bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of probiotic therapy on portal pressure in patients with cirrhosis: a pilot study
Authors: Tandon Puneeta , Moncrief Karli , Madsen Karen , Arrieta Marie C. , Owen Richard J. , Bain Vince G. , Wong Winnie W. , Ma Mang M. 
Published: April 2009

AbstractBackground: Recent literature has supported the role of bacterial translocation as a mediator of splanchnic vasodilatation and portal hypertension. The objective of this study was to determine whether the probiotic VSL#3 would reduce portal pressure in patients with cirrhosis.Methods: Eight patients with compensated or very early decompensated cirrhosis and hepatic venous pressure gradient (HVPG) >10 mmHg, received 2 months of VSL#3 (3600 billion bacteria daily). The HVPG, intestinal permeability, endotoxin, tumour necrosis factor (TNF)‐α, interleukin (IL)‐6, IL‐8, renin and aldosterone were measured at baseline and study end.Results: There was no change in the HVPG or intestinal permeability from baseline to study end but there was a trend to reduction in plasma endotoxin (P=0.09), a mild but significant increase in serum TNF‐α (P=0.02) and a significant reduction in plasma aldosterone (P=0.03).Conclusions: Within the limitations of small sample size, there does not appear to be a benefit of probiotic therapy for portal pressure reduction in patients with compensated or early decompensated cirrhosis. The reductions in endotoxin and aldosterone suggest possible beneficial effects of probiotics for this patient population. The clinical significance of the small but unexpected increase in TNF‐α is unclear. Future studies are planned in patients with decompensated cirrhosis.
Cross‐species immunohistochemical investigation of the activation of the liver progenitor cell niche in different types of liver disease
Authors: Schotanus Baukje A. , Van Den Ingh Ted S. G. A. M. , Penning Louis C. , Rothuizen Jan , Roskams Tania A. , Spee Bart 
Published: April 2009

AbstractBackground: When hepatocyte replication during liver disease is insufficient for regeneration, liver progenitor cells (LPCs) are activated. The cells and stroma in the immediate environment of LPCs, together termed the LPC niche, are thought to play an important role in this activation. Among these cells are the hepatic stellate cells (HSCs)/myofibroblasts (MFs).Aims/Methods: We assessed the activation of HSC/MFs and LPCs in relation to the histological location and extent of liver disease in immunohistochemically (double) stained serial sections. Markers of HSC/MFs [α‐smooth muscle actin, glial fibrillary acidic protein (GFAP), neurotrophin 3 and neural‐cell adhesion molecule], markers of LPCs (keratin 7 and keratin 19) and a proliferation marker (Ki67) were used. A very relevant spontaneous model to evaluate LPC niche activation in a translational approach seems to be the dog. Therefore, both human and canine liver diseases with different degree of fibrosis and disease activity were included.Results: In human and canine liver disease, type and extent of LPC niche activation depended on type and severity of disease (P<0.05) and corresponded to the main location of disease. Activated HSCs surrounded the activated LPCs. In chronic hepatitis and non‐alcoholic steatohepatitis lobular‐type HSCs were activated, while during biliary disease portal/septal MFs were mainly activated. In canine liver, GFAP further presented as an early marker of HSC activation. Activation of the LPCs correlated with disease location and severity (P<0.01), and was inversely related to hepatocyte proliferation, as was previously shown in man.Conclusion: A shared involvement of HSC/MFs, LPCs and disease severity during hepatic disease processes is shown, which is highly similar in man and dog.
Genetic differences in oxidative stress and inflammatory responses to diet‐induced obesity do not alter liver fibrosis in mice
Authors: Syn Wing‐Kin , Yang Liu , Chiang Dian Jung , Qian Yue , Jung Youngmi , Karaca Gamze , Choi Steve S. , Witek Rafal P. , Omenetti Alessia , Pereira Thiago A. , Diehl Anna Mae 
Published: April 2009

AbstractObjective:To determine how genetic factors might influence the progression of nonalcoholic fatty liver disease (NAFLD).Design/Intervention:Beginning in adolescence, male C57BL6 (BL6) and 129/SVJ mice were fed control (n=15/group) or high‐fat (HF) diets (n=30/group) for 6 months.Main Outcome Measures:Assessed were body weight, insulin resistance, hepatic production of free radicals, expression of cytokines and fibrosis‐related genes and severity of hepatic steatosis, injury and fibrosis.Results:High‐fat diets induced comparable obesity, hepatic steatosis and insulin resistance in the two strains. Compared with BL6 mice, 129/SVJ mice had impaired induction of antioxidant genes, generated three‐ to four‐fold more free radicals and exhibited two‐fold greater induction of profibrogenic cytokines (interleukin‐4 and transforming growth factor‐β1) and fibrosis‐related genes (fibronectin and tissue inhibitor of metalloproteinase‐1) (allP<0.05 for 129 vs BL6). Surprisingly, however, induction of collagen I α1 mRNA and accumulation of Sirius red‐stained fibrils and hepatic hydroxyproline were similar in BL6 and 129/SVJ mice, and although patchy sinusoidal fibrosis emerged in both strains, neither developed bridging fibrosis.Conclusions:Although BL6 and 129/SVJ mice with diet‐induced obesity, insulin resistance and steatosis differed with respect to several factors that are thought to influence human NAFLD progression, they developed comparable liver fibrosis. Moreover, none of the risk factors for NAFLD‐related cirrhosis in humans, including obesity, insulin resistance, chronic inflammatory and oxidant stress, steatohepatitis or activation of fibrogenic genes, proved to be sufficient to cause cirrhosis in these mice, even when exposure to one or more of these insults was very prolonged.
ASDIN: Establishing Learning Curve for Tenckhoff Catheter Insertion by Interventional Nephrologist Using CUSUM Analysis: How Many Procedures and in Which Situation?
Authors: Goh Bak Leong , Ganeshadeva Yudisthra M. , Lim Teck Onn 
Published: April 2009

AbstractPeritoneal dialysis (PD) catheter insertion success rate is known to vary among different operators, and peritoneoscope PD catheter insertion demands mastery of a steep learning curve. Defining a learning curve using a continuous monitoring tool such as a Cumulative Summation (CUSUM) chart is useful for planning training programs. We aimed to analyze the learning curve of a trainee nephrologist in performing peritoneoscope PD catheter implantation with CUSUM chart. This was a descriptive single‐center study using collected data from all PD patients who underwent peritoneoscope PD catheter insertion in our hospital. CUSUM model was used to evaluate the learning curve for peritoneoscope PD catheter insertion. Unacceptable primary failure rate (i.e., catheter malfunction within 1 month of insertion) was defined at >40% and acceptable performance was defined at <25%. CUSUM chart showed the learning curve of a trainee in acquiring new skill. As the trainee became more skillful with training, the CUSUM curve flattened. Technical proficiency of the trainee nephrologist in performing peritoneoscope Tenckhoff catheter insertion (<25% primary catheter malfunction) was attained after 23 procedures. We also noted earlier in our program that Tenckhoff catheters directed to the right iliac fossae had poorer survival as compared to catheters directed to the left iliac fossae. Survival of catheters directed to the left iliac fossae was 94.6% while the survival for catheters directed to the right iliac fossae was 48.6% (p < 0.01). We advocate that quality control of Tenckhoff catheter insertion is performed using CUSUM charting as described to monitor primary catheter dysfunction (i.e., failure of catheter function within 1 month of insertion), primary leak (i.e., within 1 month of catheter insertion), and primary peritonitis (i.e., within 2 weeks of catheter insertion).
THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Selection of Modality of Renal Replacement Therapy
Authors: Antoun Tania Abi , Palevsky Paul M. 
Published: April 2009

AbstractThe proliferation of new technologies has led to the availability of a broad range of options for the management of renal replacement therapy (RRT) in patients with acute kidney injury. We provide a review of the published literature comparing the continuous RRTs (CRRT) with other modalities of renal support, including intermittent hemodialysis and the more recently described “hybrid” therapies such as sustained, low efficiency dialysis as well as compare arteriovenous and venovenous and convective and diffusive modalities of CRRT. While there is clear evidence that venovenous therapies are superior to arteriovenous therapies, current evidence does not support superiority of convective when compared with diffusive therapies or greater survival or recovery of kidney function with any individual modality of RRT. Selection of modality of RRT should therefore rely on the resources and expertise available.
THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Drug Dosing During Continuous Renal Replacement Therapy
Authors: Churchwell Mariann D. , Mueller Bruce A. 
Published: April 2009

AbstractContinuous renal replacement therapy (CRRT) has given clinicians an important option in the care of critically ill patients. The slow and continuous dialysate and ultrafiltrate flow rates that are employed with CRRT can yield drug clearances similar to an analogous glomerular filtration rate of the native kidneys. Advantages such as superior volume control, excellent metabolic control, and hemodynamic tolerance by critically ill patients are well documented, but an understanding of drug dosing for CRRT is still a bit of a mystery. Although some pharmaceutical companies have dedicated postmarket research in this direction, many pharmaceutical companies have chosen not to pursue this information as it is not mandated and represents a relatively small part of their market. This lack of valuable information has created many challenges in the care of the critically ill patient as intermittent hemodialysis drug dosing recommendations cannot be extrapolated to CRRT. This drug dosing review will highlight factors that clinicians should consider when determining a pharmacotherapy regimen for a patient receiving CRRT.
THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Intensity of Continuous Renal Replacement Therapy in Acute Kidney Injury
Authors: Palevsky Paul M. 
Published: April 2009

AbstractThe intensity of continuous renal replacement therapy (CRRT) is generally assessed on the basis of small solute clearance with dosing usually expressed in terms of total effluent volume per unit time (e.g., ml/kg/hour). Although several clinical trials have suggested an improvement in survival with higher doses of CRRT, results have not been consistent across all studies. The results of recent trials of intensity of CRRT are reviewed. The largest and most recent trials suggest that there is no additional benefit to using effluent flow rates in excess of 20 ml/kg/hour, although earlier studies suggested improved survival with doses of 35 to 45 ml/kg/hour.
THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Machines for Continuous Renal Replacement Therapy
Authors: Cruz Dinna , Bobek Ilona , Lentini Paolo , Soni Sachin , Chionh Chang Yin , Ronco Claudio 
Published: April 2009

AbstractA significant number of advancements have taken place since the beginning of continuous renal replacement therapy (CRRT). In particular, high volume hemofiltration and high permeability hemofiltration have been successful extensions of the technique. The additional and combined use of sorbent has also been tested successfully. Specific machines have now been designed to permit safe and reliable performance of the therapy. These new devices are equipped with a friendly user interface that allows for easy performance and monitoring. The apparent complexity of the circuit is made simple by a self‐loading circuit or a cartridge which includes the filter and the blood and dialysate lines. Priming is performed automatically by the machine and pre‐ or postdilution (reinfusion of substitution fluid before or after the filter) can easily be performed by changing the position of the reinfusion line. These new machines permit all CRRT methodologies to be performed by programming the flows and the total amounts of fluid to be exchanged or circulated as a countercurrent dialysate at the beginning of the session. Progress has been made not only in technology in this area but also on our understanding of the pathophysiology of acute renal failure. New biomaterials and new devices are now available with new frontiers are on the horizon. We might, however, speculate that although improvements have been made, a lot remains to be done. There is no doubt that technology has progressed enormously in critical care nephrology and that more progress will come in the near future. The goal, and likely outcome, is an improvement in the morbidity and mortality of the most severely ill patients.
THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Anticoagulation for Continuous Renal Replacement Therapy
Authors: Tolwani Ashita J. , Wille Keith M. 
Published: April 2009

AbstractContinuous renal replacement therapy (CRRT) has emerged as the preferred dialysis modality for critically ill patients with acute kidney injury, particularly those with hemodynamic instability. Anticoagulation is necessary for effective delivery of CRRT, but this requirement can also present challenges, as many critically ill patients with sepsis and inflammation already have a higher risk of bleeding as well as clotting. Without anticoagulation, CRRT filter and circuit survival are diminished, and therapy becomes less helpful. Heparins are presently the most commonly used anticoagulants worldwide for CRRT. They are widely available and can be easily monitored, but disadvantages include risks of hemorrhage, heparin resistance, and heparin‐induced thrombocytopenia (HIT). Because of the potential side effects of heparin, alternative methods of anticoagulation have been investigated, including regional heparin/protamine, low molecular weight heparins, heparinoids, thrombin antagonists (hirudin and argatroban), regional citrate, and platelet inhibiting agents (prostacyclin and nafamostat). Each of these techniques has unique advantages and disadvantages, and anticoagulation for CRRT should be adapted to the patient’s characteristics and institution’s experience. Of the alternative methods, citrate anticoagulation is gaining wider acceptance with the development of simplified and safer protocols.
THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Continuous Renal Replacement Therapies in Patients with Acute Neurological Injury
Authors: Davenport Andrew 
Published: April 2009

AbstractAcute neurological injury may occur in patients with end‐stage kidney disease on dialysis. Less frequently, acute kidney injury requiring renal dialytic support develops following acute neurological injury. Surrounding any site of neurological injury there is a penumbra of damage which is potentially reversible. To maximize full potential neurological recovery in patients requiring renal dialytic support, it is important that treatments do not themselves cause further cerebral ischemia. Standard intermittent hemodialysis is associated with cerebral swelling even in healthy outpatients and often with episodes of intradialytic hypotension. Continuous modes of renal replacement therapy have been shown to cause fewer surges in intracranial pressure and greater stability of cerebral perfusion pressure than standard intermittent techniques. In patients with acute neurological injury, renal replacement therapy should be carefully adapted to minimize cardiovascular instability and reduce the rate of change of serum osmolality.
THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Modalities of Continuous Renal Replacement Therapy: Technical and Clinical Considerations
Authors: Cerdá Jorge , Ronco Claudio 
Published: April 2009

AbstractContinuous renal replacement therapies (CRRT) are continuous forms of renal functional replacement used to manage acute kidney injury (AKI) in the critically ill patient. Depurative mechanisms include convection, diffusion, and membrane adsorption utilizing high‐flux highly permeable biocompatible dialysis membranes. The simultaneous infusion of replacement fluid permits fluid removal without intravascular volume contraction and better hemodynamic stability, metabolic control to almost normal parameters, and removal of large‐size toxins and cytokines. Moreover, CRRT allows better long‐term clearance of small and middle molecules than other dialysis modalities. This article focuses on the different modalities of CRRT and reviews both the basic concepts and the newest approaches to the management of the critically ill patient with AKI.
THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Complications of Continuous Renal Replacement Therapy
Authors: Finkel Kevin W. , Podoll Amber S. 
Published: April 2009

AbstractContinuous renal replacement therapy (CRRT) is commonly used in critically ill patients with acute kidney injury. Many studies show that compared with intermittent hemodialysis, continuous therapy has superior hemodynamic stability, metabolic clearance, and volume control. Despite these benefits, no survival advantage can be demonstrated with its use. Although study design explains much of this paradox, it is also quite plausible that the complications associated with CRRT negate its potential benefits in the critically ill patient. We summarize the common complications associated with the use of CRRT.
THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Selection of Dialysate and Replacement Fluids and Management of Electrolyte and Acid‐Base Disturbances
Authors: Kraus Michael A. 
Published: April 2009

AbstractOften, too little consideration is given to the fluids used in all forms of continuous renal replacement therapy (CRRT). However, errors in fluid prescription, delivery, or creation can be rapidly fatal; in addition, fluid associated expenses can be the overriding cost in continuous renal replacement therapies. While a standard solution is frequently acceptable in most clinical circumstances, specific electrolyte and acid‐base disturbances may direct changes in fluid delivery and composition. Decisions regarding fluids, whether dialysate versus replacement, including generation and composition of therapy are discussed in this review.
THE CLINICAL APPLICATION OF CRRT—CURRENT STATUS: Volume Management in Continuous Renal Replacement Therapy
Authors: Bouchard Josée , Mehta Ravindra L. 
Published: April 2009

AbstractVolume management is an integral component of the care of critically ill patients to maintain hemodynamic stability and optimize organ function. The dynamic nature of critical illness often necessitates volume resuscitation and contributes to fluid overload particularly in the presence of altered renal function. Diuretics are commonly used as an initial therapy to increase urine output; however they have limited effectiveness due to underlying acute kidney injury and other factors contributing to diuretic resistance. Continuous renal replacement techniques (CRRT) are often required for volume management. In this setting, successful volume management depends on an accurate assessment of fluid status, an adequate comprehension of the principles of fluid management with ultrafiltration, and clear treatment goals. Complications related to excessive ultrafiltration can occur and have serious consequences. A careful monitoring of fluid balance is therefore essential for all patients. This review provides an overview of the appropriate assessment and management of volume status in critically ill patients and its management with CRRT to optimize organ function and prevent complications of fluid overload.
Decreased Sensitivity to Ethanol Reward in Adolescent Mice as Measured by Conditioned Place Preference
Authors: Dickinson Shelly D. , Kashawny Sarah K. , Thiebes Karen P. , Charles Dean Y. 
Published: April 2009

Background:  Many preclinical studies have demonstrated age‐related differential sensitivity to various effects of ethanol between adolescent and adult animals. However, published data addressing possible differences in ethanol’s motivational effects are sparse, particularly in mice. The present study examined age‐related differences in the conditioned rewarding effects of ethanol in DBA/2J mice.Methods:  In the first experiment an unbiased place conditioning procedure was used to determine the rewarding effects of 2 g/kg ethanol in adult and adolescent DBA/2J mice. In a subsequent place conditioning experiment, the effects of 2 and 4 g/kg were assessed in adolescent mice.Results:  Adolescents demonstrated a place preference with the high dose of 4 g/kg but not with a more moderate dose of 2 g/kg. In contrast, 2 g/kg was sufficient to produce place preference in adult mice.Conclusions:  Adolescents are less sensitive than adults to the rewarding effects of ethanol but can experience reward with high doses. These results extend the current literature on ethanol’s effects in adolescent animals.
Effects of Pregnanolone and Dehydroepiandrosterone on Ethanol Intake in Rats Administered Ethanol or Saline during Adolescence
Authors: Gurkovskaya Olga V. , Leonard Stuart T. , Lewis Peter B. , Winsauer Peter J. 
Published: April 2009

Background: Adolescent alcohol use may contribute to long‐term changes in the receptors and neuroactive steroids that may mediate its effects and to subsequent alcohol abuse and dependence as an adult. Therefore, in this study, ethanol preference and intake as an adult were examined after adolescent ethanol or saline administration. In addition, ethanol intake in the same groups was examined after administration of 2 neuroactive steroids with modulatory effects at GABAAreceptors.Methods: Two groups of male Long‐Evans rats were administered 15 intraperitoneal (i.p.) injections of either ethanol (2 g/kg, 20% v/v) or saline between postnatal days 35 and 63. Starting on postnatal day 75, both groups were trained to consume 10% ethanol using a saccharin‐fading procedure, and ethanol intake and preference were measured after a series of manipulations involving food deprivation, changes in the duration of access to ethanol, and changes in the concentrations of ethanol presented. Following these manipulations, pregnanolone (1 to 10 mg/kg) and dehydroepiandrosterone (DHEA, 1 to 100 mg/kg) were administered prior to preference sessions with an 18% ethanol solution.Results: Adult ethanol preference and intake did not differ significantly in subjects treated with either saline or ethanol as adolescents during training, the substitution of other ethanol concentrations (3.2 to 32%), ad‐lib feeding, or moderate food deprivation. Pregnanolone administration altered the intake of both adolescent‐treated groups after the first injection of 3.2 mg/kg and after repeated injections with 10 mg/kg, a dose that produced sedation. In contrast, multiple doses of DHEA consistently decreased intake of an 18% ethanol concentration in both groups after repeated injections and 3 doses of DHEA (10, 32, and 56 mg/kg) administered with various ethanol concentrations dose‐dependently shifted the ethanol‐concentration curves for the volume and dosage of ethanol consumed downward.Conclusions: These results indicate that chronic intermittent ethanol (CIE) administration of 2 g/kg during adolescence did not alter preference or overall consumption of ethanol in outbred rats trained to drink ethanol as an adult under the conditions tested, and that DHEA may be more effective than pregnanolone at significantly decreasing ethanol consumption.