bluuebunny/crossref_metadata_2025_split huggingface dataset:
Secondary Arteriovenous Fistulas: Converting Prosthetic AV Grafts to Autogenous Dialysis Access
Authors: Slayden Geoffrey C. , Spergel Lawrence , Jennings William C. 
Published: July 2008

AbstractAs existing arteriovenous grafts (AVGs) fail, the National Kidney Foundation KDOQI Guidelines and the AV Fistula First Breakthrough Initiative (“Fistula First”) project recommend that each patient be re‐evaluated for conversion to an arteriovenous fistula (AVF). AVFs created following failure of an AVG have been termed secondary fistulas (SAVF). We review our experience and outcomes converting AVGs to SAVFs, utilizing the mature outflow vein of the AVG when possible, otherwise creating a new AVF at a remote site. We reviewed two groups of consecutive patients undergoing operations for vascular access at different centers. Group 1 had a SAVF protocol in place during the study period with specific criteria for timing SAVF construction. Patients from group 2 were referred for evaluation by nephrologists or dialysis nurses as access problems were recognized, without a formal protocol in place. All patients had preoperative ultrasound or contrast imaging in addition to physical examination. Indications for creating a SAVF were AVG thrombosis, dysfunction, erosion, bleeding, or steal syndrome involving the existing AVG. The simple presence of a functional AVG without evidence of dysfunction was not an indication for conversion to a SAVF. SAVFs were classified according to location and the potential for utilizing the existing mature AVG outflow vein. Group 1: 40 consecutive patients, age 26–78 (mean = 62), 42% were female; 55% were diabetic. These patients had 1–22 previous access operations (mean = 3). 92.5% underwent SAVF surgery prior to loss of the AVG, minimizing catheter use. Cumulative patency was 92.5% at 1 year and 87.5% at 2 years. Group 2: 102 consecutive patients, age 24–87 (mean = 55), 52% were female; 50% were diabetic. These patients had 1–50 previous access operations (mean = 3). Only 19.3% were referred for SAVF surgery prior to loss of the AVG or outflow vein. Cumulative patency was 94.4% at 1 year and 91.6% at 2 years. Failure, dysfunction, or complications of AVGs may be resolved by conversion to a SAVF. Further, the limited lifespan of AVGs and the superiority of AVFs dictates that a plan be in place to transition the AVG patient to an AVF. Most, if not all, hemodialysis patients whose access is an AVG will have one or more anatomic sites and vessels suitable for an autogenous SAVF. Vessel mapping is critical in the evaluation of failing AVGs and in preparation for a SAVF. Cumulative patency rates exceeded 90% at 12 months for SAVFs in both patient groups in this report. The need for catheters was dramatically less in the patient group with an established SAVF conversion plan.
Chronic Alcohol Consumption Generates a Vulnerable Immune Environment During Early SIV Infection in Rhesus Macaques
Authors: Marcondes Maria Cecilia G. , Watry Debbie , Zandonatti Michelle , Flynn Claudia , Taffe Michael A. , Fox Howard 
Published: July 2008

Background:  Alcohol consumption is a common problem in HIV‐infected individuals, and the effects of alcohol may alter the efficiency of the immune response, potentially aggravating the disease as well as affecting end organs, such as the brain. However, the elements of the virus‐host interaction that are modulated by ethanol are poorly dissected.Methods:  Ethanol intake was conditioned in rhesus macaques prior to SIV infection, in order to mimic this common human behavior, and allow the evaluation of aspects of the virus‐immune system interactions during acute time‐points, when important facets of the infection are set up and when virus reproducibly enters the brain.Results:  Although ethanol had a limited effect on the acute plasma viral load, it resulted in reduced circulating memory CD4+ T cells and increased levels of monocytes expressing the viral coreceptor CCR5. In organs, ethanol consumption impacted immune cells in the liver as well as lymphoid and other nonlymphoid tissues, where CD4+ T cells were predominantly affected.Conclusion:  Overall, the consumption of alcohol causes immune cell alterations that can contribute to the generation of a disease susceptible environment upon SIV infection.
Hazardous Drinking: Prevalence and Associations in the Finnish General Population
Authors: Halme Jukka T. , Seppä Kaija , Alho Hannu , Pirkola Sami , Poikolainen Kari , Lönnqvist Jouko , Aalto Mauri 
Published: July 2008

Background:  Hazardous drinking, defined as consuming alcohol on a risky level and not meeting the diagnostic criteria of alcohol use disorders (AUDs), has been suggested for a new complementary nondependence diagnosis. This study aimed to investigate the prevalence and associations of hazardous drinking in comparison to AUDs, moderate drinking, and abstinence.Methods:  A national representative sample of Finns was examined in the Health 2000 Survey. For 4477 subjects aged 30 to 64 years (76%, 2341 females), both the quantity frequency data about alcohol consumption and Composite International Diagnostic Interview (CIDI) data concerning AUD diagnoses were available. The nationally recommended limits for hazardous dinking were used (males: 24 drinks, females: 16 drinks/wk). Logistic regression models were used to analyze associations.Results:  The prevalence of hazardous drinking was 5.8%. Hazardous drinking was more prevalent among males than females (8.5% vs. 3.1%). It was most prevalent among the subjects aged 40 to 49 years (7.3%), divorced or separated (8.3%), unemployed (8.2%) and subjects living in the southern (Helsinki) region (7.5%). AUDs versus hazardous drinking were more likely to be in males versus females and in the unemployed versus employed. Subjects aged 40 and over had higher odds for hazardous drinking versus AUDs. The odds for hazardous versus moderate drinking were higher for males versus females (adjusted odds ratio = 3.24), for subjects aged over 40 years, unemployed versus employed and cohabiting, divorced/separated or unmarried subjects versus married subjects.Conclusion:  The high prevalence of hazardous drinking makes it an important public health concern. Hazardous drinkers have different sociodemographic characteristics as compared to people in other alcohol use categories.
Relationship Between Medication Adherence and Treatment Outcomes: The COMBINE Study
Authors: Zweben Allen , Pettinati Helen M. , Weiss Roger D. , Youngblood Marston , Cox Christine E. , Mattson Margaret E. , Gorroochurn Prakash , Ciraulo Domenic 
Published: July 2008

Background:  Within the alcoholism field, there is mounting evidence supporting an important relationship between medication adherence and drinking outcomes. Little is known however, about the complex relationships between medication and treatment variables and drinking outcomes. The present paper reports on the differential impact of medication adherence and treatment factors on drinking outcomes. Data derived from the COMBINE Study was used to investigate the interrelationships between medication adherence, combination treatments and drinking outcomes.Methods:  Twelve hundred and twenty‐six patients were randomized to 1 of 8 different combination treatments involving 2 medications—naltrexone and acamprosate and placebo, and 2 behavioral treatments—medical management (MM) and combined behavioral intervention (CBI). Two primary drinking outcomes were percent days abstinent (PDA) and time to first heavy drinking day. Medication adherence was defined as a proportion that reflects the number of pills taken by the maximum number of pills expected to be taken over the course of the trial. A generalized linear mixed model was used to estimate the effects of adherence on PDA while proportional hazards model was used to examine similar co‐variate effects on time to first heavy drinking day.Results:  Concerning time to first heavy drinking day, a significant three‐way interaction was found between medication adherence, CBI and naltrexone (p = 0.0160). Within the MM only plus placebo group (no CBI), significant differences were found in “recovery” (i.e., no heavy drinking days) rates between adherers and nonadherers (40% vs. 10%, p < 0.0001). Such differences became nonsignificant (p = 0.12) when CBI was introduced into the relationship. CBI did not add any such advantage to naltrexone‐treated patients.Conclusions:  CBI might serve a protective function for nonadherers in the placebo group; the median relapse time was reduced when these nonadherers were exposed to the alcohol specialty intervention. CBI offered little additional benefit to nonadherers in the naltrexone group. Among nonadherers in the naltrexone group, relapse rates appear to be more a function of inadequate exposure to the active medication and less influenced by CBI.
One‐per‐Occasion or Less: Are Moderate‐Drinking Postmenopausal Women Really Healthier Than Their Nondrinking and Heavier‐Drinking Peers?
Authors: Tivis Laura J. , Tivis Rick D. 
Published: July 2008

Background:  While some reported benefits of moderate drinking are thought to be the direct results of physiological mechanisms associated with consumption, other effects may be attributable to mediating factors. Both explanations suggest that moderate drinkers may be healthier than nondrinking and heavier‐drinking peers. The purpose of this study was to determine whether moderate‐drinking postmenopausal women report healthier dietary and exercise patterns, and whether they demonstrate better physiological functioning compared with peers. This study also aimed to describe patterns of relationships between alcohol and measures of general health functioning in postmenopausal women.Methods:  One‐hundred and fifteen women aged 50 to 65 participated. Participants completed alcohol interviews, diet and exercise questionnaires, and bone density examination. Blood pressure, height, and weight were assessed, and blood was collected to conduct basic chemistry and complete blood count tests.Results:  Postmenopausal moderate drinkers failed to demonstrate healthier dietary or exercise habits, and did not exhibit significantly better health‐functioning compared with peers. They did evidence positive associations between drinking and healthy behavior, and between drinking and cardiovascular health. Relationships between alcohol and blood analytes differed between drinking groups, some of which suggested possible negative health consequences for higher‐end drinkers in both drinking groups.Conclusions:  These data suggested that moderate‐drinking postmenopausal women are not significantly healthier than their non‐ or heavier‐drinking peers, but may drink as part of a larger effort to take care of their health. Despite this, even 1‐drink‐per‐drinking‐day moderate drinkers may have tendencies toward unhealthy conditions. Limitations include small sample size, inability to assess specific cardiac risk and socioeconomic status, small number of correlations, and clinical relevance of analyte values.
Impact of nucleic acid testing for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus on the safety of blood supply in Italy: a 6‐year survey
Authors: Velati Claudio , Romanò Luisa , Fomiatti Laura , Baruffi Lorella , Zanetti Alessandro Remo ,   the SIMTI Research Group
Published: July 2008

BACKGROUND: Nucleic acid testing (NAT) for hepatitis C virus (HCV) and human immunodeficiency virus (HIV) has been implemented in several European countries and in the United States, while hepatitis B virus (HBV) NAT is still being questioned by opinions both in favor and against such an option, depending on the HBV endemicity, health care resources, and expected benefits.STUDY DESIGN AND METHODS: This survey was aimed to assess the NAT impact in improving the safety of blood supply in Italy, 6 years after implementation. The study involved 93 Italian transfusion centers and was carried out in 2001 through 2006. A total of 10,776,288 units were tested for the presence of HCV RNA, 7,932,430 for HIV RNA, and 3,405,497 for HBV DNA, respectively.RESULTS: Twenty‐seven donations or 2.5 per million tested were HCV RNA–positive/anti‐HCV–negative; 14 or 1.8 per million units tested were HIV RNA–positive/anti‐HIV–negative; and 197 or 57.8 per million donations tested were HBV DNA–positive/hepatitis B surface antigen–negative. Of the latter, 8 (2.3/106) were collected from donors in the window phase of infection and 189 (55.5/106) from donors with occult HBV. Sixty‐eight percent of the latter donors had hepatitis B surface antibody, 74.5 percent of whom with concentrations considered protective (≥10 mIU/mL).CONCLUSION: NAT implementation has improved blood safety by reducing the risk of entering 2.5 HCV and 1.8 HIV infectious units per million donations into the blood supply. The yield of NAT in detecting infectious blood before transfusion was higher for HBV than for HCV or HIV. However, the benefit of HBV NAT in terms of avoided HBV‐related morbidity and mortality in blood recipients needs to be further evaluated.
Balance between vasoconstriction and enhanced oxygen delivery
Authors: Cabrales Pedro , Tsai Amy G. , Intaglietta Marcos 
Published: July 2008

BACKGROUND: Hemoglobin (Hb) solutions are potential alternatives to blood transfusion when native oxygen (O2)‐carrying capacity is lacking. Polymerized bovine Hb (PBH) solutions are characterized by its vasoactivity, low O2 affinity, oncotic effect, prolonged shelf life, and stability. Responses to facilitated O2 transport, after exchange transfusion with PBH, were studied in the hamster window chamber model during acute extreme anemia to determine how PBH affects microvascular perfusion and tissue oxygenation.STUDY DESIGN AND METHODS: An anemic state was induced by hemodilution with a plasma expander (70‐kDa dextran). After hemodilution, animals were randomly assigned to exchange transfusion groups based on the concentration of PBH used, namely, PBH at 13 gHb per dL (PBH13), PBH diluted to 8 or 4 gHb per dL in albumin solution at matching colloidal osmotic pressure (COP; PBH8 and PBH4), and no PBH only albumin solution at matching COP (PBH0). Measurement of systemic variables, microvascular hemodynamics, capillary perfusion, and intravascular and tissue O2 levels was performed at 11 percent Hct.RESULTS: Restitution of O2‐carrying capacity with PBH13 restored higher arterial pressure and triggered vasoconstriction, low perfusion, and higher peripheral resistance. Groups PBH4 and PBH0 had lower arterial pressures than Group PBH13. Groups PBH4 and PBH8 maintained higher perfusion and functional capillary density than Groups PBH13 and PBH0. In all groups, blood gas variables and acid‐base balance were recovered proportional to microvascular perfusion. Arterial O2 tensions were improved for Groups PBH4 and PBH8 by preventing O2 precapillary release and increasing O2 reserve.CONCLUSION: Further studies to establish acellular Hb optimal dosage, efficacy, safety, and effects on outcome are indicated before these solutions are implemented in routine practice.
Lung transplantation complicated by graft‐versus‐host disease and confounded by incidental transfusion‐associated macrochimerism
Authors: Pavenski Katerina , Kamel‐Reid Suzanne , Wei Cuihong , Cserti‐Gazdewich Christine M. 
Published: July 2008

BACKGROUND:Passenger lymphocyte–mediated graft‐versus‐host disease (GVHD) in solid organ transplantation (SOT‐GVHD) is considered a rare complication, particularly among recipients of lung allografts. The risk of transfusion‐associated GVHD (TA‐GVHD) in solid organ transplants is also considered rare. The suspicion of either may be heralded by signs and symptoms of GVHD in the company of a population of passenger lymphocytes in excess of 1 percent (microchimerism). This case report illustrates the challenge of a patient who presented with macrochimerism both from the lung transplant allograft and from transfusions.STUDY DESIGN AND METHODS:Chimerism assessments of the pre‐ and posttransplant donor lung, and the recipient's aplastic marrow, were made using DNA‐based polymerase chain reaction testing.RESULTS:Macrochimerism was observed in both the posttransplant aplastic host marrow and the engrafted donor lung, with the former predominantly consisting of lung donor lymphocytes and the latter a mixture of lung and presumably transfusion source donor lymphocytes. The pretransplant donor lung exhibited no GVHD‐like pathology.CONCLUSION:This case demonstrates SOT‐GVHD, with the unusual feature of concomitant macrochimerism from transfusions. SOT‐GVHD likely predisposed this patient to the observed transfusion‐associated macrochimerism. However, the dissociation between transfusion‐attributable macrochimerism and attributable pathology is intriguing. Furthermore, the risk spectrum of transfusion‐associated macrochimerism and TA‐GVHD in solid organ transplant recipients with and without the complication of SOT‐GVHD is unknown and warrants further study.
Validation of HLAMatchmaker algorithm in identifying acceptable HLA mismatches for thrombocytopenic patients refractory to platelet transfusions
Authors: Brooks Erin G. , MacPherson Bruce R. , Fung Mark K. 
Published: July 2008

BACKGROUND: HLAMatchmaker (HLAMM) is an algorithm that determines donor‐recipient histocompatibility based on HLA type. This study determines the effectiveness of HLAMM in identifying suitable platelet (PLT) donors for refractory patients.STUDY DESIGN AND METHODS: Data from a previous prospectively randomized multicenter study comparing cross‐reactive group (CREG)‐matched versus serologic crossmatch‐selected PLT transfusions in refractory patients were analyzed. By use of HLAMM, the compatibility of donor‐recipient pairings was determined as the number of donor triplet mismatches (TMMs) and eplet mismatches (EMMs) and compared against the posttransfusion PLT corrected count increment (CCI). The data included 73 patients who received up to two CREG‐matched and crossmatch‐selected PLT transfusions each (214 transfusions analyzed).RESULTS: TMM and EMM values correlated well with CREG match grade. A and BU matches had TMM and EMM values of 0; BX matches had TMMs and EMMs of 4 and 6 respectively; and C and D matches had TMMs of 10 to 21 and EMMs of 13 to 24. Fewer mismatches (TMM or EMM) predicted better transfusion outcomes (p < 0.05). The median 1‐hour CCI was 8000 with TMMs of not more than 9 versus 6000 with TMMs of more than 9. The median 1‐hour CCI was 7954 with EMMs of not more than 11 versus 6356 with EMMs of more than 11. The positive predictive value of the different methods in producing a 1‐hour CCI of more than 7500 were comparable: TMM, 56 percent; EMM, 54 percent; CREG, 50 percent; and crossmatching, 45 percent (p > 0.05).CONCLUSIONS: HLAMM (both TMM and EMM) successfully identified donors associated with good transfusion outcomes in refractory recipients and represents an acceptable method of choosing donors for refractory patients.
The International Quotidian Dialysis Registry: Annual report 2008
Authors: NESRALLAH Gihad E. , SURI Rita S. , MOIST Louise M. , OFSTHUN Norma J. , HAKIM Raymond , MCDONALD Stephen P. , MARSHALL Mark R. , CARTER Shannon T. , LINDSAY Robert M. 
Published: July 2008

AbstractAlternative hemodialysis (HD) schedules, including short‐daily and nocturnal HD, continue to proliferate, with the hope of offering improved patient outcomes. Three nights per week and every other night, nocturnal HD are now being provided to more patients worldwide, both at home and in‐center. However, alternative HD schedules are still experimental in most centers, and studies establishing the efficacy of these therapies with respect to major clinical outcomes are needed. Endorsed by the National Institutes of Health, the International Quotidian Dialysis Registry is an international collaboration that was established in 2002 to prospectively study large numbers of patients treated with alternate HD schedules. The Registry will ultimately allow alternate HD modalities to be compared to conventional thrice‐weekly HD with respect to clinical endpoints, including mortality, using a prospective cohort study. To date, the Registry has enrolled 182, 1193, and 740 subjects from Canada, the United States, and Australia, respectively. This report is the fourth annual update and describes recruitment progress, baseline characteristics of enrolled patients, and worldwide prescription patterns.
Practical guidance for dialyzing a hemodialysis patient following acute brain injury
Authors: DAVENPORT Andrew 
Published: July 2008

AbstractThe incidence of acute brain injury in chronic hemodialysis patients is increasing, as the dialysis population is becoming increasingly older, often hypertensive, at risk of ischemic and/or hemorrhagic stroke, and subdural hemorrhage. Standard intermittent hemodialysis treatments typically lead to an increase in cerebral swelling, which can exacerbate underlying cerebral damage. In critically ill patients, continuous modes of renal replacement therapy may be required, but depending upon the clinical condition, simple modifications to standard intermittent therapies may suffice, and allow effective delivery of renal replacement therapy, but ensure that patient outcomes both in terms of mortality and residual functional brain damage is no different between those with normal renal function and those on the chronic dialysis program.
Severe jaw enlargement associated with uremic hyperparathyroidism
Authors: TARRASS Faissal , BENJELLOUN Meryem , BENSAHA Tarik 
Published: July 2008

AbstractMarked enlargement of the jaws is a rare complication of renal osteodystrophy. This report describes a localized enlargement of the mandible due to a brown tumor in a patient undergoing chronic hemodialysis. Literature on jaw involvement in secondary hyperparathyroidism is reviewed.
Interdialytic blood pressure obtained by ambulatory blood pressure measurement and left ventricular structure in hypertensive hemodialysis patients
Authors: MOMINADAM Siddig , OZKAHYA Mehmet , KAYIKCIOGLU Meral , TOZ Huseyin , ASCI Gulay , DUMAN Soner , ERGIN Pinar , KIRBIYIK Sait , OK Ercan , BASCI Ali 
Published: July 2008

AbstractUnlike in subjects with normal renal function, the relationship between hypertension and cardiovascular morbidity and mortality in dialysis patients is still being debated. In order to clarify this issue, we performed 44‐hour ambulatory blood pressure measurements (ABPM) during the interdialytic period in a group of 164 hypertensive patients, the blood pressure (BP) control based on conventional antihypertensive strategy previously, on chronic hemodialysis treatment in the Mediterranean region of Turkey. These results were then compared with their echocardiographic data. This is a cross‐sectional analysis. The mean ABPM during 44 hours was close to the manually measured predialysis value, but there was a gradual increase in the ABPM values in the interdialytic period. When divided into a group with mild or no left ventricular hypertrophy (LVH) (45 patients) and severe LVH (119 patients), the latter had significantly higher BP levels in all separate periods, while the difference in predialysis BP was not significant. Patients with severe LVH had larger left atrium and left ventricular diameters, and consumed more antihypertensive drugs. Systolic BP during the night before dialysis showed the strongest relation to LVH, but interdialytic weight gain was also independently related to LVH. Yet, 56% of the patients with systolic BP <135 had severe LVH. There is not only an association between BP and presence of LVH, but it is shown that volume expansion is also an important independent determinant of LVH. This may explain the difficulty in identifying hypertension as a cardiac risk factor in these patients.