bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Complications in Renal Replacement Therapy
Authors: Shingarev Roman , Wille Keith , Tolwani Ashita 
Published: April 2011

AbstractRenal replacement therapies (RRTs) are frequently employed for treatment of patients suffering from acute kidney injury in the intensive care unit (ICU). Multiple modalities of RRT are currently available. These include intermittent hemodialysis, continuous renal replacement therapies, and hybrid therapies, such as sustained low‐efficiency dialysis. Because of the high complexity of ICU patients, physicians must be aware of the limitations and complications of both intermittent and continuous dialysis modalities that can contribute to patient morbidity and mortality. In this article, we highlight the recognized complications of RRTs and the treatment approach to these complications.
Biomarker Strategies to Predict Need for Renal Replacement Therapy in Acute Kidney Injury
Authors: Cruz Dinna N. , de Geus Hilde R. , Bagshaw Sean M. 
Published: April 2011

AbstractThe early detection and diagnosis of acute kidney injury (AKI) with the standardization of novel kidney‐injury‐specific biomarkers is one of the highest research priorities in nephrology. Accordingly, the majority of studies of novel AKI biomarkers have focused on the early diagnosis of AKI using serum creatinine‐based definitions as the gold standard. However, another potential application of kidney‐injury‐specific biomarkers is for guiding decisions on when to initiate renal replacement therapy (RRT). The purpose of this review is to summarize recent findings concerning some of the more promising AKI biomarkers on their capacity, either alone or integrated with traditional surrogate measures of kidney injury, for early prediction of whether patients will develop severe AKI requiring RRT. Some studies that have examined neutrophil gelatinase‐associated lipocalin, cystatin‐C, N‐acetyl‐β‐d‐glucosaminidase, kidney injury molecule‐1, and α1‐microglobulin, among others, have suggested that these novel biomarkers have the potential to distinguish patients in whom RRT will be needed. This would imply that these biomarkers may be integrated into clinical decision algorithms and could synergistically improve our current ability to predict worsening AKI and need for RRT. However, published studies have many recognized limitations, which preclude our ability to adapt their findings into clinical practice today. While currently available data are not sufficient to conclude that biomarkers should be used routinely for clinical decision making for RRT initiation, additional data may in the future significantly modify the clinical variability for initiation of RRT, and potentially translate into improved outcomes and cost‐effectiveness. Finally, we propose a potential approach to future biomarker strategies for RRT initiation, integrating these biomarkers with “traditional” clinical factors.
Advances in Pediatric Renal Replacement Therapy for Acute Kidney Injury
Authors: Goldstein Stuart L. 
Published: April 2011

AbstractThe disease spectrum leading to pediatric renal replacement therapy (RRT) provision has broadened over the last decade. In the 1980s, intrinsic renal disease and burns comprised the most common pediatric acute renal failure etiologies; more recent data demonstrate that pediatric acute kidney injury (AKI) most often results from complications of other systemic diseases resulting from the advancements in congenital heart surgery, neonatal care, and bone marrow and solid organ transplantation. In addition, RRT modality preferences to treat critically ill children have shifted from peritoneal dialysis to continuous renal replacement therapy (CRRT) as a result of improvements in CRRT technologies. In this article, we aim to review the pediatric specific causes for RRT provision, emphasizing the emerging practice patterns with respect to modality and timing of treatment. We will focus on the application of different RRT modalities and related outcome of children with AKI who receive RRT.
When Should Renal Replacement Therapy be Initiated for Acute Kidney Injury?
Authors: Macedo Etienne , Mehta Ravindra L. 
Published: April 2011

AbstractAcute kidney injury (AKI) is now well recognized as an independent risk factor for increased morbidity and mortality particularly when dialysis is needed. Although renal replacement therapy (RRT) has been used in AKI for more than five decades, there is no standard methodology to predict which AKI patients will need dialysis and who will recover renal function without requiring dialysis. The lack of consensus on what parameters should guide the decision to start dialysis has led to a wide variation in dialysis utilization. A contributing factor is the lack of studies in the modern era evaluating the relationship of timing of dialysis initiation and outcomes. Although listed as one of the top priorities in research on AKI, timing of dialysis initiation has not been included as a factor in large, randomized controlled trials in this area. In this review we will discuss the criteria that have been used to define early vs. late initiation in previous studies on dialysis initiation. In addition, we propose a patient‐centered approach to define early and late initiation that could serve as framework for managing patients and for future studies in this area.
Technical Advances in Renal Replacement Therapy
Authors: Ricci Zaccaria , Ronco Claudio 
Published: April 2011

AbstractCritically ill patients are subject to several risk factors for organ injury: surgical intervention, trauma, rhabdomyolysis, hemodynamic instability, organ hypoperfusion, bacteremia and endotoxemia, sepsis and septic shock. These conditions may cause acute kidney injury (AKI), myocardial dysfunction, liver failure, coagulation abnormalities, acute lung injury (ALI), adult respiratory distress syndrome (ARDS), bone marrow depression, loss of acid/base homeostasis, and finally, brain dysfunction. The resulting picture of multiple organ dysfunction syndrome (MODS) is a lethal clinical entity that is refractory to all therapies in the majority of cases. According to the “humoral theory of sepsis”, soluble substances circulate in blood and participate in the generation of the different disorders of MODS; thus, AKI is not the only clinical disorder observed in intensive care unit (ICU) patients nor is it an isolated syndrome. Current extracorporeal management of such patients focuses mainly on renal replacement therapy (RRT). Nevertheless, in recent years, technical evolution of extracorporeal devices led to the potential creation of multiple organ support therapy (MOST) in order to provide a comprehensive replacement of multiorgan dysfunction: hence, other organs (liver, heart, lungs) and syndromes (abdominal sepsis, septic shock) can today be consistently supported and bridged. The technical advances of extracorporeal equipment, moreover, might allow today the design of a dedicated pediatric RRT device in order to treat patients below 10 kg, with the safety and adequacy standards that are currently granted to the adult population. This review will describe the technical evolution of MOST machines and current literature available on MOST.
Clinical Management of Dialysis Catheter‐Related Bacteremia with Concurrent Exit‐Site Infection
Authors: Sychev Dmitri , Maya Ivan D. , Allon Michael 
Published: April 2011

AbstractDialysis catheter‐related bacteremia (CRB) can frequently be treated with systemic antibiotics, in conjunction with an antibiotic lock, in an attempt to salvage the catheter. It is unknown whether CRB associated with an exit‐site infection can be treated with such an approach. We retrospectively queried a prospective, computerized vascular access database, and identified 1436 episodes of CRB, of which 64 cases had a concurrent exit site. The frequency of concurrent exit‐site infection was 9.6% with Staphylococcus epidermidis, 6.1% with Staphylococcus aureus, and only 0.7% with Gram negative CRB (p < 0.001 for Staphylococcus vs. Gram negative rods). Five serious complications (four major sepses and one endocarditis) occurred in 24 patients with S. aureus infection, but none in 32 episodes of S. epidermidis infection (p = 0.01). Catheter survival was significantly shorter in patients with S. aureus infections. The median catheter survival (without infection or dysfunction) was 14 days with S. aureus vs. 30 days with S. epidermidis infection (p = 0.035). In conclusion, concurrent exit‐site infection is seen most commonly in association with Staphylococcal CRB. When the infecting organism is S. epidermidis, attempted salvage with systemic antibiotics and an antibiotic lock is reasonable. However, prompt catheter removal is indicated when the pathogen is S. aureus.
Origin of Neointimal Cells in Arteriovenous Fistulae: Bone Marrow, Artery, or the Vein Itself?
Authors: Skartsis Nikolaos , Manning Eddie , Wei Yuntao , Velazquez Omaida C. , Liu Zhao‐Jun , Goldschmidt‐Clermont Pascal J. , Salman Loay H. , Asif Arif , Vazquez‐Padron Roberto I. 
Published: April 2011

AbstractTo elucidate the source of neointimal cells, experimental fistulas were created in Lewis wild‐type (WT) and transgenic rats that constitutively expressed the green fluorescent protein (GFP) in all tissues. Arteriovenous fistula (AVFs) were created by anastomosing the left renal vein to the abdominal aorta. The contribution of bone marrow (BM)‐derived cells to the AVF neointima was examined in lethally irradiated WT rats that had been rescued with GFP BM cells. Neointimal cells in these chimeric rats were mostly GFP negative indicating the non‐BM origin of those cells. Then, the contribution of arterial cells to the AVF neointima was assessed in a fistula made with a GFP aorta that had been implanted orthotopically into a WT rat. Most of the neointimal cells were also GFP negative demonstrating that AVF neointimal cells are not derived from the feeding artery. Finally to study local resident cells contribution to the formation of neointimal lesions, a composite fistula was created by interposing a GFP vein between the renal vein and the aorta in a WT recipient rat. GFP neointimal cells were only found in the transplanted vein. This study suggests that neointimal cells originate from the local resident cells in the venous limb of the fistula.
Computational Fluid Dynamics‐Based Hydraulic and Hemolytic Analyses of a Novel Left Ventricular Assist Blood Pump
Authors: Yang Xiao‐Chen , Zhang Yan , Gui Xing‐Min , Hu Sheng‐Shou 
Published: April 2011

AbstractThe advent of various technologies has allowed mechanical blood pumps to become more reliable and versatile in recent decades. In our study group, a novel structure of axial flow blood pump was developed for assisting the left ventricle. The design point of the left ventricular assist blood pump 25 (LAP‐25) was chosen at 4 Lpm with 100 mm Hg according to our clinical practice. Computational fluid dynamics was used to design and analyze the performance of the LAP‐25. In order to obtain a required hydraulic performance and a satisfactory hemolytic property in the LAP‐25 of a smaller size, a novel structure was developed including an integrated shroud impeller, a streamlined impeller hub, and main impeller blades with splitter blades; furthermore, tandem cascades were introduced in designing the diffuser. The results of numerical simulation show the LAP‐25 can generate flow rates of 3–5 Lpm at rotational speeds of 8500–10 500 rpm, producing pressure rises of 27.5–148.3 mm Hg with hydraulic efficiency points ranging from 13.4 to 27.5%. Moreover, the fluid field and the hemolytic property of the LAP‐25 were estimated, and the mean hemolysis index of the pump was 0.0895% with Heuser's estimated model. In conclusion, the design of the LAP‐25 shows an acceptable result.
Prevalence and Burden of Chronic Migraine in Adolescents: Results of the Chronic Daily Headache in Adolescents Study (C‐dAS)
Authors: Lipton Richard B. , Manack Aubrey , Ricci Judith A. , Chee Elsbeth , Turkel Catherine C. , Winner Paul 
Published: April 2011

(Headache 2011;51:693‐706)Objective.— To estimate the prevalence of chronic migraine (CM) among adolescents and to describe the epidemiologic profile, headache characteristics, disability, and healthcare utilization of adolescents with CM in the USA.Background.— Chronic daily headache (CDH) and CM occur in children and adolescents, but are poorly understood in these populations because their presentation is different from that in adults. It may be difficult to assign a definitive diagnosis to young people suffering from CDH because symptoms may fail to meet the criteria for one of the CDH subtypes.Methods.— A large sample of households with at least one resident aged 12 to 19 years was selected in balance with the US Census. Data were collected in 3 phases: (1) mailed questionnaire; (2) telephone interview; and (3) 30‐day interactive voice response system diary. CM prevalence was estimated by adapting the second edition of the International Classification of Headache Disorders criteria for CM to include pediatric migraine diagnostic criteria. The population was stratified for medication overuse. Medication overuse was defined as 15 or more days per month of acute medication use. Included in the study were measures of headache characteristics, headache impact (Headache Impact Test), disability (Pediatric Migraine Disability Assessment), and healthcare and medication use. Data are reported on subjects 12 to 17 years of age only.Results.— The US adolescent (12‐17 years) prevalence rate for CM was 0.79% (0.00‐1.70) excluding those with medication overuse and 1.75% (0.62‐2.89) when adolescents with medication overuse were included. The majority of adolescents with CM had Headache Impact Test scores greater than or equal to 60, indicating severe headache impact, and mean Pediatric Migraine Disability Assessment scores greater than 17, indicating severe headache and disability. The majority of adolescents with CM (approximately 60%) had not visited a healthcare provider in the previous year and less than one in 5 reported taking medications to prevent headaches during the last month.Conclusions.— Results suggest that CM occurs less frequently in adolescents than adults, but like adults, adolescents are severely burdened by the disorder. Data support an unmet medical need; however, the development of optimal criteria for diagnosing adolescents with CM is critical to fully understanding how medical needs can be met within this complex population.
One Hundred Years of Migraine Research: Major Clinical and Scientific Observations From 1910 to 2010
Authors: Tfelt‐Hansen Peer C. , Koehler Peter J. 
Published: April 2011

(Headache 2011;51:752‐778)Pain research, and headache research in particular, during the 20th century, has generated an enormous volume of literature promulgating theories, questions, and temporary answers. This narrative review describes the most important events in the history of migraine research between 1910 and 2010. Based on the standard textbooks of headache: Wolff's Headache (1948 and 1963) and The Headaches (1993, 2000, and 2006) topics were selected for a historical review. Most notably these included: isolation and clinical introduction of ergotamine (1918); further establishment of vasodilation in migraine and the constrictive action of ergotamine (1938); identification of pain‐sensitive structures in the head (1941); Lashley's description of spreading scotoma (1941); cortical spreading depression (CSD) of Leão (1944); serotonin and the introduction of methysergide (1959); spreading oligemia in migraine with aura (1981); oligemia in the wake of CSD in rats (1982); neurogenic inflammation theory of migraine (1987); a new headache classification (1988); the discovery of sumatriptan (1988); migraine and calcitonin gene‐related peptide (1990); the brainstem “migraine generator” and PET studies (1995); migraine as a channelopathy, including research from the genetic perspective (1996); and finally, meningeal sensitization, central sensitization, and allodynia (1996). Pathophysiological ideas have evolved within a limited number of paradigms, notably the vascular, neurogenic, neurotransmitter, and genetic/molecular biological paradigm. The application of various new technologies played an important role within these paradigms, in particular neurosurgical techniques, EEG, methods to measure cerebral blood flow, PET imaging, clinical epidemiological, genetic, and molecular biological methods, the latter putting migraine (at least hemiplegic migraine) within a completely new classification of diseases.
A Mechanical Comparison of Equine Proximal Interphalangeal Joint Arthrodesis Techniques: An Axial Locking Compression Plate and Two Abaxial Transarticular Cortical Screws versus an Axial Dynamic Compression Plate and Two Abaxial Transarticular Cortical Screws
Authors: Sod Gary A. , Riggs Laura M. , Mitchell Colin F. , Martin George S. 
Published: April 2011

Objectives: To compare in vitro monotonic biomechanical properties of an axial 3‐hole, 4.5 mm narrow locking compression plate (ELCP) using 5.0 mm locking screws and 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion (ELCP–TLS) with an axial 3‐hole, 4.5 mm narrow dynamic compression plate (DCP) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion (DCP–TLS) for equine proximal interphalangeal (PIP) joint arthrodesis.Design: Experimental.Animal Population: Cadaveric adult equine forelimbs (n=18 pairs).Methods: For each forelimb pair, 1 PIP joint was stabilized with an axial ELCP using 5.0 mm locking screws and 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion and 1 PIP joint with an axial 3‐hole narrow DCP (4.5 mm) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion. Six matching pairs of constructs were tested in single cycle to failure under axial compression, 6 construct pairs were tested for cyclic fatigue under axial compression, and 6 construct pairs were tested in single cycle to failure under torsional loading. Mean values for each fixation method were compared using a paired t‐test within each group with statistical significance set at P<.05.Results: Mean yield load, yield stiffness, and failure load under axial compression, single cycle to failure, of the DCP–TLS fixation were significantly greater than those of the LCP–TLS fixation. There was no significant difference between the mean number of cycles to failure in axial compression of the LCP–TLS and the DCP–TLS fixations. Mean yield load, yield stiffness, and failure load under torsion, single cycle to failure, of the LCP–TLS fixation were significantly greater than those of the DCP–TLS fixation.Conclusion: The DCP–TLS construct provided significantly greater stability under axial compression in single cycle to failure than the ELCP–TLS construct, the ELCP–TLS construct provided significantly greater stability under torsional loading in single cycle to failure than the DCP–TLS construct, and there was no significant difference in stability between the 2 constructs for cyclic loading under axial compression.
Treatment of Hydrocephalus with Ventriculoperitoneal Shunting in Twelve Dogs
Authors: Shihab Nadia , Davies Emma , Kenny Patrick J. , Loderstedt Shenja , Volk Holger A. 
Published: April 2011

Objective: To report use of ventriculoperitoneal shunt in dogs for management of hydrocephalus for which no cause could be identified.Study Design: Case series.Animals: Dogs with hydrocephalus (n=12).Methods: Medical records (June 2003–June 2009) were reviewed to determine preoperative clinical findings, initial postoperative, and long‐term outcome. Additional follow‐up information was obtained from owners and referring veterinarians.Results: All dogs had signs of forebrain dysfunction, 7 had vestibular signs and 3 had signs of spinal pain. Postoperative complications included pain (n=4), undershunting because of shunt kinking (n=1) and seizures (n=1). Initial improvement occurred in all dogs and was sustained in 9 dogs, 1 of which required revision surgery.Conclusions: Sustained clinical improvement can be achieved in hydrocephalus with no active underlying cause by use of ventriculoperitoneal shunting.
Laparoscopic‐Assisted Colopexy and Sterilization in Male Dogs: Short‐Term Results and Physiologic Consequences
Authors: Mathon Didier H. , Palierne Sophie , Meynaud‐Collard Patricia , Layssol‐Lamour Catherine , Dulaurent‐ Ferrieres Alice , Colson Arnaud , Lacroix Marlene , Bousquet‐Melou Alain , Delverdier Maxence , Autefage Andre 
Published: April 2011

Objective: To describe laparoscopic‐assisted colopexy and sterilization, and evaluate outcome and effects in healthy male dogs.Study Design: Experimental study.Animals: Male Beagle dogs (n=7).Methods: A laparoscopic‐assisted, extracorporeally sutured colopexy, and sterilization by ligation and section of the testicular vessels and ductus deferens were evaluated 11 weeks after surgery. Ex vivo tensile tests were performed on the colopexy sites and loss of testicular function was assessed by monitoring serum testosterone, and by ultrasonographic and histologic examinations of the testes. Systemic inflammation and potential iatrogenic colonic functional disorders were investigated by monitoring serum C‐reactive protein (CRP) in the perioperative period and from a sulfapyridine (SP) kinetic profile obtained before and 10 weeks after surgery.Results: No intraoperative complications were recorded and clinical outcome was considered fair in all dogs. A mean tensile force of 42 N was required to disrupt colopexies. No relevant postoperative increase in CRP concentrations or changes in SP kinetics were observed. Testicular function was lost.Conclusions: Laparoscopic‐assisted colopexy achieved adhesion of the colon to the abdominal wall and testicular endocrine function and spermatogenesis were eliminated by laparoscopic castration.
Treatment of a Coxofemoral Luxation in a Pony Using a Prosthetic Capsule Technique
Authors: Kuemmerle Jan M. , Fürst Anton E. 
Published: April 2011

Objective: To report open reduction and joint stabilization using a prosthetic capsule technique for treatment of a craniodorsal coxofemoral luxation in a lightweight pony.Study Design: Clinical report.Animals: Pony stallion (8 years old, 113 kg).Methods: A craniodorsal approach to the coxofemoral joint was performed under general anesthesia. After open reduction, a prosthetic capsule technique was used. Four 3.5 mm self‐tapping cortical anchor screws were implanted: 2 screws were inserted above the cranial aspect of the dorsal acetabular rim, and 2 screws were inserted into the femoral neck. Subsequently, a #5 USP ultra‐high molecular weight polyethylene suture was placed through these anchor screws in figure‐8 fashion to serve as a prosthetic capsule. Routine closure and a medial patellar desmotomy completed the surgical procedure. Postoperatively, the pony was cross tied for 4 weeks to prevent it from lying down.Results: Neither short‐term nor long‐term complications occurred and the pony was sound at the follow‐up examination performed 15 months postoperatively.Conclusions: A prosthetic capsule technique can be used successfully to stabilize the coxofemoral joint after open reduction of a craniodorsal luxation in a lightweight pony.