidence, predictive factors and severity of methotrexate-related liver injury in rheumatoid arthritis: a longitudinal cohort study
Authors: Mori Shunsuke , Arima Nobuyuki , Ito Masahiro , Ueki Yukitaka , Abe Yasuyo , Aoyagi Kiyoshi , Fujiyama Shigetoshi
Published: June 2020

Objectives

The aims were to determine the incidence rate, predictive factors and severity of liver injury that develops during MTX treatment for RA and to evaluate the role of pretreatment hepatic fat deposition.

Methods

We used an ongoing real-life registry containing RA patients who had started MTX between August 2007 and April 2018 at participating institutions. The liver-to-spleen attenuation ratio on CT scans at enrolment was used to evaluate pretreatment fat deposition quantitatively. Patients were followed until persistent transaminitis developed or until the end of the study. Liver biopsy was performed for patients who presented with persistent transaminitis.

Results

We followed 289 new MTX users without pretreatment elevations of transaminases (mean follow-up time, 58.3 months). Hepatic fat deposition was detected in half of the patients at enrolment. During follow-up, persistent transaminitis occurred at a crude incidence rate of 3.13 per 100 person-years, and the cumulative incidence at 5 years was estimated to be 13%. A multivariate Fine–Gray regression analysis showed that the most important predictive factors were pre-existing moderate to severe fat deposition (adjusted hazard ratio, 7.69; 95% CI: 3.10, 19.10) and obesity (adjusted hazard ratio, 2.68; 95% CI: 1.37, 5.25). Non-alcoholic steatohepatitis (NASH) was the most predominant pattern in liver biopsy samples. Hepatic fibrosis was found in 90% of samples, but most cases were not advanced.

Conclusion

Aggravation of underlying fatty liver to NASH with fibrosis seems to be an important mechanism of liver injury that occurs in MTX-treated RA patients.
Effect of treatment on cognitive and attention problems in children with narcolepsy type 1
Authors: Janssens Karin A M , Quaedackers Laury , Lammers Gert Jan , Amesz Pauline , van Mierlo Petra , Aarts Lisanne , Peeters Els , Hendriks Danielle , Vandenbussche Nele , Overeem Sebastiaan , Pillen Sigrid
Published: June 2020

Study Objectives

To ascertain the presence of cognitive and attention problems in treatment naïve children with narcolepsy type 1 (NT1) and to explore whether children recently diagnosed with NT1 improve with respect to cognition and attention problems 1 year after regular treatment for NT1.

Methods

A total of 15 treatment naïve children (7–15 years) with recently diagnosed NT1 were recruited from three sleep medicine centers in the Netherlands. The control group consisted of 15 healthy children, being frequency matched on age and gender. Both groups were investigated at baseline to examine intelligence profile (Wechsler Intelligence Scale for Children [WISC] III), attention problems, and processing speed (Bourdon Vos and sustained attention to respond task [SART]). These tests were repeated in children with NT1 1 year after regular (behavioral and medication) treatment for NT1.

Results

Children with NT1 scored significantly lower on the verbal scale and processing speed subscale of the WISC III, showed more fluctuations in reaction time of the Bourdon Vos and made more mistakes during the SART than the healthy control group at baseline. Children with NT1 significantly improved on total IQ score, and on the WISC indices processing speed, and perceptual organization 1 year after treatment. At follow-up, test scores of treated children were largely comparable to those of the control group at baseline.

Conclusions

Children with NT1 show improvement in several cognitive domains 1 year after start of treatment. Our findings stress the need for early detection and treatment of narcolepsy in childhood.
Executive Summary of the Focused Update of the ASAM National Practice Guideline for the Treatment of Opioid Use Disorder
Authors: Crotty Karen , Freedman Kenneth I. , Kampman Kyle M.
Published: June 2020

A Focused Update of the ASAM National Practice Guideline for the Treatment of Opioid Use Disorder is published in the current issue of the Journal of Addiction Medicine. The focused update included a search of Medline's PubMed database from January 1, 2014 to September 27, 2018, as well as a search of the grey literature (archives of the Clinical Guideline Clearinghouse, and key agency and society websites) for new practice guidelines and relevant systematic reviews addressing the use of medications and psychosocial treatments in the treatment of opioid use disorder, including within special populations. The search identified 11 practice guidelines and 35 systematic reviews that informed the subsequent RAND/UCLA Appropriateness Method (RAM) process employed to facilitate the focused update by a National Guideline Committee of addiction experts. New and updated recommendations were included if they were considered: (a) clinically meaningful and applicable to a broad range of clinicians treating addiction involving opioid use; and (b) urgently needed to ensure the Practice Guideline reflects the current state of the science for the existing recommendations, aligns with other relevant practice guidelines, and reflects newly approved medications and formulations.
Long-lasting response to third-line chemotherapy in metastatic pancreatic cancer
Authors: Tavares Alda , Mesquita Alexandra
Published: June 2020

At diagnosis, approximately 50% of cases of adenocarcinoma of the pancreas are metastasized and 5-year survival is only 2.9%. We reported a case of a 63-year-old woman with pancreatic adenocarcinoma with multiple hepatic and intra-abdominal metastases that progressed on 2 lines of chemotherapy. She has been under treatment with third-line chemotherapy for 19 months with stable disease and excellent performance status. She has an overall survival of 29 months. There are just a few cases of metastatic disease with long survival described in the literature. The functional status and the good tolerance to treatment may be determinants of prognosis.
Mobile-Application-Based Interventions for Patients With Hypertension and Ischemic Heart Disease: A Systematic Review
Authors: CHOI Jin Yi , CHOI Heejung , SEOMUN GyeongAe , KIM Eun Jung
Published: June 2020

Background

Hypertension and ischemic heart disease are major causes of adult mortality. Related interventions to manage these conditions are important to implement during long, symptom-free periods. The recent proliferation of smartphones has spawned numerous health interventions that rely on mobile applications.

Purpose

This systematic review was designed to summarize and analyze research on interventions using mobile applications for patients with hypertension and ischemic heart disease.

Methods

We searched for related studies published from January 2006 to August 2017 on MEDLINE, EMBASE, CINAHL, and three Korean databases. Seventeen studies were identified and evaluated against eligibility criteria that included a focus on patients with hypertension or ischemic heart disease and a discussion of the detailed effects of a mobile-app-based intervention. All of the identified studies were evaluated qualitatively using a methodology checklist.

Results

Twelve of the 17 studies were deemed as of acceptable quality according to the Scottish Intercollegiate Guideline Network quality assessment. According to the National Institutes of Health quality assessment tool, one article was of fair quality and four articles were of poor quality. Monitoring, education, and reminders were identified as application interventions. The effects of the app interventions were analyzed according to physiological factors, cognitive and behavioral factors, and psychological factors. Of the seven studies that measured blood pressure in patients with hypertension, five studies reported that the app-based interventions reduced blood pressure. Two of three studies showed a significant decrease of body mass index in patients with ischemic heart disease after the app-based interventions compared to the control group. Five of seven studies reported a significant change in medication adherence. Several studies showed different outcomes according to the disease, but the limited number of eligible studies was insufficient to demonstrate a conclusive effect.

Conclusions

To ensure the long-term effects of mobile-application-based interventions, healthcare professionals should consider the functions of mobile applications. Moreover, because the focus of these interventions may differ based on the nature of the disease, it is recommended that the composition of interventions be tailored to the specific disease.
The Related Factors of Nurses’ Participation and Perceived Benefits and Barriers in Health Policy Making
Authors: BARZEGAR SAFARI Masoumeh , BAHADORI Mohammadkarim , ALIMOHAMMADZADEH Khalil
Published: June 2020

Background

Nurses play a critical role in providing good health services.

Purpose

The aim of this study was to examine the factors related to the participation of nurses in the provision of health services and the perceived benefits and barriers to their participation in health policy making.

Methods

A cross-sectional descriptive study was conducted in several hospitals affiliated with the Iran University of Medical Sciences during the first half of 2018 on a sample size of 220 people. A standard, self-management questionnaire was used to collect the data, and SPSS 21.0 software was used for data analysis. None of the demographic characteristics were found to be significantly associated with nurse participation in or the perceived barriers and benefits to health policy making.

Results

The results of this study show that the participants were involved only moderately in health policy making. “Providing written reports on problems or receiving consultation from a related official” was the performance item most frequently cited by the participants in terms of involvement, whereas “Disappointment in work procedures” was the most frequently cited barrier item affecting involvement.

Conclusions/Implications for Practice

Despite the importance of the nursing role in health polices, this study indicates that nurses participate at only a moderate level in health policy-making activities. Providing more information to nurses regarding health policies, enhancing nurses’ image of their job and their perceptions about the importance of their participation in the health policy, increasing partnerships with nurses at the upper levels of health services management, and supporting nursing professional organizations in the field of health policy are potential strategies for encouraging greater nursing participation in health policy making.
Antifactor Xa Monitoring and Hematologic Complications of Pediatric Extracorporeal Membrane Oxygenation
Authors: Rama Gabriel , Middlesworth William , Neunert Cindy , Streltsova Svetlana , Cheung Eva W.
Published: June 2020

Hemorrhagic and thrombotic complications are a significant source of morbidity and mortality for pediatric patients on extracorporeal membrane oxygenation (ECMO). Optimal anticoagulation therapies and monitoring strategies remain unknown. In 2013, our institution changed the anticoagulation monitoring protocol from activated clotting time (ACT) to antifactor Xa (anti-Xa) levels. We conducted a retrospective review of patients who received anticoagulation management directed by ACT results (n = 96) or anti-Xa levels (n = 72) between January 2010 and March 2016. Hemorrhagic complications occurred in 25% of the ACT group and 39% of the anti-Xa group (p = 0.054). Thrombotic complications were observed in 12.5% of the ACT group and 14% of the anti-Xa group (p = 0.8). There was a greater incidence of extracorporeal cardiopulmonary resuscitations (E-CPR; 36% vs. 15%; p = 0.005) in the anti-Xa group as compared with the ACT group. Secondary analysis showed no difference in transfusion requirements for red blood cells (ml/kg; p = 0.32) or platelets (ml/kg; p = 0.32). There was no difference in average heparin infusion rates (unit/kg/hr) per cannulation (p = 0.17) between the groups. Management of anticoagulation based on anti-Xa levels appears to be as effective as management based on ACT results.
Central Versus Peripheral Arterial Cannulation for Veno-Arterial Extracorporeal Membrane Oxygenation in Post-Cardiotomy Patients
Authors: Radakovic Dejan , Hamouda Khaled , Penov Kiril , Bening Constanze , Sayed Sameh , Gietzen Carsten , Leyh Rainer G. , Aleksic Ivan
Published: June 2020

Different arterial cannulation strategies are feasible for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in postcardiotomy shock. We aimed to analyze potential benefits and safety of different arterial cannulation strategies. We identified 158 patients with postcardiotomy cardiogenic shock requiring VA-ECMO between 01/10 and 01/19. Eighty-eight patients were cannulated via axillary or femoral artery (group P), and 70 centrally via the ascending aorta directly or through an 8 mm vascular graft anastomosed to the ascending aorta (group C). Demographics and operative parameters were similar. Change of cannulation site for Harlequin’s syndrome or hyperperfusion of an extremity occurred in 13 patients in group P but never in group C (p = 0.001). Surgical revision of cannulation site was also encountered more often in group P than C. The need for left ventricular (LV) unloading was similar between groups, whereas surgical venting was more often implemented in group C (11.4% vs. 2.3, p = 0.023). Stroke rates, renal failure, and peripheral ischemia were similar. Weaning rate from ECMO (52.9% vs. 52.3%, p = NS) was similar. The 30 day mortality was higher in group P (60% vs. 76.1%, p = 0.029). Central cannulation for VA-ECMO provides antegrade flow without Harlequin’s syndrome, changes of arterial cannula site, and better 30 day survival. Complication rates regarding need for reexploration and transfusion requirements were similar.
International Normalized Ratio Test Frequency in Left Ventricular Assist Device Patients Affects Anticoagulation Quality and Adverse Events
Authors: Schlöglhofer Thomas , Zapusek Lydia , Wiedemann Dominik , Riebandt Julia , Wittmann Franziska , Dimitrov Kamen , Angleitner Philipp , Haberl Lisa , Laufer Günther , Moscato Francesco , Zimpfer Daniel , Schima Heinrich
Published: June 2020

Anticoagulation therapy in patients using left ventricular assist device (LVAD) is essential to reduce hemocompatibility related adverse events (HRAEs). Vitamin K-antagonist dosage must be adapted and monitored by INR point-of-care testing (POCT) in outpatients. The study aims to determine if the frequency of INR POCT in LVAD outpatients has an influence on the quality of anticoagulation therapy (ACQ), HRAEs, and outcomes. This retrospective study included n = 48 patients who received LVAD implantation (HMII, HM3, and HVAD) between 2013 and 2017. ACQ (% of INR tests in range, PTR), outcomes and HRAEs using Kaplan–Meier curves were compared in a daily (n = 36) and 3×/week (n = 12) INR POCT group. Further, based on the achieved PTR ranging from 0–60% (poor), 61–70% (acceptable), and 71–100% (well controlled), HRAEs and outcomes were compared. Daily and 3×/week groups were similar in perioperative risk factors and INR target (p = 0.28). Freedom from any HRAE (38.9% vs. 25.0%, p = 0.44), any readmission (72.2% vs. 75.0%, p = 0.97), and 1 year survival (91.7% vs. 91.7%, p = 0.98) were comparable in both groups. The PTR was significantly higher with the daily self-assessments (73.5% vs. 68.4%, p = 0.006). Well vs. poorly controlled INR POCT patients more often had (p = 0.01) a daily POCT frequency (92%) vs. poorly controlled (54%) and significantly higher freedom from neurologic events (96.0 vs. 69.2%, p = 0.024) as well as hemorrhagic strokes (100% vs. 76.9%, p = 0.011). Well-controlled anticoagulation of LVAD outpatients is associated with less neurologic events. The frequency of INR POCT could be one of the key factors in the reduction of HRAEs, so future prospective, large-scale studies should help to clarify the effects.
A Normative Study of Objective Measures of Disparity Vergence and Saccades in Children 9 to 17 Years Old
Authors: Namaeh Mashael , Scheiman Mitchell M. , Yaramothu Chang , Alvarez Tara L.
Published: June 2020

SIGNIFICANCE

This study establishes normative data for objective outcome measures of vergence and saccade eye movements for the pediatric population. These data should facilitate future clinical trial design.

PURPOSE

This study was designed to establish normative data for objective measures of disparity vergence and saccades in children between the ages 9 and 17 years using an objective binocular eye movement tracking system.

METHODS

Participants (aged 9 to 17 years) had a vision examination including refraction, accommodative, and binocular vision testing. Eligibility criteria included 20/25 visual acuity with best correction, normal accommodation, and binocular vision. The ISCAN RK-826PCI binocular tracking system (ISCAN, Woburn, MA) was used to objectively record horizontal, symmetrical disparity vergence, and saccadic eye movements. Parameters assessed included peak velocity, time to peak velocity, latency, and response amplitude for both disparity vergence and saccades.

RESULTS

One hundred eighteen participants were recruited (54.94% female; mean age, 13.5 years), and 77.1% (91/118) of the participants completed the assessment with usable data. A sample of the normative data included peak velocity (°/s), which had a mean ± standard deviation of 25.4 ± 2.9, 22.0 ± 3.0, 225 ± 16.7, and 332.5 ± 20.5 for 4° convergence, 4° divergence, 5° saccades, and 10° saccades, respectively. The mean ± standard deviation for the latency (seconds) measures were 0.28 ± 0.1, 0.28 ± 0.16, 0.23 ± 0.05, and 0.23 ± 0.05 for 4° convergence, 4° divergence, 5° saccades, and 10° saccades, respectively.

CONCLUSIONS

Normative data enable researchers to have benchmark results for comparison with patient populations with binocular dysfunction. These objective disparity vergence measures can serve as outcome measures in future clinical trials to assess the effectiveness of therapeutic interventions by determining whether post-treatment results are similar to normal data.