bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hemodialysis Central Venous Catheters as a Source of Inflammation and Its Implications
Authors: Hung Adriana M. , Alp Ikizler T. 
Published: October 2008

AbstractThe mortality rate for end‐stage renal disease patients is six times higher than in the general population. Hemodialysis central venous catheter (CVC) utilization has increased by 50% between 1998 and 2004 and data from the United States Renal Data System suggest that 81% of the patients initiate hemodialysis through a CVC. There is evidence that the two observations are linked in both an obvious way (catheter‐related sepsis) as well as in a less obvious manner—chronic inflammation. Inflammation is highly prevalent in chronic hemodialysis (CHD) patients and is consistently associated with poor outcomes. Some of the most important consequences of inflammation in CHD include, but are not limited to, cardiovascular disease, uremic protein‐energy wasting, erythropoietin hyporesponsiveness, and increased hospitalization and death rates. Use of CVC has been long suspected to play a role in the inflammatory response in CHD patients. Recent studies have shown that the presence of CVCs is associated with higher levels of C‐reactive protein (CRP), lower serum albumin values, and lower hemoglobin values. Furthermore, there are data showing that CRP levels decrease following CVC removal. Accordingly, avoidance of CVC represents an effective strategy to limit the inflammatory response in CHD patients and potentially prevent its devastating consequences.
Pathophysiology and Management of Fluid and Electrolyte Disturbances in Patients on Chronic Dialysis with Severe Hyperglycemia
Authors: Tzamaloukas Antonios H. , Ing Todd S. , Siamopoulos Kostas C. , Raj Dominic S. C. , Elisaf Moses S. , Rohrscheib Mark , Murata Glen H. 
Published: October 2008

AbstractThe mechanisms of fluid and solute abnormalities that should be considered in any patient with severe hyperglycemia include changes in the total amount of extracellular solute, osmotic diuresis, intake of water driven by thirst, and influences from associated conditions. The absence of osmotic diuresis distinguishes dialysis‐associated hyperglycemia (DH) from hyperglycemia with preserved renal function (HPRF). Mainly because of this absence, comparable degrees of hyperglycemia tend to produce less hypertonicity and less severe intracellular volume contraction in DH than in HPRF, while extracellular volume is expanded in DH but contracted in HPRF. Ketoacidosis can develop in both DH and HPRF. Among DH patients, hyperkalemia appears to be more frequent when ketoacidosis is present than when nonketotic hyperglycemia is present. Among HPRF patients, the frequency of hyperkalemia appears to be similar whether ketoacidosis or nonketotic hyperglycemia is present. Usually patients with severe DH have no symptoms or may exhibit a thirst. Infrequent clinical manifestations of DH include coma and seizures from hypertonicity or ketoacidosis and pulmonary edema from extracellular expansion. Insulin infusion is usually the only treatment required to correct the biochemical abnormalities and reverse the clinical manifestations of DH. Monitoring of the clinical manifestations and biochemical parameters during treatment of DH with insulin is needed to determine whether additional measures, such as administration of saline, free water, or potassium salts, as well as emergency hemodialysis (HD) are needed. Emergency HD carries the risk of excessively rapid decline in tonicity; its benefits in the treatment of DH have not been established.
Dialysis Research: Surface‐Area‐Normalized Kt/V: A Method of Rescaling Dialysis Dose to Body Surface Area—Implications for Different‐Size Patients by Gender
Authors: Daugirdas John T. , Depner Thomas A. , Greene Tom , Kuhlmann Martin K. , Levin Nathan W. , Chertow Glenn M. , Rocco Michael V. 
Published: October 2008

AbstractDialysis is measured as Kt/V, which scales the dose (Kt) to body water content (V). Scaling dialysis dose to body surface area (Sdub) has been advocated, but the implications of such rescaling have not been examined. We developed a method of rescaling measured Kt/V to Sdub and studied the effect of such alternative scaling on the minimum adequacy values that might then be applied in male and female patients of varying body size. We examined anthropometric estimates of V and S (Watson vs. Dubois estimates) in 1765 patients enrolled in the HEMO study after excluding patients with amputations. An S‐normalized target stdKt/V was defined, and an adequacy ratio (R) was computed for each patient as R = D/N where D = delivered stdKt/V (calculated using the Gotch–Leypoldt equation for stdKt/V) and N = the S‐normalized minimum target value. In the HEMO data set, we determined the extent to which baseline (prerandomization) stdKt/V values would have exceeded such an S‐based minimum target stdKt/V. The median Vwat:Sdub ratios were significantly higher in men (21.34) than in women (18.50). The average of these (20) was used to normalize the current suggested minimally adequate value (stdKt/V ≥ 2.0/week) to the S‐normalized target value (stdKt/S ≥ 40 L/M2), assuming that average modeled V = average anthropometric V. To achieve this S‐normalized target, the required single‐pool (sp) Kt/V was always higher in women than in men at any level of body size. For small patients (Vwat = 25L), required stdKt/V values were 2.05 and 2.21/week for men and women, respectively, corresponding to spKt/V values of 1.31 and 1.52/session. On the other hand, large (Vwat = 50L) male patients would need spKt/V values of only 1.0/session. Prerandomization baseline dialysis sessions in the HEMO study were found to meet such a new S‐based standard in almost all (766/773) men and in 885/992 women. An analysis of scaling dose to anthropometrically estimated liver size (L) showed similar gender ratios for Vwat:L and Vwat:Sdub, providing a potential physiologic explanation underpinning S‐based scaling. S‐based scaling of the dialysis dose would require considerably higher doses in small patients and in women, and would allow somewhat lower doses in larger male patients. Current dialysis practice would largely meet such an S‐based adequacy standard if the dose were normalized to a Vwat:Sdub ratio of 20.
Treatment Time, Chronic Inflammation, and Hemodynamic Stability: The Overlooked Parameters in Hemodialysis Quantification
Authors: Zsom Lajos , Zsom Marianna , Fulop Tibor , Flessner Michael F 
Published: October 2008

AbstractDecades after the introduction of chronic maintenance hemodialysis, the optimal means of quantifying dialysis dose remains controversial. Differences of opinion in the international dialysis community lead to substantial diversity in everyday clinical practice. Several studies suggest that the well‐recognized international mortality differences in hemodialysis populations may result from these divergent approaches to dialysis care. One of the main areas of divergence is the different degree of reliance on dialysis clearance when prescribing dialysis. The “clearance approach” implies that treatment quality is primarily dependent on efficient removal of uremic toxins as estimated by dialytic urea clearance. Urea can be rapidly removed by high efficiency dialysis in a relatively short time. The main alternative to this strategy is the “time approach” based on the recognition that longer or more frequent dialysis provides benefits beyond increasing urea removal. Some of the putative benefits are more effective volume and blood pressure control, better maintenance of hemodynamic stability because of slower ultrafiltration and removal of uremic toxins that do not behave like urea. Recently, chronic inflammation has been proposed to be an important predictor of outcome in dialysis patients. Inflammatory markers are commonly elevated in chronic renal failure and levels of these seem to correlate with malnutrition, maintenance of residual renal function, and volume control. The relationships between dialysis clearance, treatment time, chronic inflammation, volume control, and hemodynamic stability are explored in this review. We propose that a better understanding of these complex relationships may provide opportunities for improving outcomes of maintenance hemodialysis patients.
Haplotypic Variants in DRD2, ANKK1, TTC12, and NCAM1 are Associated With Comorbid Alcohol and Drug Dependence
Authors: Yang Bao‐Zhu , Kranzler Henry R. , Zhao Hongyu , Gruen Jeffrey R. , Luo Xingguang , Gelernter Joel 
Published: October 2008

Background:  Each gene in the chromosome 11q23 cluster of NCAM1, TTC12, ANKK1, and DRD2 is functionally linked to dopamine in brain. Many association studies of DRD2 and substance dependence (SD), including alcohol dependence (AD) and drug dependence (DD), have been reported; the results have been inconsistent. Recent association studies have considered this cluster more comprehensively, examining the association of SD with several risk variants mapped to the other genes in the cluster. Because comorbid AD with DD (AD+DD) is common, we hypothesized that heterogeneity of the SD diagnoses studied might have contributed to the inconsistency of prior results.Methods:  We conducted 2 separate association studies of AD+DD and AD without DD (AD‐only) in 1,090 European‐Americans using family‐based and case‐control designs and 43 single nucleotide polymorphisms mapped to this cluster. We used a generalized linear model and haplotype score tests for the case‐control sample, and the family‐based association test for the family sample.Results:  For AD+DD, the risk regions centered on TTC12 exon 3 [optimal individual haplotype simulated p (poihs) = 0.000015], and another extended from ANKK1 exon 8 to DRD2^C957T (poihs = 0.0028), in both samples. NCAM1 exon 12 markers showed global significance in both designs, but were significant for specific haplotypes (poihs = 0.0029) only for the family sample. For AD‐only, NCAM1 intron 14 to 18 and the junction of ANKK1 and DRD2 were associated globally. Population stratification was excluded as the basis for these results. Linkage disequilibrium contrast tests supported selection at TTC12 exon 3 and ANKK1 exon 2.Conclusions:  We conclude that variants in TTC12 exon 3, NCAM1 exon 12, and the two 3′‐ends of ANKK1 and DRD2 co‐regulate risk for comorbid AD and DD.
Age at First Drink and the First Incidence of Adult‐Onset DSM‐IV Alcohol Use Disorders
Authors: Dawson Deborah A. , Goldstein Risë B. , Patricia Chou S. , June Ruan W. , Grant Bridget F. 
Published: October 2008

Background:  Existing studies of the association between age at first drink (AFD) and the risk of alcohol use disorders (AUD) suffer from inconsistent levels of control and designs that may inflate associations by failure to control for duration of exposure to risk.Methods:  This study examined associations between AFD (ages <15 and 15–17 vs. 18+ years) and first incidence of DSM‐IV alcohol dependence, abuse, and specific AUD criteria over a 3‐year follow‐up in a longitudinal study of U.S. drinkers 18 years of age and older at baseline (n = 22,316), controlling for duration of exposure, family history, and a wide range of baseline and childhood risk factors.Results:  After adjusting for all risk factors, the incidence of dependence was increased for AFD < 15 years (OR = 1.38) and for women only with AFD at ages 15 to 17 (OR = 1.54). The incidence of abuse was increased at AFD <15 and 15 to 17 years (OR = 1.52 and 1.30, respectively). Most dependence criteria showed significant associations with AFD, but hazardous drinking and continued drinking despite interpersonal problems were the only abuse criteria to do so. All associations were nonsignificant after controlling for volume of consumption, except that AFD at all ages <18 combined was associated with a reduced likelihood of impaired control, and AFD at ages 15 to 17 was associated with lower odds of drinking more/longer than intended among heavy‐volume drinkers. In a population of low‐risk drinkers that excluded those with positive family histories, personality disorders, and childhood risk factors, there were strong associations between early AFD (<18) and the incidence of dependence (OR = 3.79) and continued drinking despite physical/psychological problems (OR = 2.71), but no association with incidence of abuse.Conclusions:  There is a robust association between AFD and the risk of AUD that appears to reflect willful rather than uncontrolled heavy drinking, consistent with misuse governed by poor decision‐making and/or reward‐processing skills associated with impaired executive cognitive function (ECF). Additional research is needed to determine causality in the role of impaired ECF, including longitudinal studies with samples of low‐risk adolescents.
Counting platelets in platelet concentrates on hematology analyzers: a multicenter comparative study
Authors: Van Der Meer Pieter F. , Dijkstra‐Tiekstra Margriet J. , Mahon Anne , De Wildt‐Eggen Janny 
Published: October 2008

BACKGROUND: Hematology analyzers are designed to count whole blood samples, but are also used by blood centers to perform quality control on blood components. In platelet (PLT) concentrates, the number of PLTs is approximately fivefold higher and red blood cells are absent, causing variable PLT counting results. It was our aim to compare currently used hematology analyzers for counting PLTs in PLT concentrates using fixed human PLTs.STUDY DESIGN AND METHODS: PLT samples were fixed, diluted into seven concentration levels (plus one blank), aliquoted, and shipped to 68 centers. Evaluable data were obtained for 89 hematology analyzers. All samples were counted six times, and results were reported to the coordinating center. The overall group mean was calculated, and the percentage deviation from this mean was calculated for each analyzer.RESULTS: At PLT levels relevant for blood centers, 750 × 109 to 2000 × 109 per L, analyzers gave results that were between 35 percent lower and 16 percent higher than the overall group mean. Within a group of analyzers, results were comparable with coefficient of variations usually below 10 percent, indicating that the observed differences were caused by instrument characteristics. A smaller study with fresh, unfixed PLT samples showed that analyzers behaved similarly for fixed and fresh PLTs.CONCLUSION: With a wide array of currently used hematology analyzers, a marked difference was determined for the PLT counts of fixed human‐based identical samples provided to 68 laboratories by a centralized facility. A gold standard method is needed to allow for more valid interlaboratory comparisons between hematology analyzers.
Donor platelets stored for at least 3 days can elicit activation marker expression by the recipient's blood mononuclear cells: an in vitro study
Authors: Cognasse Fabrice , Hamzeh‐Cognasse Hind , Lafarge Sandrine , Acquart Sophie , Chavarin Patricia , Courbil Rémi , Fabrigli Patrick , Garraud Olivier 
Published: October 2008

BACKGROUND: Recent studies have demonstrated that infused platelets (PLTs) can promote inflammation. The objective of this study was to evaluate the impact of storage of transfusion‐grade PLTs on the peripheral blood mononuclear cells (PBMNCs) of the recipient.STUDY DESIGN AND METHODS: An in vitro cell model system was established to measure the degree of activation of donor PLTs during 5 days of their storage and then to measure immune cell activation by detecting marker expression in coculture experiments.RESULTS: The level of soluble CD62p increased significantly by Day 3, and membrane expression of CD62p increased significantly from Day 2, indicating some degree of PLT activation over time during storage (p < 0.05). Donor PLTs and PBMNC subsets (monocytes, B cells, and T cells) from recipients were cocultured for 48 hours. The number of PLT‐PBMNC subset doublets detected by flow cytometry was correlated with the PLT storage time after Day 3 (p < 0.05), indicating consistent binding of PLTs to PBMNCs. The results of these experiments showed that there was a consistent and significant increase in expression of conventional activation markers of T cells, B cells, and monocytes compared with appropriate controls (p < 0.05 to <0.01).CONCLUSION: The results of this study indicate that, from Day 3 onward, activation markers are consistently expressed on PLTs. From these results, we conclude that activated PLTs may affect PBMNC interactions in recipients.
Fibrin glue for refractory hemorrhagic cystitis after unrelated marrow, cord blood, and haploidentical hematopoietic stem cell transplantation
Authors: Tirindelli Maria Cristina , Flammia Gerardo , Sergi Federico , Cerretti Raffaella , Cudillo Laura , Picardi Alessandra , Postorino Massimiliano , Annibali Ombretta , Greco Rosa , Avvisati Giuseppe , Arcese William 
Published: October 2008

BACKGROUND: Patients undergoing hematopoietic stem cell transplant (HSCT) are particularly exposed to the risk of developing hemorrhagic cystitis (HC), which is characterized by symptoms ranging from macroscopic hematuria to renal failure. Although HC significantly affects the quality of life and in a few cases becomes intractable leading to patient death, its therapeutic management has not been established. Fibrin glue (FG), a hemostatic agent derived from human plasma, has been largely employed in different surgical settings including urologic procedures.STUDY DESIGN AND METHODS: In this pilot study we used FG to treat refractory HC. During cystoscopy, bladder distension was maintained at a constant pressure of 12 mmHg by a carbon dioxide insufflator. An endoscopic applicator allowed spraying FG on the bleeding and raw surfaces of bladder mucosa.RESULTS: Five of 221 patients undergoing an HSCT developed a very severe, refractory HC and have been treated with endoscopic FG. The treatment was successful in 3 patients; the response was partial in 1 patient and transient in the last one, whose clinical course was severely complicated by acute graft‐versus‐host disease and multiple organ failure.CONCLUSIONS: FG therapy is a feasible procedure and this pilot study suggests that it may be an effective treatment for refractory HC. Its application could be considered also in Grade 1 or 2 HC to prevent progression of damaged mucosa. The use of FG for HC should be prospectively investigated in terms of therapeutic efficacy, transfusion support, length of hospitalization, quality of life, and costs.
Expression levels of CD47, CD35, CD55, and CD59 on red blood cells and signal‐regulatory protein‐α,β on monocytes from patients with warm autoimmune hemolytic anemia
Authors: Barros Melca M.O. , Yamamoto Mihoko , Figueiredo Maria S. , Cançado Rodolfo , Kimura Elisa Y.S. , Langhi Dante M. , Chiattone Carlos S. , Bordin Jose O. 
Published: October 2008

BACKGROUND:Animal models have shown that CD47‐deficient mice develop severe autoimmune hemolytic anemia (AIHA) because the binding of red blood cell (RBC) CD47 to signal‐regulatory protein (SIRP‐α) on macrophages contributes to the inhibition of phagocytosis. In contrast, complement‐inhibitory proteins such as CD35, CD55, and CD59 may protect RBCs against the lysis by complement.STUDY DESIGN AND METHODS:With the use of flow cytometric analyses, the expression of CD47, CD35, CD55, and CD59 on RBCs and of SIRP‐α,β on peripheral monocytes of 36 patients with warm AIHA (wAIHA; 23 with active wAIHA, 13 with wAIHA in remission) and 20 healthy subjects was evaluated.RESULTS:The mean fluorescence intensities (MFIs) of the expression of CD47, CD35, CD55, and SIRP‐α,β of active wAIHA patients, wAIHA in remission, and healthy subjects were not statistically different. Patients with active wAIHA showed significantly lower CD59 expression on RBCs than healthy individuals (MFI, 512.5 ± 59.6 vs. 553.7 ± 36.6; p = 0.009), while the CD59 expression in patients with wAIHA in remission was not significantly different from that of healthy controls (MFI, 538.4 ± 48.3 vs. 553.7 ± 36.6; p > 0.05). The expression of CD59 on RBCs of 3 patients who died from the wAIHA was lower than that seen on RBCs of healthy controls (MFI, 433.6 ± 69.6 vs. 553.74 ± 36.6; p = 0.0001).CONCLUSIONS:Our data show that the expression of CD47 on RBCs and SIRP‐α,β on monocytes of patients with wAIHA is not different from that seen in healthy individuals. In addition, we detected that patients with active wAIHA present low expression of CD59 and normal expression of CD35 and CD55 on their RBCs. Complement‐regulatory proteins may play an important role in protecting RBC destruction through the activation of complement.
Long‐term deficits in health‐related quality of life after recovery from thrombotic thrombocytopenic purpura
Authors: Lewis Qurana F. , Lanneau Marion S. , Mathias Susan D. , Terrell Deirdra R. , Vesely Sara K. , George James N. 
Published: October 2008

BACKGROUND: After recovery from thrombotic thrombocytopenic purpura (TTP), patients commonly describe persistent problems with memory, concentration, and endurance.STUDY DESIGN AND METHODS: The Oklahoma TTP‐HUS Registry, an inception cohort of 364 patients, January 1, 1989, through June 30, 2007, has annually evaluated health‐related quality‐of‐life since 1998 with the Short Form (SF)‐36, a widely used questionnaire that assesses eight domains of physical and mental health.RESULTS: A total of 128 patients were eligible for this study (age ≥ 18 years, alive in January 1998 without prior relapse, survival and no relapse ≥1 year after recovery, no overt disability or additional disorders); 118 (92%) completed the SF‐36. At their initial assessment, these patients had significantly worse functioning and well‐being than the US population for all domains (p < 0.05). Forty‐nine patients who had their initial assessment more than 2 years after recovery had better scores for three domains than 69 patients who had their initial assessment 2 years or less after recovery (p < 0.05). Among these 69 patients, there was no difference between subgroups: 1) idiopathic versus other categories of TTP, 2) the presence or absence of severe ADAMTS13 deficiency, 3) the presence or absence of severe neurologic abnormalities during the episode of TTP, and 4) less than 10 or 10 or more plasma exchange treatments required to achieve remission (p > 0.05). Analysis of serial assessments in 72 (61%) of the 118 patients who had two or more assessments within 5 years of recovery and no intervening relapses demonstrated no significant improvement in any of the domains.CONCLUSION: After recovery from TTP, patients may have persistent cognitive and physical difficulties.