bluuebunny/crossref_metadata_2025 huggingface dataset:
19 Effect of Intermittent Compression of Upper Arm Veins on Forearm Vessels in Patients with End‐Stage Renal Disease
Authors: Rus R R , Ponikvar R , Kenda R B , Urbančič A , Buturović‐Ponikvar J
Published: February 2005

Background  Native arteriovenous fistula is the best vascular access for chronic hemodialysis. Primary and long‐term success depends, in part, on the state of arteries and veins at the time of the operation. The aim of our study was to investigate the effects of intermittent compression of upper arm veins on forearm vessels in patients with terminal renal disease.

Methods  The study group comprised 16 chronic hemodialysis patients who performed daily intermittent compression of the upper arm without vascular access by elastic band (Eschmarch). Ten chronic hemodialysis patients were included in the control group which performed no specific activity.

Forearm measurements were obtained at the beginning of the study and 4 and 8 weeks later during the course of intermittent compression of the upper arm veins. The forearm circumference and maximal handgrip strength were measured. The artery parameters, including endothelium‐dependent vasodilatation and forearm vein parameters, were obtained by ultrasonography measurements.

Results  The forearm circumference, maximal handgrip strength and artery parameters, including endothelium‐dependent vasodilatation, remained unchanged. The basal venous diameters (2.29 mm ± 0.19 at the beginning, 2.46 mm ± 0.19 after 4 weeks and 2.53 mm ± 0.18 after 8 weeks) were significantly increased in the study group. The distensibility of veins was preserved in the study group. There were no significant changes in the control group.

Conclusions  Our study demonstrated that daily intermittent compression of the upper arm veins increases the forearm vein diameter and preserves the distensibility of veins in patients with end‐stage renal failure.
22 Subcutaneous Compared with Intravenous Epoetin in Patients Receiving Hemodialysis: One Center Study
Authors: Malovrh M , Premru V
Published: February 2005

Introduction  There is strong evidence from randomized trials that subcutaneous (s.c.) epoetin is as effective as intravenous (i.v.) and may allow a lower dose to be used, thereby reducing costs. Dose requirements for s.c. are reported to be from 22–32% lower than those of i.v. epoetin. The purpose of these analyses was to find out what was increasing the epotein dose after the beginning of i.v. administration.

Patients and methods  Patients (pts) on HD treated with epoetin s.c. for 10 months (group A), and then with epoetin i.v. for 10 months (group B) were included in this analysis. Hemoglobin (Hb), epoetin (alpha or beta) dose (EPO), and ferritin were evaluated.

Results  46 pts, 25 females and 21 males, mean age 58.2 ± 12.6 (range 30–80) years, HD treatment mean 9.1 ± 7.7 (range 0.2–29.2) years were observed. In Group A, mean Hb was 123.8 g/L ± 2.4 (range 119–127), mean EPO 6914 ± 810 IE/week, ferritin 603.5 ± 46.2 µg/L. In Group B mean Hb was 120.3 g/L ± 2.3 (range 117–125) (P < 0.001), mean EPO 7433 ± 787 IE/week (NS), increasing for 7.5%, ferritin 534.2 ± 126.2 µg/L. Hemoglobin and EPO at different periods are shown in Table A22.

Group A
Group B

Hb (g/L)
EPO (IE/w)
Hb (g/L)
EPO (IE/w)

 1
126.1 ± 10.9
8022 ± 5164
124.6 ± 11.1
5913 ± 3740*

 2
125.4 ± 9.5
7674 ± 5208
122.7 ± 11.1
6195 ± 3896

 3
124.9 ± 9.9
7681 ± 5147
122.2 ± 12.8
7133 ± 4938

 4
124.3 ± 11.3
7954 ± 4675
119.3 ± 13.3*
7282 ± 5439

 5
124.0 ± 11.5
7340 ± 4435
118.2 ± 9.9*
7521 ± 4636

 6
126.2 ± 11.6
7022 ± 44541
118.9 ± 10.7**
7804 ± 4558

 7
127.3 ± 11.1
6022 ± 4427
120.2 ± 10.5
8043 ± 4584*

 8
125.3 ± 12.0
5777 ± 4567
121.2 ± 10.3
7913 ± 4554*

 9
121.2 ± 12.2
6222 ± 4851
118.3 ± 11.1*
8500 ± 4660*

10
119.0 ± 12.5
6232 ± 4374
117.3 ± 9.8
8239 ± 4212

11
120.5 ± 10.5
6200 ± 4634
119.2 ± 9.8
8431 ± 4189**

12
118.9 ± 11.5
6466 ± 4148
121.0 ± 9.7
7717 ± 4166*

w, week; *P < 0.05 **P < 0.001.

Conclusions  We found minor difference between the doses of s.c. and i.v. epoetin needed. There was no significant difference when mean value of whole group was compared, but in 50% this difference was statistically significant. Our results suggest that s.c. epoetin is more effective than i.v., but not in such huge amounts as some studies showed.
23 Review of Treatment with Epoetin: 10 Months Observation
Authors: Malovrh M , Premru V
Published: February 2005

Introduction  Renal anemia is a major problem of patients with chronic kidney disease (CKD). Target hemoglobin concentration (Hb) in these patients should be > 110 g/dL and hematocrit (Ht) > 0.33. Treatment of renal anemia with epoetin is a well established practice.

The purpose of this review in one dialysis center was to analyze the quality of such treatment and to find which parameters could influence success of treatment

Patients and Methods  Patients (pts) on HD were included in this analysis. The properties Hb, Ht, epoetin (alpha or beta intravenously) dose (EPO), ferritin, transferrin saturation (TSAT), hypochromic red cells (HYPO), CRP, albumin, parathyroid hormone (PTH) Kt/V were followed during 10 months period.

Results  58 pts, 29 female and 29 male, mean age 60.5 ± 12.5 (range 32–82) years, HD treatment mean 8.4 ± 7.8 (range 0.7–30.7) years were observed. Mean Hb was 119.9 g/L ± 2.1 (range 79–142), mean Ht 0.36 ± 0.01, mean EPO 6970 ± 456.7 IE/week. EPO 110.3 ± 7.9 IE/kgBW/week, ferritin 603.5 ± 46.2 µg/L, TSAT 25.8 ± 3.3%. HYPO 2.1 ± 0.1, CRP 7.4 ± 0.21, albumin 41.9 ± 0.37 g/L, PTH 281.5 ± 47.9, Kt/V 1.68 ± 0.34. The female and male groups were analyzed and compared (Table A23)

Female
Male

Age
 61.3 ± 14.6
 59.7 ± 10.3

HD
  8.0 ± 7.9
  8.7 ± 7.7

Hb
119.8 ± 1.9
120.0 ± 1.8

Ht
 0.36 ± 0.01
 0.36 ± 0.01

EPO/w
 6737 ± 336
 7276 ± 404*

EPO/kgBW/w
116.5 ± 3.9
111.7 ± 7.0

Ferritin
589.0 ± 69.4
618.5 ± 36.5

TSAT
 27.5 ± 3.6
 23.6 ± 3.1*

CRP
  7.4 ± 0.2
  9.6 ± 0.1

Kt/V
 1.91 ± 0.31
 1.47 ± 0.21**

w, week; *P < 0.05;  **P < 0.001.

Conclusions  Regular evaluation of crucial parameters for anemia correction and strict adaptation of EPO doses and iron therapy enable optimal maintenance of Hb and Ht, recommended by European best practice guidelines. We found significant difference in EPO dose per week, but calculating to kg BW there was no significant difference between females and males.
25 Frequent Low‐Dose Iron Supplementation To Hemodialysis Patients
Authors: Premru V , Malovrh M
Published: February 2005

Outline  Regular iron supplementation to most hemodialysis (HD) patients is necessary to ensure adequate response to epoetin (Epo). As enteral absorption of ferric compounds is insufficient in uremia, parenteral application is often needed. Usually, a dose of elementary iron is injected intraveneously at the end of an HD session once weekly to monthly according to the individual patient's needs. Doses range from usual 100 mg to several hundred mg. A surplus of iron immediately after application is transported to physiologic stores but might also be deposited at other sites in the body where it becomes inaccessible. In the long term, deposition of iron might lead to hemosiderosis and organ malfunction. Increased oxidative stress and acute toxic effects might supervene along with the increased susceptibility to infection, becoming fatal.

Patients and methods  In 59 patients on regular iron supplementation, we examined the effects of frequent low‐dose (25 mg) in comparison to usual regime of 100 mg post‐dialysis i.v. iron on Hb concentration and the required Epo dose to maintain the Hb target (120 g/L).

Results  (see Table A25)

Fe++/month

 (mg)
Hb  (g/L)
Ht
Epo dose  (I.U./week)

Period 1
267
119.4
0.361
6912

Period 2
165
120.5
0.366
6895

t‐test (p)
0.002
0.278
0.905
0.609

Conclusions  Initial results suggest that stable Hb levels could be maintained at the same Epo dosage with substantially lower dose of i.v. iron. Iron applied at the moment when the requirements are the greatest (i.e., at the same time as Epo is being applied) could enable higher iron bioavailability with less iron burden to body stores. This could possibly result in a better Epo response with avoidance of long‐term iron sequestration and acute toxic effects.
33 Citrate Anticoagulation during Plasma Exchange in Patients with Thrombotic Thrombocytopenic Purpura – Short Heparin‐Free Hemodialysis Helps to Remove Citrate Load
Authors: Buturović‐Ponikvar J , Fejzuli Č , Ponikvar R
Published: February 2005

Background  Treatment of thrombotic thrombocytopenic purpura (TTP) requires daily or even twice daily plasma exchanges (PE) with fresh frozen plasma as a replacement solution. If citrate anticoagulation is needed, citrate load (both from fresh frozen plasma and citrate as an anticoagulant) can be significant, causing severe alkalosis. Citrate as a small molecule is easily dialyzable, so short heparin‐free hemodialyses performed periodically after or between PE procedures can help to remove citrate load. The aim of our report is to present our experience with citrate anticoagulation in patients with TTP treated with daily PEs.

Methods  Fifteen protocols of plasma exchange procedures performed in a 46‐year‐old female with TTP were analyzed. Blood flow in all procedures was 100 mL/min, 4% trisodium citrate was used as anticoagulant, infused into the arterial line at rate 130 mL/h. 1 m CaCl2 was infused into the venous line in a dose adjusted to maintain ionized calcium (iCa) within normal limits (mean dose of 11.5 ± 1.5 mL/h). Fresh frozen plasma was used as a replacement solution, 3258 ± 548 mL per procedure.

Results  Ionized calcium before PE ranged from 1.10–1.45 mmol/L (mean 1.27 ± 0.12). The initial iCa level gradually increased after several procedures, as a consequence of citrate‐calcium complex metabolism between the procedures. Levels of iCa during PE were: 1.15 ± 0.09 mmol/L after 1 hour, 1.18 ± 0.06 after 2 hours and 1.16 ± 0.09 after 3 hours. Significant alkalosis occurred after several PEs with plasma pH 7.51 and bicarbonate 40.7 mmol/L. It was corrected by a 2‐hour heparin‐free hemodialysis with dialysate: K 4.0 mmol/L, calcium 1.5 mmol/L, sodium 140 mmol/L and bicarbonate set to 24 mmol/L. After dialysis pH was 7.38 and bicarbonate 28.5 mmol/L. Such hemodialysis was repeated during PE treatment.

Conclusion  Citrate anticoagulation can be safely performed in patients treated with PE by daily plasma exchanges. Periodically performed short heparin‐free hemodialysis can remove excess citrate and help to correct and avoid severe metabolic alkalosis.
3 Is Metabolism of Divalent Ions in Our Peritoneal Dialysis Population Optimal?
Authors: Benedik M , Guček A
Published: February 2005

Introduction  The problems of divalent ions, trace elements and bones are present in chronic dialysis patients despite optimal diet and therapy. Many patients have signs and symptoms of uremic osteopathy.

Aim of the study To evaluate divalent ion metabolism and bone diseases in patients of our center for peritoneal dialysis.

Methods  In cross‐section study, we studied 41 patients (14 women, 27 men, mean age 56.6 ± 14.2 years) who were at least for 6 months (mean 52.9 ± 34.5 months) in our peritoneal dialysis (PD) program in the year 2003. Besides clinical, ultrasound, and X‐ray data, we evaluated their laboratory data in the last 3 years where available.

Results  Twenty‐seven patients used CAPD, 14 CCPD methods, 5/41 used PD1 solution, 34/41 PD4 and 2 both solutions. Thirty‐four patients used CaCO3, 18 aluminum hydroxide, and 9 sevelamer hydrochloride as phosphate binder as monotherapy or in combination. Sixteen patients used calcitriol and 9 sodium bicarbonate. Mean serum Ca in this population was 2.38 ± 0.09 (range 2.16–2.56) mmol/L, mean serum PO4 1.46 ± 0.2 (range 1.13–2.23) mmol/L, mean serum alkaline phosphatase 1.44 ± 0.74 (range 0.61–5.3) µkat/L, mean serum Al 21.7 ± 12.1 (range 6.5–47.3) µg/L, mean i‐PTH was 454.07 ± 484 (range 1–1828) pg/mL and mean product of Ca and PO4 was 3.48 ± 0.53 mmol2/L2 (range 2.52–4.84). We found positive correlation between alkaline phosphatase and i‐PTH (P = 0.000153) and between i‐PTH and serum Ca (P = 0.025291). 25/41 (61%) patients had maximum i‐PTH higher than 200 pg/mL, 13/41 (32%) patients had maximum i‐PTH even higher than 600 pg/mL, 4 patients were waiting for parathyroidectomy, meanwhile 8/41 (19.5%) of patients had i‐PTH < 100 pg/mL, in 4 of them parathyroidectomy was done in the past.

Conclusions  Divalent metabolism is quite optimally achieved but secondary hyperparathyroidism still prevails in our PD patients. Management of divalent ions is very important before the beginning of peritoneal dialysis.
43 Conversion To Tacrolimus Due To Cyclosporine‐Related Toxicity in Kidney Graft Recipients – Single Center Study
Authors: Bren A F , Pajek J , Grego K , Kandus A
Published: February 2005

Aim  The aim of our study was to analyze cyclosporine (Cs)‐related toxic effects that demanded conversion to tacrolimus (Tc), and the influence on blood pressure (BP), glucose control and graft function.

Methods  From 1989 to 2003 10 patients (15 to 48 years), were treated with Cs from 2 months to 11 years. The Cs dose was adjusted to maintain the target blood trough levels of 100–170 µg/mL during first three post‐transplant months and 70–100 µg/mL afterwards. Patients were switched to Tc due to following Cs‐related toxic effects: gingival hypertrophy (8), hirsutism (1), hemolytic uremic syndrome (HUS) (3), and tremor (1). The Tc dose was adjusted to maintain a target whole blood trough level of 10–20 ng/mL during the first 3 months after transplantation and 5 to 15 ng/mL afterwards.

Results   After 3 to 46 months of follow‐up Cs‐related toxic effects (gingival hypertrophy, hirsutism, HUS, tremor) significantly diminished, systolic and diastolic blood pressure were decreased from 142 mmHg to 130 mmHg and from 87 mmHg to 83 mmHg, respectively (P < 0.005 and P = 0.095, respectively), while no significant change was observed in plasma fasting glucose levels. The calculated GFR (Nankivell formula) was 69 mL/min (range 91 to 44 mL/min) 3 to 6 months before conversion and 67 mL/min (range 37 to 101 mL/min) 3 to 6 months after conversion (P = 0.279).

Conclusion  Our results show that kidney allograft function was stable after conversion from Cs to Tc in the short‐term period. The benefits of conversion from Cs to Tc included significant reduction in Cs‐related toxic effects and also reduction of systolic blood pressure.
46 Hypercalcemic Nephropathy and TNFα in Patients with Bronchial Carcinoma
Authors: Čakalaroski K , Crvenkova S , Ivanovski N , Jovanovski D
Published: February 2005

Background  The phenomenon of “paraneocrinia” is very pronounced in patients (pts) with malignant tumors. Life‐threatening hypercalcemia (H) is a very frequent condition in pts with planocellular bronchial carcinoma (PBC), and many may be related to “parahormonal” (PTH‐RP), prostaglandins, TNFα, and OAF‐activity.

Aim of the Study  The aim of the study is to demonstrate the mechanisms of humoral hypercalcemia of malignancy (HHM) associated to PBC, their clinical presentation and our therapeutic possibilities.

Material and Methods  In a 3 year period (1998–2001) we treated 436 pts with primary lung carcinoma. Five pts (5/436; 1.15%) suffering from PBC have developed bone metastases with clinically and laboratory evident HHM and hypercalcemic nephropathy (decreased PO4, metabolic alkalosis, hypochloremia, hypoalbuminemia, polyurodipsia, light reverse uremia, fatigue, anorexia, nausea, itching, lethargy, and coma).The blood calcium concentration and 24 h urinary Ca excretion were augmented (between 2.88 and 3.30 mmol/L for total calcemia and ll.80 to 13.30 mmol/L for calciuria; diuresis, 2.9–4.6l /day) with characteristic electrocardiogram (ECG) signs (bradycardia, prolonged pulse rate and shortened ST‐intervals) and moderately elevated blood urea nitrogen (BUN; 10.11 ± 3.30 mmol/L), respectively serum creatinine (141.22 ± 38.73 µmol/L). The serum TNFα was significantly high in all hypercalcemic patients (N = 5) (105.40 ± 23.85 pg/L; RV = 10.80 ± 6.8 pg/L). The routinely applied nephrologic investigations (kidney ultrasonography, s.c. “kidney, ureter, bladder” X‐ray radiography) were negative. The therapeutic measures consist in prohibition of oral Ca‐intake, non‐steroidal anti‐inflammatory drugs (NAID), and H2‐receptor antagonists. The volume expansion (300–500 mL/h saline, 0.9%), furosemide (20–80 mg/4–8 h), bisphosphonates (pamidronate, 75 mg/i.v./every 4 weeks) and corticosteroids (1–2 mg/kg/bw/4–8 h) were introduced immediately when the diagnostic of HHM was obvious. Two pts were complementarily treated with Salmon calcitonin (5 IU/kg/bw).

Results and Conclusion  Laboratory improvement with complete withdrawal of clinical symptoms was noted in four pts. One patient died because of irreversible coma. Humoral hypercalcemia of malignancy in PBC is a relatively rare condition and may be almost certainly discovered and treated early if the serum TNFα concentration is at least 10 times more in comparison with the reference values.
47 Glomerular Filtration Rate in Convalescents with Hemorrhagic Fever with Renal Syndrome
Authors: Tulumović D , Mešić E , Hukić M , Živković N
Published: February 2005

Objectives  Bosnia and Herzegovina is a known endemic region for Hantavirus infection. In this region at least two different Hantaviruses, the Dobrava viruses (DOBV) and Puumala viruses (PUUV) have been found. The aim of the study was to determine glomerular filtration rate (GFR) in patients with a history of hemorrhagic fever with renal syndrome (HFRS) 9 to 10 years after the acute phase of the disease.

Design and Methods  We prospectively reviewed clearance of technetium marked diethyl three amino pentacetic acid (Tc99m DTPA) in 42 male convalescents with serologically confirmed HFRS, 13 patients with PUUV infection and 29 patients with DOBV infection.

Results  The tubulosecretory phase of the GFR was prolonged in six patients (46%) with PUUV infection and 23 patients (79%) with DOBV infection (P < 0.05). Total and separate clearance EDTA were significantly statistically lower (P < 0.001) in patients with serologically confirmed DOBV infection. In patients with DOBV infection elimination of radio pharmac was prolonged.

Conclusions  Hemorrhagic fever with renal syndrome can cause sustained renal damage that very rarely progresses into renal failure. The tubulosecretory DTPA phase was prolonged in 46% of examinees with PUUV and in 79% of examinees with DOBV infection. Elimination of radio pharmac from the kidney was prolonged in both groups of patients. The DTPA clearance rate was lower in patients with serologically confirmed HFRS than in normal populations, especially in patients with DOBV infection.
48 Polymorphisms In α‐Adducin (G460w) and G‐Protein β‐3 Subunit (C825t) Genes In Essential Hypertension
Authors: Marčun Varda N , Zagradišnik B , Vokač N Kokalj , Gregorič A
Published: February 2005

Objectives  Essential hypertension (EH) has a multifactorial origin and is thought to arise from an interaction between susceptibility genes and environmental factors. A number of candidate genes have been proposed. In our study, the role of polymorphisms in α‐adducin (ADD1) and G‐protein β‐3 subunit (GNB3) genes in EH was investigated.

Design and Methods  Ninety‐three children and young adults, aged from 4 to 27 years, with both parents, were included in our study, giving 93 nuclear families. Two polymorphisms were detected using the polymerase chain reaction technique (PCR). Investigating the C825T polymorphism of GNB3 the C allele was identified by the presence of 152 and 116 bp signals and the T allele was present when a non‐digested 268 bp long band was detected. The allele‐specific polymerase chain reaction (PCR) was used to study the G460W polymorphism of ADD1. For statistical analysis the transmission disequilibrium test (TDT) was used. By using non‐transmitted alleles as the control population, problems of population admixture and mismatched controls are avoided.

Results  The following genotype frequencies for G460W polymorphism in ADD1gene were observed: 67 (72.0%) were GG homozygotes, 23 (24.7%) were GW heterozygotes and 3 (3.3%) were WW homozygotes. Using the TDT test, 44 nuclear families were used. There were 63 transmitted G alleles, 25 transmitted W alleles, 60 non‐transmitted G alleles and 28 non‐transmitted W alleles. The observed difference was not statistically significant (χ2 = 0.24, P = 0.62).The following genotype frequencies for the C825T polymorphism in GNB3 gene were found: 50 (53.8%) were CC homozygotes, 35 (37.6%) were CT heterozygotes and 8 (8.6%) were TT homozygotes. 73 nuclear families were used. There were 95 transmitted C alleles, 51 transmitted T alleles, 84 non‐transmitted C alleles and 62 non‐transmitted T alleles. The observed difference again was not statistically significant (χ2 = 1.75, P = 0.19).

Conclusions  Our study found no association of the polymorphisms in ADD1 and GNB3 genes with EH, respectively. However, our sample size was rather small. It seems very likely that many genes with small effects (such as the gene variants above) account for the heritability of EH.
4 Endemic Nephropathy in Croatian Registry for Renal Replacement Therapy
Authors: Čala S
Published: February 2005

In endemic regions along the River Sava, chronic progressive tubulointerstitial nephritis, driven by an unidentified environmental factor, is the frequent cause of renal failure and need for renal replacement therapy (RRT).

The Croatian Registry for Renal Replacement Therapy (CRRRT) has collected individual patient data from the year 2000. Reports on 161 patients with endemic nephropathy (EN) are available for 81 women and 80 men, 111 alive and 50 dead.

The highest concentration of EN patients on dialysis is in Slavonski Brod (31%), Vinkovci (26%), and Sisak (13%). The overall frequency of EN in Croatia is much lower. In the year 2002, EN was the primary renal disease in 3.6% of 3100 patients on RRT, and in 3.1% patients starting dialysis. Prevalence was 25 cases per million population (pmp) and incidence was 3.6 pmp.

In EN patients starting RRT from 2000–2002, median age was 64 years (62 years in all incident patients in 2002.). Endemic nephropathy patients live longer on RRT (median vintage 4.5 years, compared to 3.5 years for all patients on RRT). Favorable course is evident in spite of older age and higher burden of neoplasms. Malignant disease is present in 7% of living patients, and in 20% of deceased patients.

A trend of decline is indicated by a small but sustained decrease in the incidence and prevalence of EN patients on RRT. In the years 2000, 2001, and 2002, the prevalence was 28 pmp, 27 pmp, and 25 pmp respectively. Incidence declined from 4.1 pmp to 4.0 pmp, and to 3.6 pmp. Incident patients are getting older. During the last 3 years, the youngest EN patient starting RRT was 46 years old. The youngest patient in CRRRT was 33 years old at the start of RRT in 1988.

Changes in life style may have lowered the exposure to the detrimental environmental factor. Younger generations are spared, and in those entering RRT now, more time was needed to cumulate a toxic dose, producing progressive kidney sclerosis.
6 The Most Important Factor for Cardiovascular Morbidity in Hemodialysis Patients is Microinflammation
Authors: Lavre J , Vujkovac B , Šabović M
Published: February 2005

In hemodialysis (HD) patients, cardiovascular (CV) morbidity is 10 to 20 times higher than in the general population. Dyslipidemia, malnutrition, and non‐traditional CV risk factors are well‐known important determinants in the increased CV morbidity. We therefore measured levels of serum high‐sensitivity C‐reactive protein (CRP), interleukin 6 (IL‐6), tumor necrosis factor‐α (TNF‐α), albumin, ferritin, cholesterol (CHOL), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), lipoprotein(a) (Lpa) and body mass index (BMI) in 22 HD patients (age 62.8 ± 12.8) on maintenance HD for 65.16 ± 33 months. All patients received standard dietary guidance with an average protein intake of 1.2 g/kg/day, 35 kcal/kg, phosphate and potassium restriction. Twenty of 22 patients had well treated high blood pressure. Two patients had non‐insulin‐dependent diabetes mellitus treated only with diet. The patients were not treated with lipid lowering drugs, and only one patient was a smoker.

The mean values of serum CHOL (4.31 ± 0.88 mmol/L), TG (1.77 ± 1.1 mmol/L), HDL (1.09 ± 0.35 mmol/L) and LDL (2.43 ± 0.53 mmol/L) were normal. The patients had elevated values of serum CRP (10.63 ± 12.56 mg/L), IL‐6 (1.49 ± 1.66 pg/mL), TNF‐α (7.26 ± 5.52 pg/mL) and Lpa (0.17 ± 0.15 µg/dL). The mean value of serum albumin (41.03 ± 2.38 g/L) was also normal; the mean value of BMI (26.32 ± 4.34 kg/m2) was mildly elevated. The patients had elevated serum ferritin (518 ± 342 mmol/L), but within the expected range. The mean value of Kt/V (1.86 ± 0.23) was high normal.

Our patients have elevated CRP, IL‐6 and TNF‐α. In contrast with other studies our patients had normal lipid status and also normal nutritional status. No significant relationships were found between CRP, IL‐6, TNF‐α, or ferritin and age, history of dialysis, albumin, and BMI. There was only a significant correlation between months on dialysis and HDL (r = −0.46, P = 0.048), but no significant correlation between months on dialysis and albumin, BMI, CHOL, TG, LDL, and Lp(a).

We concluded that in our HD patients, the most important factor for high CV morbidity was microinflammation. Dyslipidemia and malnutrition are well controlled in optimally treated HD patients and seems to be only a minor factor for CV morbidity.
7 Menstrual Dysfunction in Female Dialysis Patients
Authors: Resić H , Alajbegović A , Sahović V , Mesić E , Suljić E
Published: February 2005

Introduction  Uremia is associated with different endocrinologic abnormalities, which in some cases induce polyendocrinopathia. Female patients on dialysis are often subject to menstrual disorders that are variously manifested. The aim of our paper is to evaluate the etiology of menstrual dysfunctions in female dialysis patients.

Material and methods  Anamnesis, clinical and hormonal tests were performed on 25 female patients that were in chronic dialysis programs 4 hours, 3 times per week. Oligomenorrhea is considered as menstrual interval between 35 and 90 days and amenorrhea as cease of menstruation in the last six months.

Results   All patients had had normal menstrual cycles before the dialysis. Mean age of patients was 42.7 ± 9.96 years and mean dialysis duration was 75.5 ± 62.41 months. Out of the 25 patients, 10 developed amenorrhea when beginning dialysis and 5 of them regained regular menstrual cycle after one year. Seven patients had oligomenorrhea and 8 patients had an early menopause. Prolactin concentration was significantly higher in the group which developed menopause (N = 8), cpr = 1222.3 ± 1013.4, amenorrhea (942.2 ± 1061.2), oligomenorrhea (860.4 ± 897.2), compared to the group with a regular menstruation cycle (444.8 ± 299.7). The luteinizing hormone (LH) level in serum was increased in all groups. FSH was insignificantly higher in groups with oligomenorrhea and amenorrhea and amounted to 51.1 ± 69.9, while β‐estradiol and progesterone were in normal ranges. Hemodialysis duration influenced the prolactin level and after one year of follow up prolactin level significantly decreased in the group with amenorrhea that regained regular menstruation (cpr = 596.2 ± 297.2).

Conclusion  Different menstrual disorders are developed in dialyzed patients. Hyper prolactinemia was present in our dialysis population. Significant lowering of prolactin level in 20% of patients led to normalization of menstrual cycle.
9 The Effect of Handgrip Training and Intermittent Compression of Upper Arm Veins on Forearm Vessels in Patients With End‐Stage Renal Failure
Authors: Rus R , Ponikvar R , Kenda R B , Buturović‐Ponikvar J
Published: February 2005

Background  It has already been shown that handgrip training has a beneficial effect on arteries and veins, and intermittent compression of upper arm veins alone improves the diameter of forearm veins. The purpose of our study was to investigate the additive effect of handgrip training and intermittent compression of upper arm veins on the forearm arteries and veins.

Methods  Eighteen chronic hemodialysis patients performed daily handgrip training and intermittent compression of upper arm by elastic band (Eschmarch) for 8 weeks. The activities were performed on the arm without vascular access. The forearm circumference and maximal handgrip strength were measured before exercise, and after 4 and 8 weeks, together with arterial and vein parameters including endothelium‐dependent and endothelium‐independent vasodilatation obtained by ultrasonography measurements.

Results  The maximal handgrip strength and the forearm circumference increased significantly. The radial artery diameters were significantly higher after 8 weeks of training (1.89 mm ± 0.10 at the beginning, 1.95 mm ± 0.10 after 8 weeks). Endothelium‐dependent vasodilatation was also found to be markedly increased after 4 and 8 weeks of training, but endothelium‐independent vasodilatation remained unchanged. The venous diameters before tourniquet placement increased significantly after 8 weeks (2.40 mm ± 0.16 at the beginning, 2.62 mm ± 0.17 after 8 weeks). The venous diameters after tourniquet placement increased significantly after 4 and 8 weeks (3.36 mm ± 0.17 at the beginning, 3.51 mm ± 0.18 after 4 weeks, 3.68 mm ± 0.18 after 8 weeks). Distensibility of veins was preserved.

Conclusion  Our study suggests that both activities performed daily, such as handgrip training and intermittent compression of upper arm veins, increase the diameters of both arteries and veins. The endothelium‐dependent vasodilatation was also improved.
Implant‐Supported Facial Prostheses Provided by a Maxillofacial Unit in a U.K. Regional Hospital: Longevity and Patient Opinions
Authors: Hooper S.M. , Westcott T. , Evans P.L.L. , Bocca A.P. , Jagger D.C.
Published: February 2005

Purpose: The aim of this study was to acquire information on the types and longevity of implant‐retained facial prostheses and the opinions of patients on several factors related to their prostheses.

Materials and Methods: A survey of 75 maxillofacial prosthetic patients currently under treatment and review at the Maxillofacial Unit, Morriston Regional Hospital was conducted through a 23‐question postal questionnaire. These patients were selected as representative of a group of individuals receiving treatment or under review for the fabrication of maxillofacial prostheses.

Results: Of the prosthetic replacements, 83% were ear prostheses, 8% nose, 6% eye, and 2% combination prostheses. Of the 47 respondents, 8 (17%) reported that they were currently wearing their original prostheses. The remaining 39 (83%) respondents had all been provided with at least 1 replacement prosthesis. The mean lifetime of the prostheses was found to be 14 months (range: 4–36 months). The majority of replacement prostheses in this study were provided as a result of color fade or wear of the silicone material of the previous prosthesis. Individuals with no previous experience wearing a prosthesis had an unrealistic expectation of their prosthesis longevity, with a mean value of 17.8 months. In comparison, individuals with previous experience had reduced expectations, with a mean of 14.4 months. In terms of the patients' opinions of the overall quality of their prostheses, the results demonstrated that a large number of patients were satisfied. Thirty‐five patients rated their prostheses as excellent and 9 as good. At 7–12 months, 4 patients rated their prostheses as excellent and 8 as good. At 13 months, 4 patients rated their prostheses as excellent and 5 as good.

Conclusions: It is important that advice be given to patients on the expected average longevity of their prostheses, together with information on factors affecting the longevity (i.e., environmental staining, cosmetics, and cleaning regimes). In this study, 26% of the replacement prostheses were provided due to color fading of the original prosthesis. This highlights the need for continuing research in the development of materials used for the construction of facial prostheses with improved properties, and in particular, improved color stability.
Evaluation of gingival blood flow by the use of laser Doppler flowmetry following periodontal surgery. A pilot study
Authors: Donos Nikolaos , D'Aiuto Francesco , Retzepi Maria , Tonetti Maurizio
Published: February 2005

Objectives:  The aim of this pilot study was to evaluate the applicability of laser Doppler flowmetry (LDF) in recording the gingival blood flow following periodontal surgery.

Material and methods:  Five patients suffering from advanced chronic generalized periodontitis were included in the study. After completion of basic periodontal therapy, full‐mouth plaque score, bleeding on probing, gingival recession and clinical attachment level were recorded. The upper anterior areas with a pocket probing depth of 6 mm or more were treated with an access flap. LDF recordings were performed in both the buccal and palatal aspect of the operated areas with the aid of an individual acrylic stent at the day of the surgery, prior to local anaesthesia, 3 min following anaesthesia, immediately after the operation and at days 1, 2, 3, 4, 7, 15, 30 and 60 following operation.

Results:  Overall, the blood flow decreased immediately following anaesthesia and remained in lower values compared to baseline immediately following operation. The gingival blood flow presented an overall increase in comparison to baseline values until the 7th day following surgery at the buccal and palatal interdental sites, as well as at the alveolar mucosa sites. By the 15th day, as well as at the following observation periods of 30 and 60 days, the gingival blood flow values at the palatal and alveolar mucosa sites were very similar to baseline. Increased blood flow changes were observed at 30 and 60 days following operation at the buccal interdental sites.

Conclusion:  The results of the present pilot study suggest that the LDF might present clinical applicability in recording changes in gingival blood flow following periodontal surgery.
Er:YAG laser irradiation increases prostaglandin E2 production via the induction of cyclooxygenase‐2 mRNA in human gingival fibroblasts
Authors: Pourzarandian A. , Watanabe H. , Ruwanpura S. M. P. M. , Aoki A. , Noguchi K. , Ishikawa I.
Published: February 2005

Background and objectives:  It has been reported that both prostaglandin E2 (PGE2) and Er:YAG laser irradiation accelerate wound healing. The stimulatory action of laser seems to occur during the proliferative stage of healing by stimulation of prostaglandin E2 and cyclooxygenase‐2 (COX‐2), which are crucial early mediators in the natural healing process. We have then investigated the effect of Er:YAG laser irradiation on PGE2 production and COX‐2 gene expression in human gingival fibroblast in vitro.

Material and methods:  Cultured fibroblasts were exposed to low‐power Er:YAG laser irradiation with an energy density of 3.37 J/cm2. The amount of PGE2 production was measured by enzyme‐linked immunosorbent assay (ELISA). COX‐2 mRNA level, which is a critical enzyme for PGE2 production, was analyzed by reverse transcriptase–polymerase chain reaction (RT–PCR).

Results:  Er:YAG laser significantly increased PGE2 production by human gingival fibroblasts. COX‐2 mRNA, which was hardly detectable in control, increased dramatically after irradiation. COX‐2 inhibitor, NS398, completely inhibited the PGE2 synthesis stimulated by Er:YAG laser irradiation.

Conclusion:  Our results showed that Er:YAG laser irradiation appears to exert its stimulative action on gingival fibroblasts proliferation through the production of PGE2 via the expression of COX‐2. This should be considered as one of the important regulatory pathways to accelerate wound healing after Er:YAG laser irradiation.
CONTROL OF STORAGE‐RELATED PHYSIOLOGICAL DISORDERS OF “D’ANJOU” PEARS BY INTEGRATED REDUCED DOSAGE OF ETHOXYQUIN AND LOW OXYGEN TREATMENTS1
Authors: MIELKE EUGENE A. , DRAKE STEPHEN R.
Published: February 2005

A 1000‐p.p.m. ethoxyquin drench containing 528 p.p.m. thiobendazol (TBZ) fungicide prior to controlled atmosphere (CA) storage effectively controlled the development of superficial scald (SS) for 1 month regular air (RA) storage following 5 months CA storage. The preharvest drench was not effective in controlling the development of SS in fruit returned to RA storage following 7 months CA storage. Application of a 1750‐p.p.m. ethoxyquin line spray (without TBZ) following 5 months CA storage effectively extended the control of SS to 2 months under RA conditions. The 1750 p.p.m. ethoxyquin line spray was effective in controlling SS for 1 month RA storage following an additional 2 months CA storage period. This represents a 36% reduction in the amount of ethoxyquin currently used on fruit stored for short periods of time. Minor, noncommercial amounts of pithy brown core (PBC) developed during storage, demonstrating that 1% O

2

and 1% CO

2

in a flow‐through system can be safely utilized for the storage of pears. Growing location (Oregon vs. Washington) made no difference in the sensitivity to CO

2

injury and packing and handling damage.
DETECTION OF COW MILK IN BUFFALO “MOZZARELLA” BY POLYMERASE CHAIN REACTION (PCR) ASSAY
Authors: DI PINTO ANGELA , CONVERSANO MARIA CHIARA , FORTE VITO TONY , NOVELLO LUCIA , TANTILLO GIUSEPPINA MARILIA
Published: February 2005

The authors used a polymerase chain reaction (PCR) assay on buffalo mozzarella, a typical Italian dairy product, from the Apulia markets to evaluate the presence of cow milk and verification of the mozzarella label. The results obtained from 30 mozzarella samples demonstrated the presence of the cow genome in 22/30 samples, highlighting contamination as probable fraudulent adding of cow's milk or use of the same equipments in both working cycles.
THE EFFECTS OF ALTITUDE ON FRUIT QUALITY AND COMPRESSION LOAD FOR CRACKING OF WALNUTS (Juglans regia L.)
Authors: KOYUNCU MEHMET ALI , EKINCI KAMIL , GUN AYŞE
Published: February 2005

Nuts of walnut (Juglans regia L.), cultivated in the district of Denizli (altitude of 300 m) and Cameli (altitude, 1200 m) in the Aegean region of Turkey, were used to determine the effects of altitude on fruit quality and the force and energy required to crack the nuts. The varieties used were Bilecik, Sebin, Yalova‐1, Yalova‐3 and Yalova‐4. For all cultivars, walnut trees grown at the higher altitude produced small size nuts with thick shells. Based on the average for all cultivars, kernel removal quality decreased with high altitude. The nuts obtained from the high‐altitude location were lighter‐colored and required more force to fracture the nuts than those harvested at the low altitude. The amount of energy required to crack the nuts was higher for the nuts grown at the low‐altitude location except for the cultivar, Sebin.
Beyond Financial Reporting An Integrated Approach to Disclosure
Authors: Hutton Amy
Published: February 2005

A company's market value is a key determinant of its future success, affecting its ability to raise capital, recruit and retain key employees, and make strategic acquisitions. Confident, well‐informed investors are necessary for achieving and maintaining accurate valuation of a company's stock. But standard disclosure practice has left many companies releasing a great deal of data while conveying only limited understanding to outsiders.

This article presents the outline of an integrated approach to corporate disclosure in which each of the three major elements–required financial reports, supplemental disclosure, and interactions with investors and intermediaries–are consistent and mutually reinforcing. Such an approach begins with required reports that refiect as closely as possible the economic reality of a company's business. But if GAAP income statements and balance sheets are often useful for communicating current and past performance, they are not designed to convey management's strategic vision and the company's prospects for creating value. To achieve and maintain accurate valuation, management must supplement mandated financial reporting with voluntary communication that highlights value drivers and helps investors understand both the company's strategic goals and management's progress in meeting those goals. Finally, management must interact with investors and capital market intermediaries in ways that provide them with a clear and compelling picture of the company's prospects, which should help both analysts and institutional investors become more effective monitors of the firm's performance.

Through consistent communication that goes well beyond the sell side's focus on quarterly earnings per share, management will discover that it has the power to set the agenda for how the company's performance is evaluated by the market. In the process, companies are also likely to find that their investors (and analysts) are more patient than they thought, while their operating managers feel less pressure to take shortsighted steps to boost EPS. Both of these expected benefits of an integrated disclosure policy should end up increasing a company's value.
Making Financial Goals and Reporting Policies Serve
Authors: King Tom , Stewart Bennett
Published: February 2005

The main. nancial goal of Progressive Insurance, the third largest underwriter of auto insurance in the U.S., has remained the same since the late 1960s. Expressed in three words, “96 and grow,” the goal tells the company's managers to pursue all growth opportunities while maintaining a “combined ratio” no higher than 96, or what amounts to a minimum 4% spread between revenues (premiums) and costs (including expected losses). Thanks in part to the clarity of mission provided by this goal, the company has produced an average 15% rate of growth in revenues and earnings, along with a remarkably stable 15% return for its shareholders, since going public in 1971.

Progressive's simplicity and clarity of mission is also partly responsible for another of the company's distinctive policies: product pricing that, while disciplined, is aggressive and highly decentralized. Having invested some $500 million per year developing statistical models for pricing individual customer risks and acquisition costs, the company was among the. rst in its industry to underwrite “non‐standard” risks. And aided by sophisticated pricing models, each of Progressive's 100 or so local product managers are charged with adapting those models to come up with premiums for their own regions.

To go along with its strategic and organizational innovations, Progressive also has an innovative disclosure policy. Apart from SEC reports, the company's communications seldom mention earnings or earnings per share, and the company has never provided earnings guidance. With the passage of Reg. FD in late 2000, the company brie. y considered offering guidance. But in the spring of 2001, the board decided instead to provide monthly releases of its realized combined ratio. Since adoption of this new disclosure policy, Progressive has seen a 50% drop in the volatility of its stock price.
Identifying and Attracting the “right” Investors: Evidence on the Behavior of Institutional Investors
Authors: Bushee Brian
Published: February 2005

This article summarizes the findings of research the author has conducted over the past seven years that aims to answer a number of questions about institutional investors: Are there significant differences among institutional investors in time horizon and other trading practices that would enable such investors to be classified into types on the basis of their observable behavior? Assuming the answer to the first is yes, do corporate managers respond differently to the pressures created by different types of investors– and, by implication, are certain kinds of investors more desirable from corporate management's point of view? What kinds of companies tend to attract each type of investor, and how does a company's disclosure policy affect that process?

The author's approach identifies three categories of institutional investors: (1) “transient” institutions, which exhibit high portfolio turnover and own small stakes in portfolio companies; (2) “dedicated” holders, which provide stable ownership and take large positions in individual firms; and (3) “quasi‐indexers,” which also trade infrequently but own small stakes (similar to an index strategy).

As might be expected, the disproportionate presence of transient institutions in a company's investor base appears to intensify pressure for short‐term performance while also resulting in excess volatility in the stock price. Also not surprising, transient investors are attracted to companies with investor relations activities geared toward forward‐looking information and “news events,” like management earnings forecasts, that constitute trading opportunities for such investors. By contrast, quasi‐indexers and dedicated institutions are largely insensitive to shortterm performance and their presence is associated with lower stock price volatility. The research also suggests that companies that focus their disclosure activities on historical information as opposed to earnings forecasts tend to attract quasi‐indexers instead of transient investors.

In sum, the author's research suggests that changes in disclosure practices have the potential to shift the composition of a firm's investor base away from transient investors and toward more patient capital. By removing some of the external pressures for short‐term performance, such a shift could encourage managers to establish a culture based on long‐run value maximization.
Where M&A Pays and Where It Strays: A Survey of the Research
Authors: Bruner Robert
Published: February 2005

This article uses a large and growing body of academic studies to refute the popular notion that corporate mergers and acquisitions generally fail to increase productivity and end up reducing shareholder value. A careful review of the evidence starts by con. rming the obvious–namely, that the shareholders of selling firms earn large returns from M&A–and goes on to demonstrate an economic reality that is not widely understood: shareholders of acquirers generally earn about the required rate of return on investment, and hence M&A is at least a value‐maintaining proposition.

Of greatest interest to corporate practitioners, however, is the very large dispersion of outcomes that underlies the average returns. Closer inspection of this variability shows that certain circumstances and company characteristics are reliably associated with value‐increasing M&A. In particular, acquisitions of related companies tend to be better received by the market and to produce higher post‐merger operating returns than diversifying transactions (though there are a number of successful instances of the latter). Other fairly reliable indicators of value‐increasing M&A are transactions involving mergers of equals or smaller, private targets (where the bidding competition is less intense) and deals structured as earnouts and financed primarily with cash rather than stock.