bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuous Renal Replacement Therapy for Burned Patients: Renal and Systemic Considerations
Authors: Leblanc Marline , Quérin Serge 
Published: October 2007

SummarySignificant improvements in wound care have re‐sulted in decreased mortality rates in burned pa‐tients since the mid‐seventies. The main determi‐nants of survival remain the extent of the burn and the age. Infection is still the most frequent cause of mortality. Burned patients are prone to develop MOF, not only following sepsis, but from the sys‐temic inflammation associated with thermal injury. Many metabolic derangements occur after a burn:hypermetabolism with several hormonal changes, enhanced catabolism and gluconeogenesis, im‐paired ketogenesis and lipolysis. Aggressive nutri‐tional support is particularly important in burned patients and avoiding a negative nitrogen balance is priority. Since early aggressive fluid resuscitation is widely applied, ARF occurs later during the course hospitalization, often after 10 days. Its pathogen‐esis seems multifactorial, mainly related to sepsis and nephrotoxic agents, and is usually part of MOF. Dialytic support is challenged by the important fluid intake and removal required, the high catabolism, and the hemodynamic instability that characterize burned patients. Since they allow a better hemody‐namic tolerance, a more precise fluid balance, and a more stable metabolic control, CRRTs appear as modalities of choice for ARF burned patients. How‐ever, only three series report their usefulness for this selected population. In our experience, CRRTs have been performed over long periods and have allowed significant fluid loss over time. Bleeding complications from wounds have been much more frequent than for intensive care patients treated by CRRT with a similar anticoagulation regimen, and mandate prudent monitoring. Owing to limited vas‐ cular access sites and inherent risks of arterial cath‐eterization, venovenous might be preferred to arte‐riovenous modalities, if they are available. Despite more aggressive management, the mor‐tality rates of burned patients with ARF remain high80%, reflecting the associated MOF. From a sys‐temic point of view, considering the important vol‐ume loss required, the potential for enhanced cyto‐kine removal, and the important cumulative soluteclearances provided over time by CRRT, ARF burned patients should particularly benefit from continuous over intermittent modalities. When dia‐lytic support has to be initiated, we consider CRRT, particularly hemodiafiltration which provides a larger dialysis dose, as the modality of choice.
Continuous Renal Replacement Therapy: Cost Considerations and Reimbursement
Authors: Moreno Luz , Heyka Robert J. , Paganini Emil P. 
Published: October 2007

SUMMARYCost considerations with CRRT are important and vary substantially among centers. Major areas of concern are personnel, equipment, supplies, CRRT modality chosen and patients chosen. Costs are higher with CRRT than with either IHD or APD. These cost differences narrow as greater amounts of therapy are delivered. There are signif‐ icant areas for cost control in CRRT. Each center must evaluate its program to find the areas of cost control that are potentially available.
The State of Kidney Transplantation in the United States
Authors: Wolfe Robert 
Published: October 2007

ABSTRACTAlthough transplantation is the preferred treatment for end‐stage renal disease (ESRD) patients compared to dialysis, the limited number of organ donors limits this treatment option for many patients. Various approaches to increase the number of donors are currently being investigated. While the quality of life and patient survival are far from optimal for ESRD patients, improvements have been seen recently in both dialysis and transplantation outcomes. Prevention of ESRD is preferred to either treatment option.
Increasing the Pool of Transplantable Kidneys Through Unrelated Living Donors and Living Donor Paired Exchanges
Authors: Spital Aaron 
Published: October 2007

AbstractRenal transplantation is the best therapy for eligible patients with end‐stage renal disease (ESRD). Unfortunately the ability to perform this procedure is limited by a severe shortage of transplantable kidneys. One of the most successful approaches to this serious problem has been to expand the pool of living donors. This has been accomplished primarily by lifting restrictions on the use of genetically unrelated volunteers. As a result, acceptable living kidney donors now include individuals who are related to their recipients only through emotional bonds (e.g., spouses) and, at some centers, even people who are not related to their recipients at all. Living donor paired kidney exchanges provide a novel means for increasing further the number of kidneys available for transplantation. Each of these approaches will be reviewed.
Overcoming Immunologic Incompatibility: Transplanting the Difficult to Transplant Patient
Authors: Crew R. John , Ratner Lloyd E. 
Published: October 2007

ABSTRACTImmunologic incompatibilities between donor and recipient have limited the access to renal transplantation for many patients. Previously the presence of donor‐specific alloantibodies directed against donor major histocompatibility complex (MHC) antigens or natural antibodies directed against donor ABO blood group antigens was considered an absolute contraindication to renal transplantation. However, with the current understanding of humoral immune responses, superior immunosuppressive agents, and improved diagnosis and treatment of antibody‐mediated rejection, renal transplantation can be safely performed with outstanding results despite the presence of donor‐specific antibody. In this review we discuss the biology of antibody‐mediated rejection and sensitization. We discuss the diagnostic tests necessary to characterize the type, affinity, and avidity of the donor‐directed antibodies. Current methods for performing renal transplants across ABO and human leukocyte antigen (HLA)‐sensitized barriers are covered, including the potential morbidities. The rest of the review focuses on advances in managing these antibodies to increase the likelihood of receiving a deceased donor kidney or allow transplantation from a living donor against whom one has a prohibitive antibody.
Kidney Transplant Candidate Evaluation
Authors: Scandling John D. 
Published: October 2007

ABSTRACTThe practicing nephrologist is an indispensable component in the evaluation of the candidate for kidney transplantation, from referral to the transplant center to eventual transplantation, which now may be years later. Early referral may lead to preemptive transplantation, the ideal that has been achieved in 25% of living donor transplant cases. Annually approximately 30% of U.S. deceased donor kidneys are now transplanted under the allocation policies for zero human leukocyte antigen (HLA) mismatch kidneys and expanded criteria donor kidneys. Under either of these programs, candidates may receive a kidney offer soon after entering the wait‐list, so prompt and complete evaluation and preparation by the practicing nephrologist is necessary for successful early transplantation. The remaining candidates require periodic review while ascending the wait‐list and thorough repeat evaluation when nearing the top, as years may have passed since initial evaluation. Wait‐list management is a major challenge faced by transplant centers, aggravated by the inexorable growth of the list. Active communication between the practicing nephrologist and the transplant center is essential to maintain the candidate's preparation for transplantation.
Surgical Complications After Kidney Transplantation
Authors: Humar Abhinav , Matas Arthur J. 
Published: October 2007

ABSTRACTKidney transplants have become common surgical procedures, with thousands performed yearly around the world. The surgical techniques for the transplant are well established and the procedure is associated with high success rates. The complication rate associated with the procedure is low, especially when compared to other abdominal organ transplants such as liver and pancreas transplants. Nonetheless, the detection, accurate diagnosis, and timely management of surgical complications occurring after kidney transplant are important tasks of the team managing these patients. A delay in the diagnosis or management of these complications can result in significant morbidity to the recipient, with risk of graft loss and mortality. Most surgical complications involve either the wound or one of the three anastomoses (renal artery, renal vein, or ureter). Examples include wound infection, renal artery or vein thrombosis, and urine leak. Most of these complications will require surgical or radiologic intervention for appropriate management.
Managing the Failing Allograft
Authors: Kendrick Elizabeth A. , Davis Connie L. 
Published: October 2007

ABSTRACTManaging the failing allograft juxtaposes immunosuppressive management and routine chronic kidney disease care. The complications of immunosuppression can be more pronounced in those with renal failure (infection, anemia, bone disease). The withdrawal of immunosuppression may be associated with acute allograft rejection, arthralgias, and the development of antidonor antibodies. Likewise depression is prevalent. Improving well‐being and overall survival necessitates proper titration of immunosuppressive medications and control of blood pressure, anemia, lipids, and glucose along with attention to treatment of depression.
American Society of Diagnostic and Interventional Nephrology Section Editor: Stephen Ash: Stenosis Surveillance of Hemodialysis Grafts by Duplex Ultrasound Reduces Hospitalizations and Cost of Care
Authors: Dossabhoy Neville R. , Ram Sunanda J. , Nassar Raja , Work Jack , Eason J. Mark , Paulson William D. 
Published: October 2007

AbstractMost recent randomized controlled trials (RCTs) have found that hemodialysis graft surveillance combined with preemptive correction of stenosis does not prolong graft survival. Nevertheless, such programs may be justified if they reduce other adverse outcomes or decrease the cost of care. This study tested this hypothesis by applying a secondary analysis to our original RCT. This study of 101 patients evaluated correction of stenosis based upon blood flow (Q) and stenosis surveillance. Patients were randomly assigned to control, flow, or stenosis groups, and were followed for up to 28 months. Q was measured monthly by ultrasound dilution; stenosis was measured quarterly by duplex ultrasound. Stenosis of 50% was corrected by percutaneous transluminal angioplasty (PTA) after referral for angiography. Referral criteria were: control group, clinical criteria; flow group, Q < 600 ml/min or clinical criteria; stenosis group, stenosis > 50% or clinical criteria. We compared access‐related hospitalizations and cost of care, and use of central venous dialysis catheters (CVCs), among the three groups. Hospitalization rates were higher in the control and flow groups than in the stenosis group (0.50, 0.57, 0.18/patient‐year, respectively [p < 0.01]), and hospitalization costs were lowest in the stenosis group (p = 0.026). The stenosis group had a trend toward lowest CVC rates (0.44, 0.32, 0.20/patient‐year, respectively [p = 0.20]). The costs of care were higher in the control and flow groups than in the stenosis group ($3727, $4839, $3306/patient‐year, respectively [p = 0.015]). The costs of stenosis ($142/patient‐year) and Q ($279/patient‐year) measurements were minimal compared to the total cost of access‐related care. In conclusion, stenosis surveillance by duplex ultrasound combined with preemptive correction yielded reduced hospitalization rates and costs, reduced total cost of access‐related care, and a trend of reduced CVC rates. In contrast, flow surveillance did not yield a significant benefit. Stenosis surveillance provides important benefits that may justify application of such programs.
American Society of Diagnostic and Interventional Nephrology Section Editor: Stephen Ash: Thresholds for Significant Decrease in Hemodialysis Access Blood Flow
Authors: Ram Sunanda J. , Nassar Raja , Sharaf Rashid , Magnasco Alberto , Jones Steven A. , Paulson William D. 
Published: October 2007

AbstractDuring hemodialysis access surveillance, referral for evaluation and correction of stenosis is based upon determination that a significant decrease in blood flow (Q) has occurred. However, criteria for determining when a decrease is statistically significant have not yet been established. In this study we established such criteria by analyzing Q variation with the glucose pump test (GPT). We took nine Q measurements in each of 25 patients (18 grafts, 7 fistulas) during three dialysis sessions within a 2‐week period (predialysis and during hours 1 and 3). We determined thresholds that define a significant percentage decrease in Q (ΔQ) for various p values. In order to confirm the general applicability of these thresholds, we computed the average within‐patient Q variation during the three sessions (computed as a coefficient of variation and referred to as short‐term variation). We then determined the relative influences of biological (true) variation and analytical error on short‐term variation. We found that ΔQ must be > 33% to be significant at p < 0.05, whereas the threshold is > 17% for p < 0.20. Measuring Q at uniform versus different times during the sessions did not significantly reduce these thresholds. We also found that biological variation was nearly as large as short‐term Q variation, whereas analytical error contributed minimally to short‐term variation. In conclusion, this study defines thresholds for a significant ΔQ that have wide application in determining access referral for evaluation and correction of stenosis. Selection of a particular threshold should consider the relative importance of avoiding thrombosis versus avoiding unnecessary procedures. If avoiding unnecessary procedures is a priority, then we recommend a threshold of > 33%. These thresholds apply to other methods of measuring Q, provided analytical error is significantly less than biological variation.
Autoradiographic investigation of proliferative responses in rat incisor pulp after vincristine administration
Authors: STENE TORBJØRN , KOPPANG HANNA STRØMME 
Published: October 2007

Abstract –0.7 mg/kg VCR was given to nine rats in three experimental groups. Twenty‐three hours after VCR injection the animals were injected with 3H‐thymidine. The animals were sacrificed 24, 48 and 72 h after the VCR injection, and by comparison with nine control animals similarly injected with sodium chloride solution and nucleotide, it was shown that VCR causes a delayed migration of pulp cells from the proliferative pool and a small but distinct inhibition of the incisal growth of the incisors. The growth inhibition corresponded to the normal growth over a 24‐h period in nou‐VCR‐injected animals.
Autoradiographic investigation of dentin production in rat incisors after vincristine administration
Authors: STENE TORBJØRN , KOPPANG HANNA STRØMME 
Published: October 2007

Abstract –0.7 mg/kg VCR was administered intravenously to nine rats in three experimental groups. One hour after VCR injection the animals were injected with 3H‐proline. The animals were sacrificed 1.5, 5 and 24 h after the VCR administration, and by comparison with nine control animals similarly injected with sodium chloride solution and 3H‐proline, it was shown that VCR causes an early, intracellular retention of labeled proline in the odontoblasts, an abnormal intracellular distribution of labeled material and a generally decreased secretion of dentinal matrix from the odontoblasts in the maxillary incisors. The severity of the effects were shown to vary in different parts of the incisors.
Neutrophil chemotaxis induced by anaerobic bacteria isolated from necrotic dental pulps
Authors: SUNDQVIST GÖRAN , JOHANSSON EVA 
Published: October 2007

Abstract –Anaerobic bacteria belonging to the species Bacteroides melaninogenicus, Bacteroides asaccharolyticus, Fusobacterium nucleatum, Peptostreptococcus anaerobius and Eubacterium alactolyticurn, isolated from necrotic dental pulps, were tested for their capacity to induce neutrophil leukocyte chemotaxis. Generation of chemotactic factors in serum by whole bacterial cells and chemotaxis induced by bacterial extracts were studied in vitro by the Boyden technique. Subcutaneously implanted wound chambers in guinea pigs were used for testing leukocyte migration in vivo. All bacterial strains had a similar high capacity to induce neutrophil chemotaxis. The heavy accumulation of polymorphonuclear neutrophil leukocytes associated with clinical and experimental infections by B. melaninogenicus or B. asaccharolyticus cannot be ascribed to any extreme ability of these organisms to generate chemotactic factors.
Bone tissue formation within a sintered microporous glass‐fiber network implanted in extraction sockets in the rat
Authors: EHRNFORD LARS , SUNDSTRÖM BENGT , WALLENIUS KJELL 
Published: October 2007

Abstract –Implants were prepared by sintering glass‐fibers into a three‐dimensional network with meshes smaller than 20 μm. Oblong 5x2x0.15 mm sheets of the test material were implanted in maxillary incisor alveoli in eight white rats. The alveoli were closed with a suture in the overlying mucosa. After 3 months the animals were sacrificed and sections from the site of implantation prepared. In three animals only root remnants were found but in the remaining five the implants were wholly or partially embedded in bone tissue. Sections studied with transmitted light, microradiography, and scanning electron microscopy showed that mineralized tissue had also formed within the pores of the network. The intimate contact between the individual fibers and the bone within the network was corroborated through microchemical analysis (EDX).
Pattern of age related bone loss in mandibles
Authors: VON WOWERN NINA , STOLTZE KAJ 
Published: October 2007

Abstract –A study was carried out to analyze the pattern of the age related bone loss in the mandibular cortex and to establish normal values and the observed range of morphometric variables on microradiograms of bone sections taken from a well defined site anterior to and below the mental foramen. Specimens were obtained from 100 Danish subjects with no known systemic bone disease or severe mandibular atrophy. Microradiograms of 100‐μm‐thin undemineralized vertical ground cross‐sections were produced. An electronic point‐counting system was used for the determination of 1) percentage bone mass, 2) mean cortical width (MCW), and 3) the percentage of Haversian canals with resorption surfaces. The analysis showed that cortical porosity and the percentage of Haversian canals showing resorption are unrelated to sex and increased after the age of 50. MCW and absolute bone mass (MCW ×% bone mass) are greater in males than in females and show a parallel age related decrease after the age of 50. Furthermore, the age related increase in cortical thinning and porosity is dependent on the individual as well as on age. Marked individual variation confined the use of these parameters to group analysis.
Strength properties of some gypsum‐bonded casting investments
Authors: FINGER WERNER , JØRGENSEN KNUD DREYER , ONO TAKASHI 
Published: October 2007

Abstract –The present investigations show that there is no correlation between on the one hand the wet and the dry compressive strength of the three gypsum‐bonded investments studied and on the other the compressive strength of the investments at burn‐out temperature. The study also demonstrated that there is no correlation between the compressive strength and the fracture resistance of sharp edges of the investment mold when exposed to the impact of the casting alloy entering the mold. The inconveniences caused by the fracture of such edges are prevented by a moderate rounding of the corresponding parts in the preparation.
A 3‐month study in monkeys of occlusal dysfunction and stress
Authors: BUDTZ‐JØRGENSEN EJVIND 
Published: October 2007

Abstract –A dysfunctional occlusal relationship was produced in six Macaca irus monkeys by insertion of occlusal splints in the maxilla which raised the vertical dimension of occlusion by 3–4 mm and incorporated interferences into the occlusion (test side). Gortisol levels of plasma and urine were measured by competitive protein binding analysis. At week 1 and week 3 after insertion of the splints there was a significant increase of 24 h urinary cortisol excretion rate and plasma cortisol concentration, indicating emotional stress. Furthermore, there was evidence of acute trauma from occlusion of the mandibular teeth of the test side, including a significant increase of tooth mobility and GI; radiographically there were signs of breakdown of marginal and interradicular alveolar bone. One animal developed periodontat pockets of 4–5 mm adjacent to the teeth of the test side. At week 6 and week 12 urinary and plasma cortisol levels had declined to basal values whereas tooth mobility, GI and PI remained elevated. There was no clinical or radiographic evidence of further loss of bone or increase of pocket depth adjacent to the teeth of the test side during the latter part of the experimental period. The results suggest that emotional stress may be involved in periodontal reactions associated with acute trauma from occlusion.
Morphology of a simple amelobloblastoma related to the human enamel organ
Authors: MATTHIESSEN MARTIN EBBE , VEDTOFTE POUL , RØMERT PAUL 
Published: October 2007

Abstract –The ultrastructure of a simple ameloblastoma was investigated. The epithelial cells of the tumor could be divided into peripheral cells of varying height, and dark and light central cells. The morphology was correlated to that of the human enamel organ. The low peripheral cells were very similar to the external enamel epithelium cells. The central cells had a certain resemblance to the stellate reticulum and stratum intermedium cells. The high peripheral cells had no counterparts in the enamel organ. Unlike the enamel organ the ameloblastoma showed extremely few and small gap junctions.
In vitro development of chlorhexidine resistance in Streptococcus sanguis and its transmissibility by genetic transformation
Authors: WESTERGREN GUDRUN , EMILSON CLAES‐GÖRAN 
Published: October 2007

Abstract –Three chlorhexidine‐sensitive strains of Streptococcus sanguis developed resistance to chlorhexidine when grown as continuous cultures in a fermenter containing medium with increasing concentrations of the drug. The MIC of the test strains increased by between two and three dilution steps and these high values were maintained after daily transfer in drug‐free medium for at least 15 d. In addition, the resistance of one of the strains persisted for more than 1 month of continuous growth in drug‐free medium in the fermenter. DNA from the resistant (Chx1) variants of the three strains transformed competent sensitive S. sanguis to increased chlorhexidine resistance, thus proving that resistance to this drug is an inheritable trait. Immunoelectrophoretic experiments showed that certain changes in the antigenic pattern of the Chx1 variants had occurred as compared with their sensitive wild‐type strains. Antigen extracts of the Chx1 variants and all Chx1 recombinants tested contained consistently less protein than those of the sensitive wild‐types.