bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radar Applications in Northern Scotland (RAiNS)
Authors: Neely III Ryan R. , Parry Louise , Dufton David , Bennett Lindsay , Collier Chris 
Published: October 2020

AbstractThe Radar Applications in Northern Scotland (RAiNS) experiment took place from February to August 2016 near Inverness, Scotland. The campaign was motivated by the need to provide enhanced weather radar observations for hydrological applications for the Inverness region. Here we describe the campaign in detail and observations over the summer period of the campaign that show the improvements that high-resolution polarimetric radar observations may have on quantitative precipitation estimates in this region compared to concurrently generated operational radar quantitative precipitation estimates (QPEs). We further provide suggestions of methods for generating QPE using dual-polarization X-band radars in similar regions.
Outcomes of Minimally Invasive Colectomy for Perforated Diverticulitis
Authors: Moghadamyeghaneh Zhobin , Talus Henry , Fitzgerald Simon , Muthusamy Muthukumar , Stamos Michael J. , Roudnitsky Valery 
Published: October 2020

Background We hypothesized that a laparoscopic approach to sigmoidectomy for perforated diverticulitis is associated with less morbidity and mortality. Methods The NSQIP database was used to investigate adult patients who underwent emergent colectomy with end colostomy for perforated diverticulitis. A multivariate analysis using logistic regression was used to compare outcomes of patients by surgical approach. Results We found a total of 2937 adult patients who underwent emergent colectomy for perforated diverticulitis during 2012-2017. The rate of minimally invasive surgery (MIS) was 11.4% with 38.6% conversion rate to open. The 30-day mortality and morbidity rates were 8.8% and 65.8%, respectively. Following adjustment using a multivariate analysis, the open approach was associated with higher morbidity (67.2% vs 56.8%, AOR: 1.70, P < .01) and mean hospitalization length of patients (13 days vs 10 days, P < .01) compared to the MIS approach. Respiratory complications of ventilator dependency (14.3% vs 6%, AOR: 2.95, P < .01) and unplanned intubation (7.4% vs 2.4%, AOR: 2.14, P = .03) were significantly higher in the open approach. However, patients who underwent the open approach were older (age >70; 33.5% vs 24%, P < .01) with more comorbid conditions such as COPD (10.8% vs 7.2%, P = .04) and CHF (9% vs 3.1%, P < .0). Conclusion The MIS approach to emergent partial colectomy for perforated diverticulitis is associated with decreased morbidity and hospitalization length of patients. Utilization of the MIS approach for partial colectomy for perforated diverticulitis is 11.4% with a conversion rate of 38.6%. Efforts should be directed toward increasing the utilization of laparoscopic approaches for the surgical treatment of perforated diverticulitis.
Electronic Glycemic Management System and Endocrinology Service Improve Value in Cardiac Surgery
Authors: Chancellor William Z. , Mehaffey James H. , Hawkins Robert B. , Charles Eric J. , Tribble Curt , Yarboro Leora T. , Ailawadi Gorav , Kirby Jennifer L. 
Published: October 2020

Background Postoperative glycemic control improves cardiac surgery outcomes but insulin protocols are limited by complexity and inflexibility. We sought to evaluate the effect of implementing an electronic glycemic management system (eGMS) in conjunction with a cardiac surgery endocrinology consult service on glycemic control and outcomes after cardiac surgery. Methods All patients with a calculated preoperative risk of mortality who underwent cardiac surgery before and after implementation of an eGMS and an endocrinology consult service were identified. Glycemic control and surgical outcomes were compared using univariate analysis, and multivariate regression was used to model the risk-adjusted effects of the interventions on glycemic control, surgical outcomes, and resource utilization. The health care–related value added by the interventions was calculated by dividing risk-adjusted outcomes by total hospital costs. Results A total of 2612 patients were identified, with 1263 patients in the preimplementation cohort and 1349 in the postimplementation cohort. Multivariate regression demonstrated fewer postoperative hyperglycemic events (odds ratio [OR] 0.8, 95% CI, 0.65-0.99) after protocol implementation without an increase in hypoglycemic events (OR 0.96, 95% CI, 0.71-1.3). Average day-weighted mean glucose decreased from 144 to 138 mg/dL ( P < .001). The improved glycemic control correlated with a risk-adjusted decrease in composite morbidity or mortality (OR 0.61, 95% CI, 0.47-0.79). Although hospital costs increased after implementation, the protocol increased health care–related value by 38%. Conclusion Implementation of a protocol consisting of an eGMS paired with a cardiac surgery–specific endocrinology consult service was associated with improved glycemic control and reduced morbidity. Despite higher costs health care–related value increased as a result of eGMS implementation.
A successful case of heart transplantation concurrent with pulmonary thromboendarterectomy
Authors: Cao Liang , Yao Yuntai , Yang Jing 
Published: October 2020

Introduction: Pre-transplant irreversible pulmonary hypertension and high pulmonary vascular resistance are generally considered as contraindications for orthotopic heart transplantation due to the high risk of right ventricular dysfunction after transplantation. However, there is no consensus on whether reversible pulmonary hypertension increases the incidence of post-transplant complications and mortality. Case report: A patient with acute heart failure and pulmonary artery occlusion successfully underwent heart transplantation concurrent with pulmonary thromboendarterectomy. Discussion and Conclusion: This case illustrates that heart transplantation concurrent with pulmonary thromboendarterectomy can be performed successfully with meticulous operability assessment, superb surgical technique and careful perioperative management.
Increased Utilization of Peritoneal Dialysis to Cope with Mounting Demand for Renal Replacement Therapy—Perspectives from Asian Countries
Authors: Li Philip Kam-Tao , Sing Leung Lui , Chi Bon Leung , Alex Wai-Yin Yu , Lee Evan , Just Paul M. , Abraham Georgi , Almazan–Gomez Lynn , Huang Chiu Ching , Hooi Lai Seong , Kawaguchi Yoshindo , Kuok Un I. , Tungsanga Kriang , Wang Tao , Wong Andrew Kui-Man , Yu Xue-Qing , Lo Wai Kei 
Published: October 2020

With the number of end-stage renal disease (ESRD) patients growing, one of the crucial questions facing health care professionals and funding agencies in Asia is whether funding for dialysis will be sufficient to keep up with demand. During the ISPD's 2006 Congress, academic nephrologists and government officials from China, Hong Kong, India, Indonesia, Japan, Macau, Malaysia, Philippines, Singapore, Taiwan, Thailand, and Vietnam participated in a roundtable discussion on dialysis economics in Asia. The focus was policy and health care financing. The roundtable addressed ESRD growth in Asia and how to obtain enough funding to keep up with the growth in patient numbers. Various models were presented: the “peritoneal dialysis (PD) first” policy model, incentive programs, nongovernmental organizations providing PD, and PD reimbursement in a developing economy. This article summarizes the views of the participant nephrologists on how to increase the utilization of PD to improve on clinical and financial management of patients with ESRD.
Studying the Effects of New Peritoneal Dialysis Solutions on the Peritoneum
Authors: Tak Mao Chan , Yung Susan 
Published: October 2020

♦ Background Compelling data underscore the bioincompatible nature of glucose-based peritoneal dialysis (PD) solutions and their detrimental effects on peritoneal physiology and morphology. New PD solutions have been formulated to tackle common clinical problems such as inadequate ultrafiltration or malnutrition, and to improve biocompatibility—the latter aimed at preserving the structural and functional integrity of the peritoneum and reducing adverse systemic effects on the patient. ♦ Methods This article reviews the factors in PD fluids that alter normal peritoneal anatomy and physiology, and the data that illustrate approaches to investigating the local and systemic biocompatibility of new PD solutions. ♦ Results Chronic exposure of the peritoneal membrane to glucose-based PD solutions results in denudation of the mesothelium, thickened submesothelium, and hyalinization of the vasculature, often resulting in reduced or lost solute and water clearance. Data from in vitro or animal experiments and clinical studies have shown improved bio-compatibility profiles with new PD solutions that are glucose-free (that is, dialysates with amino acids or icodextrin), bicarbonate-buffered, or compartmentalized during heat sterilization to reduce levels of glucose degradation products. Improved biocompatibility is denoted by reduced induction of proinflammatory, profibrotic, or angiogenic growth factors in mesothelial cells and macrophages, or by less perturbation of leukocyte phagocytic function. ♦ Conclusions Data from in vitro and animal experiments show more favorable biocompatibility profiles with new PD fluids than with glucose-based dialysates. Clinical studies are ongoing to assess the impact of the new PD fluids on peritoneal function, morbidity, and mortality.
Mesothelial Cells
Authors: Yung Susan , Tak Mao Chan 
Published: October 2020

♦ Background The introduction of peritoneal dialysis (PD) as a modality of renal replacement therapy has provoked much interest in the biology of the peritoneal mesothelial cell. Mesothelial cells isolated from omental tissue have immunohistochemical markers that are identical to those of mesothelial stem cells, and omental mesothelial cells can be cultivated in vitro to study changes to their biologic functions in the setting of PD. ♦ Method The present article describes the structure and function of mesothelial cells in the normal peritoneum and details the morphologic changes that occur after the introduction of PD. Furthermore, this article reviews the literature of mesothelial cell culture and the limitations of in vitro studies. ♦ Results The mesothelium is now considered to be a dynamic membrane that plays a pivotal role in the homeostasis of the peritoneal cavity, contributing to the control of fluid and solute transport, inflammation, and wound healing. These functional properties of the mesothelium are compromised in the setting of PD. Cultures of peritoneal mesothelial cells from omental tissue provide a relevant in vitro model that allows researchers to assess specific molecular pathways of disease in a distinct population of cells. Structural and functional attributes of mesothelial cells are discussed in relation to long-term culture, proliferation potential, age of tissue donor, use of human or animal in vitro models, and how the foregoing factors may influence in vitro data. ♦ Conclusions The ability to propagate mesothelial cells in culture has resulted, over the past two decades, in an explosion of mesothelial cell research pertaining to PD and peritoneal disorders. Independent researchers have highlighted the potential use of mesothelial cells as targets for gene therapy or transplantation in the search to provide therapeutic strategies for the preservation of the mesothelium during chemical or bacterial injury.
Clinical Effects of Combined Therapy with Peritoneal Dialysis and Hemodialysis
Authors: Kawanishi Hideki , Moriishi Misaki 
Published: October 2020

The fundamental objective of dialysis is to maintain the dose of solute clearance and ultrafiltration (UF). When peritoneal dialysis (PD) patients cannot maintain target clearances, the dialysis dose needs to be increased. The means of increasing dose by PD alone are limited, especially in patients with UF failure. Combination therapy with PD and hemodialysis (PD+HD) is the simplest way to solve this problem. The general prescription for PD+HD should be 5 – 6 days of PD and 1 session of HD weekly. To determine the adequacy of PD+HD, we adopted the equivalent renal clearance (EKR), transforming the weekly Kt/V from PD and then evaluating the total clearance from both modalities. The weekly PD+HD regimen improves clinical status in patients in whom PD alone does not result in dialysis adequacy, and it permits a substantial prolongation of PD. The complementary effects of PD and HD improve clinical status and prognosis in patients undergoing dialysis; we therefore propose to use the term “complementary dialysis” for this technique.
Association of Carnitine Deficiency in Indian Continuous Ambulatory Peritoneal Dialysis Patients with Anemia, Erythropoietin Use, Residual Renal Function, and Diabetes Mellitus
Authors: Ramalakshmi S. , Baben Bjoe , Ashok Ben S. , Jayanthi V. , Leslie Nancy , Abraham Georgi 
Published: October 2020

♦ In the present study, we aimed to determine levels of free carnitine in hemodialysis (HD) and peritoneal dialysis (PD) patients in India and to correlate carnitine deficiency with various clinical parameters. ♦ Patients on HD and PD at two tertiary care centers were selected for the study. Baseline data were obtained, and a free carnitine analysis was performed. Carnitine deficiency was defined as a free carnitine level of less than 40 μmol/L. ♦ The total number of study patients was 96 (77 on HD, 19 on PD). In the PD group, the mean age was 56 years, with 26.3% of the patients being vegan, 47.4% having diabetes, and 57.9% having a daily urine output of <500 mL. The mean carnitine level in that group was 38.9 μmol/L, and 68.4% of the patients had a carnitine deficiency. A Pearson correlation test failed to show any association of carnitine level with parameters such as anemia, use of erythropoietin, non-vegetarian diet, diabetes, and hypertension. In the HD group, the mean age was 45 years, with 22% of the patients being vegan, 23% having diabetes, and 45.5% having a daily urine output of <500 mL. The mean carnitine level in the group was 38.2 μmol/L, and 64.3% of the patients had a carnitine deficiency. Residual renal function and duration of dialysis were different in HD patients with and without carnitine deficiency. Carnitine levels in the HD group correlated positively and statistically significantly with the presence of diabetes and hypertension. ♦ Conclusion This study is the first demonstration that Indian dialysis patients have carnitine deficiency.
Pure Red-Cell Aplasia “Epidemic”—Mystery Completely Revealed?
Authors: Locatelli Francesco , Lucia Del Vecchio , Pozzoni Pietro 
Published: October 2020

Starting in 1998, the number of pure red-cell aplasia (PRCA) cases in patients treated with recombinant human erythropoietin (rHuEPO) increased dramatically. Most cases were observed in patients treated with epoetin alfa produced outside the United States. The peak was observed in 2002; since then, the PRCA incidence has declined. Many factors are likely to have contributed to this upsurge. The molecular structure of the various epoetins and patient characteristics do not seem to play a major role. The route of administration holds some importance, because most PRCA patients received rHuEPO subcutaneously. The peak of PRCA cases overlapped with the removal of human serum albumin from the Eprex formulation (Janssen-Pharmaceutica NV, Beerse, Belgium), for which polysorbate 80 and glycine were substituted. Polysorbate 80 may have increased the immunogenicity of Eprex by eliciting the formation of epoetin-containing micelles or by interacting with leachates released by the uncoated rubber stoppers of prefilled syringes. Compared with the previous formulation, the polysorbate 80 formulation has lower stability, making it more susceptible to stress conditions such as insufficient attention to the cold chain. This situation could facilitate protein denaturation or aggregate formation. Uncoated rubber stoppers were replaced with coated stoppers, and the cold chain was reinforced; the Eprex formulation has remained unchanged. Even though the incidence of PRCA returned to very low levels, discriminating the cause–effect relationship of a single action is difficult, given that all occurred with a similar chronology, and that PRCA develops after a relatively long exposure period. Careful observation of future trends of new PRCA cases is thus mandatory.
Risk Stratification of the Peritoneal Dialysis Patient—a Single-Center Experience
Authors: Lee Evan J.C. 
Published: October 2020

⋄ Background Peritoneal dialysis (PD) patients have many risk factors that may affect their clinical outcomes. Age and diabetes status are unequally distributed in the dialysis population of Singapore. Risk stratification is a means of reducing the effects of case mix such that high-risk groups in the dialysis population can be identified. ⋄ Patients and Methods Records for 543 patients who started on chronic dialysis during 2002 – 2005 were retrospectively studied for survival in the first year on dialysis. The age, sex, ethnicity, and diabetes status of the patients were noted. ⋄ Results For patients 60 years of age and older, we observed no differences in the prevalences of diabetes, male sex, or Chinese ethnicity between patients on PD and those on hemodialysis (HD). Patients of Chinese ethnicity on PD were found to have a higher likelihood of survival in the first year as compared with patients on HD. Age, sex, and diabetes status were not associated with survival in the first year. ⋄ Conclusions In a single PD treatment center, Chinese ethnicity conferred a survival advantage in the first year on dialysis. The reasons for that finding are not clear, but they were not related to age, diabetes status, or sex.
The Development of a Continuous Ambulatory Peritoneal Dialysis Program in Indonesia
Authors: Suhardjono  
Published: October 2020

Chronic kidney disease is prevalent in Indonesia, running at 29.1% in the population at risk (hypertension, diabetes, and proteinuria). In a recent survey, the incidence rate for end-stage renal disease (ESRD) was 30.7 per million population (pmp), and the prevalence rate was 23.4 pmp. In 2006, about 10 000 patients were being treated with hemodialysis. Nevertheless, many ESRD patients remained untreated. Financial problems, scarcity of dialysis facilities, and insufficient numbers of skilled health care providers were among reasons why renal replacement treatment is not so well developed in Indonesia. The continuous ambulatory peritoneal dialysis (CAPD) program begun in 1985 was slowly growing until an economic crisis in 1998. Afterward, with new development of CAPD and government support, the number of patients on CAPD increased. In the middle of 2007, CAPD patients numbered 774 in total. Drop-out rates remained high, because of death, infection, and catheter failure. Almost all new CAPD patients are older than 35 years of age, and the technique is still costly: 51% of patients receive 4 daily exchanges, costing $6000 annually; the rest receive 3 daily exchanges, costing $4800 annually. Government insurance reimburses only 3 exchanges. Expensive drugs such as erythropoietin, intravenous iron, and vitamin D3 are not covered by insurance. The infection rate for the most recent year was 1 episode in 47.17 patient–months. The cost of antibiotic treatment to cure peritonitis is still expensive. Many patients experience some complication related to catheter obstruction or hemorrhage. In Indonesia, CAPD is relatively new and just beginning to progress. In our archipelago, with its many islands and limited resources and investment, CAPD may be the better choice of therapy. More training is needed to increase the number of skilled and experienced doctors, nurses, and other CAPD team members. We hope that CAPD can be made more affordable for ESRD patients.
Standardized Peritoneal Equilibration Test in Japanese Children and the Influence of Long-Term Peritoneal Dialysis
Authors: Kaku Yoshitsugu , Honda Masataka 
Published: October 2020

⋄ Objective To establish a standardized method and standard values of peritoneal equilibration test (PET) in children and to elucidate the factors influencing peritoneal permeability, we standardized the method of PET in the leading hospitals of the Japanese Study Group of Pediatric Peritoneal Dialysis. ⋄ Methods Using 2.5% glucose dialysate and an infusion volume of 1100 mL/m2 body surface area (BSA), we performed 202 standardized PETs. The patients within 1 month of a peritonitis episode were excluded. ⋄ Results The–1 standard deviation (SD), mean, and +1 SD values of end dialysate–to–initial dialysate ratio of (D/D0) glucose were 0.31, 0.41, and 0.51 respectively. The dialysate-to-plasma ratios (D/P) of creatinine were 0.52, 0.65, and 0.78. These values were similar to those of Twardowski's adult PET, although previous reports about standardized pediatric PET described more permeable values. Because the duration of PD was longer in the study patients, peritoneal permeability was increased significantly in patients with and without experience of peritonitis alike. The slope indices of the regression equations between the duration of PD and peritoneal permeability in the two groups were same. ⋄ Conclusions Standardized PET in Japanese children with 2.5% glucose dialysate and an infusion volume of 1100 mL/m2 BSA produces standard values similar to those of Twardowski's adult PET. This standardized method of PET is suitable for pediatric PD patients, and peritoneal permeability in children is not higher than that in adults. In addition, the study data show that long-term peritoneal dialysis worsens peritoneal function more than experience of peritonitis does.
The Relationship of P1 and Lewis Antigens with Peritoneal Dialysis–Related Escherichia Coli Peritonitis
Authors: Ting I-Wen , Kao Tze-Wah , Chiu Yen-Ling , Lo Shyh-Chyi , Hu Fu-Chang , Wu Kwan-Dun 
Published: October 2020

It has been known that the P1 and Lewis antigens on red blood cells (RBCs) affect the risk of Escherichia coli–related urinary tract infection. In the present study, we investigated the associations between those antigens and peritoneal dialysis (PD)–related peritonitis and E. coli peritonitis. We recruited 155 patients (66 men, 89 women) who were under PD treatment in July 2005, checked the P1 and Lewis antigen status of their RBCs, reviewed their medical charts, and recorded the dates and the causative pathogens of peritonitis episodes. The relationships between peritonitis and the antigens were analyzed. The mean age of these PD patients was 52.5 ± 14.9 years, and the mean PD duration was 39.8 ± 38.2 months. A total of 66 peritonitis episodes occurred (over 93.4 patient– months) in 41 patients, with 8 patients having more than 1 episode. In particular, E. coli peritonitis accounted for 16 of the 66 peritonitis episodes. We fitted two multiple Cox proportional hazards models (with the robust variance method) for predicting the hazard rates of peritonitis-free and E. coli peritonitis-free survival times to our right-censored data with recurrent events. We found that patients on PD treatment for less than 4 years with (A) lower serum albumin, (B) one or more previous peritonitis episodes, or (C) negative Lewis a and positive Lewis b antigens (secretor) would be at higher risk of peritonitis. And, conditioning on blood type, the PD patients with one or more previous peritonitis episodes and (A) positive P1 antigen, (B) negative Lewis a and positive Lewis b antigens (secretor), or (C) positive Lewis a and negative Lewis b antigens (non-secretor) would be at higher risk of E. coli peritonitis.