bluuebunny/crossref_metadata_2025_split huggingface dataset:
The NR1 N‐Methyl‐d‐Aspartate Subunit and Brain‐derived Neurotrophic Factor in Temporal Lobe Epilepsy Hippocampus: A Comparison of Patients with and without Coexisting Psychiatric Symptoms
Authors: Toro Carla Tatiana , Hallak Jaime E. , Dunham Jason S. , Leite João P. , Sakamoto Américo C. , Guarnieri Ricardo , Fong Vivian , Deakin John F. W. 
Published: October 2007

Summary
Purpose: The glutamate N‐methyl‐d‐aspartate (NMDA) receptor and the neurotrophin brain‐derived neurotrophic factor have been implicated in the pathophysiology of schizophrenia and depression. Since these psychiatric disorders are common in temporal lobe epilepsy (TLE), a comparison of TLE patients with and without coexisting psychiatric symptoms may be useful to unravel pathophysiologic mechanisms for psychosis or depression.
Methods: We used immunoautoradiography to assess the NR1 NMDA receptor subunit and brain‐derived neurotrophic factor in resected TLE hippocampus.
Results: No changes relative to comparison controls were found for TLE patients with schizophrenia‐like psychosis or depression. Increased NR1 was found in the dentate molecular layer in the dysphoria group and unmedicated depressed patients.
Conclusions: An increase in NR1 protein in the dentate molecular layer suggests an upregulation of NMDA receptors in granule cells in TLE patients with dysphoria and depression. This finding is compatible with the theory that increased NMDA receptor function is involved in the pathogenesis of depression and that antidepressants may act by opposing this mechanism.
A Prospective Study of the Modified Atkins Diet for Intractable Epilepsy in Adults
Authors: Kossoff Eric H. , Rowley Hannah , Sinha Saurabh R. , Vining Eileen P. G. 
Published: October 2007

Summary
Purpose: The ketogenic diet is not typically offered to adults with epilepsy due to the significant lifestyle alterations needed for its use. The modified Atkins diet has been recently demonstrated to be therapeutic for children without the need for an admission, fasting period, weighing of foods, or fluid, calorie, and protein restriction.
Methods: A prospective, open‐label study was performed of adults over 18 years of age, having at least weekly seizures and prior use of at least two anticonvulsants. Carbohydrates were initially restricted to 15 g/day, fats were encouraged, and fluids, protein, and calories were allowed ad lib.
Results: Thirty patients, with age ranging from 18 to 53 years, were enrolled. Using an intent‐to‐treat analysis, 47% had a >50% seizure reduction after 1 and 3 months on the diet; 33% after 6 months. In those with seizure reduction, the median time to improvement was 2 weeks (range: 1–8 weeks). The mean weight loss was 6.8 kg, p < 0.001. Body‐mass index (BMI) decrease correlated with efficacy at 3 months, p = 0.03. Ten subjects (30%) discontinued the diet prior to 3 months. Side effects included increased cholesterol (mean 187 to 201 mg/dL), blood urea nitrogen (BUN; 13 to 16 mg/dL), and urine calcium to creatinine ratio (0.14 to 0.19).
Conclusions: A modified Atkins diet appears to demonstrate preliminary efficacy for adults with intractable epilepsy, especially in those who lost weight. Considering the rapid response in those who improved, but somewhat high discontinuation rate, a 2‐month trial period may be adequate to assess for efficacy.
Preliminary Results of a Limited Thoracotomy: New Approach to Treat Atrial Fibrillation
Authors: MCCLELLAND JAMES H. , DUKE DAVID , REDDY RAMAKOTA 
Published: October 2007

Objective: To determine efficacy of a new procedure combining epicardial bipolar radiofrequency (RF) pulmonary vein (PV) antrum isolation and ganglionated plexus (GP) ablation for treatment of atrial fibrillation (AF). Background: PV antrum electrical isolation and GP ablation have each been associated with elimination of AF. Both of these can be performed epicardially in a single combined surgical procedure, which may have advantages over endocardial ablation. Methods and Results: Twenty‐one subjects entered a prospective evaluation of limited thoracotomy epicardial bipolar PV antrum isolation, verified by PV recordings, with GP ablation, guided by GP mapping. Procedural success was defined as freedom from AF and antiarrhythmic agents during 1 year of follow‐up, including evaluation by prolonged continuous monitoring capable of detecting asymptomatic arrhythmias. All subjects had recordable PV potentials and GP activity prior to ablation. Circumferential epicardial bipolar RF eliminated PV potentials in 18 of 20 right and 14 of 20 left PV antra. This concurrently eliminated 79% of GP activity (125 of 159 active sites); nearly all remaining GP activity could then be eliminated using epicardial bipolar RF forceps. Fifteen of 20 (75%) subjects overall, and 14 of 16 (87.5%) subjects with paroxysmal or persistent AF had a successful procedure. Conclusion: Limited thoracotomy epicardial bipolar RF antrum isolation, verified by PV recordings, with GP ablation, guided by GP mapping, is effective treatment for AF and should be considered in patients with paroxysmal or persistent AF.
Sleep apnea and dialysis therapies: Things that go bump in the night?
Authors: UNRUH Mark L. 
Published: October 2007

AbstractSleep apnea has been linked to excessive daytime sleepiness, depressed mood, hypertension, and cardiovascular disease in the general population. The prevalence of severe sleep apnea in the conventional thrice‐weekly hemodialysis population has been estimated to be more than 50%. Sleep apnea leads to repetitive episodes of hypoxemia, hypercapnia, sleep disruption, and activation of the sympathetic nervous system. The hypoxemia, arousals, and intrathoracic pressure changes associated with sleep apnea lead to sympathetic activation, endothelial dysfunction, oxidative stress, and inflammation. Because sleep apnea has been shown to be widespread in the conventional dialysis population, it may be that sleep apnea contributes substantially to the sleepiness, poor quality of life, and cardiovascular disease found in this population. The causal links between conventional dialysis and sleep apnea remain speculative, but there are likely multiple factors related to volume status and azotemia that contribute to the high rate of severe sleep apnea in dialysis patients. Both nocturnal automated peritoneal dialysis and nocturnal hemodialysis have been associated with reduced severity of sleep apnea. Nocturnal dialysis modalities may provide tools to increase our understanding of the uremic sleep apnea and may also provide therapeutic alternatives for end‐stage renal disease patients with severe sleep apnea. In conclusion, sleep apnea is an important, but overlooked, public health problem for the dialysis population. The impact of sleep apnea treatment in this high‐risk population may include reduced sleepiness, better mood and blood pressure, and lowered risk of cardiovascular disease.
Nonconvulsive status epilepticus: High incidence in dialysis‐dependent patients
Authors: IFTIKHAR Sheikh , DAHBOUR Said , NAUMAN Siddiqi 
Published: October 2007

AbstractNonconvulsive status epilepticus is defined as a mental status change from baseline of at least a 30‐min duration associated with constant or near‐continuous ictal discharges on an electroencephalogram (EEG). Nonconvulsive status epilepticus is an often‐overlooked diagnosis as a cause of acute confusional state. There are few case reports in dialysis patients. We are reporting 5 patients on chronic dialysis treatment who presented with an acute confusional state. Nonconvulsive status epilepticus was diagnosed by EEG and response to intravenous benzodiazepines. We recommend early EEG to be considered in the evaluation of dialysis patients with an acute confusional state.
Ectopic mediastinal parathyroid carcinoma as a cause of dialysis‐dependent renal failure
Authors: TKACZYK Marcin , CZUPRYNIAK Aneta , NOWICKI Michał 
Published: October 2007

AbstractCarcinoma of the parathyroid gland is infrequent in patients with secondary hyperparathyroidism. Typical clinical symptoms are related to the presence of a neck mass and hypercalcemia. We describe a case of a 55‐year‐old man in whom primary parathyroid carcinoma led most likely to the development of end‐stage dialysis‐dependent renal failure, and the diagnosis of the cancer was delayed due to ectopic localization of the tumor, and dramatic complications in the clinical course of the disease, including acute pancreatitis and peritionitis. However, 6 months after successful surgery and subsequent radiotherapy, the patient is well and free from recurrences but remains chronically dialysis‐dependent.
Secondary sternal Aspergillus osteomyelitis in a diabetic hemodialysis patient with previous allograft rejection
Authors: NATESAN Sinthumathi , ABRAHAM Georgi , MATHEW Milly , LALITHA M.K. , SRINIVASAN C.N. 
Published: October 2007

AbstractA 29‐year‐old diabetic woman who had a previously failed renal allograft on maintenance hemodialysis developed sternal aspergillosis with Aspergillus terreus following a pericardiectomy. She was successfully treated with surgical debridement and a combination of antifungal agents including amphotericin B, caspofungin, and voriconizole. The diagnostic difficulties and management are discussed.
Comparison of calcium phosphate product values using measurement of plasma total calcium and serum ionized calcium
Authors: TERTTI Risto , HARMOINEN Aimo , LESKINEN Yrjö , METSÄRINNE Kaj P. , SAHA Heikki 
Published: October 2007

AbstractCalcium phosphate product (Ca × Pi) is a clinically relevant tool to estimate the cardiovascular risk of patients with renal failure. In reports, mostly total serum calcium has been used. As measurement of serum ionized calcium has some benefits and is being used increasingly, we estimated the respective levels of calcium phosphate product using both total (t‐Ca × Pi) and ionized calcium (ion‐Ca × Pi). Fifty‐eight healthy individuals and 180 hemodialysis (HD) patients from 2 centers were studied. Diagnostic accuracies for corresponding values of the t‐Ca × Pi and ion‐Ca × Pi were calculated using a GraphROC program. Of HD patients, 64% had t‐Ca × Pi <4.4 mmol2/L2 regarded as a desirable goal, and 10% had values over 5.6 mmol2/L2 associated with a high cardiovascular risk. Based on GraphROC analysis, t‐Ca × Pi of 4.4 mmol2/L2 corresponded to a value of 2.2 mmol2/L2 of ion‐Ca × Pi and, respectively, t‐Ca × Pi of 5.6 mmol2/L2 corresponded 2.8 mmol2/L2 of ion‐Ca × Pi. Owing to the good agreement between the results in the 2 centers, these values for risk levels can be used in both centers. When measurement of ionized calcium is used, Ca × Pi values of 2.2 and 2.8 mmol2/L2 can be used instead of generally used values of 4.4 and 5.6 mmol2/L2 with total calcium.
Effect of pharmacological suppression of secondary hyperparathyroidism on cardiovascular hemodynamics in predialysis CKD patients: A preliminary observation
Authors: SINGH Narinder P. , SAHNI Vaibhav , GARG Dheeraj , NAIR Mohan 
Published: October 2007

AbstractCardiovascular events are the principal cause of mortality in patients with chronic kidney disease (CKD). Secondary hyperparathyroidism (SHPT), a common complication of CKD, contributes to cardiac dysfunction. This study is an attempt to demonstrate the effects of parathyroid hormone suppression with oral calcitriol on cardiovascular hemodynamics. Twenty predialysis CKD patients with SHPT were given calcitriol therapy for 12 weeks. Ten similar patients received placebo. Echocardiographic assessment of cardiac function was performed at baseline and after 12 weeks of treatment. Calcitriol therapy effectively suppressed SHPT. Baseline left ventricular (LV) end diastolic diameter and LV end systolic diameter were 4.86±0.48 and 2.86±0.33 cm, and the mean FS was 41.02±4.79%. Left ventricular end systolic and end diastolic volumes were normal (42.30±9.07 and 91.40±19.68 mL). The ejection fraction was slightly reduced (53.54±3.57%). Pretreatment Doppler indices including E velocity (0.816±0.087 m/s), A velocity (0.696±0.089 m/s), and E/A ratio (1.193±0.210) were significantly impaired. After 12 weeks of calcitriol therapy, there was no significant change in the LV dimensions or ejection fraction, but there was a significant improvement in the diastolic parameters, namely the A velocity (0.680±0.084) and E/A ratio (1.238±0.180). Secondary hyperparathyroidism is an important factor in the pathogenesis of cardiovascular complications in CKD. There is evidence to support that correction of hyperparathyroidism can improve the systolic dysfunction seen in advanced kidney disease. This study shows that diastolic dysfunction seen in predialysis CKD patients may also be possibly improved with calcitriol therapy.
Inadvertent postdialysis anticoagulation due to heparin line locks
Authors: PEPPER Ruth J. , GALE Daniel P. , WAJED Julekha , BOMMAYYA Girish , ASHBY Damien , MCLEAN Adam , LAFFAN Mike , MAXWELL Patrick H. 
Published: October 2007

AbstractLarge‐bore dual lumen in‐dwelling venous catheters are used in hemodialysis. These catheters are usually locked with heparin after the treatment. This study addressed the underappreciated postdialysis coagulopathy that can result. Thirty‐six patients were included: 7 dialyzed through arterio‐venous fistulae, 29 through in‐dwelling venous catheters. The latter group was further subdivided according to whether they received heparin or heparin‐free dialysis. To assess the heparin lock, a full‐dose heparin lock as well as a much weaker heparin lock and a citrate lock were used. To assess the coagulopathy, blood was taken 1 hr after dialysis. The activated partial thromboplastin time (APTT) and anti‐Xa level was measured. Additionally, 6 venous catheters were removed and the amount of fluid expelled upon locking with saline was measured. Clotting from the patient group with arterio‐venous fistulae was normal following dialysis. The patients with in‐dwelling venous catheters and heparin locks had significantly deranged clotting; 6 out of 10 patients had abnormal APTT results. All patients with catheters, heparin‐free dialysis, and heparin locks had deranged clotting (7 out of 7). The rate decreased significantly when heparinized saline was used as a lock. A subset of patients had a citrate lock rather than a heparin lock; the clotting results normalized in all but one patient. An in vitro study demonstrated immediate leakage of fluid from the end of the ports upon locking. Significant postdialysis anticoagulation can occur after dialysis, which can be attributed to the heparin line locks. This risk is considerably reduced when a citrate lock is used instead.
Sleep apnea in hemodialysis patients: Risk factors and effect on survival
Authors: ARGEKAR Pushkar , GRIFFIN Valerie , LITAKER David , RAHMAN Mahboob 
Published: October 2007

AbstractSleep disorders are common in patients with end‐stage renal disease (ESRD). Using a simple questionnaire, we estimate the probability of sleep apnea in ESRD patients, determine the factors associated with a higher probability of sleep apnea, and determine the association between the probability of sleep apnea and cardiovascular and all‐cause mortality. Study design: Prospective cohort study. Setting and participants: prevalent hemodialysis patients (n=270) in 7 urban outpatient hemodialysis units. Predictor: Probability of sleep apnea as quantified by the Flemons questionnaire. Outcomes and measurements: Clinical, demographic, and dialysis‐related characteristics were obtained at baseline. Total and cardiovascular mortality was ascertained after a median follow‐up of 34 months. The probability of sleep apnea was low in 79 (29%) patients, moderate in 116 (43%) patients, and high in 75 (28%) patients. Male gender (odds ratio [OR] 5.13, p<0.001), obesity (BMI >30, OR 7.58, p<0.01), and interdialytic weight gain (OR 1.72/kg change, p<0.004) were independently associated with a high probability of sleep apnea. A high probability of sleep apnea at baseline did not predict total (hazard ratio [HR] 0.81, p=NS) or cardiovascular mortality (HR 0.9, p=NS). The Flemons questionnaire is validated in the general population, but has not been tested specifically in hemodialysis patients. The study may not be adequately powered to detect a difference in mortality. A high proportion of hemodialysis patients are likely to have sleep apnea; a simple bedside questionnaire can be used for screening to identify these patients. Excessive interdialytic weight gain is a potentially modifiable factor that increases the likelihood of sleep apnea. Despite the presence of a strong association between sleep apnea and mortality in the general population, a similar association could not be demonstrated in ESRD patients with a high prevalence of this condition.
Relative blood volume measurements during hemodialysis: Comparisons between three noninvasive devices
Authors: DASSELAAR Judith J. , HUISMAN Roel M. , DE JONG Paul E. , FRANSSEN Casper F.M. 
Published: October 2007

AbstractThe monitoring of relative blood volume changes (ΔRBV) has been advocated for the prevention of hemodialysis (HD) hypotension. Stand‐alone devices (Crit‐Line) or devices incorporated into the HD apparatus (blood volume monitor [BVM], Hemoscan) are widely used for this purpose. Comparisons between devices are scarce. The aim of this study was, first, to compare ΔRBV results from these 3 devices with ΔRBV calculated from changes in laboratory‐derived hemoglobin (ΔRBV‐lab‐Hb) and, second, to compare ΔRBV results between the different devices. Fourteen patients received 2 HD treatments in a randomized order: one with the Hemoscan and Crit‐Line combination and one with the BVM and Crit‐Line combination. ΔRBV‐lab‐Hb was measured at 2 and 4 hr into the HD session. Bland‐Altman analyses showed that ΔRBV results from the 3 devices differed systematically from ΔRBV‐lab‐Hb, i.e., the difference between the 3 devices and ΔRBV‐lab‐Hb varied significantly (p<0.05) with the magnitude of the measurement. The interdevice comparison showed considerable differences in ΔRBV results. At the end of the treatment, a significant difference (p<0.05) between ΔRBV measured by the Hemoscan and Crit‐Line device (−9.8±2.7% and −11.5±4%, respectively) was found. In most patients, a systematic difference between Crit‐Line and Hemoscan and between Crit‐Line and BVM was observed. Relative blood volume change measurements by Crit‐Line, Hemoscan, and BVM yield results that differ systematically from the results obtained from laboratory‐derived Hb changes. Furthermore, there are substantial differences in ΔRBV results between the 3 ΔRBV devices.
Aging veterans and the end‐stage renal disease management dilemma in the millennium
Authors: VACHHARAJANI Tushar J. , ATRAY Naveen K. 
Published: October 2007

AbstractThe population of aging veterans with complex multiple medical problems is increasing steadily in developed nations. The life expectancy in an aging population with end‐stage renal disease (ESRD) is often compared with terminal malignancy. Renal failure in elderly patients often generates a myriad of complicated issues and the nephrologists are faced with the dilemma of conveying the prognosis of renal failure in elderly patients and also explain the pros and cons of offering a renal replacement therapy. Our objectives were to assess the cumulative survival in veterans with ESRD over 70 years of age and to evaluate the factors considered for either not initiating or withdrawing from dialysis. All veterans above age 70 years, who were being evaluated for possible dialysis therapy over a 5‐year period, were included in the study. The cumulative survival rates at 1 year, 3 years and 5 years were 60%, 37%, and 20%, respectively. Tunneled cuffed catheter was the dialysis access in a third of these patients on dialysis adding to the morbidity. Twenty‐four patients considered either not initiating or withdrawing from dialysis therapy after consensus agreement from either the patient or the power of attorney. The decision to initiate dialysis therapy should be made considering the social, ethical, and associated comorbid conditions. A decision to not initiate or withdraw dialysis is possible in critically ill elderly patients and if taken judiciously can reduce physical and mental stress of both the patient and their family members.
Does a history of peritoneal dialysis result in an impaired gastrointestinal life quality?
Authors: HEINE Gunnar H. , KASTNER Chantal Y. , JAHNKE Thomas , KÖHLER Hans , KUHLMANN Martin K. 
Published: October 2007

AbstractPeritoneal dialysis (PD) invariably induces sclerotic changes in the peritoneal membrane. The impact of these changes on the well‐being of PD patients has not been studied sufficiently. In a matched‐pair analysis, the gastrointestinal life quality of patients with a history of PD was compared with end‐stage renal disease patients who never performed PD, using a standardized questionnaire (gastrointestinal life‐quality index [GLQI]). We identified all patients in our dialysis unit who underwent PD between 1989 and 2001 and who were alive in October 2001 (PD patients; n=53). Patients who were treated by hemodialysis (HD patients) were recruited as pairs. Hemodialysis and PD patients did not differ in gastrointestinal life quality (GLQI: HD 106.0±16.4 points; PD 104.0±16.7 points; p=0.70). Gastrointestinal life quality was neither correlated with the number of peritonitis episodes, nor with the duration of PD treatment. Peritoneal dialysis treatment is not associated with a long‐term impairment of gastrointestinal life quality.
Challenges and limitations of maintenance hemodialysis in urban South India
Authors: SANKARASUBBAIYAN Suresh , RAJKUMAR Avinash , TANGALVADI Tausif Ahmed , DAWOOD Ubaidullah Shaik , KAUR Prabhdeep 
Published: October 2007

AbstractMaintenance hemodialysis is a treatment modality available to few patients reaching end‐stage renal disease in India. However, the morbidity and outcome of such treatment remains largely unknown. A retrospective cohort of patients commencing hemodialysis in a secondary care institution in India between January 1, 2002 and December 31, 2004 was studied. Patient demographics, cardiac status, access, hospitalizations, and emergency room visits were assessed and outcomes determined. During the study period, 95 patients (66 males, 29 females) commenced maintenance hemodialysis. The underlying cause of chronic kidney disease was diabetic nephropathy in 66.3% of patients. Cumulative follow‐up was 676+9.1 patient months. The mean serum creatinine (+SD) at initiation of dialysis was 8.39+3.28 mg%. Thirty‐six percent of patients had a functioning arteriovenous fistula at commencement of dialysis, while the remaining 64% of patients required temporary access. The mean number of comorbidities was 1.9+1.0/patient; diastolic dysfunction was deemed to be present in 20.4% of the patients. The hospitalization rate was 3.9/patient year; the number of visits to the emergency room was 4.9/patient year. Cardiac pathology was the most common cause leading to hospitalization and emergency room visits. Diabetic patients were older and had higher cardiac morbidity (p<0.01). The outcome was as follows: 39% transferred to other units; 27% died; 9% switched to CAPD; 8% lost to follow‐up; 1% transplantation: Kaplan‐Meier survival analysis showed a median survival of 410 days. Patients commencing hemodialysis in an urban dialysis center in South India are predominantly male and have significant comorbidity including diabetes and cardiac disease. Outcome is generally poor. Hence, a huge opportunity for improvement exists.