bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of engraftment after autologous peripheral blood progenitor cell transplantation: CD34, colony‐forming unit–granulocyte‐macrophage, or both?
Authors: Jansen Eva M. , Hanks Susan G. , Terry Colin , Akard Luke P. , Thompson James M. , Dugan Michael J. , Jansen Jan 
Published: April 2007

BACKGROUND: The rate of hematologic recovery after peripheral blood progenitor cell (PBPC) transplantation is influenced by the dose of progenitor cells. Enumeration of cells that express CD34+ on their surface is the most frequently used method to determine progenitor cell dose. In vitro growth of myeloid progenitor cells (colony‐forming unit–granulocyte‐macrophage [CFU‐GM]) requires more time and resources, but may add predictive information.STUDY DESIGN AND METHODS: A series of 323 patients, who underwent autologous PBPC transplantation for multiple myeloma, malignant lymphoma, or locally advanced breast cancer, were studied for the effect of CD34+ dose and CFU‐GM dose on hematologic recovery. Measures for engraftment were days to absolute granulocyte and platelet (PLT) counts to greater than 500 per μL and than 20 × 109 per L, respectively, and number of PLT transfusions and red cell units required.RESULTS: The CD34+ dose had a median of 8.4 × 106 per kg, and the CFU‐GM dose a median of 84.9 × 104 per kg. The CD34+ and CFU‐GM doses showed significant correlation (R = 0.63; p < 0.0001) but a wide variation in the ratio of CD34+ and CFU‐GM. Both CD34+ and CFU‐GM doses had significant correlation with the measures of engraftment, but for all measures the relationship of CD34+ was stronger. Multivariate analysis and subgroup analysis of patients receiving CD34+ doses of less than 5 × 106 per kg also did not reveal an independent predictive value for CFU‐GM.CONCLUSION: For prediction of hematologic recovery after autologous PBPC transplantation, determination of CFU‐GM dose does not add to the predictive value of the CD34+ dose.
A new DEL variant caused by exon 8 deletion
Authors: Richard Martine , Perreault Josée , Constanzo‐Yanez Jessica , Khalifé Samir , St‐Louis Maryse 
Published: April 2007

BACKGROUND: A 28‐year‐old woman of Lebanese origin experienced two stillbirths. At the time, serology typed her red blood cells as being group A D– and found an anti‐D in her serum sample. Molecular biology analysis, however, showed that she was in fact RHD+.STUDY DESIGN AND METHODS: To better characterize this case, a full investigation including family members was undertaken. Classical serology techniques and DNA and RNA analysis were performed whenever possible.RESULTS: Serology results showed that the patient's father and two brothers were D–. RHD genotyping demonstrated that her two brothers were indeed RHD+. Polymerase chain reaction (PCR) amplification was performed on each RHD 10 exons. Exon 8 did not amplify for the patient, her father, and her two brothers. Her mother and sister had exon 8. Messenger RNA analysis showed five RHD transcripts. The longest transcript was missing exon 8 but had a part of intron 7 inserted instead. Genomic DNA sequencing revealed a 995‐bp deletion including part of intron 7, exon 8, and intron 8. This mutation, RHD(delEx8), was found to express a DEL in adsorption‐elution. To facilitate the screening of this new DEL allele, a simple PCR‐based assay was designed.CONCLUSION: This novel allele represents the first observation of a large deletion at the genomic level within the RHD gene in Caucasian persons.
Effectiveness of sodium and conductivity kinetic models in predicting end‐dialysis plasma water sodium concentration: Preliminary results of a single‐center experience
Authors: POZZONI Pietro , DI FILIPPO Salvatore , PONTORIERO Giuseppe , LOCATELLI Francesco 
Published: April 2007

AbstractThe attainment of a neutral sodium balance represents a major objective in hemodialysis patients. It requires that at the end of each dialysis session, total body water volume (Vf) and total plasma water sodium concentration (Napwf) are constant. Whereas to achieve a constant Vf it is sufficient that ultrafiltration equals the interdialytic increase in body weight, it is impossible to predict the value of Napwf and calculate the dialysate sodium concentration needed to obtain it without making use of kinetic mathematical models. The effectiveness of both sodium and conductivity kinetic models in predicting Napwf has already been validated in previous clinical studies. However, applying the sodium kinetic model appears to be poorly feasible in the everyday clinical practice, due to the need for blood samples at the start of each dialysis session for the determination of predialysis plasma water sodium concentration. The conductivity kinetic model appears to be more easily applicable, because no blood samples or laboratory tests are needed to determine plasma water conductivity (Cpw) and ionic dialysance (ID), used in place of plasma water sodium concentration and sodium dialysance, respectively. We applied the 2 models in 69 chronic hemodialysis patients using the Diascan Module® for the automatic determination of Cpw and ID, and using the latter as an estimate of sodium dialysance in the sodium kinetic model. The conductivity kinetic model was shown to be more accurate and precise in predicting Napwf as compared with the sodium kinetic model. Both accuracy and imprecision of the 2 models were not significantly affected by the method used to estimate total body water volume. These findings confirm the conductivity kinetic model as being an effective and easily applicable instrument for the achievement of a neutral sodium balance in chronic hemodialysis patients.
Essentials of anticoagulation in hemodialysis
Authors: FISCHER Karl‐Georg 
Published: April 2007

AbstractNumerous acquired hemostatic abnormalities have been identified in renal insufficiency. Hemodialysis procedures add to these disturbances as they repetitively imply turbulent blood flow, high shear stress, and contact of blood to artificial surfaces. This nonphysiological environment leads to activation of platelets, leukocytes, and the coagulation cascade, resulting in fouling of the membrane and ultimately in clotting of fibers and the whole hemodialyzer. Anticoagulation in hemodialysis is targeted to prevent this activation of coagulation during the procedure. Most agents inhibit the plasmatic coagulation cascade. Still commonly used is unfractionated heparin, followed by low‐molecular‐weight heparin preparations with distinct advantages. Immune‐mediated heparin‐induced thrombocytopenia constitutes a potentially life‐threatening complication of heparin therapy requiring immediate switch to nonheparin alternative anticoagulants. Danaparoid, lepirudin, and argatroban are currently being used for alternative anticoagulation, all of which possess both advantages and limitations. In the past, empirical strategies reducing or avoiding heparin were applied for patients at bleeding risk, whereas nowadays regional citrate anticoagulation is increasingly used to prevent bleeding by allowing procedures without any systemic anticoagulation. Avoidance of clotting within the whole hemodialyzer circuit is not granted. Specific knowledge of the mechanisms of coagulation, the targets of the anticoagulants in use, and their respective characteristics constitutes the basis for individualized anticoagulation aimed at achieving full patency of the circuit throughout the procedure. Patency of the circuit is an important prerequisite for optimal hemodialysis quality.
Use of a “composite” vascular access graft in a young child on hemodialysis
Authors: LAU Keith K. , JONES Deborah P. , GABER Osama , NEZAKATGOO Nosratollah 
Published: April 2007

AbstractAlthough arterio‐venous fistulae (AVF) are currently considered to be the first choice of permanent vascular access for hemodialysis, there are some patients who are not candidates for fistulae and synthetic grafts provide other options. The Thoratec (Vectra™) polyurethane vascular access graft is a new prosthetic graft that may be cannulated within days of insertion due to “self‐sealing” properties. However, a tendency for kinking at the suture site due to the strong elasticity of this graft, leading to undesirable complications such as thrombosis, have been reported. We describe a surgical modification of the anastomosis by interposing a segment of expanded polytetrafluoroethylene graft (ePTFE, Venaflo™) between the native vessels and the polyurethane graft sections in a pediatric patient. This modification may overcome the kinking complication associated with use of the polyurethane graft and the resulting thrombosis.
Digital clubbing as an unusual complication associated with severe secondary hyperparathyroidism: Report of two cases
Authors: GREKAS Dimitrios , AVDELİDOU Afrodite 
Published: April 2007

AbstractDigital clubbing due to secondary hyperparathyroidism has been described as an unusual complication among patients with chronic kidney disease undergoing maintenance hemodialysis therapy. Although the pathogenesis of digital clubbing is unknown, certain growth factors such as platelet‐derived growth factor and hepatocyte growth factor have been associated with this clinical syndrome. Two patients of our renal unit population presented this unique clinical feature bilaterally, among the other clinical findings of severe secondary hyperparathyroidism. Both patients were subjected to parathyroidectomy. Histological examination revealed diffuse hyperplasia of parathyroid glands. Despite the improvement of clinical symptoms and laboratory findings of secondary hyperparathyroism after parathyroidectomy, digital clubbing remained unchanged.
Daily home hemodialysis at a health maintenance organization: Three‐year experience
Authors: KUMAR Victoria A. , LEDEZMA Mateo L. , RASGON Scott A. 
Published: April 2007

AbstractDaily home hemodialysis (DHD), 5 to 7 short‐duration hemodialysis treatments per week, promotes self‐care and has beneficial effects on a number of clinical outcomes including blood pressure and volume control, electrolyte balance, uremic symptoms and sequelae, and quality of life. We sought to demonstrate that DHD is feasible and confers clinical benefits that permit savings in overall healthcare costs despite expenditures on program infrastructure and supplies. We examined the following outcomes monthly for all patients: laboratory values, dialysis adequacy, hospital admission records, surgical and interventional radiology records, and prescription medication usage. Twelve patients completed training in our home hemodialysis unit between April 2003 and April 2006. The mean age at the time of training was 58 years and mean vintage was 62 months. The mean treatment time was 147 min, and the mean number of treatments performed was 5.3 per week. When 1 patient with morbid obesity was excluded due to intentional weight loss, the mean dry weight at initiation of training was 71.9±12.4 kg and increased to 74.3±12.4 kg by the end of the study (p=0.66). The mean albumin increased from a baseline of 3.9±0.3 to 4.3±1.1 gm/dL during DHD (p=0.0015). The mean serum phosphorus levels were 5.4±1.4 mg/dL. Phosphate binder usage increased from a mean baseline of 2.6±1.4 to 4.2±2.6 tablets per meal during DHD (p=0.08). The mean delivered single pool Kt/V was 0.87 per treatment. During the 234 months studied, there were 11 hospital admissions (0.56 admissions per patient per year), with a mean length of stay of 3.7 days. Our results demonstrate that DHD improves nutritional status and decreases hospital admissions for dialysis‐dependent patients.
Volumetric hemodynamic parameters to guide fluid removal on hemodialysis in the intensive care unit
Authors: COMPTON Friederike , HOFFMANN Clemens , ZIDEK Walter , SCHMIDT Sven , SCHAEFER Juergen‐Heiner 
Published: April 2007

AbstractEstimation of removable excess body fluid is difficult in critically ill patients with renal failure. Volumetric hemodynamic parameters are increasingly being used to guide fluid therapy in the intensive care unit, but their suitability to monitor fluid removal with hemodialysis in critically ill patients is not known. Changes in the extravascular lung water index (EVLWI) and intrathoracic blood volume index (ITBVI) measured with transpulmonary thermodilution immediately before and after hemodialysis were analyzed from 39 hemodialysis sessions of 9 patients consecutively treated in the medical intensive care unit of a German University Hospital. Additional hemodynamic, ventilation, and oxygenation‐related parameters were recorded at the same time. Online relative blood volume (RBV) monitoring was performed in 29 sessions. Comparisons of pre and postdialysis values showed a significant reduction of the EVLWI with fluid removal (p=0.009), with only a slight nonsignificant decrease in the ITBVI. The cardiac index (CI) also decreased significantly (p=0.010), whereas blood pressure remained stable. Oxygenation improved significantly (p=0.005), and the hematocrit increased significantly with dialysis (p=0.039). There was no correlation between hematocrit changes and RBV measurements. Significant correlations existed between ITBVI and CI changes (p<0.001), but not to EVLWI reduction. The removal of excess body fluid on hemodialysis is reflected by the EVLWI reduction, whereas the preservation of cardiac preload is shown by ITBVI stability. Volumetric hemodynamic parameters could be useful to guide fluid removal with hemodialysis in the intensive care unit.
A case management model to improve hemodialysis outpatient outcomes
Authors: STEELE David J. R. , HAMILTON Emel , ARNAOUT M. Amin 
Published: April 2007

AbstractOptimal outpatient dialysis care is often difficult to achieve and a case management model to augment conventionally applied nursing and physician resources focusing on continuous quality improvement presents a possible solution to improving outcomes in this setting. We applied this model to patients followed by our physician group. Continuous quality improvement data generated from the dialysis unit database were used to analyze outcomes in patients enrolled in this model. Data from the cohort of patients followed in 2003 served as the reference source for comparative purposes. The nurse case manager assumed responsibility during the second quarter of 2004. Comparing outcomes data from 2005 with data from 2003, we were able to achieve a 3.12% improvement in the annualized mean percent crude mortality per 100 patient years (p<0.003). There was a 3.46‐day trend to improvement in patient hospital days per year (p<0.06). The percentage of catheters used as primary access decreased by 9.59% (p<0.025), and the percentage of patients meeting an eKdrt/V goal ≥1.2 increased by 15.33% to 92.37% (p<0.001). These data appear to support the utility of a case manager model in our system.
Chronic maintenance hemodialysis: Making sense of the terminology
Authors: AGAR John W. M. , MACGREGOR Mark S. , BLAGG Christopher R. 
Published: April 2007

AbstractDuring the early decades, the hemodialysis (HD) terminology for modality, technique and function altered little as the widely accepted regime of thrice‐weekly, 4‐hourly dialysis varied little. In the last decade, however, a wide range of new options have emerged in all facets of HD therapy. This has led to a sudden expansion in terminology, some duplicating, some contradictory, some superfluous. The definitions used in 1 geographical region may mean something entirely different elsewhere, increasing cross‐continental misunderstanding and misinterpretation and raising the often‐asked question: “What exactly did the authors mean by that?” Although clearly the definitions used in this paper are also only the authors' opinion, we have sought to explore the use and sometimes confusing application of many commonly used terms, and we propose a number of possible deletions. Finally, we offer a descriptive data set that we believe should be used for all HD‐related papers. Our conclusions will not always be welcomed—particularly by those who use terms we have rejected. Despite this, we believe it pertinent to fully review the dialysis terminology we use. Primarily, we hope to stimulate debate about which terms should be globally adopted and what those terms should mean when used. Although not all will agree with our conclusions, we hope this paper may provide a framework for a more streamlined, efficient, and globally acceptable nomenclature.
Optimal timing of initiation of chronic hemodialysis?
Authors: WILSON Barbara , HARWOOD Lori , LOCKING‐CUSOLITO Heather , CHEN Salina J. , HEIDENHEIM Paul , CRAIK Don , CLARK William F. 
Published: April 2007

AbstractDespite the availability of clinical guidelines for the timing of dialysis initiation in both the United States and Canada, patients continue to start dialysis at very low levels of predicted glomerular filtration rate (GFR). A cross‐sectional study was performed to determine the demographic and clinical characteristics of patients who started hemodialysis, their level of GFR, and mortality at 1 and 2 years following the initiation of dialysis. Retrospective data were collected on all eligible patients who commenced chronic hemodialysis in 1 tertiary care center in Canada from March 2001 to February 2005. Only those patients who had been followed by a nephrologist in the chronic kidney disease clinic before dialysis initiation were included (n=271). Seventeen percent of patients started hemodialysis late (GFR<5 mL/min/1.73 m2). Compared with the group of patients who started dialysis earlier, the late start group were significantly younger (p=0.008), had more females (p=0.013), more employed (p=0.051), less cardiac (p<0.001), and peripheral vascular disease (p=0.031), and were taking medication for hypertension (p=0.041). Serum albumin was lower in the late start group (p=0.023). At year 1, there was no difference in mortality rate while at year 2, the earlier the dialysis, the greater the mortality rate (p=0.022). After adjustment for demographic variables and comorbidities, only antihypertensive use had an independent but weak association with the 2 year mortality. Adjustment for all these variables eliminated the significant association noted for the 2 year mortality in the early versus late dialysis start. The survival benefit for late versus early dialysis start appears to be multifactorial and relates to a preponderance of clinical and demographic factors favoring a lengthened survival occurring in the late dialysis group. Our survival benefit findings suggest the premorbid health condition is a more important determinant of 2 year survival than the timing of dialysis initiation.
Economic Ideas and British Literature, 1900–1930: The Fabian Society, Bloomsbury, and The New Age
Authors: Trexler Adam 
Published: April 2007

AbstractThis article argues that economic ideas were a fundamental shaping force for popular and avant‐garde writers between 1900 and 1930 by giving an overview of three economic movements and connecting these ideas to literary experiments. The first section traces the impact of Fabian socialism's economic ideas on George Bernard Shaw and H. G. Wells, and indicates a number of other Fabian writers. The second section describes the creation of an academic orthodoxy in economics, and then explores how Bloomsbury's intellectual climate produced the interrelated phenomena of Keynes's economics, Roger Fry's Omega Workshops, the Hogarth Press, and Virginia Woolf's literary innovation. The final section documents Ezra Pound, T. S. Eliot, and Katherine Mansfield's involvement with the ideas of the radical economic journal, The New Age, and suggests connections between these ideas and the writers’ formal experiments. By tracing these intellectual networks, a number of historical connections between the economic problems of this period and the present emerge, indicating exciting directions for new research.
Amenities and Pitfalls of a Reputational Theory of Compliance with International Law
Authors: Burgstaller Markus 
Published: April 2007

AbstractSince there is no coercive power in the international system comparable to that which enforces the laws of a state, the question what motivates states to comply with international law remains among the most perplexing ones in international relations. For a long time, however, scholars have generally avoided the causal question 'why states obey international law'. Nevertheless, recent research agendas in international law and international relations have converged around the issues of norm creation and norm compliance. One influential strand of the compliance scholarship–commonly labelled reputational theory – is at the core of this article. Starting with some general characteristics of compliance with norms, mainly two contemporary theories of compliance with international law are dealt with. First, a variant of rationalist theory, Jack Goldsmith's and Eric Posner's monograph The Limits of International Law, is discussed. It shows that although these two authors seem to have some sympathy for a reputational theory of compliance with international law, they tend to stress the shortcomings of such an approach. To the contrary, Andrew Guzman's work, as exemplified in his article A Compliance-Based Theory of International Law, more readily embraces reputational concerns. It turns out that the essential thesis of a reputational theory is that reputation can alter the equilibrium: it causes future relationships to be affected by today's actions. Accounting for reputational effects, a decision to violate international law will increase today's payoff but reduce tomorrow's. International law succeeds when it alters a state's payoffs in such a way as to achieve compliance with an agreement when, in the absence of such law, states would behave differently. A reputational theory of compliance with international law is particularly well suited for areas such as international financial and economic law, i.e.for situations in which competitive market forces induce compliance with international law mainly because enforcement and monitoring are strong. Reputational incentives, like all incentives, act at the margin.