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Sample records for stages 3-5 chronic

  1. Longitudinal observations on circadian blood pressure variation in chronic kidney disease stages 3-5

    DEFF Research Database (Denmark)

    Elung-Jensen, T.; Strandgaard, S.; Kamper, Anne-Lise

    2008-01-01

    /non-dipper status prospectively in a study on dosage of enalapril in progressive chronic kidney disease (CKD) stages 3-5. METHODS: In 34 patients, 24-h ambulatory BP (A&D TM2421) was measured at baseline and every 4 months for 1 year or until the need for renal replacement therapy. For each BP recording patients...

  2. Vitamin status and needs for people with stages 3-5 chronic kidney disease.

    Science.gov (United States)

    Steiber, Alison L; Kopple, Joel D

    2011-09-01

    Patients with chronic kidney disease (CKD) often experience a decline in their nutrient intake starting at early stages of CKD. This reduction in intake can affect both energy-producing nutrients, such as carbohydrates, proteins, and fats, as well as vitamins, minerals, and trace elements. Knowledge of the burden and bioactivity of vitamins and their effect on the health of the patients with CKD is very incomplete. However, without sufficient data, the use of nutritional supplements to prevent inadequate intake may result in either excessive or insufficient intake of micronutrients for people with CKD. The purpose of this article is to briefly summarize the current knowledge regarding vitamin requirements for people with stages 3, 4, or 5 CKD who are not receiving dialysis. Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  3. Vitamins K and D status in patients with stages 3-5 chronic kidney disease

    Science.gov (United States)

    Background and Objectives: Vitamin K, vitamin K-dependent (VKD) proteins and vitamin D may be involved in the regulation of calcification in chronic kidney disease (CKD). Design, setting, participants and measurements: Vitamin K and D status was measured as dietary intake, plasma phylloquinone, se...

  4. Uraemia progression in chronic kidney disease stages 3-5 is not constant

    DEFF Research Database (Denmark)

    Heaf, James Goya; Mortensen, Leif Spange

    2011-01-01

    Chronic kidney disease (CKD) is a progressive disease leading to loss of glomerular filtration rate (ΔGFR, measured in ml/min/1.73 m(2)/year). ΔGFR is usually assumed to be constant, but the hyperfiltration theory suggests that it accelerates in severe uraemia. A retrospective analysis of estimated...... GFR (eGFR) calculated from the Modification of Diet in Renal Disease equation was performed to evaluate whether ΔGFR is constant or accelerating....

  5. Association between periodontitis and mortality in stages 3-5 chronic kidney disease: NHANES III and linked mortality study.

    Science.gov (United States)

    Sharma, Praveen; Dietrich, Thomas; Ferro, Charles J; Cockwell, Paul; Chapple, Iain L C

    2016-02-01

    Periodontitis may add to the systemic inflammatory burden in individuals with chronic kidney disease (CKD), thereby contributing to an increased mortality rate. This study aimed to determine the association between periodontitis and mortality rate (all-cause and cardiovascular disease-related) in individuals with stage 3-5 CKD, hitherto referred to as "CKD". Survival analysis was carried out using the Third National Health and Nutrition Examination Survey (NHANES III) and linked mortality data. Cox proportional hazards regression was employed to assess the association between periodontitis and mortality, in individuals with CKD. This association was compared with the association between mortality and traditional risk factors in CKD mortality (diabetes, hypertension and smoking). Of the 13,784 participants eligible for analysis in NHANES III, 861 (6%) had CKD. The median follow-up for this cohort was 14.3 years. Adjusting for confounders, the 10-year all-cause mortality rate for individuals with CKD increased from 32% (95% CI: 29-35%) to 41% (36-47%) with the addition of periodontitis. For diabetes, the 10-year all-cause mortality rate increased to 43% (38-49%). There is a strong, association between periodontitis and increased mortality in individuals with CKD. Sources of chronic systemic inflammation (including periodontitis) may be important contributors to mortality in patients with CKD. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Association of serum total bilirubin with renal outcome in Japanese patients with stages 3-5 chronic kidney disease.

    Science.gov (United States)

    Sakoh, Teppei; Nakayama, Masaru; Tanaka, Shigeru; Yoshitomi, Ryota; Ura, Yoriko; Nishimoto, Hitomi; Fukui, Akiko; Shikuwa, Yui; Tsuruya, Kazuhiko; Kitazono, Takanari

    2015-09-01

    Serum bilirubin has been reported to be associated with the progression of kidney disease in patients with diabetic nephropathy. Less is known, however, about the relationship between bilirubin and chronic kidney disease (CKD) of other etiologies. This study was designed to clarify whether serum total bilirubin concentration is associated with kidney disease progression in patients with CKD independent of etiology. This prospective observational study enrolled 279 consecutive patients with stages 3-5 CKD. The renal endpoint was the composite of the doubling of serum creatinine or end-stage renal disease requiring dialysis. Patients were divided into three groups by their serum total bilirubin concentrations: ≤0.3 (lowest), 0.4-0.5 (middle), and ≥0.6 (highest) mg/dL. A Cox proportional hazards model was applied to determine the risk factors for poor renal outcome. The median follow-up period was 21months. One-hundred and three patients reached renal end points. After multivariable adjustment, a 0.1mg/dL increase in serum bilirubin was associated negatively with poor renal outcome (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.60-0.87). In addition, after adjustment for confounding factors, including traditional and nontraditional cardiovascular risk factors, the middle (HR 3.14, 95% CI 1.36-8.57) and lowest (HR 4.22, 95% CI 1.81-11.59) bilirubin groups had significantly higher HRs for renal outcome than the highest bilirubin group. Lower serum bilirubin concentration was independently associated with adverse renal outcomes, suggesting that the measurement of serum bilirubin is useful for predicting kidney disease progression in patients with moderate to severe CKD. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Epicardial fat accumulation, cardiometabolic profile and cardiovascular events in patients with stages 3-5 chronic kidney disease.

    Science.gov (United States)

    Cordeiro, A C; Amparo, F C; Oliveira, M A C; Amodeo, C; Smanio, P; Pinto, I M F; Lindholm, B; Stenvinkel, P; Carrero, J J

    2015-07-01

    It has been hypothesized that epicardial adipose tissue (EAT) exerts pathogenic effects on cardiac structures. We analysed the associations between EAT and both cardiovascular (CV) disease risk factors and CV events in patients with chronic kidney disease (CKD). We included 277 nondialysed patients [median age 61, interquartile range (IQR) 53-68 years; 63% men] with stages 3-5 CKD in this cross-sectional evaluation. EAT and abdominal visceral adipose tissue (VAT) were assessed by computed tomography. Patients were followed for median 32 (IQR 20-39) months, and the composite of fatal and nonfatal CV events was recorded. With increasing EAT quartiles, patients were older, had higher glomerular filtration rate, body mass index, waist, VAT and coronary calcification, higher levels of haemoglobin, triglycerides, albumin, C-reactive protein and leptin and higher prevalence of left ventricular hypertrophy and myocardial ischaemia; total and high-density lipoprotein cholesterol, 25-hydroxy-vitamin D and 1, 25-dihydroxy-vitamin D progressively decreased. Associations between EAT and cardiac alterations were not independent of VAT. During follow-up, 58 CV events occurred. A 1-SD higher EAT volume was associated with an increased risk of CV events in crude [hazard ratio (HR) 1.41, 95% confidence interval (CI) (1.12-1.78) and adjusted (HR 1.55, 95% CI 1.21-1.99) Cox models. However, adding EAT to a standard CV disease risk prediction model did not result in a clinically relevant improvement in prediction. Epicardial adipose tissue accumulation in patients with CKD increases the risk of CV events independent of general adiposity. This is consistent with the notion of a local pathogenic effect of EAT on the heart or heart vessels, or both. However, EAT adds negligible explanatory power to standard CV disease risk factors. © 2015 The Association for the Publication of the Journal of Internal Medicine.

  8. Five-Year Incidence of Chronic Kidney Disease (Stage 3-5) and Associated Risk Factors in a Spanish Cohort: The MADIABETES Study

    Science.gov (United States)

    Salinero-Fort, Miguel A.; San Andrés-Rebollo, Francisco J.; de Burgos-Lunar, Carmen; Gómez-Campelo, Paloma; Chico-Moraleja, Rosa M.; López de Andrés, Ana; Jiménez-García, Rodrigo

    2015-01-01

    Objective To evaluate the incidence rate of Chronic Kidney Disease (CKD) stage 3-5 (persistent decreased kidney function under 60 mL/min per 1.73 m2) among patients with type 2 diabetes over five years, to identify the risk factors associated with CKD, and develop a risk table to predict five-year CKD stage 3-5 risk stratification for clinical use. Design The MADIABETES Study is a prospective cohort study of 3,443 outpatients with type 2 diabetes mellitus, sampled from 56 primary health care centers (131 general practitioners) in Madrid (Spain). Results The cumulative incidence of CKD stage 3-5 at five-years was 10.23% (95% CI = 9.12–11.44) and the incidence density was 2.07 (95% CI = 1.83–2.33) cases per 1,000 patient-months or 2.48 (95% CI = 2.19–2.79) cases per 100 patient-years. The highest hazard ratio (HR) for developing CKD stage 3-5 was albuminuria ≥300 mg/g (HR = 4.57; 95% CI= 2.46-8.48). Furthermore, other variables with a high HR were age over 74 years (HR = 3.20; 95% CI = 2.13–4.81), a history of Hypertension (HR = 2.02; 95% CI = 1.42–2.89), Myocardial Infarction (HR= 1.72; 95% IC= 1.25–2.37), Dyslipidemia (HR = 1.68; 95% CI 1.30–2.17), duration of diabetes mellitus ≥ 10 years (HR = 1.46; 95% CI = 1.14-1.88) and Systolic Blood Pressure >149 mmHg (HR = 1.52; 95% CI = 1.02–2.24). Conclusions After a five-year follow-up, the cumulative incidence of CKD is concordant with rates described in Spain and other countries. Albuminuria ≥ 300 mg/g and age over 74 years were the risk factors more strongly associated with developing CKD (Stage 3-5). Blood Pressure, lipid and albuminuria control could reduce CKD incidence of CKD in patients with T2DM. PMID:25856231

  9. Five-year incidence of chronic kidney disease (stage 3-5 and associated risk factors in a Spanish cohort: the MADIABETES Study.

    Directory of Open Access Journals (Sweden)

    Miguel A Salinero-Fort

    Full Text Available To evaluate the incidence rate of Chronic Kidney Disease (CKD stage 3-5 (persistent decreased kidney function under 60 mL/min per 1.73 m2 among patients with type 2 diabetes over five years, to identify the risk factors associated with CKD, and develop a risk table to predict five-year CKD stage 3-5 risk stratification for clinical use.The MADIABETES Study is a prospective cohort study of 3,443 outpatients with type 2 diabetes mellitus, sampled from 56 primary health care centers (131 general practitioners in Madrid (Spain.The cumulative incidence of CKD stage 3-5 at five-years was 10.23% (95% CI = 9.12-11.44 and the incidence density was 2.07 (95% CI = 1.83-2.33 cases per 1,000 patient-months or 2.48 (95% CI = 2.19-2.79 cases per 100 patient-years. The highest hazard ratio (HR for developing CKD stage 3-5 was albuminuria ≥ 300 mg/g (HR = 4.57; 95% CI= 2.46-8.48. Furthermore, other variables with a high HR were age over 74 years (HR = 3.20; 95% CI = 2.13-4.81, a history of Hypertension (HR = 2.02; 95% CI = 1.42-2.89, Myocardial Infarction (HR= 1.72; 95% IC= 1.25-2.37, Dyslipidemia (HR = 1.68; 95% CI 1.30-2.17, duration of diabetes mellitus ≥ 10 years (HR = 1.46; 95% CI = 1.14-1.88 and Systolic Blood Pressure >149 mmHg (HR = 1.52; 95% CI = 1.02-2.24.After a five-year follow-up, the cumulative incidence of CKD is concordant with rates described in Spain and other countries. Albuminuria ≥ 300 mg/g and age over 74 years were the risk factors more strongly associated with developing CKD (Stage 3-5. Blood Pressure, lipid and albuminuria control could reduce CKD incidence of CKD in patients with T2DM.

  10. Associations of epicardial fat with coronary calcification, insulin resistance, inflammation, and fibroblast growth factor-23 in stage 3-5 chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Kerr Jasmine D

    2013-01-01

    Full Text Available Abstract Background Epicardial fat, quantified in a single multi-slice computed tomography (MSCT slice, is a reliable estimate of total epicardial fat volume (EFV. We sought to determine risk factors for EFV detected in a single-slice MSCT measurement (ssEFV in pre-dialysis chronic kidney disease (CKD patients. Our primary objective was to determine the association between ssEFV and coronary artery calcification (CAC. Methods 94 pre-dialysis stage 3–5 CKD patients underwent MSCT to measure ssEFV and CAC. ssEFV was quantified at the level of the left main coronary artery. Measures of inflammation, traditional and kidney-related cardiovascular disease risk factors were collected. Results Mean age: 63.7 ± 14 years, 56% male, 39% had diabetes, and mean eGFR: 25.1 ± 11.9 mL/min/1.73 m2. Mean ssEFV was 5.03 ± 2.4 cm3. By univariate analysis, body mass index (BMI (r = 0.53; P = r = 0.51; P r = − 0.39; P =  Conclusions In stage 3–5 CKD, coronary calcification and IL-6 and were predictors of ssEFV. Further studies are needed to clarify the mechanism by which epicardial fat may contribute to the pathogenesis of coronary disease, particularly in the CKD population.

  11. Characteristics of bone mineral metabolism in patients with stage 3-5 chronic kidney disease not on dialysis: results of the OSERCE study.

    Science.gov (United States)

    Górriz, José L; Molina, Pablo; Bover, Jordi; Barril, Guillermina; Martín-de Francisco, Angel L; Caravaca, Francisco; Hervás, José; Piñera, Celestino; Escudero, Verónica; Molinero, Luis M

    2013-01-18

    OSERCE is a multi-centre and cross-sectional study with the aim of analysing the biochemical, clinical, and management characteristics of bone mineral metabolism alterations and the level of compliance with K/DOQI guideline recommendations in patients with chronic kidney disease (CKD) not on dialysis. The study included a total of 634 patients from 32 different Spanish nephrology units, all with CKD, estimated glomerular filtration rates <60 ml/min/1.73 m(2), and not on dialysis (K/DOQI stage: 33% stage 3, 46% stage 4, and 21% stage 5). In 409 of these patients, laboratory parameters were also measured in a centralised laboratory, including creatinine, calcium, phosphorous, intact parathyroid hormone (PTH), 25-OH-vitamin D, and 1,25-OH2-Vitamin D levels. The rates of non-compliance with the K/DOQI objectives for calcium, phosphorous, intact PTH, and calcium x phosphate product among these patients were 45%, 22%, 70%, and 4%, respectively. Of the 70% of patients with intact PTH levels outside of the target range established by the K/DOQI guidelines, 55.5% had values above the upper limit and 14.5% had values below the lower limit. Of the 45% of patients with calcium levels outside of the target range, 40% had values above the upper limit and 5% had values below the lower limit. Of the 22% of patients with phosphorous levels outside of the target range, 19% had values above the upper limit, and 3% had values below the lower limit. Finally, 4% of patients also had values for the calcium x phosphate product that were outside of the recommended range. Only 1.8% of patients complied with all four K/DOQI objectives. The values detected in centralised laboratory analyses were not significantly different from those measured in the laboratories at each institution. In addition, 81.5% of patients had a deficiency of calcidiol (25-OH-D3) (<30 ng/ml); of these, 35% had moderate-severe deficiency (<15 ng/ml) and 47% had mild deficiency (15-30 ng/ml). Calcitriol (1,25-OH2-D3

  12. Prevalence of osteoporosis in patients with chronic kidney disease (stages 3-5) in comparison with age- and sex-matched controls: A study from Kashmir Valley Tertiary Care Center.

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    Najar, M Saleem; Mir, Mohamad Muzzafer; Muzamil, Mudasir

    2017-01-01

    Chronic kidney disease (CKD) is associated with a range of metabolic bone diseases. Fracture rates are higher in CKD patients than age-matched controls throughout all the five stages of CKD. Dialysis patients have 4 times as many hip fractures as expected for their age. CKD forms an independent risk factor for osteoporosis, even in the absence of traditional risk factors. This study was carried out at the nephrology unit in a tertiary care center of Kashmir to know the prevalence of osteoporosis in CKD patients having glomerular filtration rate (GFR) stages 3-5). Among the 151 cases studied, the average estimated GFR was 16.78 ± 10.714 mL/min. There were 98 males (64.9%) and 53 females (35.1%). Their mean age was 51.01 ± 14.138 years. Osteoporosis based on femoral neck T-Score was seen in 31 patients (31.6%) while 43 patients (28.5%) had osteoporosis at L1, L2 lumbar vertebrae. The prevalence of osteoporosis based on femoral neck T-Score as well as osteopenia was highest in stage-5 CKD. In our study, the body mass index (BMI) had a positive correlation with osteoporosis; low BMI patients were at higher risk for osteoporosis (P = 0.014). In the Kashmir valley, the prevalence of osteoporosis was 31.8% in CKD patients against 22% in controls. Thus, CKD forms an important risk factor for osteoporosis even in the absence of traditional risk factors. We recommend early screening, detection, and management of osteoporosis to reduce the burden of morbidity and mortality in this subset of patients.

  13. Lifetime Risk of Stage 3-5 CKD in a Community-Based Sample in Iceland.

    Science.gov (United States)

    Inker, Lesley A; Tighiouart, Hocine; Aspelund, Thor; Gudnason, Vilmundur; Harris, Tamara; Indridason, Olafur S; Palsson, Runolfur; Shastri, Shani; Levey, Andrew S; Sarnak, Mark J

    2015-09-04

    Lifetime risk estimates of CKD can be used effectively in public education campaigns. This study sought to estimate lifetime risk of incident CKD stage 3 and higher in Iceland for people without CKD by the age of 45 years. This was a prospective cohort study with longitudinal creatinine measurements of residents in Reykjavik, Iceland, from 1967 to 2005. CKD was ascertained by two consecutive eGFR measurements <60 ml/min per 1.73 m(2), development of treated kidney failure, one eGFR<60 ml/min per 1.73 m(2) if the participant died before the next evaluation, or one eGFR<45 ml/min per 1.73 m(2) if it was the last eGFR. Mean follow-up was 25 (SD 10) years. Of the study participants, 727 (19%) developed the outcome and 942 (24%) died first. By age 85 years, the lifetime risks for 45-year-old women and men without prevalent CKD were 35.8% (95% confidence interval [95% CI], 32.7 to 38.9) and 21.3% (95% CI, 18.7 to 23.8), respectively. Risk was higher in individuals with a lower eGFR, hypertension, and a higher body mass index. Lifetime risk for higher stages of CKD 3b and 4 were less common than stage 3a; by age 85 years, the lifetime risks for CKD stages 3a, 3b, and 4 in women were 38.5% (95% CI, 25.8 to 51.1), 19.4% (95% CI, 8.9 to 29.9), and 3.6% (95% CI, 2.2 to 5.0), respectively. The lifetime risk of developing CKD stage 3 or higher is substantial, emphasizing the importance of strategies to prevent development of CKD throughout the course of life. Estimates are lower than reported using single estimates of GFR, emphasizing the importance of confirming estimates of reduced GFR in studies of CKD. Copyright © 2015 by the American Society of Nephrology.

  14. Stages of Chronic Lymphocytic Leukemia

    Science.gov (United States)

    ... in adults. It often occurs during or after middle age; it rarely occurs in children. Enlarge Anatomy of ... Approved for Chronic Lymphocytic Leukemia for more information. New types of treatment are being tested in clinical ...

  15. Longitudinal observations on circadian blood pressure variation in chronic kidney disease stages 3-5

    DEFF Research Database (Denmark)

    Elung-Jensen, T.; Strandgaard, S.; Kamper, Anne-Lise

    2008-01-01

    BACKGROUND: It has been suggested that status as a 'non-dipper' determined from 24-h blood pressure (BP) recordings is associated with increased risk of end-organ damage but little is known about the consistency of dipper status in renal patients. The present post hoc analysis evaluated dipper/no...

  16. Chronic toxicity of 1,3,5-triazine herbicides in the postembryonic development of the western clawed frog Silurana tropicalis.

    Science.gov (United States)

    Saka, Masahiro; Tada, Noriko; Kamata, Yoichi

    2018-01-01

    Seven 1,3,5- triazine (s-triazine) herbicides (ametryn, prometryn, dimethametryn, simazine, atrazine, propazine, and cyanazine) were tested using an amphibian (Silurana tropicalis) metamorphosis assay focusing on morphometric, gravimetric, and thyroid-histological endpoints. Premetamorphic tadpoles were exposed to each s-triazine at 2 concentrations between 1/1000 and 1/10 of the 96-h acute toxicity values, until all tadpoles in the control group reached either the late prometamorphosic stages or the initial stage of metamorphic climax. All s-triazines tested induced significant retardation in growth and development at the higher concentrations (0.2-1.0mg/L), and some of them induced similar effects even at the lower concentrations (0.02-0.1mg/L) while each showing a linear dose-response. Total size of the thyroid glands tended to be reduced corresponding to the delayed development, but without showing histomorphological lesions typical of anti-thyroid chemicals. These consistent results suggest that the s-triazines can act as a chemical stressor inhibiting tadpole growth and development, possibly without disrupting the thyroid axis. In addition, tadpoles exhibiting spinal curvatures appeared in either one or both of the lower and higher concentration groups for each s-triazine tested. The incidence rate in the s-triazine exposure groups where tadpoles with scoliosis were observed ranged from 3.3% to 63.3%, some of which were significantly higher than that in the respective control groups (0-6.7%). It is speculated that the s-triazines may promote to occur axial malformations in developing tadpoles. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Natural History of Progression of Chronic Kidney Disease in Stages ...

    African Journals Online (AJOL)

    Introduction: Patients with chronic kidney disease (CKD) often continue to progress spontaneously towards end stage renal disease (ESRD). In this report we studied the natural history of progression of CKD in a cohort of patients with stage 4 and 5 CKD. Methods: We retrospectively studied a cohort of patients in stage 4 ...

  18. Stage effect of chronic kidney disease in erectile function.

    Science.gov (United States)

    Costa, Márcio Rodrigues; Ponciano, Viviane Campos; Costa, Théo Rodrigues; Gomes, Caio Pereira; de Oliveira, Enio Chaves

    2018-01-01

    The study aims to assess the influence of the stage of chronic kidney disease and glomerular filtration rate on prevalence and degree of erectile dysfunction. This transversal study, conducted from May 2013 to December 2015, included patients with chronic kidney disease in conservative treatment, stages III/IV/V. Erectile dysfunction was evaluated by the International Index of Erectile Function. Data classically associated with erectile dysfunction were obtained by medical record review. Erectile dysfunction, degree of erectile dysfunction, and other main variables associated with erectile dysfunction were compared between patients with chronic kidney disease on conservative treatment stages III versus IV/V using the Chi-square test. The relationship between score of the International Index of Erectile Dysfunction and glomerular filtration rate was established by Pearson correlation coefficient. Two hundred and forty five patients with chronic kidney disease in con-servative treatment participated of the study. The prevalence of erectile dysfunction in patients with chronic kidney disease in stages IV/V was greater than in stage III. Glomerular filtration rate positively correlated with score of the International Index of Erectile Dysfunction. The study suggests that chronic kidney disease progression (glomerular filtration rate decrease and advance in chronic kidney disease stages) worsen erectile function. Hypothetically, diagnosis and treatment of erectile dysfunction may be anticipated with the analysis of chronic kidney disease progression. Copyright® by the International Brazilian Journal of Urology.

  19. Stage effect of chronic kidney disease in erectile function

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    Márcio Rodrigues Costa

    Full Text Available ABSTRACT Purpose The study aims to assess the influence of the stage of chronic kidney disease and glomerular filtration rate on prevalence and degree of erectile dysfunction. Materials and Methods This transversal study, conducted from May 2013 to December 2015, included patients with chronic kidney disease in conservative treatment, stages III/IV/V. Erectile dysfunction was evaluated by the International Index of Erectile Function. Data classically associated with erectile dysfunction were obtained by medical record review. Erectile dysfunction, degree of erectile dysfunction, and other main variables associated with erectile dysfunction were compared between patients with chronic kidney disease on conservative treatment stages III versus IV/V using the Chi-square test. The relationship between score of the International Index of Erectile Dysfunction and glomerular filtration rate was established by Pearson correlation coefficient. Results Two hundred and forty five patients with chronic kidney disease in conservative treatment participated of the study. The prevalence of erectile dysfunction in patients with chronic kidney disease in stages IV/V was greater than in stage III. Glomerular filtration rate positively correlated with score of the International Index of Erectile Dysfunction. Conclusions The study suggests that chronic kidney disease progression (glomerular filtration rate decrease and advance in chronic kidney disease stages worsen erectile function. Hypothetically, diagnosis and treatment of erectile dysfunction may be anticipated with the analysis of chronic kidney disease progression.

  20. Treatment Options by Stage (Chronic Lymphocytic Leukemia)

    Science.gov (United States)

    ... in adults. It often occurs during or after middle age; it rarely occurs in children. Enlarge Anatomy of ... Approved for Chronic Lymphocytic Leukemia for more information. New types of treatment are being tested in clinical ...

  1. Curcumin and Cholecalciferol in Treating Patients With Previously Untreated Stage 0-II Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma

    Science.gov (United States)

    2018-01-26

    Contiguous Stage II Small Lymphocytic Lymphoma; Noncontiguous Stage II Small Lymphocytic Lymphoma; Stage 0 Chronic Lymphocytic Leukemia; Stage I Chronic Lymphocytic Leukemia; Stage I Small Lymphocytic Lymphoma; Stage II Chronic Lymphocytic Leukemia

  2. The microorganisms in chronically infected end-stage and non-end-stage cystic fibrosis patients

    DEFF Research Database (Denmark)

    Rudkjøbing, Vibeke B; Thomsen, Trine R; Alhede, Morten

    2011-01-01

    Patients suffering from cystic fibrosis (CF) develop chronic lung infections because of highly viscous mucus, where bacteria can form biofilms. In this study, we investigated the microorganisms present in the lungs of end-stage and non-end-stage patients using standard culturing techniques......RNA gene analysis (J Clin Microbiol 2011, 49: 4352). Conversely, the non-end-stage patients were found to harbor several species by culturing. PNA FISH confirmed heterogeneous microbiota and showed that the bacteria were located in monospecies aggregates with no apparent physical interaction between...

  3. Staging chronic pancreatitis with exocrine function tests: Are we better?

    Science.gov (United States)

    Sperti, Cosimo; Moletta, Lucia

    2017-10-14

    Chronic pancreatitis (CP) is an inflammatory disease of the pancreas evolving in progressive fibrotic disruption of the gland with exocrine and endocrine pancreatic insufficiency. Although imaging features of CP are well known, their correlation with exocrine pancreatic function tests are not obvious, particularly in the early stage of the disease. There are many clinical classification of CP, all suggested for better distinguish and manage different forms based on etiological and clinical factors, and severity of the disease. Recently, a new classification of CP has been suggested: the M-ANNHEIM multiple risk factor classification that includes etiology, stage classification and degree of clinical severity. However, more accurate determination of clinical severity of CP requires a correct determination of exocrine function of the pancreas and fecal fat excretion. Recently, Kamath et al demonstrated that the evaluation of exocrine pancreatic function by acid steatocrit and fecal elastase-1 (EF-1) was helpful, but EF-1 was able to detect exocrine pancreatic insufficiency in more patients, upgrading some patients in higher stage of disease according to M-ANNHEIM classification. So, EF-1 is a more accurate test to determine exocrine pancreatic insufficiency and to stage chronic pancreatitis in the M-ANNHEIM classification. On the contrary, EF-1 determination shows low sensitivity in detecting exocrine pancreatic insufficiency in early stage of the disease.

  4. Nutritional management of stage 5 chronic kidney disease.

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    Pasticci, Franca; Fantuzzi, Anna Laura; Pegoraro, Marisa; McCann, Margaret; Bedogni, Giorgio

    2012-03-01

    Nutrition is a critical issue in the management of patients with stage 5 chronic kidney disease (CKD). Malnutrition is common among these patients and affects their survival and quality of life. A basic knowledge of the nutritional management of stage 5 CKD is essential for all members of the nephrology team to improve patient care. This paper demonstrates that the needs of haemodialysis patients are more complex than those receiving peritoneal dialysis. © 2011 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  5. Intermittent hemodialysis in dogs with chronic kidney disease stage III

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    Alessandra Melchert

    2017-08-01

    Full Text Available ABSTRACT: Intermittent hemodialysis (IHD is a form of renal replacement that is used in veterinary medicine for cases involving drug removal, electrolyte imbalance, acute kidney injury, and chronic kidney disease (CKD. The aim of the present study was to verify the efficacy of IHD in dogs with CKD staged at grade III and to evaluate the effect of IHD on quality of life. Twelve dogs with CKD at stage III met the inclusion criteria and were divided equally into two groups. The control group (n=6 received only clinical treatment and intravenous fluid therapy, and the hemodialysis group (n=6 received clinical and IHD treatments. Blood samples were collected before and after treatments in both groups. We evaluated complications and clinical parameters of IHD every 30 minutes. Hemodialysis decreased serum urea, creatinine, and phosphorus. Despite the evident removal of nitrogen compounds, dialysis treatment did not increase survival time in these patients. The results of this study do not support the early use of dialysis in dogs with chronic kidney disease stage III.

  6. Efficacy and safety of paricalcitol in children with stages 3 to 5 chronic kidney disease.

    Science.gov (United States)

    Webb, Nicholas J A; Lerner, Gary; Warady, Bradley A; Dell, Katherine M; Greenbaum, Larry A; Ariceta, Gema; Hoppe, Bernd; Linde, Peter; Lee, Ho-Jin; Eldred, Ann; Dufek, Matthew B

    2017-07-01

    Elevated intact parathyroid hormone (iPTH) levels can contribute to morbidity and mortality in children with chronic kidney disease (CKD). We evaluated the pharmacokinetics, efficacy, and safety of oral paricalcitol in reducing iPTH levels in children with stages 3-5 CKD. Children aged 10-16 years with stages 3-5 CKD were enrolled in two phase 3 studies. The stage 3/4 CKD study characterized paricalcitol pharmacokinetics and compared the efficacy and safety of paricalcitol with placebo followed by an open-label period. The stage 5 CKD study evaluated the efficacy and safety of paricalcitol (no comparator) in children with stage 5 CKD undergoing dialysis. In the stage 3/4 CKD study, mean peak plasma concentration and area under the time curve from zero to infinity were 0.13 ng/mL and 2.87 ng•h/((or ng×h/))mL, respectively, for 12 children who received 3 μg paricalcitol. Thirty-six children were randomized to paricalcitol or placebo; 27.8% of the paricalcitol group achieved two consecutive iPTH reductions of ≥30% from baseline versus none of the placebo group (P = 0.045). Adverse events were higher in children who received placebo than in those administered paricalcitol during the double-blind treatment (88.9 vs. 38.9%; P = 0.005). In the stage 5 CKD study, eight children (61.5%) had two consecutive iPTH reductions of ≥30% from baseline, and five (38.5%) had two consecutive iPTH values of between 150 and 300 pg/mL. Clinically meaningful hypercalcemia occurred in 21% of children. Oral paricalcitol in children aged 10-16 years with stages 3-5 CKD reduced iPTH levels and the treatment was well tolerated. Results support an initiating dose of 1 μg paricalcitol 3 times weekly in children aged 10-16 years.

  7. Magnetic resonance imaging in chronic subdural hematomas of early stages

    Energy Technology Data Exchange (ETDEWEB)

    Tsuchiya, Naoto; Muraki, Masaaki; Ohishi, Haruyuki (Shinshiro Municipal Hospital, Aichi (Japan)); Ninchoji, Toshiaki; Uemura, Kenichi

    1990-10-01

    The characteristic findings to distinguish chronic subdural hematomas of early stages from subdural CSF collections or enlarged subarachnoid spaces, was assessed by magnetic resonance imagings (MRI). Three sets of MRI, pre- and post-contrast as well as delayed post-contrast T{sub 1}-weighted coronal images were obtained in 20 cases, in which low intensity subdural spaces were observed in 6 on the right, in 5 on the left and 9 bilaterally. The characteristic findings observed were as follows: a low signal intensity band between low intensity subdural space and cerebral surface at the precontrast MRI; linear enhancement at the outer surface of low intensity space at postcontrast MRI; and enhancement of the low intensity space at the delayed MRI. A combination of more than 2 of the above-mentioned findings was noted in 24 out of 29 low intensity spaces, 7 of which were confirmed by surgery as chronic subdural hematomas with outer membranes. In the remaining 17, low intensity spaces spontaneously regressed in 10, and increased their intensity and/or changed their sizes in 7. This data was obtained from follow-up MRI's. Such a combination in the initial MRI's may indicate developing chronic subdural hematomas. In 5 out of 29 low intensity spaces, neither intensity nor size changed, nor did enhancement show in delayed imagings in the follow-up MRI's, which may strongly suggest either subdural CSF collections or enlarged subarachnoid spaces. In conclusion, the low intensity band is speculated to be subarachnoid space shown up secondarily by the relative increase of intensity in the low intensity space; the linear enhancement is thought to be outer membrane formation, and the delayed-enhancement of low intensity spaces may be extravasation of contrast media from the outer membrane. (author).

  8. New Targets for End-Stage Chronic Kidney Disease Therapy

    Directory of Open Access Journals (Sweden)

    Prakoura Niki

    2015-05-01

    Full Text Available Severe forms of chronic kidney disease can lead to a critical, end-stage condition, requiring renal replacement therapy, which may involve a form of dialysis or renal transplantation. Identification and characterization of novel markers and/or targets of therapy that could be applied in these critically ill patients remains the focus of the current research in the field of critical care medicine and has been the objective of our studies for some years past. To this end, we used models of renal vascular disease, Ang II, L-NAME or mice overexpressing renin, treated with AT1 antagonists at different stages of progression, to create cohorts of animals during progression, reversal or escape from therapy. Transcriptomic analysis and comparisons were performed and genes were selected according to the following criteria: a not previously described in the kidney, b highly upregulated during progression and returning to the normal levels during reversal, and c producing proteins that are either circulating or membrane receptors.

  9. Molecular allelokaryotyping of early-stage, untreated chronic lymphocytic leukemia.

    Science.gov (United States)

    Lehmann, Sören; Ogawa, Seishi; Raynaud, Sophie D; Sanada, Masashi; Nannya, Yasuhito; Ticchioni, Michel; Bastard, Christian; Kawamata, Norihiko; Koeffler, H Phillip

    2008-03-15

    To the authors' knowledge, genetic abnormalities in early-stage chronic lymphocytic leukemia (CLL) have not been examined fully. Single nucleotide polymorphism (SNP) genomic array (SNP-chip) is a new tool that can detect copy number changes and uniparental disomy (UPD) over the entire genome with very high resolution. The authors performed SNP-chip analysis on 56 samples from patients with early-stage, untreated CLL. To validate the SNP-chip data, fluorescence in situ hybridization (FISH) analysis was performed at selected sites. Expression levels of ZAP-70 and the mutational status of immunoglobulin heavy-chain gene also were examined. SNP-chip analysis easily detected nearly all changes that were identified by FISH, including trisomy 12, deletion of TP53 (17p13), deletion of ATM (11q22), and deletion of 13q14. Only 10 of 56 CLL samples (18%) had no genomic abnormalities. Excluding the 4 common abnormalities mentioned above, 25 CLL samples (45%) had a total of 45 copy number changes detected by SNP-chip analysis. Four samples had 6q deletion at 6q21 that involved the AIM1 gene. UPD was detected in 4 samples; 2 samples involved whole chromosome 13 resulting in homozygous deletion of micro-RNA-15a (miR-15a)/miR-16-1. CLL samples with deletion of 13q14 and trisomy 12 were mutually exclusive. Genetic abnormalities, including whole chromosome 13 UPD, are very common events in early-stage CLL. SNP-chip analysis can detect small genetic abnormalities in CLL and may be able to support or even supplant FISH and cytogenetics. Copyright (c) 2008 American Cancer Society.

  10. Cardiovascular Disease and Chronic Inflammation in End Stage Kidney Disease

    Directory of Open Access Journals (Sweden)

    Sofia Zyga

    2013-01-01

    Full Text Available Background: Chronic Kidney Disease (CKD is one of the most severe diseases worldwide. In patients affected by CKD, a progressive destruction of the nephrons is observed not only in structuralbut also in functional level. Atherosclerosis is a progressive disease of large and medium-sized arteries. It is characterized by the deposition of lipids and fibrous elements and is a common complication of the uremic syndrome because of the coexistence of a wide range of risk factors. High blood pressure, anaemia, insulin resistance, inflammation, high oxidative stress are some of the most common factors that cause cardiovascular disease and atherogenesis in patients suffering from End Stage Kidney Disease (ESRD. At the same time, the inflammatory process constitutes a common element in the apparition and development of CKD. A wide range of possible causes can justify the development of inflammation under uremic conditions. Such causes are oxidative stress, oxidation, coexistentpathological conditions as well as factors that are due to renal clearance techniques. Patients in ESRD and coronary disease usually show increased acute phase products. Pre-inflammatory cytokines, such as IL-6 and TNF-a, and acute phase reactants, such as CRP and fibrinogen, are closely related. The treatment of chronic inflammation in CKD is of high importance for the development ofthe disease as well as for the treatment of cardiovascular morbidity.Conclusions: The treatment factors focus on the use of renin-angiotensic system inhibitors, acetylsalicylic acid, statins and anti-oxidant treatment in order to prevent the action of inflammatorycytokines that have the ability to activate the mechanisms of inflammation.

  11. Paranasal Manifestations of Early Stage Chronic Lymphocytic Leukemia

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    Ceren Günel

    2015-04-01

    Full Text Available OBJECTIVE: Chronic lymphocytic leukemia (CLL is the most common adult leukemia. A few studies have been reported about the relationship between CLL and paranasal sinuses. We aimed to investigate the paranasal manifestations of CLL and to determine the expression of nuclear factor-ĸB (NF-kB and tumor necrosis factor (TNF-α in the nasal mucosa in patients with CLL. MATERIALS AND METHODS: This study was a clinical trial that involved 40 patients. Group CLL (n=20 consisted of patients with early-stage CLL who were followed-up at the hematology clinic and who did not receive any treatment. The control group (n=20 consisted of patients who had undergone concha surgery because of nasal obstruction. Paranasal sinus computer tomography scans of all patients were taken, they were scored on the basis of the Lund–Mackay system, and sinusitis findings were recorded. The biopsy material taken from the inferior concha head of all patients was immunohistochemically stained with primary antibodies against NF-kB and TNF-α. RESULTS: There were no statistically significant differences between the two groups with respect to NF-κB (p=0.716 and TNF-α staining scores (p=1.000. The Lund–Mackay scores were significantly higher in the CLL group than in the control group (p=0.004. Fourteen patients had sinusitis at different locations, while the most common diagnosis was maxillary sinusitis (n=8 in the CLL group. CONCLUSION: This study showed that patients with early-stage CLL tend to have rhinosinusitis. However, NF-kB and TNF-α may not have a role in the inflammatory process involving the paranasal sinuses in patients with CLL.

  12. End Stage and Chronic Kidney Disease: Associations with Renal Cancer

    International Nuclear Information System (INIS)

    Russo, Paul

    2012-01-01

    There is a well known association between end stage renal disease and the development of kidney cancer in the native kidney of patients requiring renal replacement therapy. There is now emerging evidence that lesser degrees of renal insufficiency (chronic kidney disease, CKD) are also associated with an increased likelihood of cancer in general and kidney cancer in particular. Nephropathological changes are commonly observed in the non-tumor bearing portions of kidney resected at the time of partial and radical nephrectomy (RN). In addition, patients with renal cancer are more likely to have CKD at the time of diagnosis and treatment than the general population. The exact mechanism by which renal insufficiency transforms normal kidney cells into tumor cells is not known. Possible mechanisms include uremic immune inhibition or increased exposure to circulating toxins not adequately cleared by the kidneys. Surgeons managing kidney tumors must have an increased awareness of their patient’s renal functional status as they plan their resection. Kidney sparing approaches, including partial nephrectomy (PN) or active surveillance in older and morbidly ill patients, can prevent CKD or delay the further decline in renal function which is well documented with RN. Despite emerging evidence that PN provides equivalent local tumor control to RN while at the same time preventing CKD, this operation remains under utilized in the United States and abroad. Increased awareness of the bi directional relationship between kidney function and kidney cancer is essential in the contemporary management of kidney cancer.

  13. Can GOLD Stage 0 provide information of prognostic value in chronic obstructive pulmonary disease?

    DEFF Research Database (Denmark)

    Vestbo, Jørgen; Lange, Peter

    2002-01-01

    In the recently published guidelines of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) for chronic obstructive pulmonary disease (COPD), the staging system included a Stage 0 for subjects without airways obstruction but with respiratory symptoms, denoting these subjects "at ris...

  14. The renal arterial resistive index and stage of chronic kidney disease in patients with renal allograft

    DEFF Research Database (Denmark)

    Winther, Stine O; Thiesson, Helle C; Poulsen, Lene N

    2012-01-01

    The study investigated the optimal threshold value of renal arterial resistive index as assessed by Doppler ultrasonography determining chronic kidney disease stage 4 or higher in patients with renal allograft.......The study investigated the optimal threshold value of renal arterial resistive index as assessed by Doppler ultrasonography determining chronic kidney disease stage 4 or higher in patients with renal allograft....

  15. Low serum leptin predicts mortality in patients with chronic kidney disease stage 5

    DEFF Research Database (Denmark)

    Scholze, Alexandra; Rattensperger, Dirk; Zidek, Walter

    2007-01-01

    Leptin, secreted from adipose tissue, regulates food intake, energy expenditure, and immune function. It is unknown whether leptin predicts mortality in patients with chronic kidney disease stage 5 on hemodialysis therapy.......Leptin, secreted from adipose tissue, regulates food intake, energy expenditure, and immune function. It is unknown whether leptin predicts mortality in patients with chronic kidney disease stage 5 on hemodialysis therapy....

  16. Untying chronic pain: prevalence and societal burden of chronic pain stages in the general population - a cross-sectional survey.

    Science.gov (United States)

    Häuser, Winfried; Wolfe, Frederik; Henningsen, Peter; Schmutzer, Gabriele; Brähler, Elmar; Hinz, Andreas

    2014-04-13

    Chronic pain is a major public health problem. The impact of stages of chronic pain adjusted for disease load on societal burden has not been assessed in population surveys. A cross-sectional survey with 4360 people aged  ≥ 14 years representative of the German population was conducted. Measures obtained included demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (by chronic pain grade questionnaire), disease load (by self-reported comorbidity questionnaire) and societal burden (by self-reported number of doctor visits, nights spent in hospital and days of sick leave/disability in the previous 12 months, and by current unemployment). Associations between chronic pain stages with societal burden, adjusted for demographic variables and disease load, were tested by Poisson and logistic regression analyses. 2508 responses were received. 19.4% (95% CI 16.8% to 22.0%) of participants met the criteria of chronic non-disabling non-malignant pain. 7.4% (95% CI 5.0% to 9.9%) met criteria for chronic disabling non-malignant pain. Compared with no chronic pain, the rate ratio (RR) of days with sick leave/disability was 1.6 for non-disabling pain and 6.4 for disabling pain. After adjusting for age and disease load, the RRs increased to 1.8 and 6.8. The RR of doctor visits was 2.5 for non-disabling pain and 4.5 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.7 and 2.6. The RR of days in hospital was 2.7 for non-disabling pain and 11.7 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.5 and 4.0. Unemployment was predicted by lower educational level (Odds Ratio OR 3.27 [95% CI 1.70-6.29]), disabling pain (OR 3.30 [95% CI 1.76-6.21]) and disease load (OR 1.70 [95% CI 1.41-2.05]). Chronic pain stages, but also disease load and societal inequalities

  17. Chronic Granulomatous Disease; fundamental stages in our understanding of CGD.

    Science.gov (United States)

    Assari, Tracy

    2006-09-21

    It has been 50 years since chronic granulomatous disease was first reported as a disease which fatally affected the ability of children to survive infections. Various milestone discoveries from the insufficient ability of patients' leucocytes to destroy microbial particles to the underlying genetic predispositions through which the disease is inherited have had important consequences. Longterm antibiotic prophylaxis has helped to fight infections associated with chronic granulomatous disease while the steady progress in bone marrow transplantation and the prospect of gene therapy are hailed as long awaited permanent treatment options. This review unearths the important findings by scientists that have led to our current understanding of the disease.

  18. Low serum leptin predicts mortality in patients with chronic kidney disease stage 5

    DEFF Research Database (Denmark)

    Scholze, Alexandra; Rattensperger, Dirk; Zidek, Walter

    2007-01-01

    Leptin, secreted from adipose tissue, regulates food intake, energy expenditure, and immune function. It is unknown whether leptin predicts mortality in patients with chronic kidney disease stage 5 on hemodialysis therapy....

  19. Prevalence, predictors, and survival in pulmonary hypertension related to end-stage chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Andersen, Kasper Hasseriis; Iversen, Martin; Kjaergaard, Jesper

    2012-01-01

    The prevalence, prognostic importance, and factors that predict the presence and degree of pulmonary hypertension (PH) diagnosed with right heart catheterization (RHC) in patients with end-stage chronic obstructive pulmonary disease (COPD) remain unclear....

  20. Prediction of Chronic Kidney Disease Stage 3 by CKD273, a Urinary Proteomic Biomarker

    Directory of Open Access Journals (Sweden)

    Claudia Pontillo

    2017-11-01

    Discussion: In conclusion, while accounting for baseline eGFR, albuminuria, and covariables, CKD273 adds to the prediction of stage 3 chronic kidney disease, at which point intervention remains an achievable therapeutic target.

  1. Renal function trajectory is more important than chronic kidney disease stage for managing patients with chronic kidney disease.

    Science.gov (United States)

    Rosansky, Steven J

    2012-01-01

    Management of patients with chronic kidney disease (CKD) emphasizes a current level of function as calculated from the modification of diet in renal disease glomerulofiltration rate equations (eGFR) and proteinuria for staging of CKD. Change in a patient's eGFR over time (renal function trajectory) is an additional and potentially more important consideration in deciding which patients will progress to the point where they will require renal replacement therapy (RRT). Many patients with CKD 3-5 have stable renal function for years. Proteinuria/albuminuria is a primary determinant of renal trajectory which may be slowed by medications that decrease proteinuria and/or aggressively lower blood pressure. A renal trajectory of >3 ml/min/1.73 m(2)/year may relate to a need for closer renal follow-up and increased morbidity and mortality. Additional CKD population-based studies need to examine the relationship of renal trajectory to: baseline renal function; acute kidney injury episodes; age, race, sex and primary etiologies of renal disease; blood pressure control and therapies; dietary protein intake; blood glucose control in diabetics and the competitive risk of death versus the requirement for renal replacement therapy. In the elderly CKD 4 population with significant comorbidities and slow decline in renal function, the likelihood of death prior to the need for RRT should be considered before placing AV access for dialysis. Prediction models of renal progression must account for the competitive risk of death as well as stable or improved renal function to be clinically useful. Copyright © 2012 S. Karger AG, Basel.

  2. Hepatic levels of bile acids in end-stage chronic cholestatic liver disease

    NARCIS (Netherlands)

    Fischer, S.; Beuers, U.; Spengler, U.; Zwiebel, F. M.; Koebe, H. G.

    1996-01-01

    In chronic cholestatic liver disease hydrophobic and potentially cytotoxic bile acids are assumed to accumulate in the liver. To test this hypothesis we investigated bile acid levels and pattern in livers and serum of patients with, (A) end-stage chronic cholestatic liver disease, and with (B)

  3. Prognostic significance of endothelial dysfunctional markers of the first stage of chronic kidney disease

    Directory of Open Access Journals (Sweden)

    M. M. Mnuskina

    2014-01-01

    Full Text Available Non-adaptive remodeling of cardiovascular system and progressive kidney damage at chronic kidney disease (CKD is associated with the development of endothelial dysfunction (ED and apoptosis. The aim of this research was to study the changes of indicators of apoptosis and ED in patients with CKD 1 stage throughout 12 months. Complex biochemical, immunoferment and tool methods were applied at patient examinations. Arterial pressure of all observed patients was resolved on target values in 12 months. However, the indicators of endothelium-dependent vasodilation (EDV increased in 55 patients (1st group, and the peak of circulating blood volume in skin microvessels in 22 patients (2nd group wasn't changed: 134±4 % и 136±4 %, p>0.1. The level of the annexin A5 reduced from 3.5±0.47 to 1.27±0.31 ng/ml (p0.1 in 2nd group. Diurnal excretion of sodium chloride decreased from 6.8±0.57 g/d to 2.8±0.39 g/d (p<0.05 in patients of 1st group. Dynamics of these indicators was not marked in patients of 2nd group: accordingly from 7.39±0.63 g/d to 7.01±0.65 g/d. Diurnal excretion of sodium chloride reflected the salt intake in patients with CKD 1 stage is associated with disturbance of endothelial-dependent vasodilation and apoptosis.

  4. Comparison of Oone-Stage Free Gracilis Muscle Flap With Two-Stage Method in Chronic Facial Palsy

    Directory of Open Access Journals (Sweden)

    J Ghaffari

    2007-08-01

    Full Text Available Background:Rehabilitation of facial paralysis is one of the greatest challenges faced by reconstructive surgeons today. The traditional method for treatment of patients with facial palsy is the two-stage free gracilis flap which has a long latency period of between the two stages of surgery.Methods: In this paper, we prospectively compared the results of the one-stage gracilis flap method with the two -stage technique.Results:Out of 41 patients with facial palsy refered to Hazrat-e-Fatemeh Hospital 31 were selected from whom 22 underwent two- stage and 9 one-stage method treatment. The two groups were identical according to age,sex,intensity of illness, duration, and chronicity of illness. Mean duration of follow up was 37 months. There was no significant relation between the two groups regarding the symmetry of face in repose, smiling, whistling and nasolabial folds. Frequency of complications was equal in both groups. The postoperative surgeons and patients' satisfaction were equal in both groups. There was no significant difference between the mean excursion of muscle flap in one-stage (9.8 mm and two-stage groups (8.9 mm. The ratio of contraction of the affected side compared to the normal side was similar in both groups. The mean time of the initial contraction of the muscle flap in the one-stage group (5.5 months had a significant difference (P=0.001 with the two-stage one (6.5 months.The study revealed a highly significant difference (P=0.0001 between the mean waiting period from the first operation to the beginning of muscle contraction in one-stage(5.5 monthsand two-stage groups(17.1 months.Conclusion:It seems that the results and complication of the two methods are the same,but the one-stage method requires less time for facial reanimation,and is costeffective because it saves time and decreases hospitalization costs.

  5. Prediction of Chronic Kidney Disease Stage 3 by CKD273, a Urinary Proteomic Biomarker

    DEFF Research Database (Denmark)

    Pontillo, Claudia; Zhang, Zhen-Yu; Schanstra, Joost P

    2017-01-01

    Introduction: CKD273 is a urinary biomarker, which in advanced chronic kidney disease predicts further deterioration. We investigated whether CKD273 can also predict a decline of estimated glomerular filtration rate (eGFR) to ... threshold (P = 0.086). Discussion: In conclusion, while accounting for baseline eGFR, albuminuria, and covariables, CKD273 adds to the prediction of stage 3 chronic kidney disease, at which point intervention remains an achievable therapeutic target....

  6. [End stage of chronic kidney disease and metabolic acidosis].

    Science.gov (United States)

    Klaboch, J; Opatrná, S; Matoušovic, K; Schück, O

    2012-01-01

    Renal function disorder is inevitably associated with metabolic acidosis. An adult produces approximately 1 mmol of acids/kg of body weight every day (3 mmol/kg in children), derived from metabolization of proteins from food. Development of metabolic acidosis in patients with kidney disease is based on accumulation of acids and insufficient production of bicarbonates; alkaline loss represents a marginal issue here limited to patients with type II renal tubular acidosis only. The prevalence of this disorder increases with declining glomerular filtration (GFR) from 2% in patients with GFR 1.0-1.5 ml/s/1.73 m2 to 39% in patients with GFR ammoniac production in residual nephrons. This is an adaptive mechanism aimed at maintaining sufficient elimination of acids despite reduced volume of functional tissue. However, an increased ammoniac production simultaneously becomes a stimulus for activation of the complement via an alternative route and is thus one of the factors contributing, through this induced inflammation, to progression of tubular interstitial fibrosis that subsequently leads to further GFR reduction. Metabolic acidosis has a number of severe adverse effects on the organism, e.g. deterioration of kidney bone disease through stimulation of bone resorption and inhibition of bone formation, inhibition of vitamin D formation, increased muscle catabolism, reduced albumin production, glucose metabolism disorder, increased insulin resistance, reduced production of thyroid hormones, increased accumulation of β2-microglobulin etc. Non-interventional studies suggest that alkali supplementation may slow down progression of chronic nephropathies. However, this approach, safe and inexpensive, has not been widely implemented in clinical practice yet. With respect to dialyzed patients, abnormal levels of bicarbonates are associated with increased mortality. Both metabolic acidosis and alkalosis, rather regularly seen in a considerable number of patients, have a negative

  7. Baseline characteristics of patients with chronic kidney disease stage 3 and stage 4 in spain: the MERENA observational cohort study

    Directory of Open Access Journals (Sweden)

    Montes Rafael

    2011-10-01

    Full Text Available Abstract Background To obtain information on cardiovascular morbidity, hypertension control, anemia and mineral metabolism based on the analysis of the baseline characteristics of a large cohort of Spanish patients enrolled in an ongoing prospective, observational, multicenter study of patients with stages 3 and 4 chronic kidney diseases (CKD. Methods Multicenter study from Spanish government hospital-based Nephrology outpatient clinics involving 1129 patients with CKD stages 3 (n = 434 and 4 (n = 695 defined by GFR calculated by the MDRD formula. Additional analysis was performed with GFR calculated using the CKD-EPI and Cockcroft-Gault formula. Results In the cohort as a whole, median age 70.9 years, morbidity from all cardiovascular disease (CVD was very high (39.1%. In CKD stage 4, CVD prevalence was higher than in stage 3 (42.2 vs 35.6% p 300 mg/day was present in more than 60% of patients and there was no significant differences between stages 3 and 4 CKD (1.2 ± 1.8 and 1.3 ± 1.8 g/day, respectively. A majority of the patients had hemoglobin levels greater than 11 g/dL (91.1 and 85.5% in stages 3 and 4 CKD respectively p Conclusion This study provides an overview of key clinical parameters in patients with CKD Stages 3 and 4 where delivery or care was largely by nephrologists working in a network of hospital-based clinics of the Spanish National Healthcare System.

  8. High infection control rate and function after routine one-stage exchange for chronically infected TKA.

    Science.gov (United States)

    Jenny, Jean-Yves; Barbe, Bruno; Gaudias, Jeannot; Boeri, Cyril; Argenson, Jean-Noël

    2013-01-01

    Many surgeons consider two-stage exchange the gold standard for treating chronic infection after TKA. One-stage exchange is an alternative for infection control and might provide better knee function, but the rates of infection control and levels of function are unclear. We asked whether a one-stage exchange protocol would lead to infection control rates and knee function similar to those after two-stage exchange. We followed all 47 patients with chronically infected TKAs treated with one-stage exchange between July 2004 and February 2007. We monitored for recurrence of infection and obtained Knee Society Scores. We followed patients a minimum of 3 years or until death or infection recurrence. Three of the 47 patients (6%) experienced a persistence or recurrence of the index infection with the same pathogen isolated. Three patients (6%) had control of the index infection but between 6 and 17 months experienced an infection with another pathogen. The 3-year survival rates were 87% for being free of any infection and 91% for being healed of the index infection. Twenty-five of the 45 patients (56%) had a Knee Society Score of more than 150 points. While routine one-stage exchange was not associated with a higher rate of infection recurrence failure, knee function was not improved compared to that of historical patients having two-stage exchange. One stage-exchange may be a reasonable alternative in chronically infected TKA as a more convenient approach for patients without the risks of two operations and hospitalizations and for reducing costs. The ideal one stage-exchange candidate should be identified in future studies.

  9. Cochlear sensitivity in children with chronic kidney disease and end-stage renal disease undergoing hemodialysis.

    Science.gov (United States)

    Renda, Rahime; Renda, Levent; Selçuk, Ömer Tarık; Eyigör, Hülya; Yılmaz, Mustafa Deniz; Osma, Üstün

    2015-12-01

    Auditory system abnormalities commonly occur in patients with chronic renal disease and end-stage renal disease undergoing hemodialysis. The aim of this study was to determine the relationship between cochlear sensitivity and hemodialysis in dialytic and non-dialytic chronic kidney disease patients. The study included children aged 6-18 years that were divided into 3 groups: 36 non-dialytic patients with chronic kidney disease, 16 end-stage renal disease patients undergoing hemodialysis, and 30 healthy controls. Blood urea nitrogen, serum cystatin C levels, duration of chronic kidney disease, and the duration of hemodialysis were compared between the chronic kidney disease patients and end-stage renal disease patients undergoing hemodialysis. Hearing health was measured via tympanometry, pure-tone audiometry and distortion product otoacoustic emissions testing. Distortion product otoacoustic emission amplitudes and signal-to-noise ratios were significantly lower at all frequencies tested in the non-dialytic and dialytic groups than in the control group (pchronic renal disease-both dialytic and non-dialytic-should be monitored to prevent any further deterioration by avoiding potential ototoxic agents, even if their hearing thresholds are within normal limits. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Cognitive behavioral therapy across the stages of psychosis : Prodromal, first episode, and chronic schizophrenia

    NARCIS (Netherlands)

    Valmaggia, Lucia R.; Tabraham, Paul; Morris, Eric; Bourrian, Theo K.

    Since the early 1990s, cognitive behavioral therapy (CBT) has been increasingly used as an adjunctive treatment for psychotic disorders. This paper describes the CBT of three cases, each at a different stage of psycholic disorder: at-risk mental state, first-episode psychosis, and chronic psychotic

  11. Mobile, one stage, bilateral ear surgery for chronic otitis media patients in remote areas

    DEFF Research Database (Denmark)

    Homøe, P; Sørensen, H C Florian; Tos, M

    2009-01-01

    OBJECTIVES: We evaluated the results of mobile, one stage, bilateral ear surgery conducted in Greenland, where chronic otitis media with and without suppuration is prevalent. The study aimed to increase the number of operations conducted and to reduce the cost of ear surgery in remote areas. MATE...

  12. Routine one-stage exchange for chronic infection after total hip replacement.

    Science.gov (United States)

    Jenny, Jean-Yves; Lengert, Régis; Diesinger, Yann; Gaudias, Jeannot; Boeri, Cyril; Kempf, Jean-François

    2014-12-01

    We hypothesized that a routine one-stage exchange for treatment of chronically infected total hip replacement (THR) will lead to (1) a higher rate of infection recurrence and (2) a poorer hip outcome than the published rates after two-stage exchange. Sixty-five cases have been treated consecutively with one-stage exchange. All patients have been followed for a period of three to six years or until death or infection recurrence. The five-year rate for infection recurrence was 16%. The five-year survival rate for recurrence of the index infection was 8%. Forty-two percent of the hips had a good or excellent PMA score, and 46% a good or excellent OH score. Routine one-stage exchange was not associated with a higher recurrence rate and a poorer hip function than previously published series of two-stage exchange. Therefore, there is little support to choose two-stage exchange as the routine treatment for management of chronically infected THR.

  13. Predictors of advanced chronic kidney disease and end-stage renal disease in HIV-positive persons

    DEFF Research Database (Denmark)

    Nielsen, Lene Ryom; Mocroft, Amanda; Kirk, Ole

    2014-01-01

    Whilst several antiretroviral drugs have been associated with moderate chronic kidney disease (CKD), their contribution to advanced CKD and end-stage renal disease (ESRD) remain unknown.......Whilst several antiretroviral drugs have been associated with moderate chronic kidney disease (CKD), their contribution to advanced CKD and end-stage renal disease (ESRD) remain unknown....

  14. Childhood Albuminuria and Chronic Kidney Disease is Associated with Mortality and End-Stage Renal Disease

    OpenAIRE

    Ching-Yuang Lin; Shiuh-Ming Huang

    2016-01-01

    We do not yet fully grasp the significance of childhood albuminuria. Based on mass urinary screening (MUS) using albumin-specific dipsticks in school children, we studied the independent association of estimated glomerular filtration rate (eGFR) and albuminuria with mortality and end-stage renal disease (ESRD) in children with chronic kidney disease (CKD). Methods: A prospective cohort of 5351 children with albuminuria detected by school MSU during the period 1992–1996, followed up to 2009...

  15. Pressure ulcer risk factors in persons with spinal cord injury part 2: the chronic stage.

    Science.gov (United States)

    Gélis, A; Dupeyron, A; Legros, P; Benaïm, C; Pelissier, J; Fattal, C

    2009-09-01

    Pressure ulcers (PUs) are a common complication following spinal cord injury (SCI). Prevalence for persons in the chronic SCI stage varies between 15 and 30%. The risk assessment scales used nowadays were designed on pathophysiological concepts and are not SCI-specific. Recently, an epidemiological approach to PU risk factors has been proposed for designing an SCI-specific assessment tool. The first results seem quite disappointing, probably because of the level of evidence of the risk factors used. To determine PU risk factors correlated to the chronic stage of SCI. Systematic review of the literature. There are several PU risk factors for chronic SCI stage: socio-demographics, neurological, medical or behavioral. The level of evidence varies: it is quite high for the socio-demographics and neurological factors and low for behavioral factors. Behavioral risk factors (relieving the pressure, careful skin monitoring, smoking) are probably the ones for which a preventive strategy can be established. It is important to develop specific assessment tools for these behavioral risk factors to determine their relevance and evaluate the effect of therapeutic educational programs on persons with SCI.

  16. Evaluation of bacteriology of middle ear in early quiescent stage of chronic otitis media

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    Ramesh Bhandari

    2013-09-01

    Full Text Available Objectives The objectives of this study were to determine whether any organism does exist in middle ear cavity during the early quiescent stage of chronic otitis media and to isolate their types. Materials and methods Forty-seven patients of age 13 years and above with diagnosis of chronic otitis media mucosal type in early quiescent stage were included. Swab was collected from middle ear cavity for culture and sensitivity in operation theatre prior to middle ear surgery and brought to microbiology laboratory within half an hour to inoculate in Blood agar, Chocolate agar and Mac Conkey agar. The isolates were identified with the use of standard bacteriological technique. Results Aerobic bacteria were isolated from 15 cases (31.9%. Staphylococcus aureus isolated in 12(80%, Pseudomonas aeruginosa in 2(13.3% and E. coli in 1(6.7%. Conclusion Aerobic bacteria were isolated from middle ear cavity in quiescent stage of chronic otitis media in 15(32% cases. Staphylococcus aureus was the most common organism. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-4, 22-26 DOI: http://dx.doi.org/10.3126/jcmsn.v8i4.8696

  17. Cognitive Gains from Gist Reasoning Training in Adolescents with Chronic-Stage Traumatic Brain Injury

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    Lori G. Cook

    2014-06-01

    Full Text Available Adolescents with traumatic brain injury (TBI typically demonstrate good recovery of previously acquired skills. However, higher-order and later emergent cognitive functions are often impaired and linked to poor outcomes in academic and social/behavioral domains. Few control trials exist that test cognitive treatment effectiveness at chronic recovery stages. The current pilot study compared the effects of two forms of cognitive training, gist reasoning (top-down versus rote memory learning (bottom-up, on ability to abstract meanings, recall facts, and utilize core executive functions (i.e., working memory, inhibition in 20 adolescents (ages 12-20 who were six months or longer post-TBI. Participants completed eight 45-minute sessions over one month. After training, the gist reasoning group (n = 10 exhibited significant improvement in ability to abstract meanings and increased fact recall. This group also showed significant generalizations to untrained executive functions of working memory and inhibition. The memory training group (n = 10 failed to show significant gains in ability to abstract meaning or on other untrained specialized executive functions, although improved fact recall approached significance. These preliminary results suggest that relatively short-term training (6 hours utilizing a top-down reasoning approach is more effective than a bottom-up rote learning approach in achieving gains in higher-order cognitive abilities in adolescents at chronic stages of TBI. These findings need to be replicated in a larger study; nonetheless, the preliminary data suggest that traditional cognitive intervention schedules need to extend to later-stage training opportunities. Chronic-stage, higher-order cognitive trainings may serve to elevate levels of cognitive performance in adolescents with TBI.

  18. [Etiological analysis of 264 cases with chronic kidney disease stage 2 to 5 in children].

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    Miao, Qianfan; Shen, Qian; Xu, Hong; Sun, Li; Tang, Xiaoshan; Fang, Xiaoyan; Liu, Haimei; Zhai, Yihui; Bi, Yunli; Wang, Xiang; Chen, Hong

    2015-09-01

    To study and summarize the etiology of children patients with chronic kidney disease (CKD) stage 2 to 5 seen in Children's Hospital of Fudan University from Jan. 2004 to Dec. 2013. By complying with the NKF-K/DOQI guidelines, we collected data of 264 cases of children patients with CKD stage 2-5 from Jan. 2004 to Dec. 2013 in the medical record system of Children's Hospital of Fudan University. And we retrospectively analyzed their age and CKD stage at first diagnosis, primary diseases, complications, etc. In the collected 264 cases, 52 cases (19.7%) were diagnosed at stage 2, 67 (25.4%) at stage 3, 52 (19.7%) at stage 4 and 93 (35.2%) at stage 5. For disease causes, 116 cases (43.9%) had congenital anomalies of the kidney and urinary tract (CAKUT), 61 cases (23.1%) had glomerular disease, 15 (5.7%) had hereditary kidney disease, 14 (5.3%) had other diseases and in 58 cases (22.0%) the causes of disease were unknown. In the group with age between 0 and 3.0 and 3.1 and 6.0 years, 57.1% (24 cases) and 60.0% (30 cases) had primary disease with CAKUT. In the group with age older than 10 years, 49.2% (30 cases) had primary disease with glomerular disease and 32.0% (32 cases) with unknown causes. The major cause of CKD stage 2-5 in children in our hospital during the last ten years was CAKUT (43.9%), followed by glomerular disease (23.1%). The primary diseases of CKD were significantly different between the 2 age groups. CAKUT was more common in infants and preschool children while for adolescents, glomerular disease was the major cause.

  19. Utility of Modeling End-Stage Liver Disease in Children with Chronic Liver Disease

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    Hamid Reza Kianifar

    2014-01-01

    Full Text Available Introduction: Chronic liver diseases consist of wide spectrum disorders that may be complicated by cirrhosis and therefore need to transplantation. The pediatric end-stage liver disease (PELD score and model of end-stage liver disease (MELD score has been used as predictors of mortality chronic liver diseases listed for liver transplantation. The aim of this study is evaluation of relation between PELDMELD score and evidence of cirrhosis in children with choronic liver disease.   Materials and Method: This cross-sectional study conducted on 106 patients of chronic liver disease referred to Ghaem Haspital, Mashhad University of Medical Science, Iran during 24 months period (2010-2013. PELD and MELD score were calculated for all patients. Clincal and patholoogical findings of cirrhosis were recorded.   Results: Mean age of patients was 68/3 ± 41.8 months. Mean PELDMELD score was -1/59± 9/64. There was significant correlation between PELDMELD score and clinical icter, spelenomegaly, evidence of hepatopulminary syndrome, esophageal varices, evidence of cirrhosis in tissue specimences.   Conclusion: PELDMELD score appear to be benefit for detection of cirrhotic children among paients with choronic liver disease.

  20. Clinical and laboratory characteristics of chronic hepatitis C on the early stages of development

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    N. S. Zhevnerova

    2016-01-01

    Full Text Available Aim of the research – to assess the clinical and laboratory parameters in patients with chronic hepatitis C (CHC on the early stages of development and their comparison with the level of galectin3. The study included 78 patients with oligosymptomatic course of the disease and minimal liver fibrosis in the most cases. In the most patients with stages of the disease exceeding 8 years, viral load was over a million copies/ml. In 10 % of patients on the early stages of the disease, changes corresponding to severe liver fibrosis and cirrhosis F3 and F4 were detected. Moderate correlation of ALT activity, viral load and low severity with the duration of the disease was identified. There is a trend towards a higher level of galectin3 in a long course of CHC in comparison with earlier stages of its development, with significantly higher average level of galectin-3 in patients with minimal liver fibrosis (F0–F1 as compared to advanced stages, suggesting its importance in the launching and initial mechanisms of fibrogenesis.

  1. Optimal management of bone mineral disorders in chronic kidney disease and end stage renal disease.

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    Lundquist, Andrew L; Nigwekar, Sagar U

    2016-03-01

    The review summarizes recent studies on chronic kidney disease-mineral bone disorders, with a focus on new developments in disease management. The term chronic kidney disease-mineral bone disorder has come to describe an increasingly complex network of alterations in minerals and skeletal disorders that contribute to the significant cardiovascular morbidity and mortality seen in patients with chronic kidney disease and end stage renal disease. Clinical studies continue to suggest associations with clinical outcomes, yet current clinical trials have failed to support causality. Variability in practice exists as current guidelines for management of mineral bone disorders are often based on weak evidence. Recent studies implicate novel pathways for therapeutic intervention in clinical trials. Mineral bone disorders in chronic kidney disease arise from alterations in a number of molecules in an increasingly complex physiological network interconnecting bone and the cardiovascular system. Despite extensive associations with improved outcomes in a number of molecules, clinical trials have yet to prove causality and there is an absence of new therapies available to improve patient outcomes. Additional clinical trials that can incorporate the complexity of mineral bone disorders, and with the ability to intervene on more than one pathway, are needed to advance patient care.

  2. Early Stage of Chronic Kidney Disease with Renal Injury Caused by Hypertension in a Dog

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    Akira Yabuki

    2011-01-01

    Full Text Available A 10-year-old spayed female Papillon weighing 4.0 kg presented with a history of persistent hematuria and pollakiuria. Concurrent bladder calculi, a mammary gland tumor, and nonazotemic early stage of chronic kidney disease with contracted kidneys were noted in this dog. The dog underwent cystectomy, unilateral mastectomy, and intraoperative renal biopsy. On the basis of histopathological analysis of renal biopsy results, it was suspected that renal injury of the dog was caused by persistent hypertension, and a follow-up examination revealed severe hypertension. The dog was treated with a combination of an angiotensin-converting enzyme inhibitor and calcium channel blocker. The treatment produced a good outcome in the dog, and there has been no progression of the chronic kidney disease for over 2 years.

  3. Iron deficiency across chronic kidney disease stages: Is there a reverse gender pattern?

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    Mabel Aoun

    Full Text Available In non-dialysis chronic kidney disease patients, looking for iron deficiency is highly variable in practice and there is a great variability regarding the cutoffs used to treat iron deficiency. The aim of this study is to investigate the degree of iron deficiency in non-dialysis chronic kidney disease patients on erythropoiesis-stimulating agents. We included all non-dialysis chronic kidney disease patients that applied to the Lebanese Ministry of Public Health for erythropoiesis-stimulating agents' coverage during a 5-month period. Iron requirement was assessed based on two guidelines' target-to-treat cutoffs: 1-ferritin <100 ng/ml and/or TSAT < 20% (KDOQI 2006, 2- ferritin ≤500 ng/ml and TSAT ≤30% (KDIGO 2012. A total of 238 CKD patients were included over 5 months. All patients had a ferritin level in their record and 64% had an available TSAT. Median age was 71.0 (59.8-79.3 years and 61.8% were female. All had an eGFR<60 ml/min. The proportion of patients found to require iron therapy ranged between 48 and 78% with a trend towards higher values when using KDIGO-based criteria. Using ANCOVA test, inverse normal transformations of ferritin and TSAT showed a reverse pattern between men and women with women being more iron deficient in the early stage. Iron deficiency is highly prevalent in non-dialysis chronic kidney disease patients on erythropoiesis-stimulating agents' therapy. These findings reflect a lack in effective iron supplementation when managing anemia in pre-dialysis patients, especially in men at advanced stages. Renal societies should spread awareness about iron deficiency screening in those patients.

  4. Regulatory T cells predict the time to initial treatment in early stage chronic lymphocytic leukemia.

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    Weiss, Lukas; Melchardt, Thomas; Egle, Alexander; Grabmer, Christoph; Greil, Richard; Tinhofer, Inge

    2011-05-15

    Early stage chronic lymphocytic leukemia is characterized by a highly variable course of disease. Because it is believed that regulatory T cells (T(regs) ) are potent suppressors of antitumor immunity, the authors hypothesized that increased T(regs) may favor disease progression. T(reg) levels (cluster of differentiation 3 [CD3]-positive, [CD4]-positive, CD25-positive, and CD127-negative) in peripheral blood from 102 patients were analyzed by flow cytometry. Statistical analysis was used to evaluate correlations with clinical data. The relative T(reg) numbers in CD4-positive T cells were significantly greater in patients with chronic lymphocytic leukemia compared with the numbers in a control group of 170 healthy individuals (P = .001). Patients were divided into 2 groups using a median T(reg) value of 9.7% (the percentage of CD4-positive T cells). Patients with higher T(reg) levels had a significantly shorter time to initial treatment (median, 5.9 years) compared with patients who had lower T(reg) levels (median, 11.7 years; log-rank P = .019). Furthermore, T(reg) levels (the percentage of CD4-positive T cells) had significant prognostic power to predict the time to initial treatment in univariate analysis (P = .023) and in multivariate Cox regression analysis that included the variables Rai stage, immunoglobulin heavy-chain variable region gene mutational status, chromosomal aberrations, and CD38 expression (P = .028). Higher T(reg) levels had significant and independent prognostic power for predicting the time to initial treatment in patients with low to intermediate stage chronic lymphocytic leukemia. 2010 American Cancer Society.

  5. Severe pulmonary hypertension in a young patient with end-stage renal disease on chronic hemodialysis

    International Nuclear Information System (INIS)

    Sharma, Satyavan; Kirpalani, Ashok L; Kulkarni, Amit

    2010-01-01

    Severe pulmonary hypertension in a teenager with end-stage renal disease on chronic hemodialysis via arteriovenous access is reported. Clinical presentation included persistent volume overload and pericardial effusion. Serial hemodynamic data obtained at cardiac catheterization confirmed the diagnosis. In addition, detailed biochemical and imaging data (echo- Doppler, computed tomography of chest, computed tomographic pulmonary angiography, VQ lung scan, etc.) were obtained to find out the mechanism. The exact cause of pulmonary hypertension remains unclear, and a multi- factorial mechanism is postulated. This rare case is presented to highlight the role of aggressive dialysis, pericardiocentesis, and use of sildenafil and bosentan in the management

  6. Progression of autosomal dominant kidney disease: measurement of the stage transitions of chronic kidney disease

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    Christopher M Blanchette

    2015-04-01

    Full Text Available Background: Autosomal dominant polycystic kidney disease (ADPKD is a progressive genetic disorder characterized by the development of numerous kidney cysts that result in kidney failure. Little is known regarding the key patient characteristics and utilization of healthcare resources for ADPKD patients along the continuum of disease progression. This observational study was designed to describe the characteristics of ADPKD patients and compare them with those of patients with other chronic kidney diseases. Methods: This retrospective cohort study involved patients with a claim for ADPKD or PKD unspecified from 1/1/2000–2/28/2013 and ≥6 months of previous continuous enrollment (baseline within a large database of administrative claims in the USA. A random sample of chronic kidney disease (CKD patients served as comparators. For a subset of ADPKD patients who had only a diagnosis code of unspecified PKD, abstraction of medical records was undertaken to estimate the proportion of patients who had medical chart-confirmed ADPKD. In patients with linked electronic laboratory data, the estimated glomerular filtration rate was calculated via serum creatinine values to determine CKD stage at baseline and during follow-up. Proportions of patients transitioning to another stage and the mean age at transition were calculated. Results: ADPKD patients were, in general, younger and had fewer physician visits, but had more specific comorbidities at observation start compared with CKD patients. ADPKD patients had a longer time in the milder stages and longer duration before recorded transition to a more severe stage compared with CKD patients. Patients with ADPKD at risk of rapid progression had a shorter time-to-end-stage renal disease than patients with CKD and ADPKD patients not at risk, but stage duration was similar between ADPKD patients at risk and those not at risk. Conclusions: These results suggest that distribution of patients by age at transition

  7. Understanding the management of early-stage chronic kidney disease in primary care: a qualitative study

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    Blakeman, Tom; Protheroe, Joanne; Chew-Graham, Carolyn; Rogers, Anne; Kennedy, Anne

    2012-01-01

    Background Primary care is recognised to have an important role in the delivery of care for people with chronic kidney disease (CKD). However, there is evidence that CKD management is currently suboptimal, with a range of practitioner concerns about its management. Aim To explore processes underpinning the implementation of CKD management in primary care. Design and setting Qualitative study in general practices participating in a chronic kidney disease collaborative undertaken as part of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester. Method Semi-structured interviews were conducted with GPs and practice nurses (n = 21). Normalisation Process Theory provided a framework for generation and analysis of the data. Results A predominant theme was anxiety about the disclosure of early-stage CKD with patients. The tensions experienced related to identifying and discussing CKD in older people and patients with stage 3A, embedding early-stage CKD within vascular care, and the distribution of work within the practice team. Participants provided accounts of work undertaken to resolve the difficulties encountered, with efforts having tended to focus on reassuring patients. Analysis also highlighted how anxiety surrounding disclosure influenced, and was shaped by, the organisation of care for people with CKD and associated long-term conditions. Conclusion Offering reassurance alone may be of limited benefit, and current management of early-stage CKD in primary care may miss opportunities to address susceptibility to kidney injury, improve self-management of vascular conditions, and improve the management of multimorbidity. PMID:22520910

  8. Trefoil Factor 1 Excretion Is Increased in Early Stages of Chronic Kidney Disease.

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    Diana Lebherz-Eichinger

    Full Text Available Chronic kidney disease (CKD is associated with high morbidity and mortality. In many patients CKD is diagnosed late during disease progression. Therefore, the implementation of potential biomarkers may facilitate the early identification of individuals at risk. Trefoil factor family (TFF peptides promote restitution processes of mucous epithelia and are abundant in the urinary tract. We therefore sought to investigate the TFF peptide levels in patients suffering from CKD and their potential as biomarkers for CKD. We analysed TFF1 and TFF3 in serum and urine of 115 patients with CKD stages 1-5 without dialysis by ELISA. 20 healthy volunteers served as controls. Our results showed, that urinary TFF1 levels were significantly increased with the onset of CKD in stages 1-4 as compared to controls and declined during disease progression (p = 0.003, 0.8. In conclusion our results show increased levels of TFF1 and TFF3 in CKD patients with a pronounced elevation of urinary TFF1 in lower CKD stages. Furthermore, TFF1 and TFF3 seems to be differently regulated and show potential to predict various CKD stages, as shown by ROC curve analysis.

  9. Stage II Chronic Maxillary Atelectasis Associated with Subclinical Visual Field Defect

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    Mangussi-Gomes, João

    2013-09-01

    Full Text Available Introduction: Chronic maxillary atelectasis (CMA is characterized by a persistent decrease in the maxillary sinus volume due to inward bowing of its walls. According to its severity, it may be classified into three clinical-radiological stages. Objective: To report a case of stage II CMA associated with subclinical visual field defect. Case Report: A 34-year-old woman presented with a 15-year history of recurrent episodes of sinusitis and intermittent right facial discomfort for the past 5 years. She denied visual complaints, and no facial deformities were observed on physical examination. Paranasal sinus computed tomography (CT demonstrated a completely opacified right maxillary sinus with inward bowing of its walls, suggesting the diagnosis of stage II CMA. A computerized campimetry (CC disclosed a scotoma adjacent to the blind spot of the right eye, indicating a possible damage to the optic nerve. The patient was submitted to functional endoscopic sinus surgery, with drainage of a thick mucous fluid from the sinus. She did well after surgery and has been asymptomatic since then. Postoperative CT was satisfactory and CC was normal. Discussion: CMA occurs because of a persistent ostiomeatal obstruction, which creates negative pressure inside the sinus. It is associated with nasosinusal symptoms but had never been described in association with any visual field defect. It can be divided into stage I (membranous deformity, stage II (bony deformity, and stage III (clinical deformity. The silent sinus syndrome is a special form of CMA. This term should only be used to describe those cases with spontaneous enophthalmos, hypoglobus, and/or midfacial deformity in the absence of nasosinusal symptoms.

  10. [Surgical treatment of varices at the stage of trophic disorders in chronic venous insufficiency].

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    Ludin, A; Ammann, J

    1991-01-01

    Most ulcers of the lower limbs are caused by existing chronic venous insufficiency. Later on, true social and professional problems will arise, with serious economic and psychological consequences not only for the patient himself, but for the community as well, such as huge medical costs--hence the importance of prevention and treatment, which must in no case be purely symptomatic. The ligation of the arch and of the perforating veins and stripping of the affected vein are part of the classical management of varices. These procedures can may prove to be virtually impossible in case of chronic venous insufficiency, if the patient also presents with subcutaneous liposclerosis or atrophy in an already pregangrenous skin. This preulcerous stage can be aggravated later on if the requirements for surgical repair are not met. Necrosis can then occur, if too aggressive surgery directly or indirectly injures the microcirculatory system of the damaged skin. Omitted or undesirable acts are dangerous at the stage of trophic disorders and surgery may fail to reach its aim, which of course would be to definitively and quickly eliminate the varicose disease.

  11. Elevated levels of plasma osteoprotegerin are associated with all-cause mortality risk and atherosclerosis in patients with stages 3 to 5 chronic kidney disease

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    M.M. Nascimento

    2014-11-01

    Full Text Available Osteoprotegerin (OPG regulates bone mass by inhibiting osteoclast differentiation and activation, and plays a role in vascular calcification. We evaluated the relationship between osteoprotegerin levels and inflammatory markers, atherosclerosis, and mortality in patients with stages 3-5 chronic kidney disease. A total of 145 subjects (median age 61 years, 61% men; 36 patients on hemodialysis, 55 patients on peritoneal dialysis, and 54 patients with stages 3-5 chronic kidney disease were studied. Clinical characteristics, markers of mineral metabolism (including fibroblast growth factor-23 [FGF-23] and inflammation (high-sensitivity C-reactive protein [hsCRP] and interleukin-6 [IL-6], and the intima-media thickness (IMT in the common carotid arteries were measured at baseline. Cardiac function was assessed by color tissue Doppler echocardiography. After 36 months follow-up, the survival rate by Kaplan-Meier analysis was significantly different according to OPG levels (χ 2=14.33; P=0.002. Increased OPG levels were positively associated with IL-6 (r=0.38, P<0.001, FGF-23 (r=0.26, P<0.001 and hsCRP (r=0.0.24, P=0.003. In addition, OPG was positively associated with troponin I (r=0.54, P<0.001 and IMT (r=0.39, P<0.0001. Finally, in Cox analysis, only OPG (HR=1.07, 95%CI=1.02-1.13 and hsCRP (HR=1.02, 95%CI=1.01-1.04 were independently associated with increased risk of death. These results suggested that elevated levels of serum OPG might be associated with atherosclerosis and all-cause mortality in patients with chronic kidney disease.

  12. Changes of serum aldosterone levels in patients with different stages of chronic renal insufficiency

    International Nuclear Information System (INIS)

    Zou Jun; Du Xueliang; Jiang Gengru

    2005-01-01

    Objective: To study the correlationship between the serum aldosterone levels and different stages of chronic renal insufficiency. Methods: Plasma renin activity (PRA), serum angiotensin II (Ang II) contents and serum aldosterone concentration (SACs) were determined with RIA in 42 patients with chronic renal insufficiency from various causes. The patients were divided into three groups according to their endogenous creatinine clearance rate: Group 1, (n=14) Ccr≥60ml/(min·1.73m 2 ); Group 2, (n =13) 20ml/(min·1.73m 2 ) ≤Ccr 2 ); Group 3, (n=15) Ccr 2 ). Results: The SACs values in Group 3 patients were significantly higher than those in Group 1 and Group 2 patients (P<0.01). The SACs values in Group 2 patients were also significantly higher than those in Group 1 patients (P<0.05). Ccr values were higher negatively correlated with the SACs values (r= -0.685, P<0.001). Conclusion: As the creatine clearance rate gradually deteriorated, the SACs values increased correspondingly in patients with chronic renal insufficiency from various causes. (authors)

  13. Compensatory Structural and Functional Adaptation after Radical Nephrectomy for Renal Cell Carcinoma According to Preoperative Stage of Chronic Kidney Disease.

    Science.gov (United States)

    Choi, Don Kyoung; Jung, Se Bin; Park, Bong Hee; Jeong, Byong Chang; Seo, Seong Il; Jeon, Seong Soo; Lee, Hyun Moo; Choi, Han-Yong; Jeon, Hwang Gyun

    2015-10-01

    We investigated structural hypertrophy and functional hyperfiltration as compensatory adaptations after radical nephrectomy in patients with renal cell carcinoma according to the preoperative chronic kidney disease stage. We retrospectively identified 543 patients who underwent radical nephrectomy for renal cell carcinoma between 1997 and 2012. Patients were classified according to preoperative glomerular filtration rate as no chronic kidney disease--glomerular filtration rate 90 ml/minute/1.73 m(2) or greater (230, 42.4%), chronic kidney disease stage II--glomerular filtration rate 60 to less than 90 ml/minute/1.73 m(2) (227, 41.8%) and chronic kidney disease stage III--glomerular filtration rate 30 to less than 60 ml/minute/1.73 m(2) (86, 15.8%). Computerized tomography performed within 2 months before surgery and 1 year after surgery was used to assess functional renal volume for measuring the degree of hypertrophy of the remnant kidney, and the preoperative and postoperative glomerular filtration rate per unit volume of functional renal volume was used to calculate the degree of hyperfiltration. Among all patients (mean age 56.0 years) mean preoperative glomerular filtration rate, functional renal volume and glomerular filtration rate/functional renal volume were 83.2 ml/minute/1.73 m(2), 340.6 cm(3) and 0.25 ml/minute/1.73 m(2)/cm(3), respectively. The percent reduction in glomerular filtration rate was statistically significant according to chronic kidney disease stage (no chronic kidney disease 31.2% vs stage II 26.5% vs stage III 12.8%, p kidney was not statistically significant (no chronic kidney disease 18.5% vs stage II 17.3% vs stage III 16.5%, p=0.250). The change in glomerular filtration rate/functional renal volume was statistically significant (no chronic kidney disease 18.5% vs stage II 20.1% vs stage III 45.9%, p chronic kidney disease stage (p <0.001). Patients with a lower preoperative glomerular filtration rate had a smaller reduction in

  14. [Risk factors for anemia in the early stages of chronic kidney disease].

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    Milovanov, Yu S; Kozlovskaya, L V; Milovanova, L Yu; Markina, M M; Kozlov, V V; Taranova, M V; Fomin, V V

    To identify the early markers of anemia in chronic kidney disease (CKD) in patients with chronic glomerulonephritis (CGN) and glomerulonephritis (GN) in systemic diseases. Seventy-nine patients with some male preponderance who were aged 21 to 65 years (45.3±11.1 years) and had CKD (CGN and GN) in systemic diseases (systemic lupus erythematosus and Wegener's granulomatosis) in the early stages (Stages I-II) of CKD were examined. GN was diagnosed by a lifetime renal biopsy. Systemic diseases were diagnosed according to the criteria for each nosological entity. The stages of CKD were defined according to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) criteria; the glomerular filtration rate (GFR) was calculated using the CKD EPI equation (2012). According to the presence or absence of anemia, all the patients included in the study were divided into 2 groups: 1) 43 (54.4%) anemic patients; 2) 36 (45.6%) non-anemic patients (a control group). In addition to general clinical examination adopted for a nephrology department, special studies, such as determination of the serum levels of hepcidin, interferon-γ (IFN-γ), soluble Klotho protein (s-Klotho), as well as iron, ferritin, and transferrin saturation (TSAT) ratio, were performed to solve the set tasks. Forty-three anemic patients who had a hemoglobin level of 110 (100; 119) g/l and 36 control patients who had the similar values were noted to have statistically significantly (panemia were also found to have a statistically significantly (panemia, its detection rate in the presence of systemic diseases was 3.2 times higher than that in CGN patients (41.7 and 12.7%). ROC analysis revealed that in the CKD patients with CGN and GN, the serum hepcidin level ≥ 25 ng/ml, with the sensitivity and specificity being of 89.7% and 74%, respectively (p > 0.001), was associated with the development of anemia. Moreover, the hemoglobin level ofdiseases, elevated serum hepcidin levels should be regarded as a predictor

  15. Role of low protein diet in management of different stages of chronic kidney disease - practical aspects.

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    Shah, Bharat V; Patel, Zamurrud M

    2016-10-21

    Chronic kidney disease (CKD) is a worldwide public health problem and more so in India. With limited availability and high cost of therapy, barely 10 % of patients with incident end stage renal disease (ESRD) cases get treatment in India. Therefore, all possible efforts should be made to retard progression of CKD. This article reviews the role of low protein diet (LPD) in management of CKD subjects and suggests how to apply it in clinical practice. The role of LPD in retarding progression of CKD is well established in animal experimental studies. However, its role in human subjects with CKD is perceived to be controversial based on the modification of diet in renal disease (MDRD) study. We believe that beneficial effect of LPD could not be appreciated due to shorter duration of follow-up in the MDRD study. Had the study been continued longer, it may have been possible to appreciate beneficial effect of LPD. It is our contention that in all cases of CKD that are slowly progressive, LPD can significantly retard progression of CKD and delay the need for renal replacement therapy (RRT). To be able to apply LPD for a long period, it is important to prescribe LPD at earlier stages (1,2,3) of CKD and not at late stage as recommended by KDIGO guidelines. Many clinicians are concerned about worsening nutritional status and hence reluctant to prescribe LPD. This actually is true for patients with advanced CKD in whom there is spontaneous decrease in calorie and protein intake. In our experience, nutritional status of patients in early stages (1,2,3) of CKD is as good as that of healthy subjects. Prescribing LPD at an early stage is unlikely to worsen status. The role of LPD in retarding progression of CKD is well established in animal experimental studies. Even in human subjects, there is enough evidence to suggest that LPD retards progression of CKD in carefully selected subjects. It should be prescribed to those with good appetite, good nutritional status and a slowly

  16. Spectrum of bone marrow changes in patients of chronic kidney disease (stage iii, iv and v)

    International Nuclear Information System (INIS)

    Latif, R.K.; Khan, S.A.; Ahmad, S.Q.; Arshad, U.

    2017-01-01

    To see the various hematological changes in the bone marrow of patients with chronic kidney disease (CKD) stage III, IV and V. Study Design: Cross sectional observational study.Place and Duration of Study: Study was conducted in the department of haematology (Pathology), Army Medical College, Rawalpindi and duration was one year, from Mar 2015 to Feb 2016. Material and Methods: Patients of both sexes and all age groups with CKD stage III, IV and V were included in this study. Patients' histories were recorded. Complete blood counts, bone marrow aspiration and trephine biopsy were done and evaluated microscopically. Mean blood counts of the patients in three groups of CKD were compared. Frequencies of various bone marrow (BM) findings in patients of CKD were calculated. Results: Out of 57 patients, 41 (71.9%) were males while 16 (28%) were females. Mean age was 60 years. There was no statistically significant difference between the mean hemoglobin, mean white cell count and mean platelets count of the patients in three groups of CKD. Reactive changes due to underlying CKD and inflammation were the most frequent findings in the BM of the patients. Conclusion: Anaemia of mild to moderate severity and reactive changes in the BM are the most frequent haematological findings encountered in patients suffering from advanced stage CKD. Since CKD is predominantly a disease of the elderly so it is not rare to find the co-morbidities including plasmacytosis, malignancies and their effects on the BM in patients of CKD. (author)

  17. Health-related quality of life in different stages of chronic kidney disease.

    Science.gov (United States)

    Aggarwal, H K; Jain, D; Pawar, S; Yadav, R K

    2016-11-01

    Improved survival of chronic kidney disease (CKD) patients has led to an increased focus on health-related quality of life (HRQoL) for evaluating treatment effectiveness and assessing health outcomes of these patients. To evaluate HRQoL in patients in different stages of CKD and to explore possible correlating and influencing factors. Cross-sectional design with 200 patients from India in CKD stages 1-5 assessed for HRQoL through 36-item short-form together with biomarkers. Patients were divided into four groups according to their estimated Glomerular Filtration Rate (eGFR); group A with GFR range > 90 ml/min/1.73 m 2 , group B with GFR range 30-59 ml/min/1.73 m 2 , group C with GFR range 15-29 ml/min/1.73 m 2 and group D with GFR stages. A statistically significant decreasing trend in physical composite summary and mental composite summary scores was found in patients from group A to D (Plife. © The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. Vitamins and Microelement Bioavailability in Different Stages of Chronic Kidney Disease.

    Science.gov (United States)

    Jankowska, Magdalena; Rutkowski, Bolesław; Dębska-Ślizień, Alicja

    2017-03-15

    Chronic kidney disease (CKD) predisposes one to either deficiency or toxic excess of different micronutrients. The knowledge on micronutrients-specifically water-soluble vitamins and trace elements-in CKD is very limited. Consequently, current guidelines and recommendations are mostly based on expert opinions or poor-quality evidence. Abnormalities of micronutrient resources in CKD develop for several reasons. Dietary restrictions and anorexia lead to an insufficient micronutrient intake, while diuretics use and renal replacement therapy lead to their excessive losses. Absorption is unpredictable, and metabolism impaired. Better understanding of the micronutrient needs of CKD patients could have an impact on many complications linked to vitamin and trace element disorders, including high mortality, increased risk of atherosclerosis, inflammation, oxidative stress, anemia, polyneuropathy, encephalopathy, weakness and fragility, muscle cramps, bone disease, depression, or insomnia. Here, we summarize the up-to-date knowledge on micronutrient resources in different stages of CKD, and share our experience with the assessment of micronutrient status.

  19. [Different strategies of substitute treatment of end-stage chronic kidney failure by dialysis].

    Science.gov (United States)

    Viron, B; Michel, C; Mignon, F

    1991-04-21

    The development, diversification and improvement of haemodialysis and transplantation techniques have radically altered the prognosis of end-stage chronic renal failure, a condition that is still inexorably lethal in many countries. In France, it is estimated that up to 20,000 patients are being kept alive by these treatments, including transplantation. The available follow-up data show that a survival of 30 years, and perhaps more, can now be expected, at the cost of cardiovascular and osteo-articular complications the incidence and severity of which should be reduced in the years to come. It is by a carefully planned recourse, based on each patient's clinical status and occupation, to the whole range of these complementary treatments that survival time and quality will be further improved.

  20. Relationship of FGF23 to indexed left ventricular mass in children with non-dialysis stages of chronic kidney disease.

    Science.gov (United States)

    Sinha, Manish D; Turner, Charles; Booth, Caroline J; Waller, Simon; Rasmussen, Pernille; Goldsmith, David J A; Simpson, John M

    2015-10-01

    The aim of this study was to evaluate the association of serum intact fibroblast growth factor 23 (FGF23) concentrations with indexed left ventricular mass in children with non-dialysis stages 3-5 of chronic kidney disease (CKD). The study cohort comprised 83 children (51 boys; mean age 12.1 ± 3.2 years) with a mean estimated glomerular filtration rate (eGFR) of 32.3 ± 14.6 ml/min/1.73 m(2) who underwent clinic and ambulatory blood pressure measurement (ABPM), echocardiography and evaluation of biochemical markers of CKD-associated mineral bone disease. The mean left ventricular mass index (LVMI) was 35.9 ± 8.5 g/m(2.7) (± standard deviation), with 30 (36.1 %) children showing left ventricular hypertrophy (LVH), all eccentric, as defined using age-specific criteria. For all subjects, the mean FGF23 concentration was 142.2 ± 204.4 ng/l and the normalised distribution following log transformation was 1.94 ± 0.39. There was significant univariate correlation of LVMI with GFR, body mass index (BMI) z-score and calcium intake, but not with 24-h systolic ABPM z-score, log intact parathyroid hormone or log FGF23. On multivariate analysis following adjustment for confounders, only elemental calcium content (g/kg/day) estimated from prescribed calcium-based phosphate binder dose (β = 154.9, p children are needed to clarify the roles of calcium-containing phosphate binders and FGF23 with LV mass and their roles in the evolution of the development of adverse cardiovascular outcomes.

  1. Chronic kidney disease stages among diabetes patients in the Cape Coast Metropolis.

    Science.gov (United States)

    Ephraim, Richard K D; Arthur, Eric; Owiredu, W K B A; Adoba, Prince; Agbodzakey, Hope; Eghan, Ben A

    2016-01-01

    Diabetes patients worldwide are at a high risk of chronic kidney disease (CKD) which affects their quality of life and increases the risk of early death. This study used the new kidney disease improving global outcomes (KDIGO) guidelines to establish the prevalence and also identify the factors associated with CKD among diabetes patients in the Cape Coast Metropolis. Two hundred (200) diabetes patients were randomly recruited from the diabetic clinic of the Cape Coast Teaching Hospital from January to April 2014. Blood and urine samples were collected for the estimation of serum creatinine and urine protein, respectively. The estimated glomerular filtration rate (eGFR) was calculated using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation; the 2012 KDIGO guidelines was used to assess CKD. Based on these guidelines, 37% of our participants had CKD. Sixteen percent (16%) of the participants had Stage 1 CKD and 17% had an eGFR <60 mL/min/1.73 m 2 . Albuminuria was higher among female diabetic patients compared to males (69.2% vs. 30.8%, P = 0.017). CKD was present in participants on oral hypoglycemic agents (OHAs) alone or both OHA and insulin. Duration of diabetes, systolic blood pressure, older age, and use of OHA were associated with CKD (P <0.05).

  2. Lung transplant in end-staged chronic obstructive pulmonary disease (COPD) patients: a concise review.

    Science.gov (United States)

    Aziz, Fahad; Penupolu, Sudheer; Xu, Xin; He, Jianxing

    2010-06-01

    Lung transplantation is commonly used for patients with end-stage lung disease. However, there is continuing debate on the optimal operation for patients with chronic obstructive pulmonary disease (COPD) and pulmonary fibrosis. Single-lung transplantation (SLT) provides equivalent short- and medium-term results compared with bilateral lung transplantation (BLT), but long-term survival appears slightly better in BLT recipients (especially in patients with COPD). The number of available organs for lung transplantation also influences the choice of operation. Recent developments suggest that the organ donor shortage is not as severe as previously thought, making BLT a possible alternative for more patients. Among the different complications, re-implantation edema, infection, rejection, and bronchial complications predominate. Chronic rejection, also called obliterative bronchiolitis syndrome, is a later complication which can be observed in about half of the patients. Improvement in graft survival depends greatly in improvement in prevention and management of complications. Despite such complications, graft survival in fibrosis patients is greater than spontaneous survival on the waiting list; idiopathic fibrosis is associated with the highest mortality on the waiting list. Patients should be referred early for the pre-transplantation work-up because individual prognosis is very difficult to predict.

  3. [Adding value to the care at the final stage of chronic diseases].

    Science.gov (United States)

    Vacas Guerrero, Mercedes

    2014-01-01

    There is a growing number of people with advanced chronic health conditions and with palliative care needs who die without their health and social needs satisfied. This is enough to redefine the traditional models of care in order to focus on the person, rather than on the disease. In these new models, the important role of nursing is unquestionably to promote an approach based on comprehensive care, coordination and continuity, and at a social health level appropriate to respond to the care of patients who require complex long-term care. The nurse contribution in the end stages of chronic conditions must be in the value of care. Taking care of someone is to be concerned about them. And this is related to attitude, commitment and responsibility. In the care of patients who live in a situation of extreme vulnerability, it is possible to help them feel warmth, confident, relieve their suffering, respect their autonomy, and help them them find sense and hope, through daily tasks. With gestures, words and facial expressions that go with this care, it is possible to preserve patient dignity. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  4. Chronic childhood adversity and stages of substance use involvement in adolescents.

    Science.gov (United States)

    Benjet, Corina; Borges, Guilherme; Medina-Mora, María Elena; Méndez, Enrique

    2013-07-01

    Studies have shown that those who experience chronic childhood adversity have a greater likelihood of substance abuse and dependence. However, substance use disorders are first preceded by substance use, and substance use is preceded by substance use opportunities. This study aims to estimate the association of chronic adversity with different stages of substance involvement: opportunities, use given the opportunity and abuse or dependence given use. 3005 adolescents aged 12-17 were interviewed in a stratified multistage general population probability survey of Mexico City, Mexico. Substance involvement and chronic childhood adversities were assessed with the World Mental Health Composite International Diagnostic Interview Adolescent Version (WMH-CIDI-A). Discrete-time survival models were performed; their survival coefficients and standard errors were exponentiated, and reported as odds-ratios (ORs). Childhood adversities were associated with alcohol opportunity, alcohol use and alcohol abuse/dependence with significant ORs for individual adversities ranging from 1.4 to 4.1. Childhood adversities were also associated with illicit drug opportunity, drug use and drug abuse/dependence with significant ORs for individual adversities ranging from 1.6 to 17.3. Having more adversities was associated with greater incremental odds of substance involvement, particularly drug use given the opportunity. While adversities are mostly related to transitioning into use and disorder, a few are related to substance opportunities, particularly those which were likely to make substances available through parents. Attending to the needs of youth living in adversity, particularly adversities related to parental dysfunction and child abuse should be integral to addiction prevention efforts. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  5. Ultrasensitive sensor for detection of early stage chronic kidney disease in human.

    Science.gov (United States)

    Desai, Dignya; Kumar, Ashok; Bose, Debajyoti; Datta, Manali

    2018-05-15

    A facile label free, ultrasensitive platform for a rapid detection of chronic kidney disease has been fabricated. Early intervention in patients with chronic kidney disease has the potential to delay, or even prevent, the development of end stage renal disease and complications, leading to a marked impact on life expectancy and quality of life. Thus, a potable electrochemical diagnostic biosensor has become an attractive option as electrochemical analysis is feasible to use for on-site detection of samples. In human, Cystatin C present in human body fluids is freely filtered by the glomerulus, but reabsorbed and catabolised by the renal tubules. Trace detectable amount is eliminated in urine, giving this molecular marker an edge over serum creatinine's disadvantages. A carboxyl functionalized multiwalled carbon nanotubes screen printed electrode was immobilized with papain (cysteine protease) where amino group of papain covalently bound carboxyl group on electrode surface by EDC (1-ethyl-3-(3-dimethylaminopropyl) carbodiimide) and NHS (N-hydroxysuccinimide) chemistry. The modifications on sensor surface were characterized by field emission scanning electron microscopy. Interaction between papain and chronic kidney disease specific biomarker, Cystatin C was detected by cyclic voltammetry and differential pulse voltammetry within 10min. The sensor is highly specific to Cystatin C and showed negligible response to non-specific macromolecules present in urine. The sensitivity of the sensor was 1583.49µAcm -2 µg -1 and lower limit of detection of Cystatin C was found 0.58ngL -1 which presents as a promising platform for designing potable kidney disease detector. Copyright © 2018 Elsevier B.V. All rights reserved.

  6. Iron Status and Inflammation in Early Stages of Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Ewelina Łukaszyk

    2015-06-01

    Full Text Available Background/Aims: One of the most common causes of anemia of chronic disease (ACD is chronic kidney disease. The main pathomechanism responsible for ACD is subclinical inflammation. The key element involved in iron metabolism is hepcidin, however, studies on new indices of iron status are in progress.The aim of the study was to assess the iron status in patients in early stages of chronic kidney disease, iron correlation with inflammation parameters and novel biomarkers of iron metabolism. Methods: The study included 69 patients. Standard laboratory measurements were used to measure the iron status, complete blood count, fibrinogen, prothrombin index, C-reactive protein concentration (CRP, creatinine, urea, uric acid. Commercially available kits were used to measure high-sensitivity CRP, interleukin 6 (IL-6, hepcidin-25, hemojuvelin, soluble transferrin receptor (sTfR, growth differentiation factor-15 (GDF-15 and zonulin. Results: Absolute iron deficiency was present in 17% of the patients, functional iron deficiency was present in 12% of the patients. Functional iron deficiency was associated with significantly higher serum levels of fibrinogen, ferritin, transferrin saturation, total iron binding capacity, hepcidin and older age relative to patients with absolute iron deficiency. In comparison with patients without iron deficiency, patients with functional iron deficiency were older, with lower prothrombin index, higher fibrinogen, CRP, hsCRP, sTfR, GDF-15, urea and lower eGFR. Hepcidin was predicted by markers of inflammation:ferritin, fibrinogen and IL-6. Conclusion: Inflammation is correlated with iron status. Novel biomarkers of iron metabolism might be useful to distinguish iron deficiency anemia connected with inflammation and absolute iron deficiency.

  7. Assessment of liver fibrosis stage influence on clinical course of periodontal diseases in patients with chronic hepatitis C

    Directory of Open Access Journals (Sweden)

    О. М. Slaba

    2017-08-01

    Full Text Available The aim. To assess the influence of liver fibrosis stage on the clinical course of periodontal diseases in patients with chronic hepatitis C. Material and Methods. 122 patients with chronic hepatitis C, treated at the 7th department ofLvivRegionalInfectiousDiseasesHospital during 2013 – 2015 were included into dental investigation. The periodontal disease was diagnosed in accordance with the classification of M. F. Danilevsky (1994. The clinical condition of periodontium was assessed by the papillary marginal alveolar index (PMA in the modification ofParma, by the periodontal index – PI (AL Russel, 1956, by the Muhlemann and Son index – the degree of bleeding in the region of the gingival papilla (PBI. The stage of liver fibrosis was determined according to the medical history. The significance of the difference between two or more relative indicators was calculated using the Fisher test with the Metropolis algorithm. The correlation dependence between the clinical condition of periodontal tissues and the stage of liver fibrosis in patients with viral hepatitis C was studied using the Spearman rank correlation coefficient. Results. The highest percentage of patients with stage of liver fibrosis F0 (70.00 ± 15.28 % was registered in patients with healthy periodont, the lowest - in patients with generalized periodontitis of the third stage (7.89 ± 4.37 %. The highest frequency of patients with the stage of liver fibrosis F3 (73.68 ± 7.14 % was also observed in persons suffering from generalized periodontitis stage III (73.68 ± 7.14 %. Conclusions. The distribution of periodontal lesion severity statistically significant (p < 0.001 depended on the stage of liver fibrosis in patients with chronic hepatitis C. Direct (R = 0.70; p < 0.001 strong correlation between the clinical state of periodontal tissues and the stage of liver fibrosis in patients with chronic hepatitis C (using the Spearman rank correlation coefficient has been determined

  8. Automating and estimating glomerular filtration rate for dosing medications and staging chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Trinkley KE

    2014-05-01

    Full Text Available Katy E Trinkley,1 S Michelle Nikels,2 Robert L Page II,1 Melanie S Joy11Skaggs School of Pharmacy and Pharmaceutical Sciences, 2School of Medicine, University of Colorado, Aurora, CO, USA Objective: The purpose of this paper is to serve as a review for primary care providers on the bedside methods for estimating glomerular filtration rate (GFR for dosing and chronic kidney disease (CKD staging and to discuss how automated health information technologies (HIT can enhance clinical documentation of staging and reduce medication errors in patients with CKD.Methods: A nonsystematic search of PubMed (through March 2013 was conducted to determine the optimal approach to estimate GFR for dosing and CKD staging and to identify examples of how automated HITs can improve health outcomes in patients with CKD. Papers known to the authors were included, as were scientific statements. Articles were chosen based on the judgment of the authors.Results: Drug-dosing decisions should be based on the method used in the published studies and package labeling that have been determined to be safe, which is most often the Cockcroft–Gault formula unadjusted for body weight. Although Modification of Diet in Renal Disease is more commonly used in practice for staging, the CKD–Epidemiology Collaboration (CKD–EPI equation is the most accurate formula for estimating the CKD staging, especially at higher GFR values. Automated HITs offer a solution to the complexity of determining which equation to use for a given clinical scenario. HITs can educate providers on which formula to use and how to apply the formula in a given clinical situation, ultimately improving appropriate medication and medical management in CKD patients.Conclusion: Appropriate estimation of GFR is key to optimal health outcomes. HITs assist clinicians in both choosing the most appropriate GFR estimation formula and in applying the results of the GFR estimation in practice. Key limitations of the

  9. Psychometric evaluation of a new instrument to measure disease self-management of the early stage chronic kidney disease patients.

    Science.gov (United States)

    Lin, Chiu-Chu; Wu, Chia-Chen; Wu, Li-Min; Chen, Hsing-Mei; Chang, Shu-Chen

    2013-04-01

    This study aims to develop a valid and reliable chronic kidney disease self-management instrument (CKD-SM) for assessing early stage chronic kidney disease patients' self-management behaviours. Enhancing early stage chronic kidney disease patients' self-management plays a key role in delaying the progression of chronic kidney disease. Healthcare provider understanding of early stage chronic kidney disease patients' self-management behaviours can help develop effective interventions. A valid and reliable instrument for measuring chronic kidney disease patients' self-management behaviours is needed. A cross-sectional descriptive study collected data for principal components analysis with oblique rotation. Mandarin- or Taiwanese-speaking adults with chronic kidney disease (n=252) from two medical centres and one regional hospital in Southern Taiwan completed the CKD-SM. Construct validity was evaluated by exploratory factor analysis. Internal consistency and test-retest reliability were estimated by Cronbach's alpha and Pearson correlation coefficients. Four factors were extracted and labelled self-integration, problem-solving, seeking social support and adherence to recommended regimen. The four factors accounted for 60.51% of the total variance. Each factor showed acceptable internal reliability with Cronbach's alpha from 0.77-0.92. The test-retest correlations for the CKD-SM was 0.72. The psychometric quality of the CKD-SM instrument was satisfactory. Research to conduct a confirmatory factor analysis to further validate this new instrument's construct validity is recommended. The CKD-SM instrument is useful for clinicians who wish to identify the problems with self-management among chronic kidney disease patients early. Self-management assessment will be helpful to develop intervention tailored to the needs of the chronic kidney disease population. © 2013 Blackwell Publishing Ltd.

  10. Predictive properties of different multidimensional staging systems in patients with chronic obstructive pulmonary disease

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    Oga T

    2011-10-01

    Full Text Available Toru Oga1, Mitsuhiro Tsukino2, Takashi Hajiro3, Akihiko Ikeda4, Koichi Nishimura5 1Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; 2Department of Respiratory Medicine, Hikone Municipal Hospital, Hikone, Japan; 3Department of Respiratory Medicine, Tenri Hospital, Tenri, Japan; 4Department of Respiratory Medicine, Nishi-Kobe Medical Center, Kobe, Japan; 5Department of Respiratory Medicine, Rakuwakai Otowa Hospital, Kyoto, Japan Background: Chronic obstructive pulmonary disease (COPD is considered to be a respiratory disease with systemic manifestations. Some multidimensional staging systems, not based solely on the level of airflow limitation, have been developed; however, these systems have rarely been compared. Methods: We previously recruited 150 male outpatients with COPD for an analysis of factors related to mortality. For this report, we examined the discriminative and prognostic predictive properties of three COPD multidimensional measurements. These indices were the modified BODE (mBODE, which includes body mass index, airflow obstruction, dyspnea, and exercise capacity; the ADO, composed of age, dyspnea, and airflow obstruction; and the modified DOSE (mDOSE, comprising dyspnea, airflow obstruction, smoking status, and exacerbation frequency. Results: Among these indices, the frequency distribution of the mBODE index was the most widely and normally distributed. Univariate Cox proportional hazards analyses revealed that the scores on three indices were significantly predictive of 5-year mortality of COPD (P < 0.001. The scores on the mBODE and ADO indices were more significantly predictive of mortality than forced expiratory volume in 1 second, the Medical Research Council dyspnea score, and the St. George's Respiratory Questionnaire total score. However, peak oxygen uptake on progressive cycle ergometry was more significantly related to mortality than the scores on

  11. Syndrome of rapid onset end stage renal disease in incident Mayo Clinic chronic hemodialysis patient

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    M. A. C. Onuigbo

    2014-01-01

    Full Text Available Despite decades of research, a full understanding of chronic kidney disease (CKD-end stage renal disease (ESRD progression remains elusive. The common consensus is a predictable, linear, progressive and time-dependent decline of CKD to ESRD. Acute kidney injury (AKI on CKD is usually assumed to be transient, with recovery as the expected outcome. AKI-ESRD association in current nephrology literature is blamed on the so-called "residual confounding." We had previously described a relationship between AKI events and rapid onset yet irreversible ESRD happening in a continuum in a high-risk CKD cohort. However, the contribution of the syndrome of rapid onset-ESRD (SORO-ESRD to incident United States ESRD population remained conjectural. In this retrospective analysis, we analyzed serum creatinine trajectories of the last 100 consecutive ESRD patients in 4 Mayo Clinic chronic hemodialysis units to determine the incidence of SORO-ESRD. Excluding 9 patients, 31 (34% patients, including two renal transplant recipients, had SORO-ESRD: 18 males and 13 females age 72 (range 50-92 years. Precipitating AKI followed pneumonia (8, acutely decompensated heart failure (7, pyelonephritis (4, post-operative (5, sepsis (3, contrast-induced nephropathy (2, and others (2. Time to dialysis was shortest following surgical procedures. Concurrent renin angiotensin aldosterone system blockade was higher with SORO-ESRD - 23% versus 5%, P = 0.0113. In conclusion, SORO-ESRD is not uncommon among the incident general US ESRD population. The implications for ESRD care planning, AV-fistula-first programs, general CKD care and any associations with renal ageing/senescence warrant further study.

  12. Systematic Analysis of Blood Cell Transcriptome in End-Stage Chronic Respiratory Diseases

    Science.gov (United States)

    Botturi, Karine; Reynaud-Gaubert, Martine; Mussot, Sacha; Stern, Marc; Danner-Boucher, Isabelle; Mornex, Jean-François; Pison, Christophe; Dromer, Claire; Kessler, Romain; Dahan, Marcel; Brugière, Olivier; Le Pavec, Jérôme; Perros, Frédéric; Humbert, Marc; Gomez, Carine; Brouard, Sophie; Magnan, Antoine

    2014-01-01

    Background End-stage chronic respiratory diseases (CRD) have systemic consequences, such as weight loss and susceptibility to infection. However the mechanisms of such dysfunctions are as yet poorly explained. We hypothesized that the genes putatively involved in these mechanisms would emerge from a systematic analysis of blood mRNA profiles from pre-transplant patients with cystic fibrosis (CF), pulmonary hypertension (PAH), and chronic obstructive pulmonary disease (COPD). Methods Whole blood was first collected from 13 patients with PAH, 23 patients with CF, and 28 Healthy Controls (HC). Microarray results were validated by quantitative PCR on a second and independent group (7PAH, 9CF, and 11HC). Twelve pre-transplant COPD patients were added to validate the common signature shared by patients with CRD for all causes. To further clarify a role for hypoxia in the candidate gene dysregulation, peripheral blood mononuclear cells from HC were analysed for their mRNA profile under hypoxia. Results Unsupervised hierarchical clustering allowed the identification of 3 gene signatures related to CRD. One was common to CF and PAH, another specific to CF, and the final one was specific to PAH. With the common signature, we validated T-Cell Factor 7 (TCF-7) and Interleukin 7 Receptor (IL-7R), two genes related to T lymphocyte activation, as being under-expressed. We showed a strong impact of the hypoxia on modulation of TCF-7 and IL-7R expression in PBMCs from HC under hypoxia or PBMCs from CRD. In addition, we identified and validated genes upregulated in PAH or CF, including Lectin Galactoside-binding Soluble 3 and Toll Like Receptor 4, respectively. Conclusions Systematic analysis of blood cell transcriptome in CRD patients identified common and specific signatures relevant to the systemic pathologies. TCF-7 and IL-7R were downregulated whatever the cause of CRD and this could play a role in the higher susceptibility to infection of these patients. PMID:25329529

  13. Hospitalization and 1-year all-cause mortality in type 2 diabetic patients with chronic kidney disease at Stages 1 and 2: Effect of mild anemia.

    Science.gov (United States)

    Nseir, William; Artul, Suheil; Nasrallah, Najib; Mograbi, Julnar; Mahamid, Mahmud

    2016-07-01

    The effect of anemia in advanced chronic kidney disease (CKD) on morbidity and mortality is known. The aim of the present study was to assess the effect of mild anemia on hospitalization and 1-year all-cause mortality in type 2 diabetes mellitus (T2DM) patients with Stage 1 and 2 CKD. Hospitalized T2DM patients (n = 307) with a glomerular filtration rate ≥ 60 mL/min per 1.73 m(2) and urinary albumin excretion > 30 mg/24 h (Stage 1 and 2 CKD) were enrolled in the study and divided into two groups based on hemoglobin (Hb) concentrations: those with (mean [ ± SD] Hb 10.7 ± 0.7 g/dL) and without (mean Hb 13.3 ± 1.28 g/dL) anemia. There was no significant difference between patients with and without anemia in terms of age, gender, body mass index, HbA1c, and cardiovascular diseases. The mean length of hospitalization of the 130 anemic and 177 non-anemic patients was 4.3 ± 3.5 and 3.5 ± 1.9 days, respectively (P anemia (9.2% vs 1.7%, respectively; P = 0.002). After adjusting for confounding variables, multivariate Cox regression analysis revealed that mild anemia was significantly associated with 1-year all-cause mortality (hazard ratio 2.15, 95% confidence interval 1.92-2.54; P = 0.033). Mild anemia may increase the length of hospitalization and was associated with 1-year all-cause mortality among hospitalized T2DM patients with Stage 1 and 2 CKD. © 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

  14. Childhood Albuminuria and Chronic Kidney Disease is Associated with Mortality and End-Stage Renal Disease.

    Science.gov (United States)

    Lin, Ching-Yuang; Huang, Shiuh-Ming

    2016-08-01

    We do not yet fully grasp the significance of childhood albuminuria. Based on mass urinary screening (MUS) using albumin-specific dipsticks in school children, we studied the independent association of estimated glomerular filtration rate (eGFR) and albuminuria with mortality and end-stage renal disease (ESRD) in children with chronic kidney disease (CKD). A prospective cohort of 5351 children with albuminuria detected by school MSU during the period 1992-1996, followed up to 2009. Cumulative mortality rate, prevalence of CKD, and ESRD were higher in children with albuminuria than those without. Albuminuria category was associated with the risk of mortality [hazard ratio (HR) 3.4] and ESRD (HR 3.24). Lower eGFR and albuminuria predicted mortality and ESRD among children with albuminuria and CKD. We found that being below a threshold of 45 mL/min/1.73 m(2) was significantly associated with ESRD. The highest renal function decline, along with the steepest slope of cumulative ESRD number, occurred in Stage 3, the critical point in renal progression. Risk factors for renal progression among different age groups with albuminuria were hypercholesterolemia and low serum albumin at 7-17 years of age. Beyond 18 years of age, besides the risk factor, a higher fasting blood sugar (BS) was also noted. Childhood albuminuria is a risk factor for CKD in later life, albuminuria provides additional prognostic information, and complications of CKD should be defined in each case. Copyright © 2016. Published by Elsevier B.V.

  15. Self-management programmes in stages 1-4 chronic kidney disease: a literature review.

    Science.gov (United States)

    Bonner, Ann; Havas, Kathryn; Douglas, Clint; Thepha, Thiwawan; Bennett, Paul; Clark, Robyn

    2014-09-01

    Chronic kidney disease (CKD) is a complex health problem, which requires individuals to invest considerable time and energy in managing their health and adhering to multifaceted treatment regimens. To review studies delivering self-management interventions to people with CKD (Stages 1-4) and assess whether these interventions improve patient outcomes. Systematic review. Nine electronic databases (MedLine, CINAHL, EMBASE, ProQuest Health & Medical Complete, ProQuest Nursing & Allied Health, The Cochrane Library, The Joanna Briggs Institute EBP Database, Web of Science and PsycINFO) were searched using relevant terms for papers published between January 2003 and February 2013. The search strategy identified 2,051 papers, of which 34 were retrieved in full with only 5 studies involving 274 patients meeting the inclusion criteria. Three studies were randomised controlled trials, a variety of methods were used to measure outcomes, and four studies included a nurse on the self-management intervention team. There was little consistency in the delivery, intensity, duration and format of the self-management programmes. There is some evidence that knowledge- and health-related quality of life improved. Generally, small effects were observed for levels of adherence and progression of CKD according to physiologic measures. The effectiveness of self-management programmes in CKD (Stages 1-4) cannot be conclusively ascertained, and further research is required. It is desirable that individuals with CKD are supported to effectively self-manage day-to-day aspects of their health. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  16. Metabolomics provide new insights on lung cancer staging and discrimination from chronic obstructive pulmonary disease.

    Science.gov (United States)

    Deja, Stanislaw; Porebska, Irena; Kowal, Aneta; Zabek, Adam; Barg, Wojciech; Pawelczyk, Konrad; Stanimirova, Ivana; Daszykowski, Michal; Korzeniewska, Anna; Jankowska, Renata; Mlynarz, Piotr

    2014-11-01

    Chronic obstructive pulmonary disease (COPD) and lung cancer are widespread lung diseases. Cigarette smoking is a high risk factor for both the diseases. COPD may increase the risk of developing lung cancer. Thus, it is crucial to be able to distinguish between these two pathological states, especially considering the early stages of lung cancer. Novel diagnostic and monitoring tools are required to properly determine lung cancer progression because this information directly impacts the type of the treatment prescribed. In this study, serum samples collected from 22 COPD and 77 lung cancer (TNM stages I, II, III, and IV) patients were analyzed. Then, a collection of NMR metabolic fingerprints was modeled using discriminant orthogonal partial least squares regression (OPLS-DA) and further interpreted by univariate statistics. The constructed discriminant models helped to successfully distinguish between the metabolic fingerprints of COPD and lung cancer patients (AUC training=0.972, AUC test=0.993), COPD and early lung cancer patients (AUC training=1.000, AUC test=1.000), and COPD and advanced lung cancer patients (AUC training=0.983, AUC test=1.000). Decreased acetate, citrate, and methanol levels together with the increased N-acetylated glycoproteins, leucine, lysine, mannose, choline, and lipid (CH3-(CH2)n-) levels were observed in all lung cancer patients compared with the COPD group. The evaluation of lung cancer progression was also successful using OPLS-DA (AUC training=0.811, AUC test=0.904). Based on the results, the following metabolite biomarkers may prove useful in distinguishing lung cancer states: isoleucine, acetoacetate, and creatine as well as the two NMR signals of N-acetylated glycoproteins and glycerol. Copyright © 2014 Elsevier B.V. All rights reserved.

  17. Hemodialysis versus peritoneal dialysis: a case control study of survival in patients with chronic kidney disease stage 5

    DEFF Research Database (Denmark)

    Maier, Alexandra; Stocks, Franziska; Pommer, Wolfgang

    2009-01-01

    It is still controversial whether the mode of dialysis or preexisting comorbidities may influence the prognosis of patients with chronic kidney disease stage 5. Therefore, we performed a prospective case control study to evaluate whether the mode of dialysis may influence outcome. We found 25 cases...

  18. Decrease in urinary creatinine excretion in early stage chronic kidney disease.

    Directory of Open Access Journals (Sweden)

    Elena Tynkevich

    Full Text Available BACKGROUND: Little is known about muscle mass loss in early stage chronic kidney disease (CKD. We used 24-hour urinary creatinine excretion rate to assess determinants of muscle mass and its evolution with kidney function decline. We also described the range of urinary creatinine concentration in this population. METHODS: We included 1072 men and 537 women with non-dialysis CKD stages 1 to 5, all of them with repeated measurements of glomerular filtration rate (mGFR by (51Cr-EDTA renal clearance and several nutritional markers. In those with stage 1 to 4 at baseline, we used a mixed model to study factors associated with urinary creatinine excretion rate and its change over time. RESULTS: Baseline mean urinary creatinine excretion decreased from 15.3 ± 3.1 to 12.1 ± 3.3 mmol/24 h (0.20 ± 0.03 to 0.15 ± 0.04 mmol/kg/24 h in men, with mGFR falling from ≥ 60 to <15 mL/min/1.73 m(2, and from 9.6 ± 1.9 to 7.6 ± 2.5 (0.16 ± 0.03 to 0.12 ± 0.03 in women. In addition to mGFR, an older age, diabetes, and lower levels of body mass index, proteinuria, and protein intake assessed by urinary urea were associated with lower mean urinary creatinine excretion at baseline. Mean annual decline in mGFR was 1.53 ± 0.12 mL/min/1.73 m(2 per year and that of urinary creatinine excretion rate, 0.28 ± 0.02 mmol/24 h per year. Patients with fast annual decline in mGFR of 5 mL/min/1.73 m(2 had a decrease in urinary creatinine excretion more than twice as big as in those with stable mGFR, independent of changes in urinary urea as well as of other determinants of low muscle mass. CONCLUSIONS: Decrease in 24-hour urinary creatinine excretion rate may appear early in CKD patients, and is greater the more mGFR declines independent of lowering protein intake assessed by 24-hour urinary urea. Normalizing urine analytes for creatininuria may overestimate their concentration in patients with reduced kidney function and low muscle mass.

  19. Vitamins and Microelement Bioavailability in Different Stages of Chronic Kidney Disease

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    Magdalena Jankowska

    2017-03-01

    Full Text Available Chronic kidney disease (CKD predisposes one to either deficiency or toxic excess of different micronutrients. The knowledge on micronutrients—specifically water-soluble vitamins and trace elements—in CKD is very limited. Consequently, current guidelines and recommendations are mostly based on expert opinions or poor-quality evidence. Abnormalities of micronutrient resources in CKD develop for several reasons. Dietary restrictions and anorexia lead to an insufficient micronutrient intake, while diuretics use and renal replacement therapy lead to their excessive losses. Absorption is unpredictable, and metabolism impaired. Better understanding of the micronutrient needs of CKD patients could have an impact on many complications linked to vitamin and trace element disorders, including high mortality, increased risk of atherosclerosis, inflammation, oxidative stress, anemia, polyneuropathy, encephalopathy, weakness and fragility, muscle cramps, bone disease, depression, or insomnia. Here, we summarize the up-to-date knowledge on micronutrient resources in different stages of CKD, and share our experience with the assessment of micronutrient status.

  20. Generating a detailed protein profile of Fasciola hepatica during the chronic stage of infection in cattle.

    Science.gov (United States)

    Haçarız, Orçun; Baykal, Ahmet Tarık; Akgün, Mete; Kavak, Pınar; Sağıroğlu, Mahmut Şamil; Sayers, Gearóid Patrick

    2014-06-01

    Fasciola hepatica is a trematode helminth causing a damaging disease, fasciolosis, in ruminants and humans. Comprehensive proteomic studies broaden our knowledge of the parasite's protein profile, and provide new insights into the development of more effective strategies to deal with fasciolosis. The objective of this study was to generate a comprehensive profile of F. hepatica proteins expressed during the chronic stage of infection in cattle by building on previous efforts in this area. The approach included an improved sample preparation procedure for surface and internal layers of the parasite, the application of nano-UPLC-ESI-qTOF-MS (nano-ultra-performance LC and ESI quadrupole TOF MS) integrated with different acquisition methods and in silico database search against various protein databases and a transcript database including a new assembly of publically available EST. Of a total of 776 identified proteins, 206 and 332 were specific to the surface and internal layers of the parasite, respectively. Furthermore, 238 proteins were common to both layers, with comparative differences of 172 proteins detected. Specific proteins not previously identified in F. hepatica, but shown to be immunomodulatory or potential drug targets for other parasites, are discussed. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  1. End Stage and Chronic Kidney Disease:Associations with Renal Cancer

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    Paul eRusso

    2012-04-01

    Full Text Available There is a well known association between end stage renal disease and the development of kidney cancer in the native kidney of patients requiring renal replacement therapy. There is now emerging evidence that lesser degrees of renal insufficiency (chronic kidney disease, CKD are also associated with an increased likelihood of cancer in general and kidney cancer in particular. Nephro pathological changes are commonly observed in the non tumor bearing portions of kidney resected at the time of partial and radical nephrectomy. In addition, patients with renal cancer are more likely to have CKD at the time of diagnosis and treatment than the general population. The exact mechanism by which renal insufficiency transforms normal kidney cells into tumor cells is not known. Possible mechanisms include uremic immune inhibition or increased exposure to circulating toxins not adequately cleared by the kidneys. Surgeons managing kidney tumors must have an increased awareness of their patient’s renal functional status as they plan their resection. Kidney sparing approaches, including partial nephrectomy or active surveillance in older and morbidly ill patients, can prevent CKD or delay the further decline in renal function which is well documented with radical nephrectomy. Despite emerging evidence that partial nephrectomy provides equivalent local tumor control to radical nephrectomy while at the same time preventing CKD, this operation remains under utilized in the United States and abroad. Increased awareness of the bi directional relationship between kidney function and kidney cancer is essential in the contemporary management of kidney cancer.

  2. Telomerase activity in patients with stage 2–5D chronic kidney disease

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    Veysel Kidir

    2017-11-01

    Full Text Available Background: Molecular mechanisms of increased cardiovascular mortality in chronic kidney disease (CKD associated with biological age are not well understood. Recent studies support the hypothesis that common factors responsible for this phenomenon are cellular aging and telomere dysfunction. Objectives: The purpose of this study was to investigate the relation between telomerase activity and CKD stages. Methods: The study included 120 patients who were followed-up for CKD stage 2–5D, composed of 30 patients of each stage and 30 healthy volunteers without any known disease who were admitted to our hospital for routine check-ups. Telomerase activity in peripheral blood mononuclear cells (PBMC was measured using the TRAP assay. Results: A significant difference was observed for telomerase activity in PBMC between groups. The detected levels were lowest in the healthy control group (0.15 ± 0.02, and highest in CKD stage 5D patients (0.23 ± 0.04. In CKD patients, telomerase activity in PBMC was positively correlated with the CKD stage, serum creatinine, potassium and parathormone levels, and negatively correlated with estimated glomerular filtration rate (eGFR, body mass index (BMI, platelet count and serum calcium levels. According to the linear regression analysis, independent predictors for high telomerase activity in CKD patients were eGFR and BMI. Conclusion: Telomerase activity in PBMC increases with advancing CKD stage in CKD patients. Increased telomerase activity in PBMC is associated with eGFR and BMI. Resumen: Antecedentes: Los mecanismos moleculares responsables del aumento de la mortalidad cardiovascular en la enfermedad renal crónica (ERC asociada a la edad biológica no se conocen bien. Los estudios recientes apoyan la hipótesis de que los factores comunes responsables de este fenómeno son el envejecimiento celular y la disfunción telomérica. Objetivos: El objetivo de este estudio fue investigar

  3. [Efficacy on chronic obstructive pulmonary disease at stable stage treated with cutting method and western medication].

    Science.gov (United States)

    Xu, Jian-hua; Xu, Bin; Deng, Yan-qing

    2014-10-01

    To compare the difference in clinical efficacy on chronic obstructive pulmonary disease (COPD) at stable stage in the patients among the combined therapy of cutting method and western medication (combined therapy), simple cutting method and simple western medication. One hundred and twenty cases of COPD were randomized into three groups, 40 cases in each one. In the cutting method group, for excessive phlegm pattern/syndrome, Feishu (BL 13), Danzhong (CV 17), Dingchuan (EX-B 1) and Yuji (LU 10) were selected as the main acupoints, and Lieque (LU 7) and Pianli (LI 6) were as the supplementary acupoints. For the pattern/syndrome of failure to consolidate kidney primary, Shenshu (BL 23), Pishu (BL 20), Guanyuan (CV 4) and Yuji (LU 10) were selected as main acupoints, and Jueyinshu (BL 14) and Zusanli (ST 36) were as the supplementary acupoint. Three acupoints were selected alternatively in each treatment and the cutting method was applied once every 10 days. Three treatments made one session. Two sessions of treatment were required. In the western medication group, salbutamol sulfate aerosol, one press (200 μg/press) was used each night, as well as salmeterol xinafoate and fluticasone propionate powder for inhalation, one inhalation each night. The treatment of 1 month made one session. Two sessions were required. In the combined therapy group, the cutting method and western medication were applied in combination. The results of clinical symptom score, lung function test, arterial blood gas analysis, degree of inflation as well as clinical efficacy were observed before and after treatment in each group. Except the degree of lung inflation, the clinical symptom score, indices of lung function test, partial pressure of arterial blood gas (PaO2) and partial pressure of carbon dioxide (PaCO2) were all obviously improved after treatment as compared with those before treatment in each group (all Psyndrome differentiation and the combined therapy with western medication

  4. Prevalence of secondary hyperparathyroidism in patients with stage 3 and 4 chronic kidney disease seen in internal medicine.

    Science.gov (United States)

    Bureo, Juan Carlos; Arévalo, Jose Carlos; Antón, Joaquín; Adrados, Gaspar; Jiménez Morales, Jose Luis; Robles, Nicolás Roberto

    2015-01-01

    Despite the high prevalence of chronic kidney disease in the elderly population, few data are available on the frequency of secondary hyperparathyroidism in the Spanish population affected by this problem. We undertook a study on this issue in patients attending the internal medicine departments in our area. An observational, cross-sectional survey performed at internal medicine departments on 415 patients with stage 3 and 4 chronic kidney disease. Clinical history and risk factors were collected using a standardized protocol. Serum creatinine, phosphate, calcium, intact parathormone (PTH) and 25-hydroxy-cholecalciferol (25-OH-vitD) levels were measured in all patients. Among stage 3 patients, 62.9% had PTH levels ≥70pg/mL and 32.7% levels ≥110pg/mL. Median PTH level in stage 4 patients was 120pg/mL (p Hyperparathyroidism is a common complication of stage 3 and 4 chronic kidney disease which is not associated to detectable changes in serum calcium and phosphate levels. It is therefore advisable to measure PTH levels in all patients with decreased glomerular filtration rate. Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  5. Increased arterial inflammation in individuals with stage 3 chronic kidney disease

    Energy Technology Data Exchange (ETDEWEB)

    Takx, Richard A.P. [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); MacNabb, Megan H.; Emami, Hamed; Abdelbaky, Amr; Lavender, Zachary R. [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); Singh, Parmanand [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); New York Presbyterian Hospital, Weill Cornell Medical College, Division of Cardiology, New York, NY (United States); Di Carli, Marcelo; Taqueti, Viviany; Foster, Courtney [Brigham and Women' s Hospital and Harvard Medical School, Division of Radiology, Department of Medicine, Boston, MA (United States); Mann, Jessica; Comley, Robert A.; Weber, Chek Ing Kiu [F. Hoffmann-La Roche Ltd., Basel (Switzerland); Tawakol, Ahmed [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); Massachusetts General Hospital and Harvard Medical School, Cardiology Division, Boston, MA (United States); Massachusetts General Hospital, Boston, MA (United States)

    2016-02-15

    While it is well known that patients with chronic kidney disease (CKD) are at increased risk for the development and progression of atherosclerosis, it is not known whether arterial inflammation is increased in mild CKD. The aim of this study was to compare arterial inflammation using {sup 18}F-FDG PET/CT in patients with CKD and in matched controls. This retrospective study included 128 patients undergoing FDG PET/CT imaging for clinical indications, comprising 64 patients with stage 3 CKD and 64 control patients matched by age, gender, and cancer history. CKD was defined according to guidelines using a calculated glomerular filtration rate (eGFR). Arterial inflammation was measured in the ascending aorta as FDG uptake on PET. Background FDG uptake (venous, subcutaneous fat and muscle) were recorded. Coronary artery calcification (CAC) was assessed using the CT images. The impact of CKD on arterial inflammation and CAC was then assessed. Arterial inflammation was higher in patients with CKD than in matched controls (standardized uptake value, SUV: 2.41 ± 0.49 vs. 2.16 ± 0.43; p = 0.002). Arterial SUV correlated inversely with eGFR (r = -0.299, p = 0.001). Venous SUV was also significantly elevated in patients with CKD, while subcutaneous fat and muscle tissue SUVs did not differ between groups. Moreover, arterial SUV remained significantly elevated in patients with CKD compared to controls after correcting for muscle and fat background, and also remained significant after adjusting for clinical risk factors. Further, CKD was associated with arterial inflammation (SUV) independent of the presence of subclinical atherosclerosis (CAC). Moderate CKD is associated with increased arterial inflammation beyond that of controls. Further, the increased arterial inflammation is independent of presence of subclinical atherosclerosis. Current risk stratification tools may underestimate the presence of atherosclerosis in patients with CKD and thereby the risk of

  6. Biomarkers for early and late stage chronic allograft nephropathy by proteogenomic profiling of peripheral blood.

    Directory of Open Access Journals (Sweden)

    Sunil M Kurian

    2009-07-01

    Full Text Available Despite significant improvements in life expectancy of kidney transplant patients due to advances in surgery and immunosuppression, Chronic Allograft Nephropathy (CAN remains a daunting problem. A complex network of cellular mechanisms in both graft and peripheral immune compartments complicates the non-invasive diagnosis of CAN, which still requires biopsy histology. This is compounded by non-immunological factors contributing to graft injury. There is a pressing need to identify and validate minimally invasive biomarkers for CAN to serve as early predictors of graft loss and as metrics for managing long-term immunosuppression.We used DNA microarrays, tandem mass spectroscopy proteomics and bioinformatics to identify genomic and proteomic markers of mild and moderate/severe CAN in peripheral blood of two distinct cohorts (n = 77 total of kidney transplant patients with biopsy-documented histology.Gene expression profiles reveal over 2400 genes for mild CAN, and over 700 for moderate/severe CAN. A consensus analysis reveals 393 (mild and 63 (moderate/severe final candidates as CAN markers with predictive accuracy of 80% (mild and 92% (moderate/severe. Proteomic profiles show over 500 candidates each, for both stages of CAN including 302 proteins unique to mild and 509 unique to moderate/severe CAN.This study identifies several unique signatures of transcript and protein biomarkers with high predictive accuracies for mild and moderate/severe CAN, the most common cause of late allograft failure. These biomarkers are the necessary first step to a proteogenomic classification of CAN based on peripheral blood profiling and will be the targets of a prospective clinical validation study.

  7. Cardiovascular alterations do exist in children with stage-2 chronic kidney disease.

    Science.gov (United States)

    Taşdemir, Mehmet; Eroğlu, Ayşe Güler; Canpolat, Nur; Konukoğlu, Dildar; Ağbaş, Ayşe; Sevim, Meltem Dönmez; Çalışkan, Salim; Sever, Lale

    2016-12-01

    Cardiovascular disease (CVD) is an important complication of chronic kidney disease (CKD) in children. However, it is not well known when and how cardiovascular alterations start. This cross-sectional, controlled study consisted of 25 patients and 28 healthy controls. 24-h ambulatory blood pressure monitoring, aortic pulse wave velocity (aPWV), carotid intima-media thickness (cIMT) and carotid distensibility (distensibility coefficient and β stiffness index), and echocardiography were assessed to evaluate CVD. Routine biochemical parameters, fibroblast growth factor-23 (FGF23) and high sensitive C- reactive protein were measured to determine cardiovascular risk factors. Hypertension was found in 12 patients (48 %). Patients had higher FGF23 levels and aPWV-standard deviation score (SDS) as compared to the controls (p = 0.003 and p = 0.002, respectively). Aortic PWV-SDS was predicted by increased daytime systolic blood pressure load (β = 0.512, p = 0.009, R 2  = 0.262). Neither cIMT nor distensibility differed between the groups; however, older age and high level of FGF23 were independent predictors of β stiffness index in patients (β = 0.507, p = 0.005, R 2  = 0.461 and β = 0.502, p = 0.005, R 2  = 0.461, respectively). As compared to controls, patients had worse left ventricular diastolic function [lower E/A ratio p = 0.006) and increased left atrial dimension (p children with stage-2 CKD. Good control of BP and decreasing the level of FGF23 may be useful to slow down the progression of cardiovascular complications.

  8. A CROSS-SECTIONAL SURVEY ON LIPID ABNORMALITIES ASSOCIATED WITH NONDIABETIC SUBJECTS WITH CHRONIC KIDNEY DISEASE, STAGE III-V

    Directory of Open Access Journals (Sweden)

    Sibi N. S

    2017-09-01

    Full Text Available BACKGROUND Chronic kidney disease is a worldwide public health problem. The adverse outcomes of chronic kidney disease, such as kidney failure, cardiovascular disease and premature death can be prevented or delayed. Chronic renal disease is accompanied by characteristic abnormalities of lipid metabolism. High cholesterol and triglyceride plasma levels have been demonstrated to be independent risk factors for progression of renal disease in humans. The pattern of lipid abnormalities in chronic renal disease patients in Kerala, India, has not been studied. The primary aim of the study is to describe the pattern of lipid profile in nondiabetic chronic kidney disease patients. The secondary objective is to determine the proportion of patients with nondiabetic chronic kidney disease who have lipid abnormalities. MATERIALS AND METHODS Our study is a cross-sectional study conducted in Department of Internal Medicine, Government Medical College, Trivandrum, during the time period of 22-08-2014 to 22-08-2015. The study was conducted after clearance from Institutional Ethics Committee and written informed consent was obtained from all study participants. 134 nondiabetic patients who were diagnosed to have Chronic Kidney disease (CKD according to KDOQI and NKF criteria with a GFR 70 years showed significantly higher serum creatinine value and lower EGFR. Significantly, higher values of Total Cholesterol (TC, Low-Density Lipoproteins (LDL, Triglycerides (TG and Very Low-Density Lipoproteins (VLDL were seen in the age group >70 years and in stage V CKD compared to other groups. CONCLUSION Dyslipidaemia is common in nondiabetic CKD patients (67.91%. Higher stages of CKD were associated with more dyslipidaemia.

  9. Keto-supplemented Low Protein Diet: A Valid Therapeutic Approach for Patients with Steroid-resistant Proteinuria during Early-stage Chronic Kidney Disease.

    Science.gov (United States)

    Zhang, J; Xie, H; Fang, M; Wang, K; Chen, J; Sun, W; Yang, L; Lin, H

    2016-04-01

    Low protein diets supplemented with keto acid (sLPD) are recommended for patients with stage 3-5 chronic kidney disease (CKD). This study assessed whether sLPD is beneficial for patients with steroid-resistant proteinuria during early-stage CKD. A 1-year randomized controlled trial was conducted from 2010 to 2012. In this study, 108 proteinuric patients who were steroid-resistant were assigned to a sLPD group (0.6 g/kg/d with 0.09 g/kg/d keto acids) or a normal protein diet group (NPD, 1.0 g/kg/d). Estimated dietary protein intake, urinary protein excretion, remission rate, renal function, nutritional status, and blood pressure were measured. Baseline characteristics were comparable between the sLPD group (47 patients) and the NPD group (49 patients). Urinary protein excretion significantly decreased in sLPD compared to NPD in months 6, 9, and 12 (Ppatients with steroid-resistant proteinuria.

  10. The Impact of Chronic Illness on Psychosocial Stages of Human Development.

    Science.gov (United States)

    Lapham, E. Virginia, Ed.; Shevlin, Kathleen M., Ed.

    This book addresses critical issues regarding the impact of chronic illness and disability on human development. It was written for health care professionals who help chronically ill and disabled persons deal with the psychological and social as well as the biological aspects of their illness or disability. An expanded version of Erik Erikson's…

  11. 43 CFR 3.5 - Application.

    Science.gov (United States)

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Application. 3.5 Section 3.5 Public Lands: Interior Office of the Secretary of the Interior PRESERVATION OF AMERICAN ANTIQUITIES § 3.5 Application. Each application for a permit should be filed with the Secretary having jurisdiction, and must be...

  12. [Changes in mineral metabolism in stage 3, 4, and 5 chronic kidney disease (not on dialysis)].

    Science.gov (United States)

    Lorenzo Sellares, V; Torregrosa, V

    2008-01-01

    With progression of chronic kidney disease (CKD), disorders of mineral metabolism appear. The classic sequence of events begins with a deficit of calcitriol synthesis and retention of phosphorus. As a result of this, serum calcium decreases and parathyroid hormone (PTH) is stimulated, producing in the bone the high turnover (HT) bone disease known as osteitis fibrosa while on the other extreme we find the forms of low turnover (LT) bone disease. Described later and initially associated with aluminum intoxication, these diseases are now seen primarily in older and/or diabetic patients, who in a uremic setting have relatively low levels of PTH to maintain normal bone turnover. Osteomalacia is also included in this group, which after the disappearance of aluminum intoxication is rarely observed. LT forms of hyperparathyroidism facilitate the exit of calcium (Ca) and phosphorus (P) from bone, whereas the adynamic bone limits the incorporation of Ca and P into bone tissue. Therefore, both forms facilitate the availability of Ca and P, which ends up being deposited in soft tissues such as arteries. The link between bone disease and vascular calcifications in CKD is now a well-established phenomenon. 2. Diagnostic strategies Calcium, Phosphorus They have little capacity to predict underlying bone disease, but their regular measurement is decisive for therapeutic management of the patient, especially in the dose titration stages of intestinal phosphorus binders, vitamin D analogs or calcimimetics. Ideally, Ca++ should be used, but total Ca is routinely used. It is recommended to adjust albumin levels in the event of hypoalbuminemia (for each g/dL of decrease in albumin, total serum Ca decreases 0.9 mg/dL). The following formula facilitates rapid calculation of corrected total calcium: Corrected total Ca (mg/dL) = total Ca (mg/dL) + 0.8 [4-albumina (g/dL)]. Parathyroid hormone "Intact" PTH is the biochemical parameter that best correlates with bone histology (levels

  13. Age and gender differences in the relationship between hepatitis C infection and all stages of Chronic kidney disease.

    Science.gov (United States)

    Li, W-C; Lee, Y-Y; Chen, I-C; Wang, S-H; Hsiao, C-T; Loke, S-S

    2014-10-01

    Chronic kidney disease (CKD) is a worldwide health issue with heavy economic burden. Chronic hepatitis C virus (HCV) infection is a common cause of CKD, which can significantly impact the progression and mortality among patients with CKD. The prevalence of both illnesses is high in Taiwan. A multicentre and population-based cross-sectional study including 24 642 subjects was conducted to explore the association of HCV infection with the prevalence and severity of CKD. The measurements of metabolic parameters, eGFR and CKD stages were compared between subjects with HCV seropositivity and seronegativity. The analyses of association between HCV infection with CKD stages and evaluation of potential risk factors of CKD were performed by gender and age (≤ and >45 years). HCV-seropositive subjects accounted for 6.9% and had a significantly older age. The prevalence of CKD increased in those with HCV seropositivity (16.5%). Significantly higher prevalence of CKD stages ≥3 in HCV-seropositive subjects was noticed (7.8%). Age (>45 year), male gender, alcohol drinking, hypertension, creatinine and HCV infection were the significant factors associated with the presence of CKD. HCV seropositivity was an independent risk factor of developing CKD and associated with an increased risk of having CKD of all stages. The higher prevalence of earlier stage of CKD warrants longitudinal studies with frequent testing on renal function and sufficient duration to determine the changes of eGFR over time. Implementation of effective treatment intervention is also required for these subjects to prevent the progression of CKD to late stages. © 2013 John Wiley & Sons Ltd.

  14. Oral Magnesium Supplementation in Chronic Kidney Disease Stages 3 and 4

    DEFF Research Database (Denmark)

    Bressendorff, Iain; Hansen, Ditte; Schou, Morten

    2017-01-01

    Introduction: Chronic kidney disease (CKD) is associated with high cardiovascular morbidity and mortality. Recent evidence suggests that increases in both serum and intracellular magnesium (Mg) can slow or even prevent the development of vascular calcification seen in CKD. Serum calcification...

  15. Water quality criteria for hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX)

    Energy Technology Data Exchange (ETDEWEB)

    Etnier, E.L.

    1989-04-01

    The occurrence of the munitions compound hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) in groundwater surrounding Army ammunition plants may result in contamination of local drinking water supplies. RDX exerts its primary toxic effect in humans on the central nervous system, but also involves gastrointestinal and renal effects. Symptomatic effects following acute exposure include hyperirritability, nausea, vomiting, generalized epileptiform seizures, and prolonged postictal confusion and amnesia. Health effects data were analyzed for RDX, and although no controlled human studies exist concerning the acute or chronic toxic effects of exposure to RDX, sufficient animal toxicity data are available to derive an ambient water quality criterion for the protection of human health. This paper summarizes the available literature on metabolism of RDX and human and animal toxicity. Based on noncarcinogenic mammalian toxicity data, and following the methodologies of the U.S. Environmental Protection Agency, an ambient water quality criterion for the protection of human health of 103 micrograms/liter is proposed for ingestion of drinking water and aquatic foodstuffs. A criterion of 105 micrograms/liter is proposed for ingestion of drinking water alone.54 references.

  16. The Potential Role of Catheter-Based Renal Sympathetic Denervation in Chronic and End-Stage Kidney Disease.

    Science.gov (United States)

    Sata, Yusuke; Schlaich, Markus P

    2016-07-01

    Sympathetic activation is a hallmark of chronic and end-stage renal disease and adversely affects cardiovascular prognosis. Hypertension is present in the vast majority of these patients and plays a key role in the progressive deterioration of renal function and the high rate of cardiovascular events in this patient cohort. Augmentation of renin release, tubular sodium reabsorption, and renal vascular resistance are direct consequences of efferent renal sympathetic nerve stimulation and the major components of neural regulation of renal function. Renal afferent nerve activity directly influences sympathetic outflow to the kidneys and other highly innervated organs involved in blood pressure control via hypothalamic integration. Renal denervation of the kidney has been shown to reduce blood pressure in many experimental models of hypertension. Targeting the renal nerves directly may therefore be specifically useful in patients with chronic and end-stage renal disease. In this review, we will discuss the potential role of catheter-based renal denervation in patients with impaired kidney function and also reflect on the potential impact on other cardiovascular conditions commonly associated with chronic kidney disease such as heart failure and arrhythmias. © The Author(s) 2016.

  17. Evidence in favor of a severely impaired net intestinal calcium absorption in patients with (early-stage) chronic kidney disease.

    Science.gov (United States)

    Viaene, L; Meijers, B K I; Vanrenterghem, Y; Evenepoel, P

    2012-01-01

    Calcium and phosphorus are essential to many vital physiological processes. Little is known about the net and fractional intestinal absorption of calcium and phosphorus in patients with chronic kidney disease (CKD) and their clinical and hormonal determinants. Blood and 24-hour urine samples were collected in 20 healthy volunteers (HV) and 72 stable CKD stage 1-4 patients and analyzed for parameters of mineral metabolism including calcidiol, calcitriol, and parathyroid hormone (PTH). Dietary intake was assessed by dietary history. The 24-hour urinary calcium excretion, as opposed to the phosphorus excretion, showed a stepwise decrease across CKD stages (median of 219, 84, 40, and 22 mg/day in HV and patients with CKD stages 1-2, 3 and 4, respectively). Younger age, high serum calcitriol, and high estimated GFR were associated with a high 24-hour urinary calcium excretion. High serum calcitriol levels and dietary phosphorus intake were associated with a high 24-hour urinary phosphorus excretion. The fractional intestinal calcium absorption, as estimated by the urinary-to-ingested calcium ratio, decreased across CKD stages. The 24-hour urinary excretion of calcium, as opposed to phosphorus, is markedly decreased in CKD, even in early-stage disease. This is partly explained by low calcitriol levels and older age. Assuming a neutral calcium balance at the time of urine collection, we infer that net intestinal calcium absorption may be severely impaired in CKD. Copyright © 2012 S. Karger AG, Basel.

  18. Patient-reported quality of life and hip function after 2-stage revision of chronic periprosthetic hip joint infection

    DEFF Research Database (Denmark)

    Poulsen, Ninna R; Mechlenburg, Inger; Søballe, Kjeld

    2017-01-01

    INTRODUCTION: Very limited information is available regarding patient-reported health-related quality of life (HRQoL) and hip function following treatment for chronic periprosthetic hip joint infection (PJI). Patient-reported outcome measures provide essential information to clinicians of the imp......INTRODUCTION: Very limited information is available regarding patient-reported health-related quality of life (HRQoL) and hip function following treatment for chronic periprosthetic hip joint infection (PJI). Patient-reported outcome measures provide essential information to clinicians...... to complete the questionnaires EuroQol-5D (EQ-5D) and Oxford Hip Score (OHS) in November 2014. Results were compared to normative population data for EQ-5Dindex. Patients re-infected after a completed 2-stage revision were compared with not re-infected. RESULTS: 45 patients completed the questionnaires. Mean...... time since re-implantation was 8.2 years (95% CI [confidence interval], 7.7-0.87). The EQ-5D index mean for the 2-stage group was 0.71 (0.64; 0.77) whereas the general population mean is 0.85 (0.84-0.85), p = 0.0004. The 2-stage revision patients scored significantly lower on every EQ-5D dimension...

  19. [Part II. Scientific evidence in end-stage chronic organ failure. A position paper on shared care planning].

    Science.gov (United States)

    Gristina, Giuseppe R; Orsi, Luciano; Carlucci, Annalisa; Causarano, Ignazio R; Formica, Marco; Romanò, Massimo

    2014-01-01

    The therapeutic options related to chronic organ failure are interconnected to the variability of human biological responses and the personal history and choices of the chronically ill patient on one hand, and with the variable human answers to therapies on the other hand. All these aspects may explain the small number and low quality of studies aimed to define the clinical criteria useful in identifying end-stage chronically ill patients, as highlighted through the 2012-2013 Medline survey performed by the task force. These results prevented the grading of scientific evidence. However, taking into account the evidence based medicine definition, the task force believes the clinical reasoning and the individual experience of clinicians as well as the patients and families preferences cannot be replaced "tout court" with a strict methodological research. Accordingly, the working method selected by the task force members was to draw up a set of clinical parameters based on the available scientific literature, submitting it to a peer review process carried out by an expert panel. This paper discusses a set of clinical parameters included in the clinical decision-making algorithm and shared by nine medical societies. For each chronic organ failure these clinical parameters should be intended not as a rigid cutoff system to make a choice between two selected care options (intensive vs palliative), rather as the starting point for a joint and careful consideration regarding the opportunity to adopt the clinical decision-making algorithm care proposed in Part I.

  20. High intensity interval training favourably affects antioxidant and inflammation mRNA expression in early-stage chronic kidney disease.

    Science.gov (United States)

    Tucker, Patrick S; Briskey, David R; Scanlan, Aaron T; Coombes, Jeff S; Dalbo, Vincent J

    2015-12-01

    Increased levels of oxidative stress and inflammation have been linked to the progression of chronic kidney disease. To reduce oxidative stress and inflammation related to chronic kidney disease, chronic aerobic exercise is often recommended. Data suggests high intensity interval training may be more beneficial than traditional aerobic exercise. However, appraisals of differing modes of exercise, along with explanations of mechanisms responsible for observed effects, are lacking. This study assessed effects of eight weeks of high intensity interval training (85% VO2max), versus low intensity exercise (45-50% VO2max) and sedentary behaviour, in an animal model of early-stage chronic kidney disease. We examined kidney-specific mRNA expression of genes related to endogenous antioxidant enzyme activity (glutathione peroxidase 1; Gpx1, superoxide dismutase 1; Sod1, and catalase; Cat) and inflammation (kidney injury molecule 1; Kim1 and tumour necrosis factor receptor super family 1b; Tnfrsf1b), as well as plasma F2-isoprostanes, a marker of lipid peroxidation. Compared to sedentary behaviour, high intensity interval training resulted in increased mRNA expression of Sod1 (p=0.01) and Cat (pinterval training resulted in increased mRNA expression of Cat (pinterval training was superior to sedentary behaviour and low intensity exercise as high intensity interval training beneficially influenced expression of genes related to endogenous antioxidant enzyme activity and inflammation. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Mineral and Bone Disorder in Children with Chronic Kidney Disease Stage I to V (Predialysis

    Directory of Open Access Journals (Sweden)

    Joo Hoon Lee

    2014-06-01

    Conclusion: As CKD progressed, hyperphosphatemia, hyperparathyroidism and 1,25D3 deficiency increased, serum FGF-23 level increased and urinary phosphorus excretion decreased in children with CKD stage I to V predialysis.

  2. Can GOLD Stage 0 provide information of prognostic value in chronic obstructive pulmonary disease?

    DEFF Research Database (Denmark)

    Vestbo, Jørgen; Lange, Peter

    2002-01-01

    " for COPD. Our aim was to validate this staging approach using data from three surveys in The Copenhagen City Heart Study, in which a sample of the general population was examined at baseline and in which, after 5 and 15 years, spirometry was performed at all surveys. Criteria for GOLD Stage 0 was fulfilled...... by 5.8% of the total adult population and 7.2% of smokers. After 5 and 15 years, 13.2 and 20.5%, respectively, of smokers with GOLD Stage 0 had developed COPD fulfilling criteria for GOLD Stage 1 or worse. This was the case for 11.6 and 18.5%, respectively, of smokers without respiratory symptoms...

  3. Zonulin, inflammation and iron status in patients with early stages of chronic kidney disease

    OpenAIRE

    Lukaszyk, Ewelina; Lukaszyk, Mateusz; Koc-Zorawska, Ewa; Bodzenta-Lukaszyk, Anna; Malyszko, Jolanta

    2017-01-01

    Background/aims Zonulin is the only known regulator of intestinal permeability. It is also considered as a potential inflammatory marker in several conditions such as diabetes and inflammatory bowel syndrome. The aim of the study was to investigate zonulin levels in patients with early stages of CKD and its possible correlation with inflammation, anemia and iron status parameters. Methods Eighty-eight patients with early stages of CKD and 23 healthy volunteers were enrolled in the study. Zonu...

  4. Prediction of Chronic Kidney Disease Stage 3 by CKD273, a Urinary Proteomic Biomarker

    NARCIS (Netherlands)

    Pontillo, Claudia; Zhang, Zhen-Yu; Schanstra, Joost P; Jacobs, Lotte; Zürbig, Petra; Thijs, Lutgarde; Ramírez-Torres, Adela; Heerspink, Hiddo J L; Lindhardt, Morten; Klein, Ronald; Orchard, Trevor; Porta, Massimo; Bilous, Rudolf W; Charturvedi, Nishi; Rossing, Peter; Vlahou, Antonia; Schepers, Eva; Glorieux, Griet; Mullen, William; Delles, Christian; Verhamme, Peter; Vanholder, Raymond; Staessen, Jan A; Mischak, Harald; Jankowski, Joachim

    2017-01-01

    Introduction: CKD273 is a urinary biomarker, which in advanced chronic kidney disease predicts further deterioration. We investigated whether CKD273 can also predict a decline of estimated glomerular filtration rate (eGFR) to <60 ml/min per 1.73 m2. Methods: In analyses of 2087 individuals from 6

  5. Clinical assessment, staging, and epidemiology of chronic obstructive pulmonary disease exacerbations

    DEFF Research Database (Denmark)

    Vestbo, Jørgen

    2006-01-01

    Patients presenting with an exacerbation of chronic obstructive pulmonary disease (COPD) are initially assessed to ensure that a proper diagnosis has been made and that relevant differential diagnoses are excluded. Although guidelines provide indicators for use, very little systematic research has...

  6. Stage 1 development of a patient-reported experience measure (PREM) for chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Walker, Susan; Andrew, Sharon; Hodson, Matthew; Roberts, C Michael

    2017-07-24

    The study aimed to explore patients' experience of living with chronic obstructive pulmonary disease and their perspective of their community healthcare for chronic obstructive pulmonary disease to extract affective responses in order to develop potential items for a patient-reported experience measure for chronic obstructive pulmonary disease. Qualitative face-face interviews were conducted, in the community, with 64 patients with chronic obstructive pulmonary disease recruited from General Practices and Breathe-Easy community groups in the Outer North East, East and City areas of London and Essex, UK. A two phase analysis of the qualitative data was conducted to identify themes arising from patients' description of living with chronic obstructive pulmonary disease and their perceptions of their community healthcare and subsequently the affective responses underlying the themes raised by patients, which gave emotional colour to the themes, bringing the thematic analysis closer to the subjective patient experience. Five themes were identified from the interview data: 'Journey to diagnosis'; 'Smoking'; 'Usual care'; 'My everyday life'; and 'Exacerbations'. Twenty-one affective responses were identified and categorised as either 'negative', 'positive' or 'bivalent'. 'Frustration', a negative affective response was prevalent in four themes. 'Gratitude', 'hope' and 'happiness/enjoyment' were among the more positive responses more prevalent across several themes. By conducting a novel two-way analysis (thematic and affective) it was possible to identify themes and affective responses that were aligned to those themes. This enabled the development of 38 chronic obstructive pulmonary disease-specific experience items to take forward for further testing including item reduction and validity and reliability in the next stage of the patient-reported experience measure development. GIVING IMPORTANCE TO PATIENTS' EMOTIONS: An exploration of patient perceptions of living with

  7. Relation of Aortic Valve and Coronary Artery Calcium in Patients With Chronic Kidney Disease to the Stage and Etiology of the Renal Disease

    NARCIS (Netherlands)

    Piers, Lieuwe H.; Touw, Hugo R. W.; Gansevoort, Ron; Franssen, Casper F. M.; Oudkerk, Matthijs; Zijlstra, Felix; Tio, Rene A.

    2009-01-01

    Patients with chronic renal failure have increased cardiac calcium loads. Previous studies have investigated the prevalence and quantitative extent of aortic valve calcium (AVC) and coronary artery calcium (CAC) in patients with various stages of chronic kidney disease (CKD). However, the impact of

  8. Biological effect of 60Co chronic irradiation on different development stage in common wheat (T. aestivum L.)

    International Nuclear Information System (INIS)

    Chen Youliang; Yang Pinghua; Xie Yukang

    1991-01-01

    Common wheats were irradiated in 60 Co garden at the stages of plant mature sporophyte, gametophyte and zygote-young embryo during the growing cycle. The biological effects of M 1 and M 2 was significantly related to the development stage of irradiation. When irradiated in the phase of zygote-young embryo, the emergence rate of M 2 was greatly influenced, but the irradiation had a little effect on the fertility of M 1 . The rate of seedling emergence in M 2 can be used for determining optimal dose of irradiation. The rate of micro-nuclei cells were low in the root tip cells of M 1 and seedling cells of M 2 . The M 1 is the major generation of irradiation injury. The irradiation injury of M 2 is minor. M 2 is the first generation for mutant selection. The generation gradation of chronic irradiation was discussed

  9. [An assessment of nutritional status in children on maintenance hemodialysis due to stage 5 chronic kidney disease].

    Science.gov (United States)

    Jiang, Ye-Ping; Shen, Ying; Liu, Xiao-Rong

    2018-03-01

    To investigate the nutritional status of children on maintenance hemodialysis due to stage 5 chronic kidney disease (CKD) and the clinical significance of nutritional assessment indices. A total of 21 children on maintenance hemodialysis due to stage 5 CKD were grouped according to body mass index. The nutritional status was assessed based on anthropometric parameters, biochemical parameters, inflammatory factors, residual renal function, indices of dialysis adequacy, and resting energy expenditure. Related indices were compared between the children with malnutrition and those with normal nutritional status. Of the 21 children, 10 had malnutrition and 11 had normal nutritional status. There were significant differences between the two groups in anthropometric parameters, levels of leptin, insulin-like growth factor-1, interleukin-1, interleukin-6, and tumor necrosis factor-α, and mean 24-hour residual urine volume (Pnutritional status of children with stage 5 CKD on maintenance hemodialysis. Further studies are needed to investigate the value of the measurement of resting energy expenditure in the evaluation and monitoring of nutritional status in children with stage 5 CKD on maintenance hemodialysis.

  10. Estimated GFR (eGFR by prediction equation in staging of chronic kidney disease compared to gamma camera GFR

    Directory of Open Access Journals (Sweden)

    Mohammad Masum Alam

    2016-07-01

    Full Text Available Background: Glomerular filtration rate is an effective tool for diagnosis and staging of chronic kidney disease. The effect ofrenal insufficiency by different method of this tool among patients with CKD is controversial.Objective: The objec­tive of this study was to evaluate the performance of eGFR in staging of CKD compared to gamma camera based GFR.Methods: This cross sectional analytical study was conducted in the Department of Biochemistry Bangabandhu Sheikh Mujib Medical University (BSMMU with the collaboration with National Institute of Nuclear Medicine and Allied Sciences, BSMMU during the period of January 2011 to December 2012. Gama camera based GFR was estimated from DTP A reno gram and eGFR was estimated by three prediction equations. Comparison was done by Bland Altman agree­ment test to see the agreement on the measurement of GFR between three equation based eGFR method and gama camera based GFR method. Staging comparison was done by Kappa analysis to see the agreement between the stages identified by those different methods.Results: Bland-Altman agreement analysis between GFR measured by gamma camera, CG equation ,CG equation corrected by BSA and MDRD equation shows statistically significant. CKD stages determined by CG GFR, CG GFR corrected by BSA , MDRD GFR and gamma camera based GFR was compared by Kappa statistical analysis .The kappa value was 0.66, 0.77 and 0.79 respectively.Conclusions: This study findings suggest that GFR estimation by MDRD equation in CKD patients shows good agreement with gamma camera based GFR and for staging of CKD patients, eGFR by MDRD formula may be used as very effective tool in Bangladeshi population.

  11. Screening for a Chronic Disease: A Multiple Stage Duration Model with Partial Observability.

    Science.gov (United States)

    Mroz, Thomas A; Picone, Gabriel; Sloan, Frank; Yashkin, Arseniy P

    2016-08-01

    We estimate a dynamic multi-stage duration model to investigate how early detection of diabetes can delay the onset of lower extremity complications and death. We allow for partial observability of the disease stage, unmeasured heterogeneity, and endogenous timing of diabetes screening. Timely diagnosis appears important. We evaluate the effectiveness of two potential policies to reduce the monetary costs of frequent screening in terms of lost longevity. Compared to the status quo, the more restrictive policy yields an implicit value for an additional year of life of about $50,000, while the less restrictive policy implies a value of about $120,000.

  12. Increased prevalence of late stage T cell activation antigen (VLA-1) in active juvenile chronic arthritis

    DEFF Research Database (Denmark)

    Ødum, Niels; Morling, Niels; Platz, P

    1987-01-01

    The presence of activated T cells as judged from the reaction with monoclonal antibodies (MoAb) against (a) a late stage T cell activation antigen (VLA-1), (b) the interleukin 2 (IL2) receptor (CD25), and (c) four different HLA class II molecules (HLA-DR, DRw52, DQ, and DP) was studied in 15 pati...

  13. Vitamin D and Stage 5 Chronic Kidney Disease: A New Paradigm?

    DEFF Research Database (Denmark)

    Heaf, James Goya; Joffe, Preben; Marckmann, Peter

    2011-01-01

    Vitamin D receptor agonists (VDRA) are currently recommended for the treatment of secondary hyperparathyroidism in stage 5 CKD. They are considered to be contraindicated in the presence of low or normal (for a dialysis patient) levels of PTH due to the risk of developing adynamic bone disease...

  14. Chronic kidney disease

    Science.gov (United States)

    Kidney failure - chronic; Renal failure - chronic; Chronic renal insufficiency; Chronic kidney failure; Chronic renal failure ... that you do not have symptoms until your kidneys have almost ... end-stage renal disease (ESRD). At this stage, the kidneys are ...

  15. Meta-Analysis of Fish Early Life Stage Tests - Association of Toxic Ratios and Acute-To-Chronic Ratios with Modes of Action

    DEFF Research Database (Denmark)

    Scholz, Stefan; Schreiber, Rene; Armitage, James

    2018-01-01

    Fish early life stage (FELS) tests (OECD test guideline 210) are widely conducted to estimate chronic fish toxicity. In these tests, fish are exposed from the embryonic to the juvenile life stage. In order to analyse whether certain modes of action are related to high toxic ratios (TR, i.e., rati...

  16. Meta-Analysis of Fish Early Life Stage Tests - Association of Toxic Ratios and Acute-To-Chronic Ratios with Modes of Action

    DEFF Research Database (Denmark)

    Scholz, Stefan; Schreiber, Rene; Armitage, James

    2018-01-01

    Fish early life stage (FELS) tests (OECD test guideline 210) are widely conducted to estimate chronic fish toxicity. In these tests, fish are exposed from the embryonic to the juvenile life stage. In order to analyse whether certain modes of action are related to high toxic ratios (TR, i.e., ratios...

  17. Occurrence of sleep-related breathing disorders in patients with chronic urticaria at its asymptomatic or oligosymptomatic stages.

    Science.gov (United States)

    Perkowska, Jolanta; Kruszewski, Jerzy; Gutkowski, Piotr; Chciałowski, Andrzej; Kłos, Krzysztof

    2016-02-01

    Chronic urticaria (CU), in view of its manifestations (pruritus, wheals), chronic and recurrent nature is very bothersome for patients and significantly influences their quality of life. To assess the importance of sleep problems and sleep-related breathing disorders (SRBDs) declared by CU patients, for their quality of life. Twenty-eight patients with CU at an asymptomatic stage or with minimal symptoms and signs were qualified for the study. In these patients, assessment of urticaria severity, QoL and SRBDs incidence was carried out. In a questionnaire study (CU-Q2oL), about 54% of the patients with CU complained of sleeping problems, about 80% reported significant fatigue and lack of concentration in the daytime. Respiratory polygraphy, an objective measure of sleep-related breathing disorders (SRBDs) demonstrated their higher incidence in patients with CU than in the general population, but these disorders were mild and had no influence on the reduced quality of life of the study patients, compared with a group of patients without SRBDs. The occurrence of SRBDs was found in 25% of patients with CU at asymptomatic or oligosymptomatic stages. The SRBDs in those patients were mild, required no treatment and their occurrence did not cause any significant reduction in their quality of life.

  18. Occurrence of sleep-related breathing disorders in patients with chronic urticaria at its asymptomatic or oligosymptomatic stages

    Directory of Open Access Journals (Sweden)

    Jolanta Perkowska

    2016-02-01

    Full Text Available Introduction : Chronic urticaria (CU, in view of its manifestations (pruritus, wheals, chronic and recurrent nature is very bothersome for patients and significantly influences their quality of life. Aim : To assess the importance of sleep problems and sleep-related breathing disorders (SRBDs declared by CU patients, for their quality of life. Material and methods : Twenty-eight patients with CU at an asymptomatic stage or with minimal symptoms and signs were qualified for the study. In these patients, assessment of urticaria severity, QoL and SRBDs incidence was carried out. Results : In a questionnaire study (CU-Q2oL, about 54% of the patients with CU complained of sleeping problems, about 80% reported significant fatigue and lack of concentration in the daytime. Respiratory polygraphy, an objective measure of sleep-related breathing disorders (SRBDs demonstrated their higher incidence in patients with CU than in the general population, but these disorders were mild and had no influence on the reduced quality of life of the study patients, compared with a group of patients without SRBDs. Conclusions : The occurrence of SRBDs was found in 25% of patients with CU at asymptomatic or oligosymptomatic stages. The SRBDs in those patients were mild, required no treatment and their occurrence did not cause any significant reduction in their quality of life.

  19. Vectorization of DOT3.5 code

    International Nuclear Information System (INIS)

    Nonomiya, Iwao; Ishiguro, Misako; Tsutsui, Tsuneo

    1990-07-01

    In this report, we describe the vectorization of two-dimensional Sn-method radiation transport code DOT3.5. Vectorized codes are not only the NEA original version developed at ORNL but also the versions improved by JAERI: DOT3.5 FNS version for fusion neutronics analyses, DOT3.5 FER version for fusion reactor design, and ESPRIT module of RADHEAT-V4 code system for radiation shielding and radiation transport analyses. In DOT3.5, input/output processing time amounts to a great part of the elapsed time when a large number of energy groups and/or a large number of spatial mesh points are used in the calculated problem. Therefore, an improvement has been made for the speedup of input/output processing in the DOT3.5 FNS version, and DOT-DD (Double Differential cross section) code. The total speedup ratio of vectorized version to the original scalar one is 1.7∼1.9 for DOT3.5 NEA version, 2.2∼2.3 fro DOT3.5 FNS version, 1.7 for DOT3.5 FER version, and 3.1∼4.4 for RADHEAT-V4, respectively. The elapsed times for improved DOT3.5 FNS version and DOT-DD are reduced to 50∼65% that of the original version by the input/output speedup. In this report, we describe summary of codes, the techniques used for the vectorization and input/output speedup, verification of computed results, and speedup effect. (author)

  20. Management of chronic hepatitis C virus infection in patients with end-stage renal disease: a review

    Directory of Open Access Journals (Sweden)

    Aguirre Valadez J

    2015-02-01

    Full Text Available Jonathan Aguirre Valadez,1 Ignacio García Juárez,1 Rodolfo Rincón Pedrero,2 Aldo Torre11Department of Gastroenterology, 2Department of Nephrology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico Abstract: Infection with hepatitis C virus (HCV is highly prevalent in chronic kidney disease (CKD patients, mainly in those on hemodialysis (HD. The seroprevalence of HCV in developing countries ranges between 7% and 40%. Risk factors for this infection in the CKD population include the number of blood transfusions, duration of end-stage renal disease (ESRD, and prevalence of HCV in HD. Chronic HCV infection in patients with ESRD is associated with an increase in morbidity and mortality in the pre and post kidney transplant periods. The increase in mortality is directly associated with liver complications and an elevated cardiovascular risk in HCV-infected patients on hemodialysis. Antiviral treatment may improve the prognosis of patients with HCV, and standard interferon remains the cornerstone of treatment. Treatment of HCV in patients with CKD is complex, but achieving a sustained viral response may decrease the frequency of complications after transplantation. It appears that HCV-infected patients who remain on maintenance dialysis are at increased risk of death compared with HCV patients undergoing renal transplantation.Keywords: hepatitis C virus, chronic kidney disease, hemodialysis, interferon

  1. Clinical Association of Thyroid Stimulating Hormone Receptor Antibody Levels with Disease Severity in the Chronic Inactive Stage of Graves' Orbitopathy.

    Science.gov (United States)

    Woo, Young Jae; Jang, Sun Young; Lim, Tyler Hyung Taek; Yoon, Jin Sook

    2015-08-01

    To investigate associations between serum thyroid stimulating hormone (TSH) receptor antibody (TRAb) levels and Graves' orbitopathy (GO) activity/severity in chronic-stage GO and compare the performance of two newly-developed TRAb assays (third-generation TSH-binding inhibition immunoglobulin [TBII] assay versus Mc4 thyroid-stimulating immunoglobulin [TSI] bioassay). This study is a retrospective review of medical charts and blood tests from Korean GO patients who first visited the departments of ophthalmology and endocrinology, Yonsei University College of Medicine from January 2008 to December 2011, were diagnosed with GO and Graves' hyperthyroidism, and were followed up for ≥18 months. Third-generation M22-TBII and Mc4-TSI assays were performed in the chronic-inactive GO patients in whom euthyroidism status was restored. Patients' GO activity/severity clinical activity scores (CAS), and modified NOSPECS scores were examined for a correlation with TRAb assays. Fifty patients (mean age, 41.3 years; 41 females) were analyzed. The mean duration of Graves' hyperthyroidism symptom was 63 months (range, 18 to 401 months) and that of GO was 46 months (range, 18 to 240 months). All patients had been treated previously with anti-thyroid drugs for a median period of 52.3 months, and two patients underwent either radioiodine therapy or total thyroidectomy. Mean CAS and NOSPECS scores were 0.5 ± 0.9 (standard deviation) and 4.8 ± 3.1, respectively. Mean M22-TBII and Mc4-TSI values were 7.5 ± 10.2 IL/L and 325.9 ± 210.1 specimen-to-reference control ratio. TSI was significantly correlated with NOSPECS score (R = 0.479, p 0.05), because GO inflammatory activity subsided in the chronic stages of GO. In chronic-inactive GO after euthyroid restoration, GO activity score did not associate with serum levels of TRAb or TBII. However, levels of the functional antibody Mc4-TSI did correlate with GO severity. Therefore, the TSI bioassay is a clinically relevant measure of disease

  2. Self-training to improve UE function at the chronic stage post-stroke: a pilot randomized controlled trial.

    Science.gov (United States)

    Rand, Debbie; Weingarden, Harold; Weiss, Ronit; Yacoby, Anat; Reif, Shlomit; Malka, Rachel; Shiller, David Andrew; Zeilig, Gabi

    2017-07-01

    On-going practice and use of the weaker upper extremity (UE) are important for maintaining and improving function in individuals with chronic stroke. The effectiveness of two self-training programs for UE function and daily-use was compared. In this pilot, single-blinded clinical trial, individuals with chronic stroke were randomized to video-games or traditional self-training (1-hour/day, 6-times/week, 5 weeks). Assessments were performed pre-intervention (an average of two assessments), post-intervention, and at 4-week follow-up. The primary outcome was the functional ability of the upper extremity [The Action Research Arm Test (ARAT)]. Secondary measures were the daily use of the upper extremity [Motor Activity Log (MAL)] and manual dexterity (Box and Block Test). Repeated measures ANOVA was used to test the effectiveness and estimate effect sizes. Twenty-four of the 142 participants screened by phone were randomized to video-games [N = 13, mean (SD) age - 59.1 (10.5)] or traditional [N = 11, mean (SD) age - 64.9 (6.9)] self-training. Significant between-group differences were not detected. ARAT significantly improved by 13.9% and 9.6% following the video-games and traditional self-training programs (respectively), with a large effect size. MAL (quantity) also improved significantly between pre- intervention to follow-up with medium-large effect size. UE functional improvement can be achieved by self-training at the chronic stage and, therefore, should be encouraged by clinicians. Implications for rehabilitation Video-games or traditional self-training programs can be used to practice repetitive UE movements without the supervision of a clinician Self-training of the UE is beneficial at the chronic stage post-stroke and, therefore, should be encouraged The type of self-training (video-games or traditional) should be suited to the client's abilities and preferences. The compliance of self-training using video-games during the follow-up period was higher

  3. Non-albuminuric renal disease among subjects with advanced stages of chronic kidney failure related to type 2 diabetes mellitus.

    Science.gov (United States)

    Boronat, Mauro; García-Cantón, César; Quevedo, Virginia; Lorenzo, Dionisio L; López-Ríos, Laura; Batista, Fátima; Riaño, Marta; Saavedra, Pedro; Checa, María D

    2014-03-01

    Urinary albumin excretion has been consistently found to be normal in a significant number of subjects with early stages of diabetic kidney disease. This study was aimed to estimate the prevalence and characteristics of non-albuminuric chronic kidney disease associated with type 2 diabetes mellitus among subjects who reach advanced stages of renal failure. Study population was composed of incident patients with advanced chronic kidney disease (glomerular filtration rate <30 mL/min) related to type 2 diabetes in a tertiary hospital from Gran Canaria (Spain) during a period of 2 years. Subjects were classified as normoalbuminuric (urinary albumin-to-creatine ratio [UACR] <30 mg/g), microalbuminuric (UACR ≥30 and <300 mg/g), or proteinuric (UACR ≥300 mg/g). Of 78 eligible patients, 21.8% had normoalbuminuria, 20.5% had microalbuminuria, and 57.7% had proteinuria. Individuals with normoalbuminuria were mostly women and had a lower prevalence of smoking and polyneuropathy than subjects with microalbuminuria or proteinuria. They also presented greater measures of body mass index and waist circumference, higher values of total and LDL cholesterol, and lower values of HbA1c and serum creatinine than subjects with microalbuminuria or proteinuria. Multivariate analysis demonstrated that female sex (positively) and HbA1c and polyneuropathy (negatively) were independently associated with absence of albuminuria. In conclusion, around 20% of subjects with diabetes-related advanced chronic kidney disease, characteristically women, have normal urinary albumin excretion. HbA1c and polyneuropathy are inversely related to this non-albuminuric form of nephropathy.

  4. Health-related quality of life in different stages of chronic kidney disease and at initiation of dialysis treatment

    Directory of Open Access Journals (Sweden)

    Pagels Agneta A

    2012-06-01

    Full Text Available Abstract Objectives To evaluate health-related quality of life (HRQoL in patients in different stages of chronic kidney disease (CKD up to initiation of dialysis treatment and to explore possible correlating and influencing factors. Methods Cross-sectional design with 535 patients in CKD stages 2–5 and 55 controls assessed for HRQoL through SF-36 together with biomarkers. Results All HRQoL dimensions deteriorated significantly with CKD stages with the lowest scores in CKD 5. The largest differences between the patient groups were seen in ‘physical functioning’, ‘role physical’, ‘general health’ and in physical summary scores (PCS. The smallest disparities were seen in mental health and pain. Patients in CKD stages 2–3 showed significantly decreased HRQoL compared to matched controls, with differences of large magnitude - effect size (ES ≥ .80 - in ‘general health’ and PCS. Patients in CDK 4 demonstrated deteriorated scores with a large magnitude in ‘physical function’, ‘general health’ and PCS compared to the patients in CKD 2–3. Patients in CKD 5 demonstrated deteriorated scores with a medium sized magnitude (ES 0.5 – 0.79 in ‘role emotional’ and mental summary scores compared to the patients in CKD 4. Glomerular filtration rate Conclusions Having CKD implies impaired HRQoL, also in earlier stages of the disease. At the time for dialysis initiation HRQoL is substantially deteriorated. Co-existing conditions, such as inflammation and cardiovascular disease seem to be powerful predictors of impaired HRQoL in patients with CKD. Within routine renal care, strategies to improve function and well-being considering the management of co-existing conditions like inflammation and CVD need to be developed.

  5. Health-related quality of life in different stages of chronic kidney disease and at initiation of dialysis treatment.

    Science.gov (United States)

    Pagels, Agneta A; Söderkvist, Birgitta Klang; Medin, Charlotte; Hylander, Britta; Heiwe, Susanne

    2012-06-18

    To evaluate health-related quality of life (HRQoL) in patients in different stages of chronic kidney disease (CKD) up to initiation of dialysis treatment and to explore possible correlating and influencing factors. Cross-sectional design with 535 patients in CKD stages 2-5 and 55 controls assessed for HRQoL through SF-36 together with biomarkers. All HRQoL dimensions deteriorated significantly with CKD stages with the lowest scores in CKD 5. The largest differences between the patient groups were seen in 'physical functioning', 'role physical', 'general health' and in physical summary scores (PCS). The smallest disparities were seen in mental health and pain. Patients in CKD stages 2-3 showed significantly decreased HRQoL compared to matched controls, with differences of large magnitude - effect size (ES) ≥ .80 - in 'general health' and PCS. Patients in CDK 4 demonstrated deteriorated scores with a large magnitude in 'physical function', 'general health' and PCS compared to the patients in CKD 2-3. Patients in CKD 5 demonstrated deteriorated scores with a medium sized magnitude (ES 0.5 - 0.79) in 'role emotional' and mental summary scores compared to the patients in CKD 4. Glomerular filtration rate stages of the disease. At the time for dialysis initiation HRQoL is substantially deteriorated. Co-existing conditions, such as inflammation and cardiovascular disease seem to be powerful predictors of impaired HRQoL in patients with CKD. Within routine renal care, strategies to improve function and well-being considering the management of co-existing conditions like inflammation and CVD need to be developed.

  6. 3' : 5'-Cyclic AMP-dependent 3'

    NARCIS (Netherlands)

    Mato, José M.; Krens, Frans A.; Haastert, Peter J.M. van; Konijn, Theo M.

    1977-01-01

    Suspensions of 3':5'-cyclic AMP (cAMP)-sensitive cells of Dictyostelium discoideum responded to a cAMP pulse with increased 3':5'-cyclic GMP (cGMP) levels. Under the assay conditions used (2 × 10^8 cells per ml in 10 mM phosphate buffer, pH 6.0) cAMP (5 × 10-8 M final concentration) increased cGMP

  7. Bumetanide promotes neural precursor cell regeneration and dendritic development in the hippocampal dentate gyrus in the chronic stage of cerebral ischemia

    Directory of Open Access Journals (Sweden)

    Wang-shu Xu

    2016-01-01

    Full Text Available Bumetanide has been shown to lessen cerebral edema and reduce the infarct area in the acute stage of cerebral ischemia. Few studies focus on the effects of bumetanide on neuroprotection and neurogenesis in the chronic stage of cerebral ischemia. We established a rat model of cerebral ischemia by injecting endothelin-1 in the left cortical motor area and left corpus striatum. Seven days later, bumetanide 200 µg/kg/day was injected into the lateral ventricle for 21 consecutive days with a mini-osmotic pump. Results demonstrated that the number of neuroblasts cells and the total length of dendrites increased, escape latency reduced, and the number of platform crossings increased in the rat hippocampal dentate gyrus in the chronic stage of cerebral ischemia. These findings suggest that bumetanide promoted neural precursor cell regeneration, dendritic development and the recovery of cognitive function, and protected brain tissue in the chronic stage of ischemia.

  8. The Chronic Stages of Bovine Fasciola hepatica Are Dominated by CD4 T-Cell Exhaustion

    Directory of Open Access Journals (Sweden)

    Divya Sachdev

    2017-08-01

    Full Text Available Fasciola hepatica infection of ruminants leads to non-resolving chronic infection, as patency develops, there is switching to a TGF-β and IL-10 led response. Here, we explore the responses of CD4 T-cells within the major draining lymph nodes. We found minimal expression of Foxp3 within CD4 cells but elevated levels within the γδ (WC1+ population. There is a strong T-cell-intrinsic exhaustion phenotype within the hepatic lymph node (HLN characterized by a lack of antigen-specific proliferation and cytokine secretion. CD4 T-cells recovered from the HLN had high levels of PD-1 expression and low levels of IL-2 secretion. Exogenous IL-2 partially rescued this defect; when combined with neutralization of IL-10 and TGF-β, full restoration of proliferation, and cytokine production was achieved. Moreover, there is a clear uncoupling of the mechanisms that facilitate this regulation with parasite-specific proliferation and cytokine secretion being governed by independent means. These data would suggest that there is a CD4 T-cell-intrinsic regulation in place early in chronic infection, potentially leading to failure in resistance to reinfection.

  9. The Chronic Stages of Bovine Fasciola hepatica Are Dominated by CD4 T-Cell Exhaustion

    Science.gov (United States)

    Sachdev, Divya; Gough, Kevin C.; Flynn, Robin J.

    2017-01-01

    Fasciola hepatica infection of ruminants leads to non-resolving chronic infection, as patency develops, there is switching to a TGF-β and IL-10 led response. Here, we explore the responses of CD4 T-cells within the major draining lymph nodes. We found minimal expression of Foxp3 within CD4 cells but elevated levels within the γδ (WC1+) population. There is a strong T-cell-intrinsic exhaustion phenotype within the hepatic lymph node (HLN) characterized by a lack of antigen-specific proliferation and cytokine secretion. CD4 T-cells recovered from the HLN had high levels of PD-1 expression and low levels of IL-2 secretion. Exogenous IL-2 partially rescued this defect; when combined with neutralization of IL-10 and TGF-β, full restoration of proliferation, and cytokine production was achieved. Moreover, there is a clear uncoupling of the mechanisms that facilitate this regulation with parasite-specific proliferation and cytokine secretion being governed by independent means. These data would suggest that there is a CD4 T-cell-intrinsic regulation in place early in chronic infection, potentially leading to failure in resistance to reinfection. PMID:28871261

  10. Functional Recovery in Chronic Stage of Spinal Cord Injury by Neurorestorative Approach: A Case Report

    Directory of Open Access Journals (Sweden)

    Alok Sharma

    2014-01-01

    Full Text Available Spinal cord injury (SCI at an early age can be debilitating for the child’s growth. Current treatments show a level of stagnancy, after which the recovery is minimal. Cellular therapy is an emerging area of research and has been found to possess many benefits in the previous studies. Transplantation of autologous bone marrow mononuclear cells (BMMNCs has demonstrated therapeutic potential for many neurological conditions, including spinal cord injury. Here we report a case of 6-year-old girl with traumatic SCI at the level of C7-D1 4 years back, who underwent 2 doses of cell transplantation with autologous BMMNCs with an interval of 6 months along with standard rehabilitation. The patient did not have any major or minor side effects. The patient showed clinical improvements throughout the 6 months after transplantation, which was assessed using Functional Independence Measure (before: 82, after: 101 out of 126. There were patchy areas of sensory gain in bilateral feet recorded, with improvements in the bladder sensation and control. Improved gait was seen as a result of better strength in abdominals and back extensors. The fact that there was functional improvement in the chronic plateau phase indicates the potential of cell therapy in chronic SCI. Further clinical studies are warranted.

  11. Gas exchange during exercise in different evolutional stages of chronic Chagas' heart disease

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    Fátima Palha de Oliveira

    2000-12-01

    Full Text Available OBJECTIVE: To compare gas exchange at rest and during exercise in patients with chronic Chagas' heart disease grouped according to the Los Andes clinical/hemodynamic classification. METHODS: We studied 15 healthy volunteers and 52 patients grouped according to the Los Andes clinical/hemodynamic classification as follows: 17 patients in group IA (normal electrocardiogram/echocardiogram, 9 patients in group IB (normal electrocardiogram and abnormal echocardiogram, 14 patients in group II (abnormal electrocardiogram/echocardiogram, without congestive heart failure, and 12 patients in group III (abnormal electrocardiogram/echocardiogram with congestive heart failure. The following variables were analyzed: oxygen consumption (V O2, carbon dioxide production (V CO2, gas exchange rate (R, inspiratory current volume (V IC, expiratory current volume (V EC, respiratory frequency, minute volume (V E, heart rate (HR, maximum load, O2 pulse, and ventilatory anaerobic threshold (AT. RESULTS: When compared with the healthy group, patients in groups II and III showed significant changes in the following variables: V O2peak, V CO2peak, V ICpeak, V ECpeak, E, HR, and maximum load. Group IA showed significantly better results for these same variables as compared with group III. CONCLUSION: The functional capacity of patients in the initial phase of chronic Chagas' heart disease is higher than that of patients in an advanced phase and shows a decrease that follows the loss in cardiac-hemodynamic performance.

  12. B cells in chronic obstructive pulmonary disease: moving to center stage

    Science.gov (United States)

    Polverino, Francesca; Seys, Leen J. M.; Bracke, Ken R.

    2016-01-01

    Chronic inflammatory responses in the lungs contribute to the development and progression of chronic obstructive pulmonary disease (COPD). Although research studies focused initially on the contributions of the innate immune system to the pathogenesis of COPD, more recent studies have implicated adaptive immune responses in COPD. In particular, studies have demonstrated increases in B cell counts and increases in the number and size of B cell-rich lymphoid follicles in COPD lungs that correlate directly with COPD severity. There are also increases in lung levels of mediators that promote B cell maturation, activation, and survival in COPD patients. B cell products such as autoantibodies directed against lung cells, components of cells, and extracellular matrix proteins are also present in COPD lungs. These autoantibodies may contribute to lung inflammation and injury in COPD patients, in part, by forming immune complexes that activate complement components. Studies of B cell-deficient mice and human COPD patients have linked B cells most strongly to the emphysema phenotype. However, B cells have protective activities during acute exacerbations of COPD by promoting adaptive immune responses that contribute to host defense against pathogens. This review outlines the evidence that links B cells and B cell-rich lymphoid follicles to the pathogenesis of COPD and the mechanisms involved. It also reviews the potential and limitations of B cells as therapeutic targets to slow the progression of human COPD. PMID:27542809

  13. Gas exchange during exercise in different evolutional stages of chronic Chagas' heart disease.

    Science.gov (United States)

    Oliveira, F P; Pedrosa, R C; Giannella-Neto, A

    2000-12-01

    To compare gas exchange at rest and during exercise in patients with chronic Chagas' heart disease grouped according to the Los Andes clinical hemodynamic classification. We studied 15 healthy volunteers and 52 patients grouped according to the Los Andes clinical and hemodynamic classification as follows: 17 patients in group IA (normal electrocardiogram and echocardiogram), 9 patients in group IB (normal electrocardiogram and abnormal echocardiogram), 14 patients in group II (abnormal electrocardiogram and echocardiogram, without congestive heart failure), and 12 patients in group III (abnormal electrocardiogram and echocardiogram with congestive heart failure). The following variables were analyzed: oxygen consumption (V O2), carbon dioxide production (V CO2), gas exchange rate (R), inspiratory current volume (V IC), expiratory current volume (V EC), respiratory frequency, minute volume (V E), heart rate (HR), maximum load, O2 pulse, and ventilatory anaerobic threshold (AT). When compared with the healthy group, patients in groups II and III showed significant changes in the following variables: V O2 peak, V CO2 peak, V IC peak, V EC peak, E, HR, and maximum load. Group IA showed significantly better results for these same variables as compared with group III. The functional capacity of patients in the initial phase of chronic Chagas' heart disease is higher than that of patients in an advanced phase and shows a decrease that follows the loss in cardiac-hemodynamic performance.

  14. Risk factors associated with prognosis of progressive stages of acute-on-chronic hepatitis B liver failure

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    YE Peiyan

    2013-04-01

    Full Text Available ObjectiveTo identify the risk factors associated with progression of acute-on-chronic liver failure (ACLF occurring in patients with chronic hepatitis B virus (HBV infection (CHB. MethodsThe clinical, demographic, treatment and outcome data of 180 ACLF patients with concomitant CHB managed in our hospital between June 2009 and September 2012 were retrospectively reviewed. Clinical data, taken at baseline, included markers of inflammation/infection (white blood cell (WBC count, coagulation (prothrombin time (PT and prothrombin activity (PTA, and liver function (alanine aminotransferase (ALT, aspartate aminotransferase (AST, total bilirubin (TBil, direct bilirubin (DBil, choninesterase (CHE, albumin (Alb, globulin (Glb, total cholesterol (TC, and ammonia. In-hospital treatments included supplementation with traditional Chinese medicine-based therapies, such as Tuihuang decoction and detoxification enema. The primary outcome was survival during hospitalization. The patients were grouped for analysis according to ACLF stage (early, n=93; mid, n=61; late, n=26 and the risk factors associated with each stage were identified by using univariate (log-rank test and multivariate (Cox’s test regression analyses. The association of risk factors with patient survival was assessed by Kaplan-Meier curve analysis. ResultsThe three ACLF groups showed significantly different amounts of leukocytes, with the late ACLF group showing the highest WBC. The late ACLF group also showed significantly lower Glb and TC. There was a trend in reduced cumulative survival rate and shorter time to death that significantly corresponded to progressive stages of ACLF (early ACLF>mid ACLF>late ACLF; all P<0.001. One-hundred-and-twenty-six (70.0% of the patients died during their hospitalization, and multivariate regression analysis of this entire patient population identified absence of colonic enema, presence of hepatic encephalopathy, presence of hepatorenal syndrome, PTA

  15. Two-stage Bayesian model to evaluate the effect of air pollution on chronic respiratory diseases using drug prescriptions.

    Science.gov (United States)

    Blangiardo, Marta; Finazzi, Francesco; Cameletti, Michela

    2016-08-01

    Exposure to high levels of air pollutant concentration is known to be associated with respiratory problems which can translate into higher morbidity and mortality rates. The link between air pollution and population health has mainly been assessed considering air quality and hospitalisation or mortality data. However, this approach limits the analysis to individuals characterised by severe conditions. In this paper we evaluate the link between air pollution and respiratory diseases using general practice drug prescriptions for chronic respiratory diseases, which allow to draw conclusions based on the general population. We propose a two-stage statistical approach: in the first stage we specify a space-time model to estimate the monthly NO2 concentration integrating several data sources characterised by different spatio-temporal resolution; in the second stage we link the concentration to the β2-agonists prescribed monthly by general practices in England and we model the prescription rates through a small area approach. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Individualized nomogram improves diagnostic accuracy of stage I-II gallbladder cancer in chronic cholecystitis patients with gallbladder wall thickening.

    Science.gov (United States)

    Zhou, Di; Wang, Jian-Dong; Yang, Yong; Yu, Wen-Long; Zhang, Yong-Jie; Quan, Zhi-Wei

    2016-04-01

    Early diagnosis of gallbladder cancer (GBC) can remarkably improve the prognosis of patients. This study aimed to develop a nomogram for individualized diagnosis of stage I-II GBC in chronic cholecystitis patients with gallbladder wall thickening. The nomogram was developed using logistic regression analyses based on a retrospective cohort consisting of 89 consecutive patients with stage I-II GBC and 1240 patients with gallbladder wall thickening treated at one biliary surgery center in Shanghai between January 2009 and December 2011. The accuracy of the nomogram was validated by discrimination, calibration and a prospective cohort treated at another center between January 2012 and December 2014 (n=928). Factors included in the nomogram were advanced age, hazardous alcohol consumption, long-standing diagnosed gallstones, atrophic gallbladder, gallbladder wall calcification, intraluminal polypoid lesion, higher wall thickness ratio and mucosal line disruption. The nomogram had concordance indices of 0.889 and 0.856 for the two cohorts, respectively. Internal and external calibration curves fitted well. The area under the receiver-operating characteristic curves of the nomogram was higher than that of multidetector row computed tomography in diagnosis of stage I-II GBC (Pcholecystitis patients with gallbladder wall thickening, especially for those the imaging features alone do not allow to confirm the diagnosis.

  17. Coping with chronic illness: A study with end-stage renal disease patients

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    Mónica Cassaretto

    2006-06-01

    Full Text Available This study identifies coping styles and strategies used by 40 end-stage renal disease patients over 20 years old who receive treatment in a general hospital in Peru. The instruments applied were a personal sociodemographic questionnaire and the Coping Inventory (Carver, Scheier & Weintraub, 1989. Results showed that emotion focused coping were most frequently used followed by problem focused coping. Planning, acceptance and positive reinterpretation-growth coping strategies were more frequently used by these patients, whereas mental disengagement, suppression of competing activities and behavioral disengagement were the less frequently used coping strategies. Other differences between coping styles and strategies and sociodemographic and medical variables were analyzed.

  18. Chronic obstructive pulmonary disease in patients with end-stage kidney disease on hemodialysis

    DEFF Research Database (Denmark)

    Plesner, Louis L; Warming, Peder E; Nielsen, Ture L

    2016-01-01

    The objectives of this study were to assess the prevalence of chronic obstructive pulmonary disease (COPD) in hemodialysis patients with spirometry and to examine the effects of fluid removal by hemodialysis on lung volumes. Patients ≥18 years at two Danish hemodialysis centers were included....... Forced expiratory volume in one second (FEV1 ), forced vital capacity (FVC), and FEV1 /FVC ratio were measured with spirometry before and after hemodialysis. The diagnosis of COPD was based on both the GOLD criteria and the lower limit of normal criteria. There were 372 patients in treatment at the two...... centers, 255 patients (69%) completed spirometry before dialysis and 242 of these (65%) repeated the test after. In the initial test, 117 subjects (46%) had airflow limitation indicative of COPD with GOLD criteria and 103 subjects (40.4%) with lower limit of normal criteria; COPD was previously diagnosed...

  19. Scale and pattern of atrophy in the chronic stages of moderate-severe TBI

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    Robin E.A. Green

    2014-03-01

    Full Text Available Background. Moderate-severe traumatic brain injury (TBI is increasingly being understood as a progressive disorder, with growing evidence of reduced brain volume and white matter integrity as well as lesion expansion in the chronic phases of injury. The scale of these losses has yet to be investigated, and pattern of change across structures has received limited attention. Objectives. To measure (1 proportion of moderate-severe TBI patients with atrophy from 5 to 20 mos post-injury, and (2 relative vulnerability to and consistency of volume loss in structures with vulnerability to acute TBI. Methods. 56 patients (mean GCS = 6.1 underwent MRI 5 and 20 mos post-injury; 12 healthy controls underwent MRI twice. Mean monthly percent change was computed for whole brain (ventricle-to-brain ratio; VBR, corpus callosum (CC, and right and left hippocampi (HPC. Results. (1 Using a threshold of 2 z-scores below controls, 96% of patients declined on at least one region; 75% declined in at least 3/4. (2 There were no significant differences in proportion of patients showing decline across structures. For those showing decline in VBR, there was a significant association with both the CC and the right HPC (P < .05 for both comparisons. There were significant associations between those showing decline in (i right and left HPC (P < .05; (ii genu, body and splenium of the CC, and (iii head and tail of the right HPC (P< .05 all sub-structure comparisons. Conclusions. Atrophy in chronic moderate-severe TBI is robust, and the CC, right HPC and left HPC appear equally vulnerable. Significant associations between the right and left HPC, and within substructures of the CC and right HPC raise the possibility of common mechanisms affecting associated regions, or spread of degeneration across structures (e.g., transneuronal degeneration. As atrophy has been associated with poorer functional outcomes, offsetting atrophy should be a target of rehabilitation interventions.

  20. Health-related quality of life and chronic obstructive pulmonary disease in early stages - longitudinal results from the population-based KORA cohort in a working age population.

    Science.gov (United States)

    Wacker, Margarethe E; Hunger, Matthias; Karrasch, Stefan; Heinrich, Joachim; Peters, Annette; Schulz, Holger; Holle, Rolf

    2014-08-09

    It is widely recognized that health-related quality of life (HRQL) is impaired in patients with Chronic Obstructive Pulmonary Disease (COPD), but there is a lack of research on longitudinal associations of COPD and HRQL. This study examined the effects of COPD in early stages of disease on HRQL over ten years in a working-age general population setting in Southern Germany while considering the influence of common comorbidities. In the population-based KORA F4 study (2006-08) 1,321 participants aged 41-61 years performed spirometry and reported information on HRQL (measured by the generic SF-12) and comorbidities. For the same participants, HRQL information was available seven years before and three years after the lung function test from the previous S4 (1999-2001) and the F4L follow-up study (2010). Using linear mixed models, the physical and mental component summary scores (PCS-12 / MCS-12) of the SF-12 were compared over time between COPD groups. 7.8% of participants were classified as having COPD (according to the LLN definition and the Global Lungs Initiative), 59.4% of them in grade 1. Regression models showed a negative cross-sectional association of COPD grade 2+ with PCS-12 which persisted when comorbidities were considered. Adjusted mean PCS-12 scores for the COPD grade 2+ group were reduced (-3.5 (p=0.008) in F4, -3.3 (p=0.014) in S4 and -4.7 (p=0.003) in F4L) compared to the group without airflow limitation. The size of the COPD effect in grade 2+ was similar to the effect of myocardial infarction and cancer. Over ten years, a small decline in PCS-12 was observed in all groups. This decline was larger in participants with COPD grade 2+, but insignificant. Regarding MCS-12, no significant cross-sectional or longitudinal associations with COPD were found. Despite small HRQL differences between COPD patients in early disease stages and controls and small changes over ten years, our results indicate that it is important to prevent subjects with airflow

  1. Zonulin, inflammation and iron status in patients with early stages of chronic kidney disease.

    Science.gov (United States)

    Lukaszyk, Ewelina; Lukaszyk, Mateusz; Koc-Zorawska, Ewa; Bodzenta-Lukaszyk, Anna; Malyszko, Jolanta

    2018-01-01

    Zonulin is the only known regulator of intestinal permeability. It is also considered as a potential inflammatory marker in several conditions such as diabetes and inflammatory bowel syndrome. The aim of the study was to investigate zonulin levels in patients with early stages of CKD and its possible correlation with inflammation, anemia and iron status parameters. Eighty-eight patients with early stages of CKD and 23 healthy volunteers were enrolled in the study. Zonulin, hepcidin-25, soluble transferrin receptor, interleukin-6 and high-sensitivity C-reactive protein were measured using commercially available assays. Zonulin was significantly lower among patients with CKD in comparison with healthy volunteers. There were no statistically significant differences in zonulin concentration between patients with and without inflammation. Zonulin was significantly correlated with hepcidin only in patients with inflammation. Zonulin was neither related to iron nor related to ferritin. Zonulin cannot be considered as an inflammatory marker in CKD. It does not play a role in the disturbances of iron metabolism in CKD. Its physiological role remains to be elucidated.

  2. The Role of Ultrasound Imaging in the Definition of the Stage of Liver Fibrosis in Patients with Chronic Hepatitis C

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    Dmitry Konstantinov

    2014-09-01

    Full Text Available The aim of this research was to develop a method for noninvasive staging of liver fibrosis (LF in patients with chronic hepatitis C (CHC based on ultrasound imaging (UI of the abdominal cavity. We examined 124 patients with CHC. The diagnosis was verified on the basis of clinical and epidemiological, serological and molecular biological data. Direct ultrasonic parameters of the structure and hemodynamics of liver and spleen were supplemented with estimated indicators: square of the expected cross-section of the lobes of the liver and spleen, as well as their ratio. On the basis of the discriminant analysis of the survey data of 82 patients, we developed an analytical model (with predictive value of 95.2% for interval estimation of the fibrosis degree in CHC patients. We have concluded that UI performed on modern equipment, including Doppler, is able to determine the degree of LF without resorting to histological verification.

  3. [Current aspects of endothelial protection in treatment of patients with chronic venous insufficiency at the stage of trophic disorders].

    Science.gov (United States)

    Stoiko, Yu M; Gudymovich, V G; Tsyplyashchuk, A V

    The authors analysed the results of comprehensive examination and treatment of a total of 40 patients presenting with lower limb chronic venous insufficiency at the stage of trophic disorders (class C6), including 28 (70%) patients with varicose disease of lower extremities and 12 (30%) patients with post-thrombotic disease. Studying the microcirculatory blood flow by means of laser Doppler flowmetry showed a statistically significant (ptrophic ulcers completely epithelialized in 9 patients and decreased by half of its initial surface in 22 patients. The study of the microcirculatory blood flow in dynamics suggested improvement of microcirculation during treatment. Hence, comprehensive therapy using sulodexide in patients with venous trophic ulcers is accompanied by an endothelium-protecting effect and leads to improvement of the indices of microcirculation of the skin of the crus.

  4. Hepatic cholesterol metabolism following a chronic ingestion of cesium-137 starting at fetal stage in rats

    International Nuclear Information System (INIS)

    Racine, R.; Grandcolas, L.; Blanchardon, E.; Gourmelon, P.; Souidi, M.; Veyssiere, G.

    2010-01-01

    The Chernobyl accident released many radionuclides in the environment. Some are still contaminating the ground and thus the people through dietary intake. The long-term sanitary consequences of this disaster are still unclear and several biological systems remain to be investigated. Cholesterol metabolism is of particular interest, with regard to the link established between atherosclerosis and exposure to high-dose ionizing radiations. This study assesses the effect of cesium-137 on cholesterol metabolism in rats, after a chronic exposure since fetal life. To achieve this, rat dams were contaminated with cesium-137-supplemented water from two weeks before mating until the weaning of the pups. Thereafter, the weaned rats were given direct access to the contaminated drinking water until the age of 9 months. After the sacrifice, cholesterol metabolism was investigated in the liver at gene expression and protein level. The cholesterolemia was preserved, as well as the cholesterol concentration in the liver. At molecular level, the gene expressions of ACAT 2 (a cholesterol storage enzyme), of Apolipoprotein A-I and of RXR (a nuclear receptor involved in cholesterol metabolism) were significantly decreased. In addition, the enzymatic activity of CYP27A1, which catabolizes cholesterol, was increased. The results indicate that the rats seem to adapt to the cesium-137 contamination and display modifications of hepatic cholesterol metabolism only at molecular level and within physiological range. (author)

  5. Decreased staging of differentiated thyroid cancer in patients with chronic lymphocytic thyroiditis.

    Science.gov (United States)

    Borowczyk, M; Janicki, A; Dworacki, G; Szczepanek-Parulska, E; Danieluk, M; Barnett, J; Antonik, M; Kałużna, M; Bromińska, B; Czepczyński, R; Bączyk, M; Ziemnicka, K; Ruchała, M

    2018-04-04

    The biological association between chronic lymphocytic thyroiditis (CLT) and differentiated thyroid cancer (DTC) has not been elucidated yet. The aim of the study was to assess whether the presence of CLT exerts any influence on clinical or histological presentation of DTC. Nine hundred and seven consecutive patients with DTC treated in the years 1998-2016 were divided into two groups according to the presence or absence of concomitant CLT. The statistical differences were analysed. Out of 907 patients included in the study, 331 were diagnosed with DTC and CLT (studied group), while 576 patients with DTC but without CLT constituted a control group. The distribution of papillary and follicular thyroid cancer did not differ. In CLT group, the prevalence of pT1 was greater than for pT2-pT4 DTC (P = 0.0003; OR = 1.69, 95% CI 1.27-2.24) compared to controls (68.3 vs. 56.1%, respectively). The presence of multifocal lesions was similar. The thyroid capsule infiltration without extrathyroidal invasion (P CLT (P = 0.004; OR = 1.66; 95% CI 1.17-2.34) as well as nodal involvement (P = 0.048; OR = 0.65, 95% CI 0.42-0.99). The collected data indicate a protective role of CLT in preventing the spread of the DTC. The presence of CLT might limit tumour growth to the primary site.

  6. Vitamin D deficiency, insulin resistance, and ventricular hypertrophy in the early stages of chronic kidney disease.

    Science.gov (United States)

    Lai, Silvia; Coppola, Bettina; Dimko, Mira; Galani, Alessandro; Innico, Georgie; Frassetti, Nicla; Mariotti, Amalia

    2014-02-01

    Chronic kidney disease (CKD) is associated with markedly increased cardiovascular (CV) risk. This increase is not fully explained by traditional CV risk factors but may in part be mediated by nontraditional risk factors, such as inadequate vitamin D (vit D) levels and insulin resistance (IR). Although IR is shown in nondiabetic CKD, its association with vit D deficiency and vascular disease in this population is unknown and what this study aims to investigate. The study comprised 67 patients with CKD (eGFR ≥ 30 mL/min) and 15 healthy controls matched for age and sex. The phlogosis indexes, vit D levels, IR, carotid intima-media thickness (cIMT), and left ventricular mass index (LVMI) were measured. In our study, the mean value of LVMI and cIMT was significantly higher in patients with eGFR ≥ 30 mL/min compared with controls (p = 0.037 and p hypertrophy and atherosclerotic disease. Vitamin D deficiency and IR are thus associated with increased CV risk. More novel approaches to improving IR and vit D supplementation in the CKD population might lead to potential strategies for preventing excess CV mortality.

  7. Effect of aggressive osteodystrophy management on clinical outcomes in stage 5 chronic kidney disease.

    Science.gov (United States)

    Byham-Gray, Laura; Drasher, Tammy; Deckman, Karen; Graham, Diane; Liftman, Carol; Roberto, Linda; Peiffer, Phyllis; Denmark, Robert

    2009-07-01

    The study investigated whether the type of bone disease management (aggressive versus conventional) had an impact on clinical outcomes, namely bone health measures (e.g., biointact parathyroid hormone [BiPTH], serum corrected calcium [cCa] level, serum phosphorus [phos] level, and corrected calcium-phosphorus product [cCaPO(4)]). Retrospective chart review of 173 closed medical records of maintenance hemodialysis patients on thrice-weekly therapy from January 1, 2005, through December 31, 2005. Two Conventional Management (i.e., control group) and three Aggressive Management (i.e., treatment group) dialysis facilities were enrolled. There was a significant interaction for group assignment and BiPTH levels (F = 4.12, P = .01), with the Aggressive Group trending toward lower BiPTH levels than the Conventional Group. The Conventional Group experienced a significantly lower mean annualized serum cCa level (F = 8.85, P = .003), and used non-calcium-based binders significantly more (P management appears to be as effective as traditional interventions in the treatment of mineral and bone metabolism disorders in chronic kidney disease.

  8. Co-morbidities in patients with gold stage 4 chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    V. Areias

    2014-01-01

    Full Text Available Introduction: Chronic Obstructive Pulmonary Disease (COPD is associated with several co-morbidities, however their prevalence varies from one study to another. Aim: To determine the prevalence of several co-morbidities in patients with COPD severity score GOLD 4 (The Global Initiative for Chronic Obstructive Lung Disease, 2010 followed in ambulatory care, in a University Hospital. Methods: A questionnaire was designed and carried out in order to characterize COPD and its co-morbidities. Clinical files were consulted in order to complete the data. Results: 89 patients (87% male with a mean age of 68 years old, of which 79% were ex-smokers, were included. The average value of FEV1 (forced expiratory volume in one second was 38% of the expected values and all the patients presented chronic respiratory failure. Thirty-five patients (39% were frequent exacerbators.Thirty-seven patients (42% had been hospitalized at least once due to exacerbation of their respiratory disease in the previous year, and 66 patients (74% hospitalized in the previous five years.Most of the patients (97% presented at least one comorbidity, with an average of 4 co-morbidities per patient and an average Charlson index of 2.The most frequent co-morbidities were cardiovascular diseases (69%, osteoarticular pathology (51%, erectile dysfunction (48%, sleep apnoea syndrome (43% dyslipidaemia (35%, cataracts (31%, gastroesophageal reflux (29% and diabetes (20%.Frequent exacerbators presented an increased risk of having two or more co-morbidities (Odds Ratio of 5, as well as a higher prevalence of gastroesophageal reflux (p = 0, 0006 and more hospitalizations in the last year and in the previous 5 years (p < 0,001. Conclusion: This study confirmed the high prevalence and the association of co-morbidities in patients with COPD severity score GOLD 4, thus justifying the need for a comprehensive and integrating therapeutic approach. Resumo: Introdução: A Doença Pulmonar

  9. Glycaemic, blood pressure and lipid goal attainment and chronic kidney disease stage of type 2 diabetic patients treated in primary care practices.

    Science.gov (United States)

    Corcillo, Antonella; Pivin, Edward; Lalubin, Fabrice; Pitteloud, Nelly; Burnier, Michel; Zanchi, Anne

    2017-07-11

    The prevalence of chronic kidney disease and diabetes is rising in Europe. These patients are at high cardiovascular and renal risk and need a challenging multifactorial therapeutic approach. The goal of this cross-sectional study was to examine the treatment and attainments of goals related to cardiovascular risk factors within chronic kidney disease stages in type 2 diabetic patients followed up by primary care physicians in Switzerland. Each participating physician entered into a web database the anonymised data of up to 15 consecutive diabetic patients attending her/his office between December 2013 and June 2014. Diabetes, hypertension and lipid lowering therapies were analysed, as well as glycated haemoglobin (HbA1c), blood pressure and low-density lipoprotein-cholesterol (LDL-c) levels and goal attainments by KDIGO chronic kidney disease stage 1 to 4. A total of 1359 patients (mean age 66.5±12.4 years) were included by 109 primary care physicians. Chronic kidney disease stages 0-2, 3a, 3 b and 4 were present in 77.6%, 13.9%, 6.1%, and 2.4%, respectively. Average HbA1c was independent of chronic kidney disease stage and close to 7%; more than half of the patients reached the HbA1c goal. Eighty-four percent of patients were hypertensive and only 18.2% reached the then current Swiss or American Diabetes Association 2013 blood pressure goals. Despite loosening of blood pressure goals in 2015, only half of the patients reached them and most needed multiple therapies. Increased body mass index and advanced chronic kidney disease stage decreased the chance of reaching blood pressure goals. Lipid lowering therapy was prescribed in 62.1% of cases, with average LDL-c levels similar across chronic kidney disease stages. Only 42% of patients reached the LDL-c goal of primary prevention and 32% reached primary care physicians in Switzerland. Goal attainments for HbA1c and LDL-c were not influenced by chronic kidney disease stages, in contrast to blood pressure. Reaching

  10. Oral calcium carbonate affects calcium but not phosphorus balance in stage 3–4 chronic kidney disease

    Science.gov (United States)

    Hill, Kathleen M.; Martin, Berdine R.; Wastney, Meryl; McCabe, George P.; Moe, Sharon M.; Weaver, Connie M.; Peacock, Munro

    2014-01-01

    Chronic kidney disease (CKD) patients are given calcium carbonate to bind dietary phosphorus and reduce phosphorus retention, and to prevent negative calcium balance. Data are limited on calcium and phosphorus balance in CKD to support this. The aim of this study was to determine calcium and phosphorus balance and calcium kinetics with and without calcium carbonate in CKD patients. Eight stage 3/4 CKD patients, eGFR 36 mL/min, participated in two 3-week balances in a randomized placebo-controlled cross-over study of calcium carbonate (1500 mg/d calcium). Calcium and phosphorus balance were determined on a controlled diet. Oral and intravenous 45calcium with blood sampling and urine and fecal collections were used for calcium kinetics. Fasting blood and urine were collected at baseline and end of each week of each balance period for biochemical analyses. Results showed that patients were in neutral calcium and phosphorus balance while on placebo. Calcium carbonate produced positive calcium balance, did not affect phosphorus balance, and produced only a modest reduction in urine phosphorus excretion compared with placebo. Calcium kinetics demonstrated positive net bone balance but less than overall calcium balance suggesting tissue deposition. Fasting biochemistries of calcium and phosphate homeostasis were unaffected by calcium carbonate. If they can be extrapolated to effects of chronic therapy, these data caution against the use of calcium carbonate as a phosphate binder. PMID:23254903

  11. Worse Prognosis for Stage IA Lung Cancer Patients with Smoking History and More Severe Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Yoshida, Yukihiro; Kage, Hidenori; Murakawa, Tomohiro; Sato, Yasunori; Ota, Satoshi; Fukayama, Masashi; Nakajima, Jun

    2015-01-01

    This retrospective study examined whether the severity of chronic obstructive lung disease (COPD) affects surgical outcomes. The subjects were 243 consecutive patients who underwent lobectomy for clinical stage IA lung cancer from 1999 to 2008 in our hospital. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) grading system was used to classify the severity of COPD in smokers. Among the 149 smokers, 62 were diagnosed with COPD (25 as GOLD 1, 33 as GOLD 2, and 4 as GOLD 3). In univariate analysis, postoperative pulmonary complications were associated with male sex and more severe COPD. The frequencies were 17.1% in non-COPD, 24.0% in GOLD 1-COPD, and 46.0% in GOLD 2/3-COPD smokers (p = 0.0006). In univariate analysis, older age, smoking history, higher smoking pack-years and more severe COPD were associated with poor relapse-free survival. Relapse-free survival at five years was 80.7%, 66.9%, and 61.3% in non-COPD, GOLD 1-COPD, and GOLD 2/3-COPD smokers, respectively (p = 0.0005). Multivariate analyses showed that only GOLD 2/3-COPD was associated with postoperative pulmonary complications and relapse-free survival. Inhaled bronchodilators were prescribed preoperatively to 24.3% of the GOLD 2/3-COPD group. Smokers with GOLD 2/3-COPD are at high risk for pulmonary complications and have an unfavorable long-term prognosis.

  12. Nutritional evaluation of stage 5 chronic kidney disease patients on dialysis

    Directory of Open Access Journals (Sweden)

    Cynthia Mauro Piratelli

    Full Text Available CONTEXT AND OBJECTIVE: Patients with chronic kidney failure undergoing dialysis have high prevalence of protein-energy malnutrition. There is still no uniform method for assessing these patients' nutritional status. It is recommended that a set of subjective and objective methods should be applied so that an adequate nutritional diagnosis can be reached. The aim of this study was to evaluate the nutritional profile of patients undergoing hemodialysis. DESIGN AND SETTING: Cross-sectional study conducted in the Dialysis Treatment Unit, Araraquara, São Paulo, Brazil, in 2008. METHODS: Anthropometric and biochemical indicators were characterized for 48 patients who also gave responses to the modified Subjective Global Assessment questionnaire (SGAm, and possible correlations between these indicators were investigated. RESULTS: The frequency of moderate or severe malnutrition ranged from 22% to 54%, according to the parameter used. Regarding the patients' conformity with the ideal weight, 29% of them weighed less than 75% of the ideal, and thus were classified as having moderate or severe malnutrition. The most significant correlations were observed between body mass index (BMI and the idealness of triceps skinfold (TSF, upper arm circumference (UAC and upper arm muscle circumference (UAMC; and between SGAm and the idealness of UAC and UAMC. CONCLUSION: The frequency of malnutrition showed great variability among the patients, according to the evaluation criterion chosen. Routine nutritional monitoring and validation of methods for assessing body composition among such patients are extremely important for diagnosing malnutrition early on, thus preventing complications and reducing the morbidity and mortality rates in this population.

  13. Geometry task sheets : grades 3-5

    CERN Document Server

    Rosenberg, Mary

    2009-01-01

    For grades 3-5, our Common Core State Standards-based resource meets the geometry concepts addressed by the NCTM standards and encourages the students to learn and review the concepts in unique ways. Each task sheet is organized around a central problem taken from real-life experiences of the students.

  14. Cost-effectiveness of kidney transplantation compared with chronic dialysis in end-stage renal disease.

    Science.gov (United States)

    Rosselli, Diego; Rueda, Juan-David; Diaz, Carlos Eduardo

    2015-01-01

    To estimate the costs and effectiveness measured in quality-adjusted life years (QALY) of kidney transplantation compared with dialysis in adults suffering from end-stage renal disease from the perspective of the Colombian healthcare system, we designed a Markov model with monthly cycles over a five-year time horizon and eight transitional states, including death as an absorbing state. Transition probabilities were obtained from international registries, costs from different local sources [case studies, official tariffs (ISS 2001 + 35%) for procedures and SISMED for medications]. Data were validated by an expert panel and we performed univariate, multivariate and probabilistic sensitivity analyses. Effectiveness indicators were months of life gained, months of dialysis averted and deaths prevented. The annual discount rate was 3% and the cost-utility threshold (willingness to pay) was three times gross domestic product (GDP) = USD 20,000 per QALY. The costs were adopted in US dollars (USD) using the 2012 average exchange rate (1 USD = COP$ 1798). The discounted average total cost for five years was USD 76,718 for transplantation and USD 76,891 for dialysis, with utilities 2.98 and 2.10 QALY, respectively. Additionally, renal transplantation represented 6.9 months gained, 35 months in dialysis averted per patient and one death averted for each of the five patients transplanted in five years. We conclude that renal transplantation improves the overall survival rates and quality of life and is a cost-saving alternative compared with dialysis.

  15. Cost-effectiveness of kidney transplantation compared with chronic dialysis in end-stage renal disease

    Directory of Open Access Journals (Sweden)

    Diego Rosselli

    2015-01-01

    Full Text Available To estimate the costs and effectiveness measured in quality-adjusted life years (QALY of kidney transplantation compared with dialysis in adults suffering from end-stage renal disease from the perspective of the Colombian healthcare system, we designed a Markov model with monthly cycles over a five-year time horizon and eight transitional states, including death as an absorbing state. Transition probabilities were obtained from international registries, costs from different local sources [case studies, official tariffs (ISS 2001 + 35% for procedures and SISMED for medications]. Data were validated by an expert panel and we performed univariate, multivariate and probabilistic sensitivity analyses. Effectiveness indicators were months of life gained, months of dialysis averted and deaths prevented. The annual discount rate was 3% and the cost-utility threshold (willingness to pay was three times gross domestic product (GDP = USD 20,000 per QALY. The costs were adopted in US dollars (USD using the 2012 average exchange rate (1 USD = COP$ 1798. The discounted average total cost for five years was USD 76,718 for transplantation and USD 76,891 for dialysis, with utilities 2.98 and 2.10 QALY, respectively. Additionally, renal transplantation represented 6.9 months gained, 35 months in dialysis averted per patient and one death averted for each of the five patients transplanted in five years. We conclude that renal transplantation improves the overall survival rates and quality of life and is a cost-saving alternative compared with dialysis.

  16. Relations between the stimulation of mixed lymphocyte populations and the staging system according Rai in patients with chronic lymphatic leukemia

    International Nuclear Information System (INIS)

    Heilmann, E.; Venne, U.

    1979-01-01

    By means of the incorporation rate of 3 H thymidine into the lymphocytes of patients with chronic lymphatic leukemia the possibility of stimulating them by using different mitogens was checked and compared with normal persons. The examination covered 11 patients treated with extracorporeal irradiation of the blood (ECIB), 5 patients treated with a chlorambucil therapy, and 10 untreated patients who where classified according to the staging system proposed by Rai. The lymphocytes of the peripheral blood were stimulated as mixed and isolated T and B-lymphocytes in the microculture by using the mitogens PHA, PWM, ConA, and LPS. In all CLL patients there was a diminished stimulation rate of a mixed lymphocyte population. A relation existed between the seriousness of the stage and the deminution of the incorporation rate of 3 H thymidine. A corresponding correlation could not be identified in untreated CLL patients. Isolated T-lymphocytes revealed better results of stimulation than the total population. As to their function B-lymphocytes showed a dependence on the kind of therapy. In the mixed lymphocyte culture of normal persons the best findings could be observed after stimulation with PHA, that is also valid for CLL patients. PHA, PWA, ConA, and LPS were suitable as substances stimulating B-lymphocytes with different efficacy in normal persons and CLL patients. Both collectives showed the best results in the T-lymphocyte culture after stimulation with LPS. (author)

  17. Oral calcium carbonate affects calcium but not phosphorus balance in stage 3-4 chronic kidney disease.

    Science.gov (United States)

    Hill, Kathleen M; Martin, Berdine R; Wastney, Meryl E; McCabe, George P; Moe, Sharon M; Weaver, Connie M; Peacock, Munro

    2013-05-01

    Patients with chronic kidney disease (CKD) are given calcium carbonate to bind dietary phosphorus, reduce phosphorus retention, and prevent negative calcium balance; however, data are limited on calcium and phosphorus balance during CKD to support this. Here, we studied eight patients with stage 3 or 4 CKD (mean estimated glomerular filtration rate 36 ml/min) who received a controlled diet with or without a calcium carbonate supplement (1500 mg/day calcium) during two 3-week balance periods in a randomized placebo-controlled cross-over design. All feces and urine were collected during weeks 2 and 3 of each balance period and fasting blood, and urine was collected at baseline and at the end of each week. Calcium kinetics were determined using oral and intravenous (45)calcium. Patients were found to be in neutral calcium and phosphorus balance while on the placebo. Calcium carbonate supplementation produced positive calcium balance, did not affect phosphorus balance, and produced only a modest reduction in urine phosphorus excretion compared with placebo. Calcium kinetics demonstrated positive net bone balance but less than overall calcium balance, suggesting soft-tissue deposition. Fasting blood and urine biochemistries of calcium and phosphate homeostasis were unaffected by calcium carbonate. Thus, the positive calcium balance produced by calcium carbonate treatment within 3 weeks cautions against its use as a phosphate binder in patients with stage 3 or 4 CKD, if these findings can be extrapolated to long-term therapy.

  18. Clinical Trial of Vadadustat in Patients with Anemia Secondary to Stage 3 or 4 Chronic Kidney Disease.

    Science.gov (United States)

    Martin, Edouard R; Smith, Mark T; Maroni, Bradley J; Zuraw, Qing C; deGoma, Emil M

    2017-01-01

    Therapeutic options for the treatment of anemia secondary to chronic kidney disease (CKD) remain limited. Vadadustat (AKB-6548) is an oral hypoxia-inducible factor prolyl-hydroxylase domain (HIF-PHD) inhibitor that is being investigated for the treatment of anemia secondary to CKD. A phase 2a, multicenter, randomized, double-blind, placebo-controlled, dose-ranging trial (NCT01381094) was undertaken in adults with anemia secondary to CKD stage 3 or 4. Eligible subjects were evenly randomized to 5 groups: 240, 370, 500, or 630 mg of once-daily oral vadadustat or placebo for 6 weeks. All subjects received low-dose supplemental oral iron (50 mg daily). The primary endpoint was the mean absolute change in hemoglobin (Hb) from baseline to the end of treatment. Secondary endpoints included iron indices, safety, and tolerability. Ninety-three subjects were randomized. Compared with placebo, vadadustat significantly increased Hb after 6 weeks in a dose-dependent manner (analysis of variance; p anemia secondary to stage 3 or 4 CKD. Global multicenter, randomized phase 3 trials are ongoing in non-dialysis-dependent and dialysis-dependent patients. © 2017 The Author(s) Published by S. Karger AG, Basel.

  19. Relationship between symptom clusters and quality of life in patients at stages 2 to 4 chronic kidney disease in Korea.

    Science.gov (United States)

    Lee, Suk Jeong; Jeon, JaeHee

    2015-11-01

    This study was conducted to identify the relationship between symptom clusters and quality of life (QOL) in patients with stages 2 to 4 chronic kidney disease (CKD) in Korea. Using self-reported questionnaires, data were collected from 143 patients who underwent treatment for CKD at one hospital in Korea. The 17-item Patient Outcome Scale was used to measure symptoms, and the 36-item Short Form Health Survey Instrument Version 2 (SF-36v2) was used to measure the QOL. Data were analyzed using factor analysis to draw symptom clusters. Among five symptom clusters, the energy insufficiency and pain cluster was found to have the highest prevalence and greatest severity. The severity of symptom clusters showed negative correlations with both physical and mental component summary (PCS and MCS) scores. Elderly patients scored low on PCS, whereas younger patients in their 30s and 40s scored low on MCS. Negative correlations were found between symptom clusters and PCS as well as MCS. The severity of symptoms and QOL had stronger relationships with subjective perception of symptoms and psychological factors than with objective clinical indicators. As the effects of physical and psychological symptoms on the QOL in patients with stages 2 to 4 CKD were identified in this study, nurses should develop strategic nursing plans focused on symptom clusters and patients' subjective perception of symptoms rather than objective clinical indicators in order to improve the QOL in patients with CKD. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Combination of Transcranial Direct Current Stimulation and Neuromuscular Electrical Stimulation Improves Gait Ability in a Patient in Chronic Stage of Stroke

    OpenAIRE

    Satow, Takeshi; Kawase, Tomotaka; Kitamura, Atsushi; Kajitani, Yuki; Yamaguchi, Takuya; Tanabe, Nobuhiko; Otoi, Reiko; Komuro, Taro; Kobayashi, Akira; Nagata, Hirokazu; Mima, Tatsuya

    2016-01-01

    Background: Walking ability is important in stroke patients to maintain daily life. Nevertheless, its improvement is limited with conventional physical therapy in chronic stage. We report the case of a chronic stroke patient showing a remarkable improvement in gait function after a new neurorehabilitation protocol using transcranial direct current stimulation (tDCS) and neuromuscular electrical stimulation (NMES). Case Presentation: A 62-year-old male with left putaminal hemorrhage suffered f...

  1. During the pre-dialysis stage of chronic kidney disease, which treatment is associated with better survival in dialysis?

    Science.gov (United States)

    Caravaca, Francisco; Alvarado, Raúl; García-Pino, Guadalupe; Martínez-Gallardo, Rocío; Luna, Enrique

    2014-01-01

    Specialised care of patients in advanced stages of chronic kidney disease (CKD) is associated with better survival in dialysis, but it is not known which treatments specifically favour this outcome. To analyse normal treatment in advanced stages of CKD and establish which treatments are associated with better survival in dialysis as well as their relationship with causes of death. Cohort, prospective observational study of 591 patients who started dialysis (491 haemodialysis and 100 peritoneal dialysis), who had previously been monitored in the CKD clinic. The treatments analysed were: antihypertensive treatments, statins, antiplatelet drugs, xanthine oxidase inhibitors, correction of metabolic acidosis, treatment with (calcium or non-calcium) phosphate binders, vitamin D (calcitriol or paricalcitol), erythropoietin and the availability of an internal arteriovenous fistula (IAVF). The independent association of each of these treatments with mortality in dialysis was analysed using Cox regression models adjusted for age, sex, pre-dialysis monitoring time, renal function at the start of dialysis, comorbidity, serum albumin and C-reactive protein, and with stratification of the type of dialysis. With a median follow-up period of 28 months, the total number of patients who died was 191 (32%). In the multivariate models, we observed that, in addition to age, the comorbidity index, serum albumin, pre-dialysis treatment with angiotensin-converting-enzyme inhibitors and/or angiotensin receptor blockers, correction of acidosis with sodium bicarbonate and IAVF at the start of haemodialysis were significantly associated with better survival in dialysis. We did not observe differences in causes of death between the different treatments analysed. These results suggest a potential delayed benefit of some treatments in pre-dialysis stages on the outcome of dialysis. Furthermore, beginning dialysis without an IAVF, resulting in the need for intravenous catheters, worsens prognosis

  2. [Nephroprotective role of early correction of impaired nutritional status in patients with chronic disease of the kidneys at a predialysis stage].

    Science.gov (United States)

    Milovanov, Iu S; Kozlovskaia, L V; Milovanova, L Iu

    2008-01-01

    To assess the rate and clinical significance of impaired nutritional status and impact of low-protein diet on inhibition of renal insufficiency in patients of stage III-IV chronic disease of the kidneys (CDK). A total of 200 patients with CDK stage III-IV were randomized into three groups: group 1 consisted of 123 patients with chronic glomerulonephritis (73 with stage III and 50 with stage 1V), group 2--45 patients with systemic diseases (30 with stage III and 15 with stage IV), group 3 (a comparison group)--32 patients with CGN (17 with stage 111 and 15 with stage IV). Patients of groups 1 and 2 received low-protein diet (0.6 g protein kg/day) balanced by either high-calorie mix containing protein SUPRO 760 or ketosteril for 24-48 months. The nutritional status was studied by anthropometric data, absolute number of lymphocytes, levels of blood albumin and transferring, intake of protein, food calorie value according to 3-day diaries. Among 200 patients impaired nutritional status was detected in 22 (11.0%) patients. More than half of them had glomerulonephritis in systemic diseases (SLE, systemic vasculitis). Only in patients with systemic diseases nutritional disorders manifested at stage III. These disorders grew with progression of renal insufficiency and were detected primarily in patients with stage IV CDK. Patients with CGN on low-protein diet for a year and longer demonstrated slowing of the fall of the glomerular filtration rate (GFR). Early (predialysis) use of low-protein diet balanced by addition of amino- and keto-acids and high-energy nutritional mixes has a positive influence on nutritional status of patients with chronic renal insufficiency and can inhibit GFR lowering.

  3. Staged protocol for the treatment of chronic femoral shaft osteomyelitis with Ilizarov's technique followed by the use of intramedullary locked nail

    Directory of Open Access Journals (Sweden)

    Po-Hsin Chou

    2017-06-01

    Conclusion: In the treatment of chronic femur osteomyelitis, the staged protocol of Ilizarov distraction osteogenesis followed by intramedullary nailing was safe and successful, and allowed for union, realignment, reorientation, and leg-length restoration. With regard to the soft tissue, this technique provides a unique type of reconstructive closure for infected wounds. It is suggested that the staged protocol is reliable in providing successful simultaneous reconstruction for bone and soft tissue defects without flap coverage.

  4. Prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent hemodialysis: a systematic review

    Directory of Open Access Journals (Sweden)

    Brkovic T

    2016-06-01

    Full Text Available Tonci Brkovic,1 Eliana Burilovic,2 Livia Puljak3 1Department of Internal Medicine, Division of Nephrology, 2Department of Psychiatry, University Hospital Split, 3Department of Anatomy, Histology and Embryology, Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia Objectives: Understanding the epidemiology of pain in patients on hemodialysis (HD is crucial for further improvement in managing pain. The aim of this study was to systematically review available evidence on the prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent HD. Materials and methods: We carried out a systematic review of the literature and developed a comprehensive search strategy based on search terms on pain and HD. We searched the databases MEDLINE, Scopus, PsycINFO, and CINAHL from the earliest date of each database to July 24, 2014. Manuscripts in all languages were taken into consideration. Two authors performed each step independently, and all disagreements were resolved after discussion with the third author. The quality of studies was estimated using the STROBE checklist and Cochrane risk-of-bias tool.Results: We included 52 studies with 6,917 participants. The prevalence of acute and chronic pain in HD patients was up to 82% and 92%, respectively. A considerable number of patients suffered from severe pain. Various locations and causes of pain were described, with most of the studies reporting pain in general, pain related to arteriovenous access, headache, and musculoskeletal pain.Conclusion: The findings of this systematic review indicate high prevalence of pain in HD patients and considerable gaps and limitations in the available evidence. Pain in this population should be recognized as a considerable health concern, and the nephrology community should promote pain management in HD patients as a clinical and research priority to improve patients’ quality of life and pain

  5. Comparison of health-related quality of life between patients with stage 3 and 4 chronic kidney disease and patients undergoing continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Lee, Suk Jeong; Son, Heesook

    2016-01-01

    This study compared health-related quality of life in patients with early to mid-stage chronic kidney disease. This study utilized a comparative descriptive design. Patients receiving continuous ambulatory peritoneal dialysis were recruited from a hospital in Korea. Information from patients with stage 3 and 4 chronic kidney disease was obtained from Korean national survey data. A total of 75 pairs were matched using the propensity score method. Health-related quality of life was compared using the European Quality of Life-5 Dimensions questionnaire. Only 4% of patients with stage 3 or 4 chronic kidney disease are aware of their disease. These patients have decreased mobility and ability to perform their usual activities (χ(2)  = 10.77, P = 0.001; χ(2)  = 7.22, P = 0.007, respectively). However, they have lower levels of anxiety and depression than patients undergoing continuous ambulatory peritoneal dialysis (χ(2)  = 13.37, P chronic kidney disease. Educational intervention in asymptomatic patients is important to increase awareness and early detection of chronic kidney disease. © 2015 Japan Academy of Nursing Science.

  6. Effect of Behavior Modification on Outcome in Early- to Moderate-Stage Chronic Kidney Disease: A Cluster-Randomized Trial.

    Science.gov (United States)

    Yamagata, Kunihiro; Makino, Hirofumi; Iseki, Kunitoshi; Ito, Sadayoshi; Kimura, Kenjiro; Kusano, Eiji; Shibata, Takanori; Tomita, Kimio; Narita, Ichiei; Nishino, Tomoya; Fujigaki, Yoshihide; Mitarai, Tetsuya; Watanabe, Tsuyoshi; Wada, Takashi; Nakamura, Teiji; Matsuo, Seiichi

    2016-01-01

    Owing to recent changes in our understanding of the underlying cause of chronic kidney disease (CKD), the importance of lifestyle modification for preventing the progression of kidney dysfunction and complications has become obvious. In addition, effective cooperation between general physicians (GPs) and nephrologists is essential to ensure a better care system for CKD treatment. In this cluster-randomized study, we studied the effect of behavior modification on the outcome of early- to moderate-stage CKD. Stratified open cluster-randomized trial. A total of 489 GPs belonging to 49 local medical associations (clusters) in Japan. A total of 2,379 patients (1,195 in group A (standard intervention) and 1,184 in group B (advanced intervention)) aged between 40 and 74 years, who had CKD and were under consultation with GPs. All patients were managed in accordance with the current CKD guidelines. The group B clusters received three additional interventions: patients received both educational intervention for lifestyle modification and a CKD status letter, attempting to prevent their withdrawal from treatment, and the group B GPs received data sheets to facilitate reducing the gap between target and practice. The primary outcome measures were 1) the non-adherence rate of accepting continuous medical follow-up of the patients, 2) the collaboration rate between GPs and nephrologists, and 3) the progression of CKD. The rate of discontinuous clinical visits was significantly lower in group B (16.2% in group A vs. 11.5% in group B, p = 0.01). Significantly higher referral and co-treatment rates were observed in group B (pbehavior modification of CKD patients, namely, significantly lower discontinuous clinical visits, and behavior modification of both GPs and nephrologists, namely significantly higher referral and co-treatment rates, resulting in the retardation of CKD progression, especially in patients with proteinuric Stage 3 CKD. The University Hospital Medical Information

  7. Use of Extended-Release Calcifediol to Treat Secondary Hyperparathyroidism in Stages 3 and 4 Chronic Kidney Disease.

    Science.gov (United States)

    Sprague, Stuart M; Crawford, Paul W; Melnick, Joel Z; Strugnell, Stephen A; Ali, Shaukat; Mangoo-Karim, Roberto; Lee, Sungchun; Petkovich, P Martin; Bishop, Charles W

    2016-01-01

    Vitamin D insufficiency and secondary hyperparathyroidism (SHPT) are associated with increased morbidity and mortality in chronic kidney disease (CKD) and are poorly addressed by current treatments. The present clinical studies evaluated extended-release (ER) calcifediol, a novel vitamin D prohormone repletion therapy designed to gradually correct low serum total 25-hydroxyvitamin D, improve SHPT control and minimize the induction of CYP24A1 and FGF23. Two identical multicenter, randomized, double-blind, placebo-controlled studies enrolled subjects from 89 US sites. A total of 429 subjects, balanced between studies, with stage 3 or 4 CKD, SHPT and vitamin D insufficiency were randomized 2:1 to receive oral ER calcifediol (30 or 60 µg) or placebo once daily at bedtime for 26 weeks. Most subjects (354 or 83%) completed dosing, and 298 (69%) entered a subsequent open-label extension study wherein ER calcifediol was administered without interruption for another 26 weeks. ER calcifediol normalized serum total 25-hydroxyvitamin D concentrations (>30 ng/ml) in >95% of per-protocol subjects and reduced plasma intact parathyroid hormone (iPTH) by at least 10% in 72%. The proportion of subjects receiving ER calcifediol who achieved iPTH reductions of ≥30% increased progressively with treatment duration, reaching 22, 40 and 50% at 12, 26 and 52 weeks, respectively. iPTH lowering with ER calcifediol was independent of CKD stage and significantly greater than with placebo. ER calcifediol had inconsequential impact on serum calcium, phosphorus, FGF23 and adverse events. Oral ER calcifediol is safe and effective in treating SHPT and vitamin D insufficiency in CKD. © 2016 S. Karger AG, Basel.

  8. Differential inhibitory and activating NK cell receptor levels and NK/NKT-like cell functionality in chronic and recovered stages of chikungunya.

    Science.gov (United States)

    Thanapati, Subrat; Ganu, Mohini A; Tripathy, Anuradha S

    2017-01-01

    The role of natural killer (NK; CD3-CD56+)/NKT (CD3+CD56+)-like cells in chikungunya virus (CHIKV) disease progression/recovery remains unclear. Here, we investigated the expression profiles and function of NK and NKT-like cells from 35 chronic chikungunya patients, 30 recovered individuals, and 69 controls. Percentage of NKT-like cells was low in chronic chikungunya patients. NKp30+, CD244+, DNAM-1+, and NKG2D+ NK cell percentages were also lower (MFI and/or percentage), while those of CD94+ and NKG2A+ NKT-like cells were higher (MFI and/or percentage) in chronic patients than in recovered subjects. IFN-γ and TNF-α expression on NKT-like cells was high in the chronic patients, while only IFN-γ expression on NK cells was high in the recovered individuals. Furthermore, percentage of perforin+NK cells was low in the chronic patients. Lower cytotoxic activity was observed in the chronic patients than in the controls. CD107a expression on NK and NKT-like cells post anti-CD94/anti-NKG2A blocking was comparable among the patients and controls. Upregulated inhibitory and downregulated activating NK receptor expressions on NK/NKT-like cells, lower perforin+ and CD107a+NK cells are likely responsible for inhibiting the NK and NKT-like cell function in the chronic stage of chikungunya. Therefore, deregulation of NKR expression might underlie CHIKV-induced chronicity.

  9. Neurofibrillary tangle pathology and Braak staging in chronic epilepsy in relation to traumatic brain injury and hippocampal sclerosis: a post-mortem study.

    Science.gov (United States)

    Thom, Maria; Liu, Joan Y W; Thompson, Pam; Phadke, Rahul; Narkiewicz, Marta; Martinian, Lillian; Marsdon, Derek; Koepp, Matthias; Caboclo, Luis; Catarino, Claudia B; Sisodiya, Sanjay M

    2011-10-01

    The long-term pathological effects of chronic epilepsy on normal brain ageing are unknown. Previous clinical and epidemiological studies show progressive cognitive decline in subsets of patients and an increased prevalence of Alzheimer's disease in epilepsy. In a post-mortem series of 138 patients with long-term, mainly drug-resistant epilepsy, we carried out Braak staging for Alzheimer's disease neurofibrillary pathology using tau protein immunohistochemistry. The stages were compared with clinicopathological factors, including seizure history and presence of old traumatic brain injury. Overall, 31% of cases were Braak Stage 0, 36% Stage I/II, 31% Stage III/IV and 2% Stage V/VI. The mean age at death was 56.5 years and correlated with Braak stage (P < 0.001). Analysis of Braak stages within age groups showed a significant increase in mid-Braak stages (III/IV), in middle age (40-65 years) compared with data from an ageing non-epilepsy series (P < 0.01). There was no clear relationship between seizure type (generalized or complex partial), seizure frequency, age of onset and duration of epilepsy with Braak stage although higher Braak stages were noted with focal more than with generalized epilepsy syndromes (P < 0.01). In 30% of patients, there was pathological evidence of traumatic brain injury that was significantly associated with higher Braak stages (P < 0.001). Cerebrovascular disease present in 40.3% and cortical malformations in 11.3% were not significantly associated with Braak stage. Astrocytic-tau protein correlated with the presence of both traumatic brain injury (P < 0.01) and high Braak stage (P < 0.001). Hippocampal sclerosis, identified in 40% (bilateral in 48%), was not associated with higher Braak stages, but asymmetrical patterns of tau protein accumulation within the sclerotic hippocampus were noted. In over half of patients with cognitive decline, the Braak stage was low indicating causes other than Alzheimer's disease pathology. In summary

  10. Relationship between Stage of Chronic Kidney Disease and Sarcopenia in Korean Aged 40 Years and Older Using the Korea National Health and Nutrition Examination Surveys (KNHANES IV-2, 3, and V-1, 2), 2008–2011

    Science.gov (United States)

    Moon, Sung Jin; Kim, Tae Ho; Yoon, Soo Young; Chung, Jae Ho; Hwang, Hee-Jin

    2015-01-01

    Background Protein-energy wasting is common in patients with end-stage kidney disease. However, few studies have examined the relationship between early stages of chronic kidney disease (CKD) and sarcopenia. Methods We conducted a cross-sectional study based on data in the Korea National Health and Nutrition Examination Survey, 2008–2011. In total, 11,625 subjects aged 40 years or older who underwent dual-energy X-ray absorptiometry were analyzed. Sarcopenia was defined based on values of appendicular skeletal muscle mass as a percentage of body weight (ASM/Wt) two standard deviations below the gender-specific mean for young adults. Estimated glomerular filtration rates (eGFR) were calculated using the CKD-EPI equation. Results Mean age, body mass index (BMI), and HOMA-IR were higher and caloric intake, physical activity, and vitamin D level were lower in the sarcopenia groups in both men and women. As the stage of CKD increased, the prevalence of sarcopenia increased, even in the early stages of CKD (normal and CKD1, 2, and 3-5: 2.6%, 5.6%, and 18.1% in men and 5.3%, 7.1%, and 12.6% in women, respectively; p sarcopenia with respect to CKD 3–5 was 1.93 (95% CI = 1.02–3.68) in men but was not statistically significant in women. Conclusions The prevalence of sarcopenia was higher in elderly Korean patients with even mildly reduced kidney function. Stage of CKD was associated with an increased prevalence of sarcopenia in men but not women. Thus, we should evaluate the risk of sarcopenia and work to prevent it, even in patients with early CKD. PMID:26083479

  11. Relative risks of Chronic Kidney Disease for mortality and End Stage Renal Disease across races is similar

    Science.gov (United States)

    Wen, Chi-Pang; Matsushita, Kunihiro; Coresh, Josef; Iseki, Kunitoshi; Islam, Muhammad; Katz, Ronit; McClellan, William; Peralta, Carmen A; Wang, HaiYan; de Zeeuw, Dick; Astor, Brad C; Gansevoort, Ron T; Levey, Andrew S; Levin, Adeera

    2014-01-01

    Some suggest race-specific cutpoints for kidney measures to define and stage chronic kidney disease (CKD), but evidence for race-specific clinical impact is limited. To address this issue, we compared hazard ratios of estimated glomerular filtration rates (eGFR) and albuminuria across races using meta-regression in 1.1 million adults (75% Asians, 21% whites, and 4% blacks) from 45 cohorts. Results came mainly from 25 general population cohorts comprising 0.9 million individuals. The associations of lower eGFR and higher albuminuria with mortality and end-stage renal disease (ESRD) were largely similar across races. For example, in Asians, whites, and blacks, the adjusted hazard ratios (95% confidence interval) for eGFR 45–59 vs. 90–104 ml/min/1.73m2 were 1.3 (1.2–1.3), 1.1 (1.0–1.2) and 1.3 (1.1–1.7) for all-cause mortality, 1.6 (1.5–1.8), 1.4 (1.2–1.7), and 1.4 (0.7–2.9) for cardiovascular mortality, and 27.6 (11.1–68.7), 11.2 (6.0–20.9), and 4.1 (2.2–7.5) for ESRD, respectively. The corresponding hazard ratios for urine albumin-to-creatinine ratio 30–299 mg/g or dipstick 1-positive vs. an albumin-to-creatinine ratio under 10 or dipstick negative were 1.6 (1.4–1.8), 1.7 (1.5–1.9) and 1.8 (1.7–2.1) for all-cause mortality, 1.7 (1.4–2.0), 1.8 (1.5–2.1), and 2.8 (2.2–3.6) for cardiovascular mortality, and 7.4 (2.0–27.6), 4.0 (2.8–5.9), and 5.6 (3.4–9.2) for ESRD, respectively. Thus, the relative mortality or ESRD risks of lower eGFR and higher albuminuria were largely similar among three major races, supporting similar clinical approach to CKD definition and staging, across races. PMID:24522492

  12. Aerobic Exercise Improves Signs of Restless Leg Syndrome in End Stage Renal Disease Patients Suffering Chronic Hemodialysis

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    Mojgan Mortazavi

    2013-01-01

    Full Text Available Background. Restless leg syndrome (RLS is one of the prevalent complaints of patients with end stage renal diseases suffering chronic hemodialysis. Although there are some known pharmacological managements for this syndrome, the adverse effect of drugs causes a limitation for using them. In this randomized clinical trial we aimed to find a nonpharmacological way to improve signs of restless leg syndrome and patients’ quality of life. Material and Methods. Twenty-six patients were included in the study and divided into 2 groups of control and exercise. The exercise group used aerobic exercise during their hemodialysis for 16 weeks. The quality of life and severity of restless leg syndrome were assessed at the first week of study and final week. Data were analyzed using SPSS software. Results. The difference of means of RLS signs at the first week of study and final week was in exercise group and in control group. There was not any statistical difference between control group and exercise group in quality of life at the first week of study and final week. Conclusions. We suggest using aerobic exercise for improving signs of restless leg syndrome, but no evidence was found for its efficacy on patient’s quality of life.

  13. Subjective global assessment of nutritional status of patients with chronic renal insufficiency and end stage renal disease on dialysis.

    Science.gov (United States)

    Tapiawala, Shruti; Vora, H; Patel, Zamrud; Badve, S; Shah, B

    2006-12-01

    (1)To assess the nutritional status of chronic renal insufficiency (CRI) and dialysis patients using the subjective global assessment (SGA) method. (2) To validate SGA in assessing the nutritional status of this group of patients. The nutritional status of 81 patients was evaluated using dietary recall, anthropometry, biochemical parameters and SGA. There were 51 males and 30 females. Their mean +/- SD age was 53.8 +/- 14.3 years. There were 27 patients with (CRI) on conservative management, 38 patients with end stage renal disease (ESRD) on maintenance hemodialysis (HD) and 16 patients with ESRD on continuous ambulatory peritoneal dialysis (CAPD). SGA was done using seven variables derived from medical history and physical examination. Each variable was scored from 1-7 depending on the severity. The SGA scores were correlated with the standard methods. Thirteen (48%) patients with CRI, 22 (58%) patients on HD and 8 (50%) patients on CAPD were malnourished. It was seen that the dietary protein & calorie intake and serum albumin level did not correlate well with the SGA scores. The anthropometric measures correlated with the SGA scores (Skinfolds and SGA r = 0.2, MAC and SGA r = 0.5 and MAMC and SGA r = 0.5). Malnutrition is an important complication in CRI patients and ESRD patients on dialysis. SGA is a reliable method of assessing nutritional status. Most important is the fact that it can detect the changing trend of nutritional status, which may be missed by one-time anthropometry and biochemical methods.

  14. Nutrition education in the care of patients with chronic kidney disease and end-stage renal disease.

    Science.gov (United States)

    Anderson, Cheryl A M; Nguyen, Hoang Anh

    2018-03-01

    Diet counseling and nutrition education are recommended in the prevention and management of chronic kidney disease (CKD) and end-stage renal disease (ESRD). The importance of effectively addressing nutrition with patients has grown given the increasing prevalence of obesity, hypertension, and diabetes; conditions which influence CKD/ESRD. Dietary advice for individuals with CKD/ESRD can be seen as complex; and successful dietary management requires careful planning, periodic assessment of nutritional status, as well as monitoring of dietary compliance. In spite of recommendations and pressing need, formal training in nutrition and adequate preparation for providers is limited; and for physicians the lack of nutrition education has been acknowledged, repeatedly, as an area for improvement in medical training curricula. It has also been suggested that dietitians have an essential role in management of CKD in the primary care setting; however, dietitians who do not practice renal education daily may need training on the specific challenges in CKD/ESRD. The objectives of this chapter were to: characterize select nutrition education resources for providers who care for patients with CKD/ESRD; summarize key dietary components emphasized in the care of patients with CKD/ESRD; and address practical considerations in educational efforts focused on nutrition and CKD/ESRD. © 2018 Wiley Periodicals, Inc.

  15. Advanced chronic kidney disease, end-stage renal disease and renal death among HIV-positive individuals in Europe

    DEFF Research Database (Denmark)

    Ryom, L; Kirk, O; Lundgren, Jd

    2013-01-01

    OBJECTIVES: Knowledge about advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) in HIV-positive persons is limited. The aim of this study was to investigate incidence, predictors and outcomes for advanced CKD/ESRD and renal death. METHODS: Advanced CKD was defined as confirmed...... (two consecutive measurements ≥ 3 months apart) estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m(2) using Cockcroft-Gault, and ESRD as haemodialysis or peritoneal dialysis for ≥ 1 month or renal transplant. Renal death was death with renal disease as the underlying cause, using Coding...... Causes of Death in HIV (CoDe) methodology. Follow-up was from 1 January 2004 until last eGFR measurement, advanced CKD, ESRD or renal death, whichever occurred first. Poisson regression was used to identify predictors. RESULTS: Of 9044 individuals included in the study, 58 (0.64%) experienced advanced...

  16. Comparison of clinical and laboratory parameters in patients with end-stage renal failure in the outcome of chronic glomerulonephritis and patients with end-stage renal failure in the outcome of other diseases.

    Science.gov (United States)

    Popova, J A; Yadrihinskaya, V N; Krylova, M I; Sleptsovа, S S; Borisovа, N V

    frequent complications of hemodialysis treatments are coagulation disorders. This is due to activation of the coagulation of blood flow in the interaction with a dialysis membrane material vascular prostheses and extracorporeal circuit trunks. In addition, in hemodialysis patients receiving heparin for years, there is depletion of stocks in endothelial cells in tissue factor inhibitor, inhibits the activity of an external blood clotting mechanism. the aim of our study was to evaluate the hemostatic system parameters in patients with end-stage renal failure, depending on the cause of renal failure. to evaluate the hemostatic system parameters in patients with end-stage renal failure, depending on the cause of renal failure and hemodialysis treatment duration conducted a study that included 100 patients observed in the department of chronic hemodialysis and nephrology hospital №1 Republican National Medical Center in the period of 2013-2016. in patients with end-stage renal failure in the outcome of chronic glomerulonephritis, a great expression of activation of blood coagulation confirm increased the mean concentration of fibrinogen, whereas in the group, which included patients with end-stage renal failure in the outcome of other diseases, such is not different from the norm, and a higher rate of hyperfibrinogenemia, identified in 2/3 patients in this group. it was revealed that the state of homeostasis in patients with end-stage renal failure in increasingly characterizes the level of fibrinogen and the activation of the hemostatic markers: soluble fibrin monomer complexes, D-dimers.

  17. [A retrospective study on nutritional status and growth and development of 37 children with chronic kidney disease stage 3 to 5].

    Science.gov (United States)

    Bao, R; Chen, C Y

    2016-09-01

    To retrospectively analyze the nutritional status and growth and development situation of the children with chronic kidney disease stage 3 to 5 when they were diagnosed at the first visit. After searching for the data of all the hospitalized cases during January 2007 to September 2015 in the Department of Nephrology of Children's Hospital Affiliated to the Capital Institute of Pediatrics from the medical record system, data of 37 cases with complete clinical data were collected; all these cases were diagnosed as chronic kidney disease stage 3 to 5 according to the diagnostic criteria.We recorded these children's age, height, weight, body mass index, albumin, blood lipids and acidosis situation when they were first diagnosed, and then, analyzed and summarized their nutritional status and growth and development situation. In these 37 cases, 24 cases were boys and 13 cases were girls; 23 cases (62%) were shorter than the third percentile of age-sex-specific height; 18 cases (49%) exhibited lower weight than the third percentile of age-sex-specific weight; 5 cases (13.5%) showed lower BMI than the third percentile of height-age BMI, and 5 cases (13.5%) had obesity. The level of albumin was (37.0±8.7) g/L, and no statistically significant difference was observed within each stage. In all of these cases, 10 cases were hypoalbuminemia (27%), and the difference of its frequency between stage 3-4 and stage 5 was not statistically significant. Triglyceride was (2.2±1.1) mmol/L. The mean level was higher than the normal range, but with no statistically significant difference within each stage; 21 cases (62%) were diagnosed as hypertriglyceridemia, which were more frequent compared with the occurrence of the hypercholesterolemia (32%), the high low density lipoprotein (26%) and the low high density lipoprotein(12%). And the occurrence of decompensated metabolic acidosis in stage 5 (69%) was significantly higher than that in stage 3-4 (38%) (P=0.036 6, Growth retardation is

  18. Study of Red Cell Fragility in Different Stages of Chronic Kidney Disease in Relation to Parathyroid Hormone.

    Science.gov (United States)

    Panda, Suchismita; Mishra, Anuva; Jena, Manoranjan; Rout, Sashi Bhusan; Mohapatra, Srikrushna

    2017-08-01

    Anaemia is one of the common complications associated with Chronic Kidney Disease (CKD) responsible for the increase in the morbidity and mortality in such patients. Several factors have been attributed to cause renal anaemia, amongst which hyperparathyroidism is one of the less recognised reasons. Most studies have been conducted in this regard in CKD patients undergoing haemodialysis. The level of PTH in early stages of chronic kidney disease has not been much studied. The excess amount of Parathyroid Hormone (PTH) secondary to CKD has been suggested to be a causative factor for anaemia. To evaluate the serum PTH level in CKD patients before haemodialysis and to study the association of the haemoglobin status with the parathyroid hormone. Forty CKD patients above 18 years of age before haemodialysis and 25 age and sex matched healthy controls were included in the study. Routine biochemical and haematological parameters such as Routine Blood Sugar (RBS), urea, creatinine, Na + , K + , Ca 2+ , PTH and Hb% were perfomed. Red cell osmotic fragility was measured by serial dilutions of whole blood with varying concentrations of sodium chloride ranging from 0.1% to 0.9%. The study revealed a significant fall in Hb%, along with a rise in Median Osmotic Fragility (MOF) and PTH in the CKD patients when compared to the control group. Linear regression of PTH with Hb% revealed significant negative association between both the parameters with a R 2 value of 0.677. Multilinear regression analysis of MOF and other independent variables such as Hb%, Na + , K + , Ca 2+ , urea, PTH and creatinine highlighted the variance of MOF by 72%, maximal variance contributed by PTH. Receiver Operating Curve (ROC) analysis revealed an area under the curve of 0.980 with a sensitivity of 100% and specificity of 87% in detecting osmotic fragility at a cut off value of PTH ≥100 pg/ml. The underlying cause of anaemia should be identified early in the CKD patients before haemodialysis. Secondary

  19. Osseous and Nonosseous Bone Scan Findings in Liver Transplant Candidates with end-stage Chronic Liver Disease

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    Seval Erhamamcı

    2013-08-01

    Full Text Available Objective: End-stage chronic liver disease (CLD adversely affects the function of multiple organ systems including the skeletal system. The aim of this study was to assess osseous and nonosseous bone scintigraphy (BS findings in liver transplant (LT candidates with end-stage CLD. Methods: We retrospectively evaluated BS findings in 50 consecutive patients with end-stage CLD who were undergoing preoperative assessment for LT from January 2006 to December 2011. All the patients were analyzed with respect to clinical and laboratory parameters, and BS findings. Scintigrams were visually assessed for the presence of osseous and nonosseous abnormalities. Osseous abnormalities were classified as those indicating bone metabolism changes or metastatic bone disease. Typical scintigraphic findings denoting to changes in bone metabolism were the presence of decreased osseous uptake, increased periarticular uptake, asymmetrical or unusual uptake patterns. Nonosseous findings were classified according to the degree of soft-tissue uptake as mild and severe. Results: The group consisted of 46 adult and 4 adolescent patients. All adolescent patients had normal skeletal accumulation with growth plate uptake and one had mildly increased renal cortical activity. A total of 46 adult patients had one or more of the following osseous findings: generalized decrease in osseous uptake (n=4, 8.7%; bilateral decrease in lower extremity uptake (n=26, 56.5%; symmetrically increased periarticular uptake (n=26, 56.5%; bilateral cortical/periosteal increased uptake in the lower extremity indicating hepatic hypertrophic osteoarthropathy (HOA (n=8, 17.4%; bilateral increased sacroiliac activity (n=16, 34.8%; sacral activity (n=10, 21.7%, coccygeal activity (n=2, 4.3%, focally increased uptake suggestive of metastases (n=5, 10.9%. Three rib metastases appeared to be linear. Nonosseous findings observed in adult patients were mild diffuse liver uptake (n=4, 8.7% and bilateral

  20. Relationship between Stage of Chronic Kidney Disease and Sarcopenia in Korean Aged 40 Years and Older Using the Korea National Health and Nutrition Examination Surveys (KNHANES IV-2, 3, and V-1, 2, 2008-2011.

    Directory of Open Access Journals (Sweden)

    Sung Jin Moon

    Full Text Available Protein-energy wasting is common in patients with end-stage kidney disease. However, few studies have examined the relationship between early stages of chronic kidney disease (CKD and sarcopenia.We conducted a cross-sectional study based on data in the Korea National Health and Nutrition Examination Survey, 2008-2011. In total, 11,625 subjects aged 40 years or older who underwent dual-energy X-ray absorptiometry were analyzed. Sarcopenia was defined based on values of appendicular skeletal muscle mass as a percentage of body weight (ASM/Wt two standard deviations below the gender-specific mean for young adults. Estimated glomerular filtration rates (eGFR were calculated using the CKD-EPI equation.Mean age, body mass index (BMI, and HOMA-IR were higher and caloric intake, physical activity, and vitamin D level were lower in the sarcopenia groups in both men and women. As the stage of CKD increased, the prevalence of sarcopenia increased, even in the early stages of CKD (normal and CKD1, 2, and 3-5: 2.6%, 5.6%, and 18.1% in men and 5.3%, 7.1%, and 12.6% in women, respectively; p < 0.001. In addition, a correlation analysis showed that GFR and ASM/Wt had significant correlations in both men and women. Logistic regression analyses, after adjusting for age, BMI, caloric intake, log(physical activity, vitamin D level, and log(HOMA-IR, showed that the odds ratio for sarcopenia with respect to CKD 3-5 was 1.93 (95% CI = 1.02-3.68 in men but was not statistically significant in women.The prevalence of sarcopenia was higher in elderly Korean patients with even mildly reduced kidney function. Stage of CKD was associated with an increased prevalence of sarcopenia in men but not women. Thus, we should evaluate the risk of sarcopenia and work to prevent it, even in patients with early CKD.

  1. Evaluation of relationship between sexual functions, depression and quality of life in patients with chronic kidney disease at predialysis stage.

    Science.gov (United States)

    Esen, Bennur; Kahvecioglu, Serdar; Atay, Ahmet Engin; Ozgen, Gulten; Okumus, Muhammed Masuk; Seyahi, Nurhan; Sit, Dede; Kadioglu, Pınar

    2015-03-01

    The relation of chronic kidney disease (CKD) with metabolic, psychiatric and endocrinologic disorder is well-known. Depressive mood and sexual dysfunction are frequently observed as renal functions deteriorate. We aimed to analyze the relationship of sexual dysfunction, depressive mood and life quality in patients with CKD at predialysis stage. Fifty-three patients; 27 female and 26 male with CKD who had estimated glomerular filtration rate (eGFR) between 15 and 90 mL/min and followed up in the Nephrology Department, Bursa Sevket Yılmaz Education and Research Hospital, were enrolled. Age- and sex-matched 20 female and 20 male healthy control subjects were assigned to the control group. Detailed medical and sexual history was obtained by using Female Sexual Function Index (FSFI), Erectile Function International Evaluation Form (IEFF), Short form (SF) 36 Form and Beck Depression Questionnaire (BDI). Biochemical and hormonal parameters including urea, creatinine, uric acid, sedimentation rate, c-reactive protein, total testosterone, DHEA-S, FSH, LH, TSH, estradiol and prolactin were analyzed. Depression was observed in 12 male (46%) and 14 female (51%) patients. The frequency of depression among male patients and control subjects was similar, however, significantly higher in female patients than female controls (p=0.036). Physical function score, physical role score and pain score in SF 36 of entire patients were significantly lower than controls (p=0.0001, 0.0001, 0.001, respectively). The frequency of depression was similar between patients and controls (p>0.05). When SF 36 tests of male and female patients were compared, general health status, vitality and mental health status were significantly better in male patients (p=0.005, 0.016, 0.035, respectively). SF 36 scores of female patients were significantly lower than female controls (p=0.0001). The frequency of erectile dysfunction (ED) was similar between male patients (84%) and controls (75%) (p=0.62). On the

  2. Hepcidin-25 in diabetic chronic kidney disease is predictive for mortality and progression to end stage renal disease.

    Directory of Open Access Journals (Sweden)

    Martin Wagner

    Full Text Available Anemia is common and is associated with impaired clinical outcomes in diabetic chronic kidney disease (CKD. It may be explained by reduced erythropoietin (EPO synthesis, but recent data suggest that EPO-resistance and diminished iron availability due to inflammation contribute significantly. In this cohort study, we evaluated the impact of hepcidin-25--the key hormone of iron-metabolism--on clinical outcomes in diabetic patients with CKD along with endogenous EPO levels.249 diabetic patients with CKD of any stage, excluding end-stage renal disease (ESRD, were enrolled (2003-2005, if they were not on EPO-stimulating agent and iron therapy. Hepcidin-25 levels were measured by radioimmunoassay. The association of hepcidin-25 at baseline with clinical variables was investigated using linear regression models. All-cause mortality and a composite endpoint of CKD progression (ESRD or doubling of serum creatinine were analyzed by Cox proportional hazards models.Patients (age 67 yrs, 53% male, GFR 51 ml/min, hemoglobin 131 g/L, EPO 13.5 U/L, hepcidin-25 62.0 ng/ml were followed for a median time of 4.2 yrs. Forty-nine patients died (19.7% and forty (16.1% patients reached the composite endpoint. Elevated hepcidin levels were independently associated with higher ferritin-levels, lower EPO-levels and impaired kidney function (all p<0.05. Hepcidin was related to mortality, along with its interaction with EPO, older age, greater proteinuria and elevated CRP (all p<0.05. Hepcidin was also predictive for progression of CKD, aside from baseline GFR, proteinuria, low albumin- and hemoglobin-levels and a history of CVD (all p<0.05.We found hepcidin-25 to be associated with EPO and impaired kidney function in diabetic CKD. Elevated hepcidin-25 and EPO-levels were independent predictors of mortality, while hepcidin-25 was also predictive for progression of CKD. Both hepcidin-25 and EPO may represent important prognostic factors of clinical outcome and have the

  3. Etiology and management of dyslipidemia in children with chronic kidney disease and end-stage renal disease.

    Science.gov (United States)

    Khurana, Mona; Silverstein, Douglas M

    2015-12-01

    Lipids are essential components of cell membranes, contributing to cell fuel, myelin formation, subcellular organelle function, and steroid hormone synthesis. Children with chronic kidney disease (CKD) and end-stage renal disease (ESRD) exhibit various co-morbidities, including dyslipidemia. The prevalence of dyslipidemias in children with CKD and ESRD is high, being present in 39-65% of patients. Elevated lipid levels in children without renal disease are a risk factor for cardiovascular disease (CVD), while the risk for CVD in pediatric CKD/ESRD is unclear. The pathogenesis of dyslipidemia in CKD features various factors, including increased levels of triglycerides, triglyceride-rich lipoproteins, apolipoprotein C3 (ApoC-III), decreased levels of cholesterylester transfer protein and high-density lipoproteins, and aberrations in serum very low-density and intermediate-density lipoproteins. If initial risk assessment indicates that a child with advanced CKD has 2 or more co-morbidities for CVD, first-line treatment should consist of non-pharmacologic management such as therapeutic lifestyle changes and dietary counseling. Pharmacologic treatment of dyslipidemia may reduce the incidence of CVD in children with CKD/ESRD, but randomized trials are lacking. Statins are the only class of lipid-lowering drugs currently approved by the U.S. Food and Drug Administration (FDA) for use in the pediatric population. FDA-approved pediatric labeling for these drugs is based on results from placebo-controlled trial results, showing 30-50% reductions in baseline low-density lipoprotein cholesterol. Although statins are generally well tolerated in adults, a spectrum of adverse events has been reported with their use in both the clinical trial and post-marketing settings.

  4. What is the impact of chronic kidney disease stage and cardiovascular disease on the annual cost of hospital care in moderate-to-severe kidney disease?

    DEFF Research Database (Denmark)

    Kent, Seamus; Schlackow, Iryna; Lozano-Kühne, Jingky

    2015-01-01

    BACKGROUND: Reliable estimates of the impacts of chronic kidney disease (CKD) stage, with and without cardiovascular disease, on hospital costs are needed to inform health policy. METHODS: The Study of Heart and Renal Protection (SHARP) randomized trial prospectively collected information on kidney...... disease progression, serious adverse events and hospital care use in a cohort of patients with moderate-to-severe CKD. In a secondary analysis of SHARP data, the impact of participants' CKD stage, non-fatal cardiovascular events and deaths on annual hospital costs (i.e. all hospital admissions, routine...... or vascular disease incurred annual hospital care costs ranging from £403 (95% confidence interval: 345-462) in CKD stages 1-3B to £525 (449-602) in CKD stage 5 (not on dialysis). Patients in receipt of maintenance dialysis incurred annual hospital costs of £18,986 (18,620-19,352) in the year of initiation...

  5. Efficacy and safety of febuxostat in 73 gouty patients with stage 4/5 chronic kidney disease: A retrospective study of 10 centers.

    Science.gov (United States)

    Juge, Pierre-Antoine; Truchetet, Marie-Elise; Pillebout, Evangeline; Ottaviani, Sébastien; Vigneau, Cécile; Loustau, Clotilde; Cornec, Divi; Pascart, Tristan; Snanoudj, Renaud; Bailly, Florian; Cornec-Le Gall, Emilie; Schaeverbeke, Thierry; Saraux, Alain; Dieudé, Philippe; Flipo, René-Marc; Richette, Pascal; Lioté, Frédéric; Bardin, Thomas; Chalès, Gérard; Ea, Hang-Korng

    2017-10-01

    The allopurinol dose is limited in chronic kidney disease, particularly stage 4/5 chronic kidney disease. Febuxostat has a hepatic metabolism and has been approved without dose adaptation in gouty patients with stage 1-3 chronic kidney disease. We aimed to study the safety and efficacy of febuxostat for stage 4/5 chronic kidney disease. In this retrospective study, we included patients with (1) a diagnosis of gout, (2) febuxostat treatment, (3) estimated glomerular filtration rate≤30mL/min/1.73m 2 (Modification of Diet in Renal Disease formula) at febuxostat initiation and (4) follow-up for at least 3 months after febuxostat initiation. Efficacy, safety and variation in estimated glomerular filtration rate were analyzed. We included 73 patients (mean age 70.2±11.8, 61 men, 31 with vascular chronic kidney disease and 18 renal transplantation) with gout (baseline serum uric acid level=9.86±2.85mg/dL, mean gout duration 6.2±7.0 years) from 10 academic centers. Comorbidities included cardiac failure (17.8%), hypertension (98.6%), diabetes mellitus (30.1%), dyslipidemia (64.8%) and history of cardiovascular events (38.4%). At the last visit (mean follow-up 68.5±64.8 weeks), the daily dose of febuxostat was 40mg for 7 patients (10.5%), 80mg for 50 (74.6%) and 120mg for 10 (14.9%). Serum uric acid level waschronic kidney disease. However, safety data were not clear regarding renal function. Larger studies are needed to assess safety. Copyright © 2016 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  6. Ambulatory arterial stiffness index in chronic kidney disease stage 2-5. Reproducibility and relationship with pulse wave parameters and kidney function

    DEFF Research Database (Denmark)

    Boesby, Lene; Thijs, Lutgarde; Elung-Jensen, Thomas

    2012-01-01

    Arterial stiffness contributes to the increased cardiovascular risk in patients with chronic kidney disease (CKD). Reproducible and easily obtainable indices of arterial stiffness are needed in order to monitor therapeutic strategies. The ambulatory arterial stiffness index (AASI) has been proposed...... as such a marker. The present study investigated the day-to-day reproducibility of AASI in CKD stage 2-5 and its relationship with other markers of arterial stiffness as well as with kidney function....

  7. The experiences of close persons caring for people with chronic kidney disease stage 5 on conservative kidney management: contested discourses of ageing.

    Science.gov (United States)

    Low, Joe; Myers, Jason; Smith, Glenn; Higgs, Paul; Burns, Aine; Hopkins, Katherine; Jones, Louise

    2014-11-01

    Chronic kidney disease stage 5 is a global health challenge in the context of population ageing across the world. The range of treatment options available to patients at all ages has increased and includes transplantation and dialysis. However, these options are often seen as inappropriate for older frailer patients who are now offered the option of conservative kidney management, which is presented as a non-invasive alternative to dialysis, involving symptom management and addressing psychosocial needs. In this study, we conducted qualitative interviews with 26 close persons caring for someone with chronic kidney disease stage 5 in the United Kingdom to investigate how conservative kidney management interacted with implicit ideas of ageing, in both the experience of conservative kidney management and the understanding of the prognosis and future care of the kidney disease. Our findings highlighted participant confusion about the nature of conservative kidney management, which stems from an initial lack of clarity about how conservative kidney management differed from conventional treatments for chronic kidney disease stage 5. In particular, some respondents were not aware of the implicit palliative nature of the intervention or indeed the inevitable end-of-life issues. Although these findings can be situated within the context of communication failure, we would further argue that they also bring to the surface tensions in the discourses surrounding ageing and old age, drawing on the use of a 'natural' and a 'normal' paradigm of ageing. In the context of chronic kidney disease stage 5, more patients are being dialysed at older ages, but conservative kidney management is being advanced as a better option than dialysis in terms of quality of life and experience. However, in doing so, conservative kidney management implicitly draws on a notion of older age that echoes natural ageing rather than advocate a more interventionist approach. The role of discourses of ageing

  8. AB003. Validation of a two-stage screening model to predict moderate to severe obstructive sleep apnea in chronic tetraplegia

    Science.gov (United States)

    Graco, Marnie; Cross, Susan; Thiyagarajan, Chinnaya; Shafazand, Shirin; Ayas, Najib; Schembri, Rachel; Booker, Lauren; Nicholls, Carmel; Burns, Patricia; Nash, Mark; Green, Sally; Berlowitz, David J.

    2018-01-01

    Background Prevalence of obstructive sleep apnea (OSA) in people with chronic spinal cord injury (SCI) is estimated at between 28% and 77%. Current guidelines recommend polysomnography (PSG) for all people with SCI and symptoms of OSA. However, PSG is a resource intensive and frequently inaccessible test, especially in SCI. A two-stage model of questionnaire followed by overnight oximetry has been found to accurately detect moderate to severe OSA in the able-bodied. To determine whether a similar two-stage model can detect moderate to severe OSA in chronic tetraplegia. Methods An existing dataset of 78 people with tetraplegia was examined to determine predictors of OSA for inclusion in a new questionnaire. Cut-offs for the model were estimated with receiver operating characteristics (ROC) curve analysis. Model accuracy was evaluated prospectively in 100 participants with chronic, traumatic tetraplegia across four international SCI units. Results Multivariate analysis identified injury completeness, age, sleepiness, self-reported snoring and apneas for the new questionnaire [ROC area under curve (AUC) 0.87 (95% CI: 0.79–0.95)]. Oxygen desaturation index was also highly predictive [0.93 (0.87–0.98)]. The two-stage model had a sensitivity and specificity of 83% (66–93%) and 88% (75–94%) in the development group (n=78), and 77% (65–87%) and 81% (68–90%) in the validation group (n=100). Conclusions The two-stage screening model provides an accurate and translatable alternative to full PSG for identifying moderate to severe OSA in people with chronic tetraplegia. Implementation of this screening model could substantially increase the detection of OSA in tetraplegia and improve access to treatments.

  9. Combination of Transcranial Direct Current Stimulation and Neuromuscular Electrical Stimulation Improves Gait Ability in a Patient in Chronic Stage of Stroke.

    Science.gov (United States)

    Satow, Takeshi; Kawase, Tomotaka; Kitamura, Atsushi; Kajitani, Yuki; Yamaguchi, Takuya; Tanabe, Nobuhiko; Otoi, Reiko; Komuro, Taro; Kobayashi, Akira; Nagata, Hirokazu; Mima, Tatsuya

    2016-01-01

    Walking ability is important in stroke patients to maintain daily life. Nevertheless, its improvement is limited with conventional physical therapy in chronic stage. We report the case of a chronic stroke patient showing a remarkable improvement in gait function after a new neurorehabilitation protocol using transcranial direct current stimulation (tDCS) and neuromuscular electrical stimulation (NMES). A 62-year-old male with left putaminal hemorrhage suffered from severe right hemiparesis. He could move by himself with a wheelchair 1 year after the ictus. Anodal tDCS at the vertex (2 mA, 20 min) with NMES at the anterior tibialis muscle had been applied for 3 weeks. The Timed Up and Go test and 10-meter walk test improved after the intervention, which had been maintained for at least 1 month. This single case suggests the possibility that tDCS with NMES could be a new rehabilitation approach to improve the gait ability in chronic stroke patients.

  10. Progression to end-stage kidney disease in Japanese children with chronic kidney disease: results of a nationwide prospective cohort study.

    Science.gov (United States)

    Ishikura, Kenji; Uemura, Osamu; Hamasaki, Yuko; Ito, Shuichi; Wada, Naohiro; Hattori, Motoshi; Ohashi, Yasuo; Tanaka, Ryojiro; Nakanishi, Koichi; Kaneko, Tetsuji; Honda, Masataka

    2014-04-01

    The risk of progressing to end-stage kidney disease (ESKD) and factors associated with progression in children with chronic kidney disease (CKD) are unclear, especially in Asian children. We started a nationwide, prospective cohort study of 447 Japanese children with pre-dialysis CKD in 2010, with follow-up in 2011. Progression to ESKD was analyzed by Kaplan-Meier analysis according to CKD stage. Cox regression analysis was used to identify risk factors for progression. Data were analyzed for 429/447 children. Five patients died, of which four died before progression to ESKD. Fifty-two patients progressed to ESKD (median follow-up 1.49 years), including 9/315 patients with stage 3 CKD, 29/107 with Stage 4 CKD and 14/25 with Stage 5 CKD. One-year renal survival rates were 98.3, 80.0 and 40.9%, for Stages 3, 4 and 5 CKD, respectively. Risk factors for progression to ESKD included CKD stage [versus Stage 3; Stage 4: hazard ratio (HR) 11.12, 95% confidence interval (CI) 4.22-29.28, P 2.0 g/g urine creatinine; HR 7.56, 95% CI 3.22-17.77, P children with pre-dialysis CKD progressed to ESKD with a median-follow-up of 1.49 years. Children with advanced (Stage 4/5) CKD were particularly likely to progress. To our knowledge, this is the first, nationwide, prospective cohort study of children with pre-dialysis CKD in Asia.

  11. Description of cardiovascular remodeling parameters and osteopontin plasma level in dynamics of the candesartan therapy in patients with chronic kidney disease on the stage before dialysis

    Directory of Open Access Journals (Sweden)

    V. A. Vizir

    2015-04-01

    Full Text Available Aim. To examine the cardiovascular remodeling parameters and osteopontin plasma level in dynamics of the candesartan therapy in patients with chronic kidney disease on the stage before dialysis Methods and results. Peculiarities of the cardiovascular remodeling were studied in 52 patients with chronic kidney disease III, IV, and V stage. Echocardiography, carotid dopplerography, and immunoassay detection of the osteopontin level were done. The predominant type of pathological left ventricular geometry was concentric hypertrophy, its prevalence increased with worsening of the renal function. The maximum level of IMT was observed at stage V of the CKD. The chronic kidney disease progression was accompanied by increased plasma levels of the osteopontin. Conclusion. Direct correlation between the concentration of the protein and the index of left ventricular mass and the intima-media thickness were detected. The therapy with candesartan during 12 weeks leads to the significant reduction of osteopontin, which can be considered as a marker of cardiovascular remodeling in patients with CKD.

  12. Staged protocol for the treatment of chronic femoral shaft osteomyelitis with Ilizarov's technique followed by the use of intramedullary locked nail.

    Science.gov (United States)

    Chou, Po-Hsin; Lin, Hsi-Hsien; Su, Yu-Pin; Chiang, Chao-Ching; Chang, Ming-Chau; Chen, Chuan-Mu

    2017-06-01

    Infected nonunion of the femoral shaft is uncommon, and usually presents with challenging therapeutic and reconstructive problems. There are still controversies over treating infected nonunion of the femoral shaft. The purposes of this retrospective study were to review the treatment outcomes and describe a staged protocol for spontaneous wound healing. Six patients with chronic femoral shaft infected-nonunion from October 2002 to September 2010 were included in this retrospective study. Serial plain films and triple films of lower legs were performed to evaluate the alignment of the treated femoral shaft and bony union following our staged protocol of Ilizarov distraction osteogenesis and intramedullary nailing. An average bone defect of 7 cm was noted after staged osteotomy. Mean follow-up was 87.5 (range, 38-133) months. Union was achieved in all six patients, with an average external fixation time of 6.8 (range, 5-11) months. There was no reinfection. One complication of a 4-cm leg discrepancy was noted, with an initial shortening of 15 cm. The mean knee ranges of motion (ROM) before staged protocols and at final follow-up were 64.2±8.6 (range, 60-75)° and 53.3±9.3 (range, 40-65)°, respectively. The ROM at the knee joint statistically decreased following staged protocols. In the treatment of chronic femur osteomyelitis, the staged protocol of Ilizarov distraction osteogenesis followed by intramedullary nailing was safe and successful, and allowed for union, realignment, reorientation, and leg-length restoration. With regard to the soft tissue, this technique provides a unique type of reconstructive closure for infected wounds. It is suggested that the staged protocol is reliable in providing successful simultaneous reconstruction for bone and soft tissue defects without flap coverage. Copyright © 2017. Published by Elsevier Taiwan LLC.

  13. Clinical pharmacy activities in chronic kidney disease and end-stage renal disease patients: a systematic literature review

    Directory of Open Access Journals (Sweden)

    Stemer Gunar

    2011-07-01

    Full Text Available Abstract Background Chronic kidney disease (CKD and end-stage renal disease (ESRD represent worldwide health problems with an epidemic extent. Therefore, attention must be given to the optimisation of patient care, as gaps in the care of CKD and ESRD patients are well documented. As part of a multidisciplinary patient care strategy, clinical pharmacy services have led to improvements in patient care. The purpose of this study was to summarise the available evidence regarding the role and impact of clinical pharmacy services for these patient populations. Methods A literature search was conducted using the Medline, Embase and International Pharmaceutical Abstracts databases to identify relevant studies on the impact of clinical pharmacists on CKD and ESRD patients, regarding disease-oriented and patient-oriented outcomes, and clinical pharmacist interventions on drug-related problems. Results Among a total of 21 studies, only four (19% were controlled trials. The majority of studies were descriptive (67% and before-after studies (14%. Interventions comprised general clinical pharmacy services with a focus on detecting, resolving and preventing drug-related problems, clinical pharmacy services with a focus on disease management, or clinical pharmacy services with a focus on patient education in order to increase medication knowledge. Anaemia was the most common comorbidity managed by clinical pharmacists, and their involvement led to significant improvement in investigated disease-oriented outcomes, for example, haemoglobin levels. Only four of the studies (including three controlled trials presented data on patient-oriented outcomes, for example, quality of life and length of hospitalisation. Studies investigating the number and type of clinical pharmacist interventions and physician acceptance rates reported a mean acceptance rate of 79%. The most common reported drug-related problems were incorrect dosing, the need for additional

  14. Renal calcium, phosphorus, magnesium and uric acid handling: comparison between stage III chronic kidney disease patients and healthy oldest old.

    Science.gov (United States)

    Musso, C G; Juarez, R; Vilas, M; Navarro, M; Rivera, H; Jauregui, R

    2012-10-01

    It is known that chronic kidney disease (CKD) and senescence bring about a progressive reduction in glomerular filtration rate (GFR) and that in the former this is usually associated with an increase in the fractional excretion of calcium, phosphorus, magnesium, and uric acid. However, it has not yet been explained how these substances are excreted in the healthy oldest old. Thus, in the present study, we examined the renal handling of these substances in very aged people in comparison with CKD patients with similar GFR levels (stage III-CKD). Twenty volunteers were studied; 10 of them were healthy very old (VO) (≥ 75 years old) individuals and 10 were stage III CKD patients. Exclusion criteria were as follows: presence of altered (abnormally high or low) plasma calcium, phosphorus, magnesium and uric acid, as well as previous diagnoses of diabetes mellitus and obstructive uropathy and use of drugs that could alter plasma levels of the studied substances. All volunteers were on a diet with the same content of these elements (3-day dietary register). We measured calcium, phosphorus, magnesium, uric acid, creatinine in serum plasma and morning urine, as well as serum parathyroid hormone level, in each volunteer. From these data, fractional excretion (FE) of these substances was obtained. A statistical analysis was carried out using the Wilcoxon test. Serum creatinine: 1.8 ± 0.4 mg/dl (CKD) versus 0.8 ± 0.2 mg/dl (VO), p = 0.0002; serum calcium: 9.1 ± 0.3 mg/dl (CKD) versus 8.7 ± 0.4 (VO), p = 0.022; serum magnesium: 2.3 ± 0.2 mg/dl (CKD) versus 2.0 ± 0.1 (VO), p = 0.05; serum phosphorus: 3.9 ± 0.5 mg/dl (CKD) versus 3.0 ± 0.4 mg/dl (VO), p = 0.002; serum uric acid: 6.6 ± 1.5 (CKD) versus 5.2 ± 1.4 mg/dl (VO), p = 0.04; FE of calcium: 2.5 ± 1 % (CKD) versus 0.8 ± 0.3 % (VO), p = 0.04; FE of magnesium: 7.2 ± 4.1 % (CKD) versus 2.9 ± 0.9 % (VO), p = 0.02; FE of phosphorus: 25 ± 9 % (CKD) versus 9.1 ± 5.7(VO), p = 0.001; FE of uric acid: 10 ± 3 % (CKD

  15. Galvanostatic response of AA2024 aluminium alloy in 3.5% NaCl ...

    Indian Academy of Sciences (India)

    Galvanostatic responses of AA2024T3 alloy in de-aerated and naturally aerated 3.5% NaCl solution have been investigated. In the de-aerated condition, two distinct stages of polarization were revealed. From the first stage, the relationships between the pitting incubation time, pitting potential and applied current density for ...

  16. Galvanostatic response of AA2024 aluminium alloy in 3.5% NaCl ...

    Indian Academy of Sciences (India)

    Abstract. Galvanostatic responses of AA2024T3 alloy in de-aerated and naturally aerated 3.5% NaCl solution have been investigated. In the de-aerated condition, two distinct stages of polarization were revealed. From the first stage, the relationships between the pitting incubation time, pitting potential and applied current ...

  17. Safety and effectiveness of daily teriparatide for osteoporosis in patients with severe stages of chronic kidney disease: post hoc analysis of a postmarketing observational study.

    Science.gov (United States)

    Nishikawa, Atsushi; Yoshiki, Fumito; Taketsuna, Masanori; Kajimoto, Kenta; Enomoto, Hiroyuki

    2016-01-01

    Teriparatide (recombinant 1-34 N-terminal sequence of human parathyroid hormone) for the treatment of osteoporosis should be prescribed with caution in patients with severe stages of chronic kidney disease (CKD). However, in clinical settings, physicians and surgeons who treat such patients have few available options. We sought to further explore the safety and effectiveness of teriparatide for the treatment of osteoporosis in Japanese patients with severe stages of CKD. This was a post hoc analysis of a postmarketing surveillance study that included patients with osteoporosis at high risk of fracture and stage 4 or 5 CKD. Patients received subcutaneous teriparatide 20 μg daily for up to 24 months. Safety profiles were assessed by physician-reported adverse drug reactions (ADRs). Effectiveness was assessed by measuring bone formation (via procollagen type 1 N-terminal propeptide [P1NP]), bone mineral density (BMD), and the incidence of clinical vertebral or nonvertebral fragility fractures. A total of 33 patients with severe stages of CKD (stage 4, n=30; stage 5, n=3) were included. All patients were female, and 81.8% had a history of previous fracture. No serious ADRs were recorded; a total of 4 ADRs were recorded for 4 of 33 patients. Increases in BMD and P1NP levels were observed both overall and in most individual patients. New fractures occurred in 1 patient with stage 5 CKD, but not in patients with stage 4 CKD. In this post hoc analysis conducted in Japan, teriparatide appeared to be effective for the treatment of osteoporosis in elderly female patients with severe stages of CKD, and no new safety concerns were observed.

  18. Biodegradation of 1,3,5-trinitro-1,3,5-triazine (RDX).

    Science.gov (United States)

    Lee, Sheng-Yih; Brodman, Bruce W

    2004-01-01

    Two bacteria were isolated from 1,3,5-trinitro-1,3,5-triazine (RDX) contaminated soil at Picatinny Arsenal, New Jersey. These organisms were subsequently identified as Rhiziobium rhizogenes BL and Burkholderia sp.BL by the Deutsche Sammlung von Mikroorganismen und Zellkulturen GmbH (DSMZ, German Collection of Microorganisms and Cell Cultures). In addition a fungus, identified as Cladosporium cladosporioides by DSMZ, was found to be growing on water wet RDX. All of these organisms were found to degrade RDX. The two bacteria were found to represent new species that have not been reported before. It was found that these organisms along with an added carbon source could degrade RDX to simple gaseous products. Data are presented that elucidate the mechanisms of RDX biodegradation for these organisms.

  19. The chronic lymphocytic leukemia international prognostic index (CLL-IPI) predicts time to first treatment in early CLL: Independent Validation in a Prospective Cohort of Early Stage Patients

    Science.gov (United States)

    Molica, Stefano; Shanafelt, Tait D.; Giannarelli, Diana; Gentile, Massimo; Mirabelli, Rosanna; Cutrona, Giovanna; Levato, Luciano; Di Renzo, Nicola; Di Raimondo, Francesco; Musolino, Caterina; Angrilli, Francesco; Famà, Angelo; Recchia, Anna Grazia; Chaffee, Kari G.; Neri, Antonino; Kay, Neil E.; Ferrarini, Manlio; Morabito, Fortunato

    2016-01-01

    The chronic lymphocytic leukemia International Prognostic Index (CLL-IPI) combines 5 parameters (age, clinical stage, TP53 status [normal vs. del(17p) and/or TP53 mutation], IGHV mutational status, serum β2-microglobulin) to predict survival and time-to-first-treatment (TTFT) in CLL patients. We performed an observational study in 337 prospectively collected, Binet stage A patients to validate the ability of the CLL-IPI to predict TTFT in an independent cohort of early stage CLL patients. The CLL-IPI score stratified Binet stage A patients into three subgroups with different outcome. Since the CLL-IPI was originally developed to predict survival, we next investigated the optimal cut-off score to predict TTFT in Binet stage A patients. Recursive partitioning analysis identified three subsets with scores of 0 (n=139), 1 (n=90), and ≥ 2(n=108). The probability of remaining free from therapy 5 years after diagnosis was 85%, 67% and 46% in these three categories (PIPI scoring for TTFT was subsequently validated in an independent cohort of Binet A patients from the Mayo Clinic (n=525). The ability of either original or optimized CLL-IPI to predict TTFT was equivalent to other prognostic models specifically designed for this endpoint (2011 MDACC score and O-CLL1 score). Although originally developed to predict suvival, the CLL-IPI is useful for predicting TTFT in early stage CLL patients. PMID:27465919

  20. Dose-Volume Histogram Predictors of Chronic Gastrointestinal Complications After Radical Hysterectomy and Postoperative Concurrent Nedaplatin-Based Chemoradiation Therapy for Early-Stage Cervical Cancer

    International Nuclear Information System (INIS)

    Isohashi, Fumiaki; Yoshioka, Yasuo; Mabuchi, Seiji; Konishi, Koji; Koizumi, Masahiko; Takahashi, Yutaka; Ogata, Toshiyuki; Maruoka, Shintaroh; Kimura, Tadashi; Ogawa, Kazuhiko

    2013-01-01

    Purpose: The purpose of this study was to evaluate dose-volume histogram (DVH) predictors for the development of chronic gastrointestinal (GI) complications in cervical cancer patients who underwent radical hysterectomy and postoperative concurrent nedaplatin-based chemoradiation therapy. Methods and Materials: This study analyzed 97 patients who underwent postoperative concurrent chemoradiation therapy. The organs at risk that were contoured were the small bowel loops, large bowel loop, and peritoneal cavity. DVH parameters subjected to analysis included the volumes of these organs receiving more than 15, 30, 40, and 45 Gy (V15-V45) and their mean dose. Associations between DVH parameters or clinical factors and the incidence of grade 2 or higher chronic GI complications were evaluated. Results: Of the clinical factors, smoking and low body mass index (BMI) (<22) were significantly associated with grade 2 or higher chronic GI complications. Also, patients with chronic GI complications had significantly greater V15-V45 volumes and higher mean dose of the small bowel loops compared with those without GI complications. In contrast, no parameters for the large bowel loop or peritoneal cavity were significantly associated with GI complications. Results of the receiver operating characteristics (ROC) curve analysis led to the conclusion that V15-V45 of the small bowel loops has high accuracy for prediction of GI complications. Among these parameters, V40 gave the highest area under the ROC curve. Finally, multivariate analysis was performed with V40 of the small bowel loops and 2 other clinical parameters that were judged to be potential risk factors for chronic GI complications: BMI and smoking. Of these 3 parameters, V40 of the small bowel loops and smoking emerged as independent predictors of chronic GI complications. Conclusions: DVH parameters of the small bowel loops may serve as predictors of grade 2 or higher chronic GI complications after postoperative

  1. Eplerenone attenuates pulse wave reflection in chronic kidney disease stage 3-4--a randomized controlled study

    DEFF Research Database (Denmark)

    Boesby, Lene; Elung-Jensen, Thomas; Strandgaard, Svend

    2013-01-01

    Patients with chronic kidney disease (CKD) have high cardiovascular mortality and morbidity associated with increased arterial stiffness. Plasma aldosterone levels are increased in CKD, and aldosterone has been found to increase vascular inflammation and fibrosis. It was hypothesized...

  2. Efficacy and safety of osteoporosis medications in a rat model of late-stage chronic kidney disease accompanied by secondary hyperparathyroidism and hyperphosphatemia.

    Science.gov (United States)

    Ota, M; Takahata, M; Shimizu, T; Kanehira, Y; Kimura-Suda, H; Kameda, Y; Hamano, H; Hiratsuka, S; Sato, D; Iwasaki, N

    2017-04-01

    This study showed that bisphosphonate was safe and effective for the treatment of bone disorders in stage 4 chronic kidney disease (CKD) rats. Intermittent teriparatide therapy showed an anabolic action on bone even under secondary hyperparathyroidism conditions without having an adverse effect on mineral metabolism in late-stage CKD. Patients with late-stage CKD are at high risk for fragility fractures. However, there are no consensus on the efficacy and safety of osteoporosis medications for patients with late-stage CKD. In the present study, we aimed to examine the efficacy and safety of alendronate (ALN) and teriparatide (TPD) for treating bone disorder in late-stage CKD with pre-existing secondary hyperparathyroidism using a rat model of CKD. Male 10-week-old Sprague-Dawley rats were subjected to a 5/6 nephrectomy or sham surgery and randomized into the following four groups: sham, vehicle (saline subcutaneous (sc) daily), ALN (50 μg/kg sc daily), and TPD (40 μg/kg sc daily). Medications commenced at 24 weeks of age and continued for 4 weeks. Micro-computed tomography, histological analysis, infrared spectroscopic imaging, and serum assays were performed. Nephrectomized rats developed hyperphosphatemia, secondary hyperparathyroidism (SHPT), and high creatinine, equivalent to CKD stage 4 in humans. ALN suppressed the bone turnover and increased the degree of mineralization in cortical bone, resulting in an improvement in the mechanical properties. TPD further increased the bone turnover and significantly increased the degree of mineralization, micro-geometry, and bone volume, resulting in a significant improvement in the mechanical properties. Both ALN and TPD had no adverse effect on renal function and mineral metabolism. BP is safe and effective for the treatment of bone disorders in stage 4 CKD rats. Intermittent TPD therapy showed an anabolic action on bone even under SHPT conditions without having an adverse effect on mineral metabolism in late-stage

  3. Safety and effectiveness of daily teriparatide for osteoporosis in patients with severe stages of chronic kidney disease: post hoc analysis of a postmarketing observational study

    Directory of Open Access Journals (Sweden)

    Nishikawa A

    2016-11-01

    Full Text Available Atsushi Nishikawa,1 Fumito Yoshiki,2 Masanori Taketsuna,2 Kenta Kajimoto,2 Hiroyuki Enomoto2 1Global Patient Safety Japan, Quality and Patient Safety, Eli Lilly Japan K.K., 2Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan Abstract: Teriparatide (recombinant 1–34 N-terminal sequence of human parathyroid hormone for the treatment of osteoporosis should be prescribed with caution in patients with severe stages of chronic kidney disease (CKD. However, in clinical settings, physicians and surgeons who treat such patients have few available options. We sought to further explore the safety and effectiveness of teriparatide for the treatment of osteoporosis in Japanese patients with severe stages of CKD. This was a post hoc analysis of a postmarketing surveillance study that included patients with osteoporosis at high risk of fracture and stage 4 or 5 CKD. Patients received subcutaneous teriparatide 20 µg daily for up to 24 months. Safety profiles were assessed by physician-reported adverse drug reactions (ADRs. Effectiveness was assessed by measuring bone formation (via procollagen type 1 N-terminal propeptide [P1NP], bone mineral density (BMD, and the incidence of clinical vertebral or nonvertebral fragility fractures. A total of 33 patients with severe stages of CKD (stage 4, n=30; stage 5, n=3 were included. All patients were female, and 81.8% had a history of previous fracture. No serious ADRs were recorded; a total of 4 ADRs were recorded for 4 of 33 patients. Increases in BMD and P1NP levels were observed both overall and in most individual patients. New fractures occurred in 1 patient with stage 5 CKD, but not in patients with stage 4 CKD. In this post hoc analysis conducted in Japan, teriparatide appeared to be effective for the treatment of osteoporosis in elderly female patients with severe stages of CKD, and no new safety concerns were observed. Keywords: bone mineral density, chronic kidney disease, fragility

  4. Comparison of serum cystatin C and creatinine levels in determining glomerular filtration rate in children with stage I to III chronic renal disease.

    Science.gov (United States)

    Dönmez, Osman; Korkmaz, Hüseyin Anıl; Yıldız, Nalan; Ediz, Bülent

    2015-06-01

    Pediatric studies are relatively scarce on the superiority of cystatin C over creatinine in estimation of glomerular filtration rate (GFR). This study measured cystatin C and serum creatinine levels, and compared GFR estimated from these two parameters in patients with chronic renal disease. This prospective, observational, controlled study included 166 patients aged 1-18 years diagnosed with stage I to III chronic renal disease, and 29 age- and sex-matched control subjects. In all patients, GFR was estimated via creatinine clearance, Schwartz formula, Zappitelli 1 and Zappitelli 2 formula and the results were compared using Bland-Altman analysis. Patients and controls did not differ with regard to height, body weight, BMI, serum creatinine and serum cystatin levels, and Schwartz formula-based GFR (p > 0.05). There was a significant relationship between creatinine and cystatin C levels. However, although creatinine levels showed a significant association with age, height, and BMI, cystatin C levels showed no such association. ROC analysis showed that cystatin C performed better than creatinine in detecting low GFR. Cystatin C is a more sensitive and feasible indicator than creatinine for the diagnosis of stage I to III chronic renal disease.

  5. Quality of life in children and adolescents with chronic kidney disease: a comparative study between different disease stages and treatment modalities.

    Science.gov (United States)

    Kul, Müslüm; Cengel Kültür, Ebru; Senses Dinç, Gülser; Bilginer, Yelda; Uluç, Sait; Baykan, Hayriye

    2013-01-01

    This study aimed to compare the quality of life of children and adolescents in various stages of their chronic kidney disease (CKD) who were managed with different treatment modalities to that of children and adolescents without any chronic disease. The study included 18 renal transplant and 21 dialysis patients (8 on hemodialysis, 13 on peritoneal dialysis) and 16 patients who did not yet require renal replacement therapy. The control group consisted of 37 children without any chronic disease. Psychosocial Health Summary scores, Physical Health Summary scores, and Total Scale scores of Pediatric Quality of Life Inventory scores were estimated for the groups. CKD patients had lower scores in all scales of Pediatric Quality of Life Inventory than the control group. There were no differences in self-reported scores on the Pediatric Quality of Life scale scores between treatment groups; however, parents of the transplant patients had reported higher (more favorable) Physical Health Summary scores than those of the dialysis patients. Reports of parents and their children differed only in Physical Health Summary scores in the dialysis group; self-reports of the children were more favorable. These findings show that children and adolescents with CKD experience impaired quality of life on the physical and psychosocial functioning domains in comparison with healthy controls. The study findings implicate the need for further studies to investigate the quality of life in CKD patients at different stages as well as the perceptional differences between pediatric and adolescent CKD patients and caregiver proxy-reports about their quality of life.

  6. Spontaneous adsorption of 3,5-bis(3,5-dinitrobenzoylamino) benzoic acid onto carbon

    International Nuclear Information System (INIS)

    Paez, Julieta I.; Strumia, Miriam C.; Passeggi, Mario C.G.; Ferron, Julio; Baruzzi, Ana M.; Brunetti, Veronica

    2009-01-01

    Dendritic molecules contain multifunctional groups that can be used to efficiently control the properties of an electrode surface. We are developing strategies to generate a highly functionalized surface using multifunctional and rigid dendrons immobilized onto different substrates. In the present work, we explore the immobilization of a dendritic molecule: 3,5-bis(3,5-dinitrobenzoylamino) benzoic acid (D-NO 2 ) onto carbon surfaces showing a simple and rapid way to produce conductive surfaces with electroactive chemical functions. The immobilized D-NO 2 layer has been characterized using atomic force microscopy and cyclic voltammetry. D-NO 2 adsorbs onto carbon surfaces spontaneously by dipping the electrode in dendron solutions. Reduction of this layer generates the hydroxylamine product. The resulting redox-active layer exhibits a well-behaved redox response for the adsorbed nitroso/hydroxylamine couple. The film permeability of the derivatized surface has been analyzed employing the electrochemical response of redox probes: Ru(NH 3 ) 6 3+ /Ru(NH 3 ) 6 2+ and Fe(CN) 6 3- /Fe(CN) 6 4- . Electrocatalytic oxidation of nicotinamide adenine dinucleotide onto a modified carbon surface was also observed.

  7. Color Doppler Indices of Orbital Arterial Flow in End-Stage Renal Disease Patients; Are the Changes Related to Chronic Hemodialysis or Chronic Renal Failure?

    International Nuclear Information System (INIS)

    Rokni Yazdi, Hadi; Faraji, Safoura; Ahmadi, Farokhlegha; Shahmirzae, Reza

    2012-01-01

    Endothelial injury is a well-known complication in chronic kidney disease (CKD) and hemodialysis. One of the sites in which early vascular changes may be detected is the retina. Of course, these flow changes may not be detected in ophthalmologic exams, but it seems that color Doppler sonography of retinal arteries may be helpful in these cases. In previous studies on CKD patients who underwent chronic hemodialysis,hemodynamic changes were noted in retinal arteries, but no study has been performed to determine which of the two processes (CKD or chronic hemodialysis) can produce these changes. In this study, we tried to answer this question. Doppler ultrasonography of the orbital vasculature including the ophthalmic artery and the central retinal artery was carried out in 17 patients (34 eyes) with chronic renal failure (CRF) who underwent hemodialysis, 17 patients (34 eyes)with CRF without a history of hemodialysis and 17 normal patients (34 eyes). The peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index were measured excluding hypertensive, diabetic patients and patients with cardiovascular disease. The mean PSV and EDV were lower only in the ophthalmic artery of CRF patients irrespective of the history of hemodialysis (PSV was 35.2 in hemodialysis, 38.8 in CRF and 51.6 in normal patients, P value = 0.001 and EDV was 7.4, 9.4, 11.8, respectively, P value =0.001) with no significant difference in the resistance index of the ophthalmic artery and other parameters [EDV, PSV, Resistance Index (RI)] in the central retinal artery. The mean PSV and DSV in the ophthalmic artery were lower only in the ophthalmic artery of CRF patients regardless of the history of hemodialysis. No significant difference in the resistance index of the ophthalmic artery and other parameters (EDV, PSV) of the central retinal artery were noted between different groups. These findings suggest that microvascular disease and endothelial cell dysfunction of the orbital

  8. The relation of Complementary-Alternative Medicine use with glomerular filtration rate and depression in patients with chronic kidney disease at predialysis stage.

    Science.gov (United States)

    Esen, Bennur; Atay, Ahmet Engin; Gokmen, Emel Saglam; Karakoc, Ayten; Sari, Hakan; Sarisakal, Samprie; Kahvecioglu, Serdar; Kayabasi, Hasan; Sit, Dede

    2015-05-08

    Complementary and alternative medicine is a broad field of health including all health care practices and methods; and their accompanying theories and beliefs. In the present study, we aimed to examine the frequency of complementary-alternative medicine use, and its relation with glomerular filtration rate and depression in patients with chronic kidney disease at predialysis stage. A total of 1053 predialysis patients; 518 female and 535 male, that were followed up with chronic kidney disease for at least 3 months were enrolled into the study. Demographic features, biochemical parameters and findings of physical examination were recorded. Their compliance to diet, and knowledge about disease were questioned. Beck depression inventory and questionnaire regarding to complementary-alternative medicine use were performed. The overall frequency of complementary-alternative medicine use was 40.3% . Total ratio of herbal products was 46%. Complementary-alternative medicine use was significantly more frequent in female or single patients, and patients that informed about chronic kidney disease or under strict diet (p:0.007, p:0.016, p:0.02, p:0.016; respectively). When glomerular filtration rate of participants were considered, complementary-alternative medicine use was similar in different stages of kidney disease. Depression was observed in 41.9% of patients and significantly frequent in patients with alternative method use (p:0.002). Depression score was higher as creatinine increases and glomerular filtration rate decreases (p:0.002; r: 0,093). We determined that complementary-alternative medicine use gradually increases at predialysis stage as glomerular filtration rate decreases and there is a strict relation between complementary-alternative medicine use and depression or female gender. Disorder related stressors may lead to seeking of alternative methods. This article is protected by copyright. All rights reserved.

  9. Ergocalciferol treatment and aspects of mineral homeostasis in patients with chronic kidney disease stage 4-5

    DEFF Research Database (Denmark)

    Gravesen, Eva; Hofman-Bang, Jacob; Lewin, Ewa

    2013-01-01

    Focus on non-classical effects and possible less side effects of treatment with nutritional vitamin D, raises the expectation of possible benefits from treating chronic kidney disease (CKD) patients with ergocalciferol (vitamin D2). Treatment with 1,25(OH)2 vitamin D (calcitriol) induces elevated...

  10. Cementless One-Stage Revision in Chronic Periprosthetic Hip Joint Infection. Ninety-One Percent Infection Free Survival in 56 Patients at Minimum 2-Year Follow-Up

    DEFF Research Database (Denmark)

    Lange, Jeppe; Troelsen, Anders; Solgaard, Søren

    2018-01-01

    was re-revision performed due to infection and was evaluated by competing risk analysis, with death and aseptic revision as competing events. All-cause mortality was evaluated by Kaplan-Meier survival analysis. Oxford Hip Score (OHS) was used as disease-specific patient-reported outcome measure. RESULTS......BACKGROUND: Cementless 1-stage revision in chronic periprosthetic hip joint infections is limited evaluated. The purpose of this study was to evaluate a specific treatment protocol in this patient group. METHODS: The study was performed as a multicenter, proof-of-concept, observational study...

  11. [The SIAARTI consensus document on the management of patients with end-stage chronic organ failure. From evidence-based medicine to knowledge-based medicine].

    Science.gov (United States)

    Bertolini, Guido

    2014-01-01

    The management of patients with end-stage chronic organ failure is an increasingly important topic, since the extraordinary medical and technological advances have significantly reduced mortality and improved quality of life with prolonged survival of end-stage diseases. What should be the plan of care for these patients? Who should bear the responsibility for care? With what targets? These are crucial questions, to which modern medicine should provide convincing answers. The authors of the document explicitly resisted the temptation to draw up guidelines, showing that it is possible to customize medical intervention on the individual patient, keeping it tightly linked to the available knowledge. This is the most relevant aspect of the document: it goes beyond the classical concept of evidence-based medicine choosing to refer to the most dynamic knowledge-based medicine approach.

  12. Effects of hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) metabolites on cricket (Acheta domesticus) survival and reproductive success

    Energy Technology Data Exchange (ETDEWEB)

    Zhang Baohong [Institute of Environmental and Human Health (TIEHH), and Department of Environmental Toxicology, Texas Tech University, Box 41163, Lubbock, TX 79409-1163 (United States); Freitag, Christina M. [Institute of Environmental and Human Health (TIEHH), and Department of Environmental Toxicology, Texas Tech University, Box 41163, Lubbock, TX 79409-1163 (United States); Canas, Jaclyn E. [Institute of Environmental and Human Health (TIEHH), and Department of Environmental Toxicology, Texas Tech University, Box 41163, Lubbock, TX 79409-1163 (United States); Cheng Qiuqiong [Institute of Environmental and Human Health (TIEHH), and Department of Environmental Toxicology, Texas Tech University, Box 41163, Lubbock, TX 79409-1163 (United States); Anderson, Todd A. [Institute of Environmental and Human Health (TIEHH), and Department of Environmental Toxicology, Texas Tech University, Box 41163, Lubbock, TX 79409-1163 (United States)]. E-mail: todd.anderson@tiehh.ttu.edu

    2006-11-15

    The effect of two major hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) metabolites, hexahydro-1-nitroso-3,5-dinitro-1,3,5-triazine (MNX) and hexahydro-1,3,5-trinitroso-1,3,5-triazine (TNX), on cricket (Acheta domesticus) survival and reproduction was studied. RDX metabolites did not have adverse effects on cricket survival, growth, and egg production. However, MNX and TNX did affect egg hatching. MNX and TNX were more toxic in spiked-sand than in topical tests. TNX was more toxic to egg than MNX. Developmental stage and exposure time affected hatching. After 30 days exposure to MNX or TNX, the EC{sub 2}, EC{sub 5}, and EC{sub 95} were 47, 128, and 247 {mu}g/g for TNX, and 65, 140, and 253 {mu}g/g for MNX in topical tests. The ECs for 20, 50, and 95 were 21, 52, and 99 {mu}g/g for MNX, and 12, 48, and 97 {mu}g/g for TNX in sand. No gross abnormalities in cricket nypmhs were observed in all experiments indicating that neither TNX or MNX is teratogenic in this assay. - RDX metabolites did not have adverse effects on cricket survival, growth, and egg production, but adversely affected egg hatching.

  13. Effects of hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) metabolites on cricket (Acheta domesticus) survival and reproductive success

    International Nuclear Information System (INIS)

    Zhang Baohong; Freitag, Christina M.; Canas, Jaclyn E.; Cheng Qiuqiong; Anderson, Todd A.

    2006-01-01

    The effect of two major hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) metabolites, hexahydro-1-nitroso-3,5-dinitro-1,3,5-triazine (MNX) and hexahydro-1,3,5-trinitroso-1,3,5-triazine (TNX), on cricket (Acheta domesticus) survival and reproduction was studied. RDX metabolites did not have adverse effects on cricket survival, growth, and egg production. However, MNX and TNX did affect egg hatching. MNX and TNX were more toxic in spiked-sand than in topical tests. TNX was more toxic to egg than MNX. Developmental stage and exposure time affected hatching. After 30 days exposure to MNX or TNX, the EC 2 , EC 5 , and EC 95 were 47, 128, and 247 μg/g for TNX, and 65, 140, and 253 μg/g for MNX in topical tests. The ECs for 20, 50, and 95 were 21, 52, and 99 μg/g for MNX, and 12, 48, and 97 μg/g for TNX in sand. No gross abnormalities in cricket nypmhs were observed in all experiments indicating that neither TNX or MNX is teratogenic in this assay. - RDX metabolites did not have adverse effects on cricket survival, growth, and egg production, but adversely affected egg hatching

  14. Effects of hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) metabolites on cricket (Acheta domesticus) survival and reproductive success.

    Science.gov (United States)

    Zhang, Baohong; Freitag, Christina M; Cañas, Jaclyn E; Cheng, Qiuqiong; Anderson, Todd A

    2006-11-01

    The effect of two major hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) metabolites, hexahydro-1-nitroso-3,5-dinitro-1,3,5-triazine (MNX) and hexahydro-1,3,5-trinitroso-1,3,5-triazine (TNX), on cricket (Acheta domesticus) survival and reproduction was studied. RDX metabolites did not have adverse effects on cricket survival, growth, and egg production. However, MNX and TNX did affect egg hatching. MNX and TNX were more toxic in spiked-sand than in topical tests. TNX was more toxic to egg than MNX. Developmental stage and exposure time affected hatching. After 30 days exposure to MNX or TNX, the EC20, EC50, and EC95 were 47, 128, and 247 microg/g for TNX, and 65, 140, and 253 microg/g for MNX in topical tests. The ECs for 20, 50, and 95 were 21, 52, and 99 microg/g for MNX, and 12, 48, and 97 microg/g for TNX in sand. No gross abnormalities in cricket nypmhs were observed in all experiments indicating that neither TNX or MNX is teratogenic in this assay.

  15. Acute and chronic toxicity of cadmium to different life history stages of the freshwater crustacean Asellus aquaticus (L)

    Energy Technology Data Exchange (ETDEWEB)

    Green, D.W.J.; Williams, K.A.; Pascoe, D.

    1986-09-01

    Different life-history stages of the freshwater isopod crustacean Asellus aquaticus were exposed to a range of cadmium concentrations using a semi-static toxicity testing procedure. Median lethal concentrations (96-hr LC50) ranged from 80 ..mu..g Cd/L for juveniles to > 2000 ..mu..g Cd/L for embryos. Pre-treatment of eggs with cadmium did not increase their tolerance to the metal as juveniles. The responses of each stage are discussed in relation to the use of macroinvertebrate toxicity test data in predicting the hazardous effects of pollutants.

  16. 28 CFR 3.5 - Forfeiture of gambling devices.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Forfeiture of gambling devices. 3.5 Section 3.5 Judicial Administration DEPARTMENT OF JUSTICE GAMBLING DEVICES § 3.5 Forfeiture of gambling devices. For purposes of seizure and forfeiture of gambling devices see section 8 of this chapter. [Order...

  17. Subperiosteal hematoma of the iliac bone: imaging features of acute and chronic stages with emphasis on pathophysiology

    Energy Technology Data Exchange (ETDEWEB)

    Guillin, Raphael [Rennes University Hospital, Department of Musculoskeletal Imaging, Rennes Cedex 2 (France); Moser, Thomas [Montreal University Hospital, Department of Musculoskeletal Imaging, Montreal (Canada); Koob, Meriam [Strasbourg University Hospital, Department of Pediatric Imaging, Strasbourg (France); Khoury, Viviane [Mc Gill University Health center, Department of Radiology, Montreal (Canada); Chapuis, Madeleine [Rennes University Hospital, Department of Pediatric Orthopedic Surgery, Rennes (France); Ropars, Mickael [Rennes University Hospital, Department of orthopedic surgery, Rennes (France); Cardinal, Etienne [Radiologie Laennec, Montreal (Canada)

    2012-06-15

    The goal of this work is to describe the radiological appearance and clinical presentation of subperiosteal iliac hematoma and present a review of the literature. We retrospectively reviewed the radiological and clinical files of 19 patients (age range: 12-75; mean: 47) who presented with acute or chronic subperiosteal iliac hematomas. Imaging findings and relevant clinical information were recorded. A thorough literature search was performed to find additional cases of this rare condition. Three young patients presented with acute subperiosteal iliac hematoma following a fall. Clinical presentation was characterized by pain and gait disturbance presumed to result from crural nerve compression. Unilateral or bilateral lenticular hematomas deep in the iliacus muscle were demonstrated by CT for all patients while MRI was also available for two of them. In 16 asymptomatic patients, chronic ossified subperiosteal iliac hematomas were incidentally detected by CT. Progressive ossification of acute hematoma was demonstrated at follow-up in two patients. Subperiosteal iliac hematoma is rare but has typical imaging findings that may present acutely in adolescents or chronically in asymptomatic adults. (orig.)

  18. Combination of Transcranial Direct Current Stimulation and Neuromuscular Electrical Stimulation Improves Gait Ability in a Patient in Chronic Stage of Stroke

    Directory of Open Access Journals (Sweden)

    Takeshi Satow

    2016-02-01

    Full Text Available Background: Walking ability is important in stroke patients to maintain daily life. Nevertheless, its improvement is limited with conventional physical therapy in chronic stage. We report the case of a chronic stroke patient showing a remarkable improvement in gait function after a new neurorehabilitation protocol using transcranial direct current stimulation (tDCS and neuromuscular electrical stimulation (NMES. Case Presentation: A 62-year-old male with left putaminal hemorrhage suffered from severe right hemiparesis. He could move by himself with a wheelchair 1 year after the ictus. Anodal tDCS at the vertex (2 mA, 20 min with NMES at the anterior tibialis muscle had been applied for 3 weeks. The Timed Up and Go test and 10-meter walk test improved after the intervention, which had been maintained for at least 1 month. Conclusion: This single case suggests the possibility that tDCS with NMES could be a new rehabilitation approach to improve the gait ability in chronic stroke patients.

  19. Addition of Rice Bran Arabinoxylan to Curcumin Therapy May Be of Benefit to Patients With Early-Stage B-Cell Lymphoid Malignancies (Monoclonal Gammopathy of Undetermined Significance, Smoldering Multiple Myeloma, or Stage 0/1 Chronic Lymphocytic Leukemia)

    Science.gov (United States)

    Golombick, Terry; Diamond, Terrence H.; Manoharan, Arumugam; Ramakrishna, Rajeev

    2016-01-01

    Hypothesis. Prior studies on patients with early B-cell lymphoid malignancies suggest that early intervention with curcumin may lead to delay in progressive disease and prolonged survival. These patients are characterized by increased susceptibility to infections. Rice bran arabinoxylan (Ribraxx) has been shown to have immunostimulatory, anti-inflammatory, and proapoptotic effects. We postulated that addition of Ribraxx to curcumin therapy may be of benefit. Study design. Monoclonal gammopathy of undetermined significance (MGUS)/smoldering multiple myeloma (SMM) or stage 0/1 chronic lymphocytic leukemia (CLL) patients who had been on oral curcumin therapy for a period of 6 months or more were administered both curcumin (as Curcuforte) and Ribraxx. Methods. Ten MGUS/SMM patients and 10 patients with stage 0/1 CLL were administered 6 g of curcumin and 2 g Ribraxx daily. Blood samples were collected at baseline and at 2-month intervals for a period of 6 months, and various markers were monitored. MGUS/SMM patients included full blood count (FBC); paraprotein; free light chains/ratio; C-reactive protein (CRP)and erythrocyte sedimentation rate (ESR); B2 microglobulin and immunological markers. Markers monitored for stage 0/1 CLL were FBC, CRP and ESR, and immunological markers. Results. Of 10 MGUS/SMM patients,5 (50%) were neutropenic at baseline, and the Curcuforte/Ribraxx combination therapy showed an increased neutrophil count, varying between 10% and 90% among 8 of the 10 (80%) MGUS/SMM patients. An additional benefit of the combination therapy was the potent effect in reducing the raised ESR in 4 (44%) of the MGUS/SMM patients. Conclusion. Addition of Ribraxx to curcumin therapy may be of benefit to patients with early-stage B-cell lymphoid malignancies. PMID:27154182

  20. Platelet Endothelial Cell Adhesion Molecule-1 Gene Polymorphisms are Associated with Coronary Artery Lesions in the Chronic Stage of Kawasaki Disease.

    Science.gov (United States)

    Lu, Wen-Hsien; Huang, Sin-Jhih; Yuh, Yeong-Seng; Hsieh, Kai-Sheng; Tang, Chia-Wan; Liou, Huei-Han; Ger, Luo-Ping

    2017-05-01

    Kawasaki disease is the most common cause of pediatric acquired heart disease. The role of platelet endothelial cell adhesion molecule-1 in the inflammatory process has been documented. To date, no report has investigated the relationship between coronary artery lesions of Kawasaki disease and platelet endothelial cell adhesion molecule-1 polymorphisms. A total of 114 Kawasaki disease children with coronary artery lesions and 185 Kawasaki disease children without coronary artery lesions were recruited in this study. The TaqMan assay was conducted to identify the genotype in this case-control study. In three single nucleotide polymorphisms (Leu125Val, Ser563Asn, and Arg670Gly) of platelet endothelial cell adhesion molecule-1, we found that the Leu-Ser-Arg haplotype was associated with a significantly increased risk for coronary artery lesions in the chronic stage (odds ratio 3.05, 95% confidence interval 1.06-8.80, p = 0.039), but not for coronary artery lesions in the acute stage. Analysis based on the diplotypes of platelet endothelial cell adhesion molecule-1 also showed that Kawasaki disease with one or two alleles of Leu-Ser-Arg had a significantly increased risk of chronic coronary artery lesions (odds ratio 3.38, 95% confidence interval 1.11-10.28, p = 0.032) and had increased platelet counts after Kawasaki disease was diagnosed, as compared to those with other diplotypes. The haplotype of platelet endothelial cell adhesion molecule-1 Leu-Ser-Arg might be associated with the increased platelet counts and the following risk of chronic coronary artery lesions in a dominant manner in Kawasaki disease.

  1. Downregulation of interferon-γ-induced protein 10 in the tears of patients with Stevens-Johnson syndrome with severe ocular complications in the chronic stage.

    Science.gov (United States)

    Ueta, Mayumi; Nishigaki, Hiromi; Sotozono, Chie; Kinoshita, Shigeru

    2017-01-01

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute inflammatory vesiculobullous reactions of the skin and mucosa such as the ocular surface, oral cavity and genitals. Severe ocular complications (SOC) arise in some patients with SJS/TEN diagnosed by dermatologists. To investigate the pathophysiology of ocular surface inflammation in SJS/TEN with SOC in the chronic stage, we examined cytokines in the tears of patients with ocular surface diseases and healthy controls. SJS/TEN eyes in the chronic stage (n>30), healthy eyes (n>20, controls) and eyes (n>20) from patients with atopic keratoconjunctivitis representing different ocular surface inflammatory disorders. Tear samples were collected on Schirmer's measurement strips. To measure the level of various cytokines in the tears we used BD CBA Flex sets. An observational study (case-control study). We recorded the level of interleukin (IL)-6, IL-8, eotaxin, macrophage inflammatory protein (MIP)-1β, RANTES (regulated on activation, normal T cell expressed and secreted), interferon gamma (IFN)-γ, monocyte chemoattractant protein-1, IFN-γ-induced protein 10 (IP-10) and total IgE. We found that compared with the controls, in SJS/TEN with SOC, IL-6, IL-8, eotaxin and MIP-1β were significantly upregulated while IP-10 was significantly downregulated. Compared with atopic keratoconjunctivitis, IP-10 was significantly downregulated in SJS/TEN with SOC; on the other hand, total IgE was significantly upregulated in atopic keratoconjunctivitis compared with SJS/TEN with SOC. IP-10 in tears may be a biomarker to distinguish between chronic SJS/TEN with SOC and other ocular inflammatory disorders such as atopic keratoconjunctivitis.

  2. The Chronic Stages of BovineFasciola hepaticaAre Dominated by CD4 T-Cell Exhaustion.

    Science.gov (United States)

    Sachdev, Divya; Gough, Kevin C; Flynn, Robin J

    2017-01-01

    Fasciola hepatica infection of ruminants leads to non-resolving chronic infection, as patency develops, there is switching to a TGF-β and IL-10 led response. Here, we explore the responses of CD4 T-cells within the major draining lymph nodes. We found minimal expression of Foxp3 within CD4 cells but elevated levels within the γδ (WC1 + ) population. There is a strong T-cell-intrinsic exhaustion phenotype within the hepatic lymph node (HLN) characterized by a lack of antigen-specific proliferation and cytokine secretion. CD4 T-cells recovered from the HLN had high levels of PD-1 expression and low levels of IL-2 secretion. Exogenous IL-2 partially rescued this defect; when combined with neutralization of IL-10 and TGF-β, full restoration of proliferation, and cytokine production was achieved. Moreover, there is a clear uncoupling of the mechanisms that facilitate this regulation with parasite-specific proliferation and cytokine secretion being governed by independent means. These data would suggest that there is a CD4 T-cell-intrinsic regulation in place early in chronic infection, potentially leading to failure in resistance to reinfection.

  3. Association of Vitamin D Metabolites with Parathyroid Hormone, Fibroblast Growth Factor-23, Calcium, and Phosphorus in Dogs with Various Stages of Chronic Kidney Disease.

    Science.gov (United States)

    Parker, V J; Harjes, L M; Dembek, K; Young, G S; Chew, D J; Toribio, R E

    2017-05-01

    Hypovitaminosis D is associated with progression of renal disease, development of renal secondary hyperparathyroidism (RHPT), chronic kidney disease-mineral bone disorder (CKD-MBD), and increased mortality in people with CKD. Despite what is known regarding vitamin D dysregulation in humans with CKD, little is known about vitamin D metabolism in dogs with CKD. The purpose of our study was to further elucidate vitamin D status in dogs with different stages of CKD and to relate it to factors that affect the development of CKD-MBD, including parathyroid hormone (PTH), fibroblast growth factor-23 (FGF-23), calcium, and phosphorus concentrations. Thirty-seven dogs with naturally occurring CKD were compared to 10 healthy dogs. Serum 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH) 2 D], and 24,25-dihydroxyvitamin D [24,25(OH) 2 D], and PTH and FGF-23 concentrations were measured. Their association with serum calcium and phosphorus concentrations and IRIS stage was determined. Compared to healthy dogs, all vitamin D metabolite concentrations were significantly lower in dogs with International Renal Interest Society (IRIS) stages 3 and 4 CKD (r [creatinine]: -0.49 to -0.60; P Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  4. Bardoxolone Methyl Improves Kidney Function in Patients with Chronic Kidney Disease Stage 4 and Type 2 Diabetes: Post-Hoc Analyses from Bardoxolone Methyl Evaluation in Patients with Chronic Kidney Disease and Type 2 Diabetes Study

    Science.gov (United States)

    Chin, Melanie P.; Bakris, George L.; Block, Geoffrey A.; Chertow, Glenn M.; Goldsberry, Angie; Inker, Lesley A.; Heerspink, Hiddo J.L.; O'Grady, Megan; Pergola, Pablo E.; Wanner, Christoph; Warnock, David G.; Meyer, Colin J.

    2018-01-01

    Background Increases in measured inulin clearance, measured creatinine clearance, and estimated glomerular filtration rate (eGFR) have been observed with bardoxolone methyl in 7 studies enrolling approximately 2,600 patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). The largest of these studies was Bardoxolone Methyl Evaluation in Patients with Chronic Kidney Disease and Type 2 Diabetes (BEACON), a multinational, randomized, double-blind, placebo-controlled phase 3 trial which enrolled patients with T2D and CKD stage 4. The BEACON trial was terminated after preliminary analyses showed that patients randomized to bardoxolone methyl experienced significantly higher rates of heart failure events. We performed post-hoc analyses to characterize changes in kidney function induced by bardoxolone methyl. Methods Patients in ­BEACON (n = 2,185) were randomized 1: 1 to receive once-daily bardoxolone methyl (20 mg) or placebo. We compared the effects of bardoxolone methyl and placebo on a post-hoc composite renal endpoint consisting of ≥30% decline from baseline in eGFR, eGFR <15 mL/min/1.73 m2, and end-stage renal disease (ESRD) events (provision of dialysis or kidney transplantation). Results Consistent with prior studies, patients randomized to bardoxolone methyl experienced mean increases in eGFR that were sustained through study week 48. Moreover, increases in eGFR from baseline were sustained 4 weeks after cessation of treatment. Patients randomized to bardoxolone methyl were significantly less likely to experience the composite renal endpoint (hazards ratio 0.48 [95% CI 0.36–0.64]; p < 0.0001). Conclusions Bardoxolone methyl preserves kidney function and may delay the onset of ESRD in patients with T2D and stage 4 CKD. PMID:29402767

  5. Restorative physical and occupational therapy: a critical need for patients with chronic kidney and end-stage renal disease.

    Science.gov (United States)

    Nussbaum, James; Garcia, Ralph K

    2009-11-01

    Patients with CKD and ESRD present with many health problems, which may lead to increased mortality and dysfunction. Numerous comorbidities may contribute toward physical, emotional, and social problems and a decreased quality of life. Difficulty ambulating, balance deficits, joint pain and stiffness, muscle spasm and weakness, fatigue, neuropathy, and difficulty with activities of daily living (ADLs) may contribute to a decrease in functional independence. Physical therapy (PT) and occupational therapy (OT) aim to restore physical functioning, facilitate independence in ADLs, and promote functional independence by using various therapeutic procedures. PT and OT are the usual services of choice to address impaired function associated with acute and chronic pathology. The purpose of this article is multifold: (1) to describe specific interventions provided by PTs and OTs that may be beneficial to individuals with CKD and ESRD, (2) to identify and describe the potential benefits of rehabilitation for these patient populations, and (3) to provide programmatic rehabilitation recommendations for patients with CKD and ESRD.

  6. Performance of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Young Eun Chon

    Full Text Available Transient elastography (TE, a non-invasive tool that measures liver stiffness, has been evaluated in meta-analyses for effectiveness in assessing liver fibrosis in European populations with chronic hepatitis C (CHC. However, these data cannot be extrapolated to populations in Asian countries, where chronic hepatitis B (CHB is more prevalent. In this study, we performed a meta-analysis to assess the overall performance of TE for assessing liver fibrosis in patients with CHB.Studies from the literature and international conference abstracts which enrolled only patients with CHB or performed a subgroup analysis of such patients were enrolled. Combined effects were calculated using area under the receiver operating characteristic curves (AUROC and diagnostic accuracy values of each study.A total of 18 studies comprising 2,772 patients were analyzed. The mean AUROCs for the diagnosis of significant fibrosis (F2, severe fibrosis (F3, and cirrhosis (F4 were 0.859 (95% confidence interval [CI], 0.857-0.860, 0.887 (95% CI, 0.886-0.887, and 0.929 (95% CI, 0.928-0.929, respectively. The estimated cutoff for F2 was 7.9 (range, 6.1-11.8 kPa, with a sensitivity of 74.3% and specificity of 78.3%. For F3, the cutoff value was determined to be 8.8 (range, 8.1-9.7 kPa, with a sensitivity of 74.0% and specificity of 63.8%. The cutoff value for F4 was 11.7 (range, 7.3-17.5 kPa, with a sensitivity of 84.6% and specificity of 81.5%.TE can be performed with good diagnostic accuracy for quantifying liver fibrosis in patients with CHB.

  7. 39 CFR 3.5 - Delegation of authority by Board.

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Delegation of authority by Board. 3.5 Section 3.5 Postal Service UNITED STATES POSTAL SERVICE THE BOARD OF GOVERNORS OF THE U.S. POSTAL SERVICE BOARD OF GOVERNORS (ARTICLE III) § 3.5 Delegation of authority by Board. As authorized by 39 U.S.C. 402, these bylaws...

  8. Uncovering the exposure mechanisms of sunken heavy oil that makes it chronically toxic to early life stages of fish

    Energy Technology Data Exchange (ETDEWEB)

    Martin, J.; Young, G.; Lemire, B.; Hodson, P. [Queen' s Univ., Kingston, ON (Canada)

    2010-07-01

    A train derailment in 2005 caused the release of 150,000 litres of No. 6 heavy fuel oil into a lake in Alberta. The oil is a residue of the crude oil refinement process and contains 3-4 ringed alkylated forms of polycyclic aromatic hydrocarbons (PAH) that are known to cause sub-lethal toxic responses during the early life stages of rainbow trout. Because the oil does not disperse well, oil patches still persist in near-shore sediments of the lake where fish spawn. This study assessed how the behaviour of heavy oil in water interacts with exposure and toxicity to the early life stages of fish. Daily renewal tests with heavy fuel oil coated on glass plate demonstrated higher levels of toxicity to trout embryos than oil that was mechanically or chemically dispersed. A flow-through oil gravel column was used to assess whether the toxic constituents of the heavy oil are transferred quickly enough to cause toxicity. The aim of the study was to develop exposure and toxicity test methods that accurately reflect the behaviour of heavy oil after a spill.

  9. Uncovering the exposure mechanisms of sunken heavy oil that makes it chronically toxic to early life stages of fish

    International Nuclear Information System (INIS)

    Martin, J.; Young, G.; Lemire, B.; Hodson, P.

    2010-01-01

    A train derailment in 2005 caused the release of 150,000 litres of No. 6 heavy fuel oil into a lake in Alberta. The oil is a residue of the crude oil refinement process and contains 3-4 ringed alkylated forms of polycyclic aromatic hydrocarbons (PAH) that are known to cause sub-lethal toxic responses during the early life stages of rainbow trout. Because the oil does not disperse well, oil patches still persist in near-shore sediments of the lake where fish spawn. This study assessed how the behaviour of heavy oil in water interacts with exposure and toxicity to the early life stages of fish. Daily renewal tests with heavy fuel oil coated on glass plate demonstrated higher levels of toxicity to trout embryos than oil that was mechanically or chemically dispersed. A flow-through oil gravel column was used to assess whether the toxic constituents of the heavy oil are transferred quickly enough to cause toxicity. The aim of the study was to develop exposure and toxicity test methods that accurately reflect the behaviour of heavy oil after a spill.

  10. Analysis of local chronic inflammatory cell infiltrate combined with systemic inflammation improves prognostication in stage II colon cancer independent of standard clinicopathologic criteria.

    Science.gov (United States)

    Turner, Natalie; Wong, Hui-Li; Templeton, Arnoud; Tripathy, Sagarika; Whiti Rogers, Te; Croxford, Matthew; Jones, Ian; Sinnathamby, Mathuranthakan; Desai, Jayesh; Tie, Jeanne; Bae, Susie; Christie, Michael; Gibbs, Peter; Tran, Ben

    2016-02-01

    In Stage II colon cancer, multiple independent studies have shown that a dense intratumoural immune infiltrate (local inflammation) is associated with improved outcomes, while systemic inflammation, measured by various markers, has been associated with poorer outcomes. However, previous studies have not considered the interaction between local and systemic inflammation, nor have they assessed the type of inflammatory response compared with standard clinicopathologic criteria. In order to evaluate the potential clinical utility of inflammatory markers in Stage II colon cancer, we examined local and systemic inflammation in a consecutive series of patients with resected Stage II colon cancer between 2000 and 2010 who were identified from a prospective clinical database. Increased intratumoural chronic inflammatory cell (CIC) density, as assessed by pathologist review of hematoxylin and eosin stained slides, was used to represent local inflammation. Neutrophil-to-lymphocyte ratio (NLR) >5, as calculated from pre-operative full blood counts, was used to represent systemic inflammation. In 396 eligible patients identified, there was a non-significant inverse relationship between local and systemic inflammation. Increased CIC density was significantly associated with improved overall (HR 0.45, p = 0.001) and recurrence-free survival (HR 0.37, p = 0.003). High NLR was significantly associated with poorer overall survival (HR 2.56, p < 0.001). The combination of these markers further stratified prognosis independent of standard high-risk criteria, with a dominant systemic inflammatory response (low CIC/high NLR) associated with the worst outcome (5-year overall survival 55.8%). With further validation this simple, inexpensive combined inflammatory biomarker might assist in patient selection for adjuvant chemotherapy in Stage II colon cancer. © 2015 UICC.

  11. Chronic intermittent hypoxia from pedo-stage decreases glucose transporter 4 expression in adipose tissue and causes insulin resistance.

    Science.gov (United States)

    Chen, Lin; Cao, Zhao-long; Han, Fang; Gao, Zhan-cheng; He, Quan-ying

    2010-02-20

    The persistence of sleep disordered breathing (SDB) symptoms after tonsil and/or adenoid (T&A) surgery are common in children with obstructive sleep apnea (OSA). We tested the hypothesis that disturbances of glucose transporters (GLUTs) in intraabdominal adipose tissue caused by chronic intermittent hypoxia (CIH) from the pedo-period could facilitate the appearance of periphery insulin resistance in Sprague-Dawley (SD) rats. We tested the hypothesis that the changes of GLUTs in adipose tissue may be one of the reasons for persistent SDB among clinical OSA children after T&A surgery. Thirty 21-day-old SD rats were randomly divided into a CIH group, a chronic continuous hypoxia (CCH) group, and a normal oxygen group (control group) and exposed for 40 days. The changes of weight, fasting blood glucose and fasting blood insulin levels were measured. Hyperinsulinemic-euglycemic clamp techniques were used to measure insulin resistance in each animal. Real-time quantitative PCR and Western blotting were used to measure GLUT mRNA and proteins in intraabdominal adipose tissue. Additional intraabdomial white adipose tissue (WAT) was also processed into paraffin sections and directly observed for GLUTs1-4 expression. When compared with control group, CIH increased blood fasting insulin levels, (245.07 +/- 53.89) pg/ml vs. (168.63 +/- 38.70) pg/ml, P = 0.038, and decreased the mean glucose infusion rate (GIR), (7.25 +/- 1.29) mg x kg(-1) x min(-1) vs. (13.34 +/- 1.54) mg x kg(-1) x min(-1), P < 0.001. GLUT-4 mRNA and protein expression was significantly reduced after CIH compared with CCH or normal oxygen rats, 0.002 +/- 0.002 vs. 0.039 +/- 0.009, P < 0.001; 0.642 +/- 0.073 vs. 1.000 +/- 0.103, P = 0.035. CIH in young rats could induce insulin resistance via adverse effects on glycometabolism. These findings emphasize the importance of early detection and treatment of insulin insensitivity in obese childhood OSA.

  12. Increased intestinal permeability to macromolecules and endotoxemia in patients with chronic alcohol abuse in different stages of alcohol-induced liver disease

    DEFF Research Database (Denmark)

    Parlesak, Alexandr; Schäfer, C.; Schütz, Tanja

    2000-01-01

    BACKGROUND/AIMS: No information is yet available about the influence of alcohol abuse on the translocation of larger molecules (Mr>1200) through the intestinal mucosa in man. The present study aimed to determine the intestinal permeability to macromolecules in patients with chronic alcohol abuse...... and mild to more advanced stages of liver disease, and to measure the concentration of endotoxins in the plasma, as these compounds derive from the intestinal flora and are suspected to contribute to the development of alcoholic liver disease (ALD). METHODS: The permeability to polyethylene glycol Mr 400......, Mr 1500, Mr 4000, and Mr 10,000 and endotoxin plasma concentrations were measured in 54 patients with alcoholic liver disease, 19 of them with cirrhosis, and in 30 non-alcoholic healthy controls. RESULTS: Permeability to polyethylene glycol Mr 400 was found to be unchanged in patients with ALD...

  13. No independent association of serum phosphorus with risk for death or progression to end-stage renal disease in a large screen for chronic kidney disease

    Science.gov (United States)

    Mehrotra, Rajnish; Peralta, Carmen A.; Chen, Shu-Cheng; Li, Suying; Sachs, Michael; Shah, Anuja; Norris, Keith; Saab, Georges; Whaley-Connell, Adam; Kestenbaum, Bryan; McCullough, Peter A.

    2014-01-01

    Whether higher serum phosphorus levels are associated with a higher risk for death and/or progression of chronic kidney disease (CKD) is not well established, and whether the association is confounded by access and barriers to care is unknown. To answer these questions, data of 10,672 individuals identified to have CKD (estimated glomerular filtration rate disease (ESRD) (unadjusted hazards ratio, 6.72 (4.16–10.85)); however, the risk became nonsignificant on adjustment for potential confounders. There was no appreciable change in hazards ratio with inclusion of variables related to access and barriers to care. Additional analyses in subgroups based on 12 different variables yielded similar negative associations. Thus, in the largest cohort of individuals with early-stage CKD to date, we could not validate an independent association of serum phosphorus with risk for death or progression to ESRD. PMID:23615501

  14. Etiology and treatment of growth retardation in children with chronic kidney disease and end-stage renal disease: a historical perspective.

    Science.gov (United States)

    Fine, Richard N

    2010-04-01

    Dramatic changes have occurred in our understanding of the etiology of the growth retardation associated with chronic kidney disease (CKD) and end-stage renal disease (ESRD) during the past 50 years. Significant interest has been focused on preventing and/or correcting the growth retardation because of the emergence of the dual therapeutic modalities of dialysis and renal transplantation to prolong the lives of infants, children, and adolescents afflicted with CKD and ESRD. These efforts have resulted in a significant improvement in the height Z-score over the past two decades of children with CKD and ESRD. This has had a salutary impact on the final adult height of such children which should hopefully lead to an enhanced quality of life in the future. This report addresses the progress that has been made in the management of growth retardation in the pediatric population with CKD and ESRD.

  15. Impact of short-term HAART initiated during the chronic stage or shortly post-exposure on SIV infection of male genital organs.

    Directory of Open Access Journals (Sweden)

    Marina Moreau

    Full Text Available BACKGROUND: The male genital tract is suspected to constitute a viral sanctuary as persistent HIV shedding is found in the semen of a subset of HIV-infected men receiving effective antiretroviral therapy (HAART. The origin of this persistent shedding is currently unknown. Phylogenetic studies indicated that HIV in semen from untreated men arises from local sources and/or passive diffusion from the blood. We previously demonstrated in human and macaque low levels and localized infection of several semen-producing organs by HIV/SIV. Using a macaque model, this study investigates the impact of short term HAART (2-4 weeks initiated either during the asymptomatic chronic stage or 4 h post-intravenous inoculation of SIVmac251 on the infection of male genital organs. METHODOLOGY/PRINCIPAL FINDINGS: Short term HAART during the chronic stage decreased blood viral load. No major impact of HAART was observed on SIV DNA levels in male genital organs using a sensitive nested PCR assay. Using in situ hybridization, SIV RNA+ cells were detected in all male genital tract organs from untreated and treated animals with undetectable blood viral load following HAART. Infected CD68+ myeloid cells and CD3+ T lymphocytes were detected pre- and post-HAART. In contrast, short term HAART initiated 4 h post-SIV exposure led to a drastic decrease of the male genital tissues infection, although it failed to prevent systemic infection. In both cases, HAART tended to decrease the number of CD3+ T cells in the male organs. CONCLUSIONS: Our results indicate that the established infection of male genital organs is not greatly impacted by short term HAART, whereas the same treatment during pre-acute phase of the infection efficiently impairs viral dissemination to the male genital tract. Further investigations are now needed to determine whether infection of male genital organs is responsible for long term persistent HIV shedding in semen despite HAART.

  16. Setting the stage for chronic health problems: cumulative childhood adversity among homeless adults with mental illness in Vancouver, British Columbia.

    Science.gov (United States)

    Patterson, Michelle L; Moniruzzaman, Akm; Somers, Julian M

    2014-04-12

    It is well documented that childhood abuse, neglect and household dysfunction are disproportionately present in the backgrounds of homeless adults, and that these experiences adversely impact child development and a wide range of adult outcomes. However, few studies have examined the cumulative impact of adverse childhood experiences on homeless adults with mental illness. This study examines adverse events in childhood as predictors of duration of homelessness, psychiatric and substance use disorders, and physical health in a sample of homeless adults with mental illness. This study was conducted using baseline data from a randomized controlled trial in Vancouver, British Columbia for participants who completed the Adverse Childhood Experiences (ACE) scale at 18 months follow-up (n=364). Primary outcomes included current mental disorders; substance use including type, frequency and severity; physical health; duration of homelessness; and vocational functioning. In multivariable regression models, ACE total score independently predicted a range of mental health, physical health, and substance use problems, and marginally predicted duration of homelessness. Adverse childhood experiences are overrepresented among homeless adults with complex comorbidities and chronic homelessness. Our findings are consistent with a growing body of literature indicating that childhood traumas are potent risk factors for a number of adult health and psychiatric problems, particularly substance use problems. Results are discussed in the context of cumulative adversity and self-trauma theory. This trial has been registered with the International Standard Randomized Control Trial Number Register and assigned ISRCTN42520374.

  17. Perceived benefits and barriers to exercise among persons with physical disabilities or chronic health conditions within action or maintenance stages of exercise.

    Science.gov (United States)

    Malone, Laurie A; Barfield, J P; Brasher, Joel D

    2012-10-01

    Information regarding factors that affect the initial step to exercise behavior change among persons with physical disabilities or chronic health conditions is available in the literature but much less is known regarding perceived benefits and barriers to exercise among those who are regularly active. The purpose of this study was to examine the perceived benefits and barriers to exercise among persons with physical disabilities or chronic health conditions within action or maintenance stages of exercise. Participants (n = 152) completed the Exercise Benefits and Barriers Scale (EBBS). For data analyses, disabilities and health conditions were grouped as neuromuscular, orthopedic, cardiovascular/pulmonary, or multiple conditions. Multivariate analysis of variance (MANOVA) was conducted to determine if mean differences on EBBS benefits and barriers scores existed among disability types, between sexes, among age groups, and between physical activity levels. Sum scores were computed to determine the strongest benefit and barrier responses. No significant mean differences in EBBS scores were found between disability types, sexes, age groups, or physical activity levels (p > 0.05). Strongest benefit responses varied by group. Strongest barrier responses were the same for all demographic groups: "Exercise tires me," "Exercise is hard work for me," and "I am fatigued by exercise." EBBS scores were similar across disability/health condition, sex, age, and physical activity level. Primary benefits reported were in the areas of improved physical performance and psychological outlook whereas the primary barriers were in the area of physical exertion. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. Contemporary Management of Coronary Artery Disease and Acute Coronary Syndrome in Patients with Chronic Kidney Disease and End-Stage Renal Disease

    Science.gov (United States)

    Huang, Chin-Chou; Chen, Jaw-Wen

    2013-01-01

    Chronic kidney disease (CKD) and end-stage renal disease (ESRD) have emerged as a worldwide public health problem. Due to the remarkably higher incidence and prevalence of this chronic disease in Taiwan than in other countries, CKD/ESRD has contributed to a significant health burden in Taiwan. Patients with CKD/ESRD have an increased risk of coronary artery disease (CAD) and acute coronary syndrome (ACS) compared to the normal population. Patients with ACS alone can present differently than patients with ACS and CKD/ESRD. Also, due to the lower prevalence of chest pain and ST-segment elevation, CKD/ESRD patients were more difficult to diagnose than other patients. Furthermore, whether advances in ACS management with medical therapy and an early invasive approach could improve patient outcomes with CKD/ESRD is not known. The use of antiplatelets such as aspirin and other antithrombotic agents might reduce the incidence of ACS or stroke in CKD patients. However, such use could also increase bleeding risk and even increase the likelihood of mortality, especially in dialysis patients. While recent clinical data suggest the potential benefit of aggressive management with coronary intervention for CAD and ACS in this category of patients, further clinical studies are still indicated for the proper medical strategy and revascularization therapy to improve the outcomes of CAD and ACS in CKD/ESRD patients, both in Taiwan and worldwide. PMID:27122697

  19. The development of anemia is associated to poor prognosis in NKF/KDOQI stage 3 chronic kidney disease

    Science.gov (United States)

    2013-01-01

    Background Anemia is a common condition in CKD that has been identified as a cardiovascular (CV) risk factor in end-stage renal disease, constituting a predictor of low survival. The aim of this study was to define the onset of anemia of renal origin and its association with the evolution of kidney disease and clinical outcomes in stage 3 CKD (CKD-3). Methods This epidemiological, prospective, multicenter, 3-year study included 439 CKD-3 patients. The origin of nephropathy and comorbidity (Charlson score: 3.2) were recorded. The clinical characteristics of patients that developed anemia according to EBPG guidelines were compared with those that did not, followed by multivariate logistic regression, Kaplan-Meier curves and ROC curves to investigate factors associated with the development of renal anemia. Results During the 36-month follow-up period, 50% reached CKD-4 or 5, and approximately 35% were diagnosed with anemia (85% of renal origin). The probability of developing renal anemia was 0.12, 0.20 and 0.25 at 1, 2 and 3 years, respectively. Patients that developed anemia were mainly men (72% anemic vs. 69% non-anemic). The mean age was 68 vs. 65.5 years and baseline proteinuria was 0.94 vs. 0.62 g/24h (anemic vs. non anemic, respectively). Baseline MDRD values were 36 vs. 40 mL/min and albumin 4.1 vs. 4.3 g/dL; reduction in MDRD was greater in those that developed anemia (6.8 vs. 1.6 mL/min/1.73 m2/3 years). These patients progressed earlier to CKD-4 or 5 (18 vs. 28 months), with a higher proportion of hospitalizations (31 vs. 16%), major CV events (16 vs. 7%), and higher mortality (10 vs. 6.6%) than those without anemia. Multivariate logistic regression indicated a significant association between baseline hemoglobin (OR=0.35; 95% CI: 0.24-0.28), glomerular filtration rate (OR=0.96; 95% CI: 0.93-0.99), female (OR=0.19; 95% CI: 0.10-0.40) and the development of renal anemia. Conclusions Renal anemia is associated with a more rapid evolution to CKD-4, and a higher

  20. The Impact of Chronic Obstructive Pulmonary Disease and Smoking on Mortality and Kidney Transplantation in End-Stage Kidney Disease.

    LENUS (Irish Health Repository)

    Kent, Brian D

    2012-09-07

    Background: Chronic obstructive pulmonary disease (COPD) and tobacco use are leading causes of morbidity and mortality. The prevalence and clinical impact of COPD on mortality and kidney transplantation among patients who begin dialysis therapy is unclear. Methods: We explored the clinical impact of COPD and continued tobacco use on overall mortality and kidney transplantation in a national cohort study of US dialysis patients. National data on all dialysis patients (n = 769,984), incident between May 1995 and December 2004 and followed until October 31, 2006, were analyzed from the United States Renal Data System. Prevalence and period trends were determined while multivariable Cox regression evaluated relative hazard ratios (RR) for death and kidney transplantation. Results: The prevalence of COPD was 7.5% overall and increased from 6.7 to 8.1% from 1995-2004. COPD correlated significantly with older age, cardiovascular conditions, cancer, malnutrition, poor functional status, and tobacco use. Adjusted mortality risks were significantly higher for patients with COPD (RR = 1.20, 95% CI 1.18-1.21), especially among current smokers (RR = 1.28, 95% CI 1.25-1.32), and varied inversely with advancing age. In contrast, the adjusted risks of kidney transplantation were significantly lower for patients with COPD (RR = 0.47, 95% CI 0.41-0.54, for smokers and RR = 0.54, 95% CI 0.50-0.58, for non-smokers) than without COPD [RR = 0.72, 95% CI 0.70-0.75, for smokers and RR = 1.00 for non-smokers (referent category)]. Conclusions: Patients with COPD who begin dialysis therapy in the US experience higher mortality and lower rates of kidney transplantation, outcomes that are far worse among current smokers.

  1. Circulating sCD138 and Some Angiogenesis-Involved Cytokines Help to Anticipate the Disease Progression of Early-Stage B-Cell Chronic Lymphocytic Leukemia

    Directory of Open Access Journals (Sweden)

    2006-01-01

    Full Text Available Syndecan-1 (CD138 is a transmembrane heparin sulfate proteoglycan expressed on distinct stages of differentiation of B-lymphoid cells. Its prognostic value in B-cell chronic lymphocytic leukemia (B-CLL has not been evaluated so far. The serum concentration of sCD138 and some angiogenesis-involved cytokines: vascular endothelial growth factor (VEGF, basis fibroblast growth factor (bFGF, and endostatin were studied in 52 previously untreated patients with B-CLL. We found that bFGF and sCD138 levels were significantly higher in B-CLL patients than in controls. In patients with sCD138 level or endostatin level below the median value the lymphocyte count was higher than in patients with serum level of those cytokines above the median value. In patients with progressive disease bFGF level was significantly higher and sCD138 level significantly lower than in patients with stable one. Moreover, high sCD138 level was associated with longer lymphocyte doubling-free survival, and, on the limit of statistical significance, a high endostatin level was associated with shorter progression-free survival. We conclude that serum sCD138 level is increased in early stage B-CLL patients and may have a positive prognostic value as to the dynamics of the disease.

  2. [Intervention of chronic hepatitis B liver fibrosis patients in different stages by syndrome typing and different activating blood removing stasis methods: a clinical study].

    Science.gov (United States)

    Liu, Shi-yi; Zhang, Yin-qiang; Liu, Yan-ling; Guo, Peng; Zhou, Chun-mei

    2013-11-01

    To observe the clinical efficacy of treating chronic hepatitis B liver fibrosis (CHBLF) in different stages by syndrome typing and different activating blood removing stasis methods (ABRSM). Totally 100 CHBLF patients of vital qi deficiency blood stasis syndrome (VQDBSS) treated at the Department of Liver Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences from July 2008 to December 2011, were randomly assigned to the treatment group and the control group, 50 in each group. Those in the treatment group were treated by self-formulated decoctions for activating blood nourishing blood (ABNB), activating blood removing stasis (ABRS), and activating blood softening hard mass (ABSHM) according to their stages of disease conditions (mild, moderate, and severe). Those in the control group were treated with Compound Biejia Ruangan Tablet (CBRT). Integrals of Chinese medical syndromes, liver functions [mainly including alanine aminotransferase (ALT), albumin/globulin (A/ G)], ultrasonographic examinations of liver (mainly including echoes of liver, width of spleens, width of portal vein), four indicators of serum hepatic fibrosis [including serum hyaluronic acid (HA), laminin (LN), type IV collagen (IV-C), type III collagen peptide (P-III-P)] were statistically analyzed. The therapeutic course was 6 months for all. Compared with before treatment in the same group, the integrals of Chinese medical syndromes both decreased after treatment in the two groups (P serum biochemical indicators.

  3. Effect of Treadmill Exercise Using 80% Intensity of Six Minute Walk Test on Walking Distance and Quality of Life in Moderate Stage Chronic Obstructive Pulmonary Disease Patients

    Directory of Open Access Journals (Sweden)

    Farida Arisanti

    2016-06-01

    Full Text Available Skeletal muscle dysfunction poses as one of the systemic manifestation of chronic obstructive pulmonary disease (COPD in the impact of inactivity and deconditioning from early fatigue to the end of declining quality of life (QoL. Giving pulmonary rehabilitation program of treadmill exercise will overcome the problem, but standard method for moderate stage of COPD is not yet available. This study aimed to evaluate the effect of treadmill exercise using 80% intensity of six minute walk test on walking distance and QoL in moderate stage COPD in order to overcome muscle dysfunction. Samples were taken from Physical Medicine and Rehabilitation and Respirology subdivision of Internal Medicine outpatient clinic of Dr. Hasan Sadikin General Hospital Bandung, from March 2012–April 2013. Data analysis was tested using t-test for comparison of two independent mean data. Otherwise, non parametric test of Mann Whitney and Wilcoxon Match Pair test. Thirty three subjects of moderate stage COPD were divided into 2 groups (intervention and control. Intervention group received treadmill exercise with 80% intensity from preliminary 6MWT for 30–60 minutes/session, 3 session/week for 6 weeks. Significant increase on walking distance was found in intervention group (70.66 m compared to control group (7.43 m after 6 weeks (p≤0.05. QoL using St. George Respiratory Questionnaire (SGRQ showed significant decrease in intervention group for all components in the end of 6 weeks (total p=0.0038, symptoms p=0.0162, activities p=0.0043 and impact p=0.0057, p≤0.05. Eighty percent intensity of 6MWT in treadmill exercise for 6 weeks was well tolerated and could overcome skeletal muscle dysfunction in moderate stage COPD. It also revealed higher values in aerobic capacity and QoL compared to previous studies. In conclusion, treadmill exercise using 80% intensity of 6MWT provides further walking distance and higher QoL compared to control in moderate stage COPD.

  4. A longitudinal study on the acceptance and effects of a therapeutic renal food in pet dogs with IRIS-Stage 1 chronic kidney disease.

    Science.gov (United States)

    Hall, J A; Fritsch, D A; Yerramilli, M; Obare, E; Yerramilli, M; Jewell, D E

    2018-02-01

    Currently, nutritional management is recommended when serum creatinine (Cr) exceeds 1.4 mg/dl in dogs with IRIS-Stage 2 chronic kidney disease (CKD) to slow progressive loss of kidney function, reduce clinical and biochemical consequences of CKD, and maintain adequate nutrition. It is unknown if dietary interventions benefit non-azotemic dogs at earlier stages. A prospective 12-month feeding trial was performed in client-owned dogs with IRIS-Stage 1 CKD (n = 36; 20 had persistently dilute urine with urine specific gravity (USG) 0.5; 10 had both). Ease of transition to therapeutic renal food and effects on renal biomarkers and quality of life attributes were assessed. Dogs were transitioned over 1 week from grocery-branded foods to renal food. At 0, 3, 6, 9, and 12-months a questionnaire to assess owner's perception of their pet's acceptance of renal food and quality of life was completed. Renal biomarkers, including serum Cr, blood urea nitrogen (BUN), and symmetric dimethylarginine (SDMA), and USG and UPC ratio were measured. Of 36 dogs initially enrolled, 35 (97%) dogs were transitioned to therapeutic renal food. Dogs moderately or extremely liked the food 88% of the time, ate most or all of the food 84% of the time, and were moderately or extremely enthusiastic while eating 76% of the time. All renal biomarkers (Cr, BUN, and SDMA) were decreased (p ≤ .05) from baseline at 3-months, and remained decreased from baseline at 12-months in dogs completing the study (n = 20). Proteinuria was reduced in 12 of 16 dogs (p = .045) with proteinuria. Owners reported improvement in overall health and quality of life attributes, and hair and coat quality (all p food. Decreasing serum biomarker concentrations and reduction in proteinuria suggest stabilized kidney function. © 2017 The Authors. Journal of Animal Physiology and Animal Nutrition Published by Blackwell Verlag GmbH.

  5. Circulating FGF21 levels are progressively increased from the early to end stages of chronic kidney diseases and are associated with renal function in Chinese.

    Directory of Open Access Journals (Sweden)

    Zhuofeng Lin

    Full Text Available BACKGROUND: Fibroblast growth factor 21 (FGF21 is a hepatic hormone involved in the regulation of lipid and carbohydrate metabolism. This study aims to test the hypothesis that elevated FGF21 concentrations are associated with the change of renal function and the presence of left ventricular hypertrophy (LVH in the different stages of chronic kidney disease (CKD progression. METHODOLOGY/PRINCIPAL FINDINGS: 240 subjects including 200 CKD patients (146 outpatients and 54 long-term hemodialytic patients and 40 healthy control subjects were recruited. All CKD subjects underwent echocardiograms to assess left ventricular mass index. Plasma FGF21 levels and other clinical and biochemical parameters in all subjects were obtained based on standard clinical examination methods. Plasma FGF21 levels were significantly increased with the development of CKD from early- and end-stage (P<0.001 for trend, and significantly higher in CKD subjects than those in healthy subjects (P<0.001. Plasma FGF21 levels in CKD patients with LVH were higher than those in patients without LVH (P = 0.001. Furthermore, plasma FGF21 level correlated positively with creatinine, blood urea nitrogen (BUN, β2 microglobulin, systolic pressure, adiponectin, phosphate, proteinuria, CRP and triglyceride, but negatively with creatinine clearance rate (CCR, estimated glomerular filtrate rate (eGFR, HDL-c, LDL-c, albumin and LVH after adjusting for BMI, gender, age and the presence of diabetes mellitus. Multiple stepwise regression analyses indicated that FGF21 was independently associated with BUN, Phosphate, LVMI and β2 microglobulin (all P<0.05. CONCLUSION: Plasma FGF21 levels are significantly increased with the development of early- to end-stage CKD and are independently associated with renal function and adverse lipid profiles in Chinese population. Understanding whether increased FGF21 is associated with myocardial hypertrophy in CKD requires further study.

  6. The use of vitamin D analogs is independently associated with the favorable renal prognosis in chronic kidney disease stages 4-5: the CKD-ROUTE study.

    Science.gov (United States)

    Arai, Yohei; Kanda, Eiichiro; Iimori, Soichiro; Naito, Shotaro; Noda, Yumi; Kawasaki, Tomoki; Sato, Hidehiko; Ando, Ryoichi; Sasaki, Sei; Sohara, Eisei; Okado, Tomokazu; Rai, Tatemitsu; Uchida, Shinichi

    2017-06-01

    Vitamin D analogs have generally been recommended for treatment of mineral bone disease in chronic kidney disease (CKD). However, the association between this treatment and CKD progression has not yet been established. We designed a post hoc propensity score-matched cohort analysis derived from 3-year follow-up data of a prospective cohort. Adult participants with pre-dialysis CKD stages 4-5 who had newly been prescribed active vitamin D analogs during the observation period were eligible as matched cases. Then, matched controls were extracted from participants who had never been prescribed active vitamin D analogs. The primary outcome was a composite of end-stage renal disease or a 50 % reduction in estimated glomerular filtration rate (eGFR). A Cox proportional hazards model evaluated the association between the use of vitamin D analogs and the primary outcome. We enrolled 240 patients (males, 65 %). The number of matched cases and controls was 30 and 210, respectively. The primary outcome was observed in 94 patients, whereas 25 patients died. The mean ± standard deviation age and eGFR were 69 ± 12 years and 17 ± 5.7 ml/min/1.73 m 2 , respectively. In a Cox proportional hazard model, the use of vitamin D analogs was independently associated with a lower risk of the primary outcome (crude hazard ratio 0.41; 95 % confidence interval 0.19, 0.89; adjusted hazard ratio 0.38; 95 % confidence interval 0.17, 0.88). The use of vitamin D analogs is independently associated with the preservation of renal function in patients with pre-dialysis CKD stages 4-5.

  7. Correlation of glomerular filtration rate measurement using Tc-99m DTPA with cystatin-C levels and creatinine clearance for staging of chronic kidney disease

    International Nuclear Information System (INIS)

    Elliyanti, A.; Iskandar, Azmi S.

    2007-01-01

    Full text: The presence of Chronic Kidney Disease (CKD) was established based on kidney damage presence and the level of kidney function through Glomerular filtration rate (GFR). It was also recognized that renal scintigraphy (renogram) using TC-99m DTPA (diethylenetriamine pentacetic acid) has advantages in the measurement of GFR. Recently, serum Cystatin-C is proposed as the new marker of GFR. The aim of this study is to find out the correlation of GFR, derived from renogram, with Cystatin- C levels and Creatinine Clearance (CC) in CKD. Material and Methods: A total of 30 subjects (age mean is 60.8 years, 21 males and 9 females) were enrolled in this study with diagnosis stage 2 of CKD. CKD staging was determined by Cockroft-Gault (CG) equation, taking into account the serum creatinine. Renogram was performed using a single head camera with IV administration of 5 mCi DTPA. Cystatin-C and creatinine clearance (24-hours urine samples) were include in this study. Results: The mean GFR of renogram, Cystatin-C, CC and CG are 64.96 ml/min/1.73m2 (SD 28.047), 53.37 ml/min/1.73m2 (SD 21.29), 58.09 ml/min/1.73m2 (SD 35.45), 46.00 ml/min/1.73m2 (SD 12.06) respectively. There is better correlation between renogram and Cystatin-C (r=0.585, p0.0007) compared renogram and CC (r=0.388, p=0.03) or renogram and CG (r=-0.029, p=0.87). Conclusion: Cystatin-C shows better indicator of GFR than CC and CG. Serum creatinine concentration alone should not be used to assess the level of kidney function in the staging of CKD. (author)

  8. IRIS Toxicological Review of Hexahydro-1,3,5-Trinitro-1,3,5-Triazine (RDX) (External Review Draft)

    Science.gov (United States)

    The IRIS Toxicological Review of Hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) was released for external peer review in September 2016. The EPA’s Science Advisory Board’s (SAB) Chemical Assessment Advisory Committee (CAAC) will conduct a peer review of the scientific basis suppor...

  9. Evaluation of volume overload by bioelectrical impedance analysis, NT-proBNP and inferior vena cava diameter in patients with stage 3&4 and 5 chronic kidney disease.

    Science.gov (United States)

    Yilmaz, Zülfükar; Yildirim, Yaşar; Oto, Ferhat; Aydin, Fatma Yilmaz; Aydin, Emre; Kadiroglu, Ali Kemal; Yilmaz, Mehmet Emin

    2014-05-01

    Determination of fluid overload is important in chronic kidney disease. Early diagnosis and treatment of volume overload may decrease morbidity and mortality. We aimed to determine body composition by using bioelectrical impedance analysis, and studying other clinical characteristics, inferior vena cava diameter, and N-terminal pro-B natriuretic peptide associated with hydration status in chronic kidney disease Stages 3&4 and 5 in patients not undergoing dialysis. We examined 62 patients with Stages 3&4 and 68 patients with Stage 5 chronic kidney disease. Plasma NT-proBNP was measured and analyzed after log transformation. Inferior vena cave diameter was measured with echocardiography and indexed for body surface area. Hydration status was assessed using multi-frequency bioelectrical impedance analysis. Overhydration was defined as overhydration/extracellular water >0.15. Overhydration was more frequent in Stage 5 than in Stages 3&4 patients. Systolic and diastolic blood pressure, inferior vena cava index, and log NT-proBNP were higher in overhydrated compared to non-overhydrated patients. A significant positive correlation existed between overhydration/extracellular water and log NT-proBNP, systolic and diastolic blood pressures, and inferior vena cava index. In multiple linear regression analysis, the variables associated with hydration status were male sex, extracellular water/total body water, and extracellular water/intracellular water (greater overhydration), while serum albumin levels had a negative association with overhydration. Overhydration is more prevalent in Stage 5 chronic kidney disease patients than in Stages 3&4 patients. Bioelectrical impedance analysis, inferior vena cava diameter, and NT-proBNP analysis in chronic kidney disease are useful methods to determine the volume overload.

  10. Using pharmacists to improve risk stratification and management of stage 3A chronic kidney disease: a feasibility study.

    Science.gov (United States)

    Chang, Alex R; Evans, Michael; Yule, Christina; Bohn, Larissa; Young, Amanda; Lewis, Meredith; Graboski, Elisabeth; Gerdy, Bethany; Ehmann, William; Brady, Jonathan; Lawrence, Leah; Antunes, Natacha; Green, Jamie; Snyder, Susan; Kirchner, H Lester; Grams, Morgan; Perkins, Robert

    2016-11-08

    Measurement of albuminuria to stratify risk in chronic kidney disease (CKD) is not done universally in the primary care setting despite recommendation in KDIGO (Kidney Disease Improving Global Outcomes) guidelines. Pharmacist medication therapy management (MTM) may be helpful in improving CKD risk stratification and management. We conducted a pragmatic, cluster-randomized trial using seven primary care clinic sites in the Geisinger Health System to evaluate the feasibility of pharmacist MTM in patients with estimated glomerular filtration rate (eGFR) 45-59 ml/min/1.73 m 2 and uncontrolled blood pressure (≥150/85 mmHg). In the three pharmacist MTM sites, pharmacists were instructed to follow a protocol aimed to improve adherence to KDIGO guidelines on testing for proteinuria and lipids, and statin and blood pressure medical therapy. In the four control clinics, patients received usual care. The primary outcome was proteinuria screening over a follow-up of 1 year. A telephone survey was administered to physicians, pharmacists, and patients in the pharmacist MTM arm at the end of the trial. Baseline characteristics were similar between pharmacist MTM (n = 24) and control (n = 23) patients, although pharmacist MTM patients tended to be younger (64 vs. 71 y; p = 0.06) and less likely to have diabetes (17 % vs. 35 %; p = 0.2) or baseline proteinuria screening (41.7 % vs. 60.9 %, p = 0.2). Mean eGFR was 54 ml/min/1.73 m 2 in both groups. The pharmacist MTM intervention did not significantly improve total proteinuria screening at the population level (OR 2.6, 95 % CI: 0.5-14.0; p = 0.3). However, it tended to increase screening of previously unscreened patients (78.6 % in the pharmacist MTM group compared to 33.3 % in the control group; OR 7.3, 95 % CI: 0.96-56.3; p = 0.05). In general, the intervention was well-received by patients, pharmacists, and providers, who agreed that pharmacists could play an important role in CKD

  11. [Post-stroke dysphagia in chronic stage treated with magnetic-ball sticking therapy at the auricular points: a randomized controlled trial].

    Science.gov (United States)

    Jin, Hai-Peng; Wu, Qiu-Yan; Zhang, Wei; Xie, Jun-Jie; Chen, Jin-Chun

    2014-01-01

    To assess the effectiveness and safety on post-stroke dysphagia in chronic stage treated with magnetic-ball sticking therapy at the auricular points. Ninety cases of post-apoplexy dysphagia in chronic stage were randomized into an auricular points group and an acupuncture group. In the auricular points group, the magnetic-ball sticking therapy was applied to subcortex (pizhixia, AT4), brainstem (naogan, AT(3,4i)), mouth (kou, CO1), cheek (mianjia, LO(5,6i)), tongue (she, LO2) and throat (yanhou, TG3) on one ear each time, and were changed on the other ear once every 3 days. In the acupucnture group, acupuncture was applied to Feng-chi (GB 20), Yifeng (TE 17), Shanglianquan (Extra), Jinjin (EX-HN 12), Yuye (EX-HN 13), Shuigou (GV 26) and Tongli (TH 5), etc. The needles were retained for 30 min in each treatment. The treatment was gi-yen once a day in the two groups and the treatment of 6 days made one session. There was 1 day at an interval among the sessions. Totally, 3 sessions of treatment were required. The video fluoroscopic swallowing study (VFSS) was performed for 4 kinds of food with different properties and shapes in each patient. The main indices were Rosenbek penetration-aspiration score, oral-retaining score and throat-retaining score. The efficacy, and the incidences of aspiration pneumonia and malnutrition were compared between the two groups. The nutrition indices were compared before and after treatment between the two groups, such as the skinfold thickness of triceps brachii muscle, serum albumin and peralbumin. In 21 days of treatment, in the auricular points group, the 1 mL liquid loversol Rosenbek penetration-aspiration score (1.51 +/- 0.69), oral-retaining score (1.17 +/- 0.38) and throat-retaining score (1.30 +/- 0.66) were all lower than those (2.51 +/- 0.67, 1.63 +/- 0.72, 1.67 +/- 0.7) in the acupuncture group separately. The 10 mL liquid loversol Rosenbek penetration-aspiration score (2.27 +/- 0.65), oral-retaining score (1.60 +/- 0.50) and

  12. Measurement properties of a novel survey to assess stages of organizational readiness for evidence-based interventions in community chronic disease prevention settings

    Directory of Open Access Journals (Sweden)

    Stamatakis Katherine A

    2012-07-01

    Full Text Available Abstract Background There is a great deal of variation in the existing capacity of primary prevention programs and policies addressing chronic disease to deliver evidence-based interventions (EBIs. In order to develop and evaluate implementation strategies that are tailored to the appropriate level of capacity, there is a need for an easy-to-administer tool to stage organizational readiness for EBIs. Methods Based on theoretical frameworks, including Rogers’ Diffusion of Innovations, we developed a survey instrument to measure four domains representing stages of readiness for EBI: awareness, adoption, implementation, and maintenance. A separate scale representing organizational climate as a potential mediator of readiness for EBIs was also included in the survey. Twenty-three questions comprised the four domains, with four to nine items each, using a seven-point response scale. Representatives from obesity, asthma, diabetes, and tobacco prevention programs serving diverse populations in the United States were surveyed (N = 243; test-retest reliability was assessed with 92 respondents. Results Confirmatory factor analysis (CFA was used to test and refine readiness scales. Test-retest reliability of the readiness scales, as measured by intraclass correlation, ranged from 0.47–0.71. CFA found good fit for the five-item adoption and implementation scales and resulted in revisions of the awareness and maintenance scales. The awareness scale was split into two two-item scales, representing community and agency awareness. The maintenance scale was split into five- and four-item scales, representing infrastructural maintenance and evaluation maintenance, respectively. Internal reliability of scales (Cronbach’s α ranged from 0.66–0.78. The model for the final revised scales approached good fit, with most factor loadings >0.6 and all >0.4. Conclusions The lack of adequate measurement tools hinders progress in dissemination and implementation

  13. Obsessive Compulsive Inventory-Child Version (OCV-CI) to Evaluate Obsessive Compulsive Disorder in Children With Early Stages of Chronic Kidney Disease: A Case Control Study.

    Science.gov (United States)

    Yousefichaijan, Parsa; Sharafkhah, Mojtaba; Rafeie, Mohammad; Salehi, Bahman

    2016-01-01

    Chronic kidney disease (CKD) is a common medical condition among children and obsessive-compulsive disorder (OCD) is a frequent, chronic, costly, and disabling disorder among them. The aim of this study was to investigate obsessive-compulsive disorder (OCD) in children with early stages of CKD, and to compare it with the occurrence of OCD in healthy children. In this case-control study, we evaluated 160 children aged 7 to 17 years old who were visited in the pediatric clinics of Amir-Kabir hospital, Arak, Iran. The control group consisted of 80 healthy children and the case group included 80 children with Stage 1 to 3 CKD. The ages and sex of the children in the two groups were matched. OCD in children was evaluated using the obsessive compulsive inventory-child version (OCI-CV). The mean scores of doubting/checking (case: 3.52 ± 2.54, control: 2.5 ± 2.32, P = 0.007) and ordering (case: 2.59 ± 1.81, control: 1.5 ± 2.56, P = 0.005) in the children with CKD was significantly higher than in the healthy ones. Moreover, the mean total scores for the OCI-CV of the children with CKD at 15.32 ± 7.69 was significantly higher than the scores of the healthy ones at 11.12 ± 2.54 (P = 0.021). There was a significant correlation between the CKD duration and doubting/checking (P = 0.004, correlation coefficient (CC): 0.4), obsessing (P = 0.06, CC: 0.02), washing (P = 0.031, CC: 0.8), ordering (P = 0.001, CC: 0.2), and the total scores of the OCI-CV questionnaire (P = 0.04, CC: 0.4). The risk of OCD in children with CKD is significantly higher than that in healthy children. Although the results seem to suggest that psychiatric intervention can be helpful in treating OCD in children with CKD, further investigation into the medical condition is required so as to obtain more definitive conclusions.

  14. Preparation and Properties of 1, 3, 5, 7-Tetranitro-1, 3, 5, 7-Tetrazocane-based Nanocomposites

    OpenAIRE

    Xiaofeng Shi; Jingyu Wang; Xiaodong Li; Chongwei An; Jiang Wang; Wei Ji

    2015-01-01

    A new insensitive explosive based on octahydro-1, 3, 5, 7-tetranitro-1, 3, 5, 7-tetrazocine (HMX) was prepared by spray drying using Viton A as a binder. The HMX sample without binder (HMX-1) was obtained by the same spray drying process also. The samples were characterised by Scanning Electron Microscope, and X-ray diffraction. The Differential Scanning Calorimetry and the impact sensitivity of HMX-1 and nanocomposites were also being tested. The nanocomposite morphology was found to be micr...

  15. The use of DWI to assess spleen and liver quantitative ADC changes in the detection of liver fibrosis stages in chronic viral hepatitis

    Energy Technology Data Exchange (ETDEWEB)

    Cece, Hasan, E-mail: hasan_cece@yahoo.com [Harran University, Faculty of Medicine, Department of Radiology, Sanliurfa (Turkey); Ercan, Abdulbasit, E-mail: abdulbasitercan@hotmail.com [Harran University, Faculty of Medicine, Department of Radiology, Sanliurfa (Turkey); Yıldız, Sema, E-mail: drsemayildiz@yahoo.com [Harran University, Faculty of Medicine, Department of Radiology, Sanliurfa (Turkey); Karakas, Ekrem, E-mail: karakasekrem@yahoo.com [Harran University, Faculty of Medicine, Department of Radiology, Sanliurfa (Turkey); Karakas, Omer, E-mail: dromerkarakas@hotmail.com [Harran University, Faculty of Medicine, Department of Radiology, Sanliurfa (Turkey); Boyacı, Fatıma Nurefsan, E-mail: drnurefsan@yahoo.com [Harran University, Faculty of Medicine, Department of Radiology, Sanliurfa (Turkey); Aydogan, Timucin, E-mail: drtaydogan@yahoo.com.tr [Harran University, Faculty of Medicine, Department of Gastroenterology, Sanliurfa (Turkey); Karakas, Emel Yigit, E-mail: e.ygtkarakas@yahoo.com.tr [Sanliurfa Training and Research Hospital, Department of İnternal Medicine, Sanliurfa (Turkey); Cullu, Nesat, E-mail: nesatcullu77@gmail.com [Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Radiology, Mugla (Turkey); Ulas, Turgay, E-mail: turgayulas@yahoo.com [Harran University, Faculty of Medicine, Department of İnternal Medicine, Sanliurfa (Turkey)

    2013-08-15

    This study aimed to evaluate the changes in spleen and liver diffusion-weighted magnetic resonance imaging (DWI) in chronic viral hepatitis patients. The study comprised 47 patients and 30 healthy volunteers. DWIs were obtained. Apparent Diffusion Coefficient (ADC) measurements were made by transferring the images to the workstation. The measurements of value b 1000 were made from a total of five points of the liver and three points of the spleen. Liver biopsy was performed on the 47 patients. The fibrosis stages of the patients were defined according to the METAVIR scoring system. Student's t-test was used in the comparison of mean ages, liver and spleen ADC values between the patient and the control group. Kruskal–Wallis followed by Mann–Whitney U Test with Bonferroni adjustment was performed in the comparison of mean ADC values of the patients at different stages and the control group. A statistically significant difference was determined between the patient and control group in respect of liver and spleen mean ADC values (P < 0.05). F3 group showed a significant difference compared to control and F1 and F4 group showed a significant difference compared to control, F1, F2 and F3 group in terms of the mean liver ADC value (P < 0.01). F3 and F4 group showed a significant difference compared to control and F1 group in terms of the mean spleen ADC value (P < 0.01). As a result we believe that the measurement of liver and spleen ADC values may be an indicator in the determination of the level of fibrosis.

  16. Enzymatic creatinine assays allow estimation of glomerular filtration rate in stages 1 and 2 chronic kidney disease using CKD-EPI equation.

    Science.gov (United States)

    Kuster, Nils; Cristol, Jean-Paul; Cavalier, Etienne; Bargnoux, Anne-Sophie; Halimi, Jean-Michel; Froissart, Marc; Piéroni, Laurence; Delanaye, Pierre

    2014-01-20

    The National Kidney Disease Education Program group demonstrated that MDRD equation is sensitive to creatinine measurement error, particularly at higher glomerular filtration rates. Thus, MDRD-based eGFR above 60 mL/min/1.73 m² should not be reported numerically. However, little is known about the impact of analytical error on CKD-EPI-based estimates. This study aimed at assessing the impact of analytical characteristics (bias and imprecision) of 12 enzymatic and 4 compensated Jaffe previously characterized creatinine assays on MDRD and CKD-EPI eGFR. In a simulation study, the impact of analytical error was assessed on a hospital population of 24084 patients. Ability using each assay to correctly classify patients according to chronic kidney disease (CKD) stages was evaluated. For eGFR between 60 and 90 mL/min/1.73 m², both equations were sensitive to analytical error. Compensated Jaffe assays displayed high bias in this range and led to poorer sensitivity/specificity for classification according to CKD stages than enzymatic assays. As compared to MDRD equation, CKD-EPI equation decreases impact of analytical error in creatinine measurement above 90 mL/min/1.73 m². Compensated Jaffe creatinine assays lead to important errors in eGFR and should be avoided. Accurate enzymatic assays allow estimation of eGFR until 90 mL/min/1.73 m² with MDRD and 120 mL/min/1.73 m² with CKD-EPI equation. Copyright © 2013 Elsevier B.V. All rights reserved.

  17. B-type natriuretic peptide predicts an ischemic etiology of acute heart failure in patients with stage 4-5 chronic kidney disease.

    Science.gov (United States)

    Kim, Sung Eun; Park, Sunghoon; Kim, Jwa-Kyung; Kim, Sung Gyun; Kim, Hyung Jik; Song, Young Rim

    2014-04-01

    The non-invasive differentiation of ischemic and non-ischemic acute heart failure (AHF) not resulting from acute myocardial infarction is difficult and has therapeutic and prognostic implications. The aim of this study was to assess whether plasma B-type natriuretic peptide (BNP) can identify ischemic etiology in patients with stage 4-5 chronic kidney disease (CKD) presenting with AHF. We prospectively analyzed 61 patients. The diagnosis of ischemic AHF was confirmed by coronary angiography or stress myocardial perfusion imaging. Plasma levels of BNP were measured at admission (BNP1) and 48 h after admission (BNP2). The mean age of the study patients was 67 years. In these patients, 70.5% had diabetes and 47.5% had dialysis-dependent CKD; 28 of these patients (45.9%) had an ischemic etiology with significantly higher concentrations of BNP1 and BNP2 than did patients without ischemia. The area under the receiver operating characteristic curve was 0.755 (P=0.001) for BNP1 and 0.868 (Pischemic etiology of AHF. Plasma BNP1 >2907 ng/L (odds ratio [OR], 10.9; 95% confidence interval [CI] 2.5-48.4; P=0.002) and BNP2 >2322 ng/L (OR 93.1, 95% CI 7.0-1238.7; P=0.001) were independently associated with an ischemic etiology of AHF. Plasma BNP may represent a clinically useful non-invasive tool for identification of ischemic etiology of AHF in patients with stage 4-5 CKD. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  18. Cementless two-staged total hip arthroplasty with a short term interval period for chronic deep periprosthetic infection. Technique and long-term results.

    Science.gov (United States)

    Erhart, Jochen; Jaklitsch, Karl; Schurz, Mark; Vécsei, Vilmos; Ehall, Reinhard

    2010-05-01

    The two-staged exchange with delayed reimplantation is the most reliable method to treat a deep periprosthetic infection after a total hip arthroplasty (THR). Nether uniform recommendations for the technique of cementless reimplantation, nor long term clinical and radiological results are reported. Our protocol is performed under short term antibiosis with cementless primary porous hip implants to treat chronic deep periprosthetic infections following THR. A retrospective study was performed to evaluate the clinical and radiological long term outcome and the rate of persistent infection of 14 patients. In a five year minimum follow up persistent infection was observed twice in a two-staged revision THR. A dislocation of the hip components was observed in three cases, and could be surgically treated in twice and by wearing a hip-brace in one case. We could not find a loosening of THR components. Three patients had a good or excellent, 11 patients a fair or bad functional outcome. There was a significant correlation between functional outcome and length of interval of prosthesis exand reimplantation. Patients have an increased comfort resulting from a short, CRP depending time interval between ex- and reimplantation. Functional outcome is the better the shorter the interval is. The reinfection rate is comparable to those of cemented revision THR's with a long term interval. We could observe advantages in a reduced amount of bone loss and better osseous integration of the uncemented implants, compared to cemented implants reviewing literature. Alterations of acetabular bone stock and soft tissue are responsible for a high rate of instability of the THR. An inaccurate gait pattern is caused by gluteal weakness in the majority of patients. Repeated surgical intervention and duration of immobilization have to be minimalized.

  19. Comparison of Appetite-regulating Hormones and Body Composition in Pediatric Patients in Predialysis Stage of Chronic Kidney Disease and Healthy Control Group

    Directory of Open Access Journals (Sweden)

    Mohammad Hassan Eftekhari

    2015-01-01

    Full Text Available Background: Protein-energy malnutrition (PEM is a common complication in pediatric patients with chronic kidney disease (CKD. Components incorporated in the regulation of appetite and body composition appear to be of the focus in renal insufficiency and may influence the CKD-associated PEM. The purpose of this study was to investigate plasma levels of appetite-regulating hormones and their correlation with the body composition variables in a pediatric in predialysis stage of CKD. Methods: Thirty children with CKD in predialysis stage were selected and compared with 30 healthy sex- and age-matched controls. Blood samples were collected in fasting. Serum total ghrelin, leptin, and obestatin levels were measured using enzyme immunometric assay methods. Anthropometric parameters measurement and body composition analysis were done using the bioelectric impedance analysis (BIA method. Results: Patients showed insignificant elevated total ghrelin (105.40±30.83 ng/l, leptin (5.32±1.17 ng/ml and obestatin (5.07±1.09 ng/ml levels in comparison with healthy participants. By using BIA, patients had significantly different Dry Lean Weight (P=0.048, Extra Cellular Water (P=0.045, Body Cell Mass (BCM (P=0.021, Basal Metabolic Rate (P=0.033 and Body Mass Index (P=0.029 compared with controls. Furthermore, the total body water was slightly and the ECW was significantly higher in CKD participants. There were significant negative correlation between obestatin and BCM (r=-0.40, P=0.03 and fat free mass index (FFMI (r=-0.40, P=0.029 in patients. Conclusion: It seems that our results are insufficient to clarify the role of appetite-regulating hormones in PEM in CKD patients. It is apparent that there are still many unknown parameters related to both appetite regulating and CKD-associated PEM.

  20. Dietary phosphorus restriction by a standard low-protein diet decreased serum fibroblast growth factor 23 levels in patients with early and advanced stage chronic kidney disease.

    Science.gov (United States)

    Goto, Shunsuke; Nakai, Kentaro; Kono, Keiji; Yonekura, Yuriko; Ito, Jun; Fujii, Hideki; Nishi, Shinichi

    2014-12-01

    Elevated serum fibroblast growth factor 23 (FGF23) levels are associated with mortality, cardiovascular disease, and disease progression in patients with chronic kidney disease (CKD). Although recent studies demonstrated that FGF23 levels decreased in response to dietary restriction of phosphorus and/or use of phosphate binders, research on the effects of a standard low-protein diet is lacking. The effects of a standard low-protein diet on serum FGF23, intact parathyroid hormone, and 1,25-dihydroxyvitamin D levels were investigated in patients with early (n = 15) and advanced (n = 20) CKD. Serum FGF23 levels decreased in both groups. Changes in FGF23 levels correlated with changes in 24 h urinary phosphorus excretion in the advanced CKD group. Decreased serum intact parathyroid hormone levels were observed only in the advanced CKD group and increased serum 1,25-dihydroxyvitamin D levels only in the early CKD group. These findings suggest that consuming standard low-protein diet decreased serum FGF23 levels in patients with CKD. Serum FGF23 levels may therefore be a useful marker to monitor the effects of a low-protein diet in early and advanced stage CKD.

  1. Magnesium modifies the association between serum phosphate and the risk of progression to end-stage kidney disease in patients with non-diabetic chronic kidney disease.

    Science.gov (United States)

    Sakaguchi, Yusuke; Iwatani, Hirotsugu; Hamano, Takayuki; Tomida, Kodo; Kawabata, Hiroaki; Kusunoki, Yasuo; Shimomura, Akihiro; Matsui, Isao; Hayashi, Terumasa; Tsubakihara, Yoshiharu; Isaka, Yoshitaka; Rakugi, Hiromi

    2015-10-01

    It is known that magnesium antagonizes phosphate-induced apoptosis of vascular smooth muscle cells and prevents vascular calcification. Here we tested whether magnesium can also counteract other pathological conditions where phosphate toxicity is involved, such as progression of chronic kidney disease (CKD). We explored how the link between the risk of CKD progression and hyperphosphatemia is modified by magnesium status. A post hoc analysis was run in 311 non-diabetic CKD patients who were divided into four groups according to the median values of serum magnesium and phosphate. During a median follow-up of 44 months, 135 patients developed end-stage kidney disease (ESKD). After adjustment for relevant clinical factors, patients in the lower magnesium-higher phosphate group were at a 2.07-fold (95% CI: 1.23-3.48) risk for incident ESKD and had a significantly faster decline in estimated glomerular filtration rate compared with those in the higher magnesium-higher phosphate group. There were no significant differences in the risk of these renal outcomes among the higher magnesium-higher phosphate group and both lower phosphate groups. Incubation of tubular epithelial cells in high phosphate and low magnesium medium in vitro increased apoptosis and the expression levels of profibrotic and proinflammatory cytokine; these changes were significantly suppressed by increasing magnesium concentration. Thus, magnesium may act protectively against phosphate-induced kidney injury.

  2. 3,5-Dichlorophenol Removal From Wastewater Using Alternative Adsorbents

    Directory of Open Access Journals (Sweden)

    Kobetičová Hana

    2015-06-01

    Full Text Available The main objective of this paper is to evaluate the efficiency of 3,5-dichlorophenol removal from wastewater by using alternative low cost adsorbents. Waste from the production and processing of metals (black nickel mud, red mud and a biosorbent (Lemna minor were used for this research. Initial concentration of the contaminant was 4 mmol L−1, the contact time of sorbent and waste water was 0 - 48 hrs and the temperature during experiment was 25 ± 0.2 °C. The results show that the highest removal efficiency of 3,5 - dichlorophenol (58.18 % was reached by the red mud in 48 hours.

  3. 3,5-Dichlorophenol Removal From Wastewater Using Alternative Adsorbents

    Science.gov (United States)

    Kobetičová, Hana; Lipovský, Marek; Wachter, Igor; Soldán, Maroš

    2015-06-01

    The main objective of this paper is to evaluate the efficiency of 3,5-dichlorophenol removal from wastewater by using alternative low cost adsorbents. Waste from the production and processing of metals (black nickel mud, red mud) and a biosorbent (Lemna minor) were used for this research. Initial concentration of the contaminant was 4 mmol L-1, the contact time of sorbent and waste water was 0 - 48 hrs and the temperature during experiment was 25 ± 0.2 °C. The results show that the highest removal efficiency of 3,5 - dichlorophenol (58.18 %) was reached by the red mud in 48 hours.

  4. Study of FibroTest and hyaluronic acid biological variation in healthy volunteers and comparison of serum hyaluronic acid biological variation between chronic liver diseases of different etiology and fibrotic stage using confidence intervals.

    Science.gov (United States)

    Istaces, Nicolas; Gulbis, Béatrice

    2015-07-01

    Personalized ranges of liver fibrosis serum biomarkers such as FibroTest or hyaluronic acid could be used for early detection of fibrotic changes in patients with progressive chronic liver disease. Our aim was to generate reliable biological variation estimates for these two biomarkers with confidence intervals for within-subject biological variation and reference change value. Nine fasting healthy volunteers and 66 chronic liver disease patients were included. Biological variation estimates were calculated for FibroTest in healthy volunteers, and for hyaluronic acid in healthy volunteers and chronic liver disease patients stratified by etiology and liver fibrosis stage. In healthy volunteers, within-subject biological coefficient of variation (with 95% confidence intervals) and index of individuality were 20% (16%-28%) and 0.6 for FibroTest and 34% (27%-47%) and 0.79 for hyaluronic acid, respectively. Overall hyaluronic acid within-subject biological coefficient of variation was similar among non-alcoholic fatty liver disease and chronic hepatitis C with 41% (34%-52%) and 45% (39%-55%), respectively, in contrast to chronic hepatitis B with 170% (140%-215%). Hyaluronic acid within-subject biological coefficients of variation were similar between F0-F1, F2 and F3 liver fibrosis stages in non-alcoholic fatty liver disease with 34% (25%-49%), 41% (31%-59%) and 34% (23%-62%), respectively, and in chronic hepatitis C with 34% (27%-47%), 33% (26%-45%) and 38% (27%-65%), respectively. However, corresponding hyaluronic acid indexes of individuality were lower in the higher fibrosis stages. Non-overlapping confidence intervals of biological variation estimates allowed us to detect significant differences regarding hyaluronic acid biological variation between chronic liver disease subgroups. Copyright © 2015 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  5. Feasibility of combined treatment with enalapril and candesartan in advanced chronic kidney disease

    DEFF Research Database (Denmark)

    Frimodt-Møller, Marie; Høj Nielsen, Arne; Strandgaard, Svend

    2010-01-01

    BACKGROUND: Dual blockade of the renin-angiotensin system (RAS) has been claimed to have a specific renal protective effect in chronic kidney disease (CKD). The present short-term study reports on the feasibility of dual blockade in a consecutive group of patients with CKD stage 3-5. METHODS: Forty...

  6. Stages of Chronic Myelogenous Leukemia

    Science.gov (United States)

    ... marrow disease that usually occurs during or after middle age, and rarely occurs in children. Enlarge Anatomy of ... Surgery Splenectomy is surgery to remove the spleen . New types of treatment are being tested in clinical ...

  7. Diabetes mellitus as a risk factor for incident chronic kidney disease and end-stage renal disease in women compared with men: a systematic review and meta-analysis.

    Science.gov (United States)

    Shen, Yanjue; Cai, Rongrong; Sun, Jie; Dong, Xue; Huang, Rong; Tian, Sai; Wang, Shaohua

    2017-01-01

    Diabetes mellitus is a strong risk factor for chronic kidney disease and end-stage renal disease. Whether sex differences in chronic kidney disease and end-stage renal disease incidence exist among diabetic patients remains unclear. This systematic review and meta-analysis was conducted to evaluate the relative effect of diabetes on chronic kidney disease and end-stage renal disease risk in women compared with men. We systematically searched Embase, PubMed, and the Cochrane Library for both cohort and case-control studies until October 2015. Studies were selected if they reported a sex-specific relationship between diabetes mellitus and chronic kidney disease or end-stage renal disease. We generated pooled estimates across studies using random-effects meta-analysis after log transformation with inverse variance weighting. Ten studies with data from more than 5 million participants were included. The pooled adjusted risk ratio of chronic kidney disease associated with diabetes mellitus was 3.34 (95 % CI 2.27, 4.93) in women and 2.84 (95 % CI 1.73, 4.68) in men. The data showed no difference in diabetes-related chronic kidney disease risk between the sexes (pooled adjusted women-to-men relative risk ratio was 1.14 [95 % CI 0.97, 1.34]) except for end-stage renal disease-the pooled adjusted women-to men relative risk ratio was 1.38 (95 % CI 1.22, 1.55; p = 0.114, I² = 38.1 %). The study found no evidence of a sex difference in the association between diabetes mellitus and chronic kidney disease. However, the excess risk for end-stage renal disease was higher in women with diabetes than in men with the same condition, from which we assume that the female gender could accelerate the disease progression. Further studies are needed to support this notion and elucidate the underlying mechanisms.

  8. 4-Chloro-2,3,5-trifluorobenzoic Acid

    Directory of Open Access Journals (Sweden)

    Shuitao Yu

    2015-11-01

    Full Text Available A new tetrahalogenated benzoic acid 4-chloro-2,3,5-trifluorobenzoic acid was synthesized from methyl 2,3,4,5-tetrafluorobenzoate via three steps. The structure of the newly synthesized compound was established by FTIR, NMR, MS and elemental analysis.

  9. trans-1,2-Bis(3,5-dimethoxyphenylethene

    Directory of Open Access Journals (Sweden)

    Stefanie Ritter

    2009-09-01

    Full Text Available The title compound, C18H20O4, was prepared in high yield from 3,5-dimethoxystyrene via a Ru-catalysed homo-olefin metathesis. Exclusive formation of the E-configurated isomer was observed. Interestingly, one symmetric unit contains two molecules adopting an s-syn-anti and and an all-s-anti conformation.

  10. Number & operations task sheets : grades 3-5

    CERN Document Server

    Reed, Nat

    2009-01-01

    For grades 3-5, our Common Core State Standards-based resource meets the number & operations concepts addressed by the NCTM standards and encourages the students to learn and review the concepts in unique ways. Each task sheet is organized around a central problem taken from real-life experiences of the students.

  11. Theoretical studies on proton transfer reaction of 3 (5)-substituted ...

    Indian Academy of Sciences (India)

    Home; Journals; Journal of Chemical Sciences; Volume 126; Issue 1. Theoretical studies on proton transfer reaction of 3(5)-substituted pyrazoles ... Abstract. The inter and intra molecular proton transfer reactions of a series of pyrazole derivatives have been studied by using density functional theory (DFT) andMP2 methods ...

  12. Cognitive Impairment and Structural Neuroimaging Abnormalities Among Patients with Chronic Kidney Disease

    OpenAIRE

    Hai-Chen Pi; Yu-Feng Xu; Rong Xu; Zhi-Kai Yang; Zhen Qu; Yu-Qing Chen; Gui-Ling Liu; Jie Dong

    2016-01-01

    Background/Aims: Cognitive impairment and abnormal structural neuroimaging is common in chronic kidney disease patients. We aimed to explore its association with dialysis modality and the relationship between cognitive impairment and abnormal structural neuroimaging. Methods: Sixty peritoneal dialysis patients and 30 hemodialysis and 30 non-dialyzed stage 3-5 chronic kidney disease patients without history of stroke were enrolled for the study. Participants were matched for age, gender, educa...

  13. Domiciliary VR-Based Therapy for Functional Recovery and Cortical Reorganization: Randomized Controlled Trial in Participants at the Chronic Stage Post Stroke.

    Science.gov (United States)

    Ballester, Belén Rubio; Nirme, Jens; Camacho, Irene; Duarte, Esther; Rodríguez, Susana; Cuxart, Ampar; Duff, Armin; Verschure, Paul F M J

    2017-08-07

    findings suggest that, in chronic stages, remote delivery of customized VR-based motor training promotes functional gains that are accompanied by neuroplastic changes. International Standard Randomized Controlled Trial Number NCT02699398 (Archived by ClinicalTrials.gov at https://clinicaltrials.gov/ct2/show/NCT02699398?term=NCT02699398&rank=1). ©Belén Rubio Ballester, Jens Nirme, Irene Camacho, Esther Duarte, Susana Rodríguez, Ampar Cuxart, Armin Duff, Paul F.M.J. Verschure. Originally published in JMIR Serious Games (http://games.jmir.org), 07.08.2017.

  14. Prevalence of chronic kidney disease among patients undergoing transradial percutaneous coronary interventions.

    Science.gov (United States)

    Hossain, Mohammad A; Quinlan, Amy; Heck-Kanellidis, Jennifer; Calderon, Dawn; Patel, Tejas; Gandhi, Bhavika; Patel, Shrinil; Hetavi, Mahida; Costanzo, Eric J; Cosentino, James; Patel, Chirag; Dewan, Asa; Kuo, Yen-Hong; Salman, Loay; Vachharajani, Tushar J

    2018-03-01

    While transradial approach to conduct percutaneous coronary interventions offers multiple advantages, the procedure can cause radial artery damage and occlusion. Because radial artery is the preferred site for the creation of an arteriovenous fistula to provide dialysis, patients with chronic kidney disease are particularly dependent on radial artery for their long-term survival. In this retrospective study, we investigated the prevalence of chronic kidney disease in patients undergoing coronary interventions via radial artery. Stage of chronic kidney disease was based on estimated glomerular filtration rate and National Kidney Foundation - Kidney Disease Outcomes Quality Initiative guidelines. A total of 497 patients undergoing transradial percutaneous coronary interventions were included. Over 70.4% (350/497) of the patients had chronic kidney disease. Stage II chronic kidney disease was observed in 243 (69%) patients (estimated glomerular filtration rate = 76.0 ± 8.4 mL/min). Stage III was observed in 93 (27%) patients (estimated glomerular filtration rate = 49 ± 7.5 mL/min). Stage IV chronic kidney disease was observed in 5 (1%) patients (estimated glomerular filtration rate = 25.6 ± 4.3 mL/min) and Stage V chronic kidney disease was observed in 9 (3%) patients (estimated glomerular filtration rate = 9.3 ± 3.5 mL/min). Overall, 107 of 350 patients (30%) had advanced chronic kidney disease, that is, stage III-V chronic kidney disease. Importantly, 14 of the 107 (13%) patients had either stage IV or V chronic kidney disease. This study finds that nearly one-third of the patients undergoing transradial percutaneous coronary interventions have advanced chronic kidney disease. Because many of these patients may require dialysis, the use of radial artery to conduct percutaneous coronary interventions must be carefully considered in chronic kidney disease population.

  15. Effect of tiotropium on lung function decline in early-stage of chronic obstructive pulmonary disease patients: propensity score-matched analysis of real-world data

    Directory of Open Access Journals (Sweden)

    Lee HY

    2015-10-01

    Full Text Available Ha Youn Lee,1,2 Sun Mi Choi,1,2 Jinwoo Lee,1,2 Young Sik Park,1,2 Chang-Hoon Lee,1,2 Deog Kyeom Kim,2,3 Sang-Min Lee,1,2 Ho Il Yoon,2,4 Jae-Joon Yim,1,2 Young Whan Kim,1,2 Sung Koo Han,1,2 Chul-Gyu Yoo1,2 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; 3Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea; 4Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea Background: Tiotropium failed to slow the annual rate of forced expiratory volume in 1 second (FEV1 decline in chronic obstructive pulmonary disease (COPD patients with <70% predicted FEV1. However, the rate of FEV1 decline is known to be faster at early stages, which suggests that the effects of tiotropium may be more prominent in early-stage of COPD patients. The aim of this study was to test the hypothesis that tiotropium modifies the rate of FEV1 decline in COPD patients with an FEV1≥70%.Methods: We retrospectively reviewed the records of COPD patients diagnosed between January 1, 2004, and July 31, 2012, at Seoul National University Hospital, Seoul National University Bundang Hospital, and Seoul Metropolitan Government-Seoul National University Boramae Medical Center. The inclusion criteria were as follows: age ≥40 years, postbronchodilator (BD FEV1≥70% of predicted and FEV1/FVC (forced vital capacity <0.70, and spirometry more than two times at certain times of the year. Conversely, the exclusion criteria were as follows: asthma, lung cancer, pulmonary tuberculosis, pulmonary resection, or long-term use of a short-acting muscarinic antagonist. The annual lung function decline in patients using tiotropium was compared with that in patients not

  16. Neuronal activation in the central nervous system of rats in the initial stage of chronic kidney disease-modulatory effects of losartan and moxonidine.

    Directory of Open Access Journals (Sweden)

    Miklós Palkovits

    Full Text Available The effect of mild chronic renal failure (CRF induced by 4/6-nephrectomy (4/6NX on central neuronal activations was investigated by c-Fos immunohistochemistry staining and compared to sham-operated rats. In the 4/6 NX rats also the effect of the angiotensin receptor blocker, losartan, and the central sympatholyticum moxonidine was studied for two months. In serial brain sections Fos-immunoreactive neurons were localized and classified semiquantitatively. In 37 brain areas/nuclei several neurons with different functional properties were strongly affected in 4/6NX. It elicited a moderate to high Fos-activity in areas responsible for the monoaminergic innervation of the cerebral cortex, the limbic system, the thalamus and hypothalamus (e.g. noradrenergic neurons of the locus coeruleus, serotonergic neurons in dorsal raphe, histaminergic neurons in the tuberomamillary nucleus. Other monoaminergic cell groups (A5 noradrenaline, C1 adrenaline, medullary raphe serotonin neurons and neurons in the hypothalamic paraventricular nucleus (innervating the sympathetic preganglionic neurons and affecting the peripheral sympathetic outflow did not show Fos-activity. Stress- and pain-sensitive cortical/subcortical areas, neurons in the limbic system, the hypothalamus and the circumventricular organs were also affected by 4/6NX. Administration of losartan and more strongly moxonidine modulated most effects and particularly inhibited Fos-activity in locus coeruleus neurons. In conclusion, 4/6NX elicits high activity in central sympathetic, stress- and pain-related brain areas as well as in the limbic system, which can be ameliorated by losartan and particularly by moxonidine. These changes indicate a high sensitivity of CNS in initial stages of CKD which could be causative in clinical disturbances.

  17. Utility of fractional anisotropy imaging analyzed by statistical parametric mapping for detecting minute brain lesions in chronic-stage patients who had mild or moderate traumatic brain injury

    International Nuclear Information System (INIS)

    Asano, Yoshitaka; Shinoda, Jun; Okumura, Ayumi; Aki, Tatsuki; Takenaka, Shunsuke; Miwa, Kazuhiro; Yamada, Mikito; Ito, Takeshi; Yokohama, Kazutoshi

    2012-01-01

    Diffusion tensor imaging (DTI) has recently evolved as valuable technique to investigate diffuse axonal injury (DAI). This study examined whether fractional anisotropy (FA) images analyzed by statistical parametric mapping (FA-SPM images) are superior to T 2 *-weighted gradient recalled echo (T2*GRE) images or fluid-attenuated inversion recovery (FLAIR) images for detecting minute lesions in traumatic brain injury (TBI) patients. DTI was performed in 25 patients with cognitive impairments in the chronic stage after mild or moderate TBI. The FA maps obtained from the DTI were individually compared with those from age-matched healthy control subjects using voxel-based analysis and FA-SPM images (p<0.001). Abnormal low-intensity areas on T2*GRE images (T2* lesions) were found in 10 patients (40.0%), abnormal high-intensity areas on FLAIR images in 4 patients (16.0%), and areas with significantly decreased FA on FA-SPM image in 16 patients (64.0%). Nine of 10 patients with T2* lesions had FA-SPM lesions. FA-SPM lesions topographically included most T2* lesions in the white matter and the deep brain structures, but did not include T2* lesions in the cortex/near-cortex or lesions containing substantial hemosiderin regardless of location. All 4 patients with abnormal areas on FLAIR images had FA-SPM lesions. FA-SPM imaging is useful for detecting minute lesions because of DAI in the white matter and the deep brain structures, which may not be visualized on T2*GRE or FLAIR images, and may allow the detection of minute brain lesions in patients with post-traumatic cognitive impairment. (author)

  18. Clinical-radiological, histological and genetic analyses in a lung transplant recipient with Mounier-Kuhn syndrome and end-stage chronic obstructive pulmonary disease.

    Science.gov (United States)

    Mitterbauer, Andreas; Hoetzenecker, Konrad; Birner, Peter; Mildner, Michael; Prosch, Helmut; Streubel, Berthold; Taghavi, Shahrokh; Klepetko, Walter; Ankersmit, Hendrik Jan

    2015-07-01

    The Mounier-Kuhn syndrome (MKS) is a rare disease characterized by a pathological dilation of the trachea and the bronchial system. The etiology of the disorder remains elusive, but genetic alterations and degradation of elastic fibers are thought to be involved in the pathogenesis. No causative treatment is available although transplantation is an option for end-stage disease. Here, we describe a patient suffering from MKS who received a double lung transplant at our department. Since a familial clustering of MKS is discussed in the literature, we performed a chromosomal analysis and an array-comparative genomic hybridization (CGH) to search for genetic abnormalities. At the time of transplantation, we collected samples from the bronchi and performed hematoxylin and eosin (HE), Elastic von-Gieson (EVG) and immunohistochemical stains of the explanted MKS bronchus, a control bronchus and of the inflammatory infiltrates. Specimens of main bronchi from the donor lung harvested for transplant served as control. Bronchial smears were taken from both main bronchi of the recipient for microbiological cultures. No genetic alterations could be found in chromosomal analysis and in array-CGH. Histological analysis revealed a strong reduction of elastic fibers in the submucosal connective tissue and a diffuse inflammatory infiltrate, mainly comprised of CD4+ cells. In addition, immunohistochemistry showed increased matrix metalloproteinases (MMPs) protein expression of MMP-1, 2, 3 and 9. Based on our findings, we hypothesize that MKS is a chronic inflammatory disease characterized by an MMP-mediated degradation of submucosal elastic fibers. © 2014 John Wiley & Sons Ltd.

  19. Beneficial Effects of 6-Month Supplementation with Omega-3 Acids on Selected Inflammatory Markers in Patients with Chronic Kidney Disease Stages 1–3

    Directory of Open Access Journals (Sweden)

    Agnieszka Pluta

    2017-01-01

    Full Text Available Introduction. Chronic kidney disease (CKD is accompanied by inflammation. The aim of this study was to evaluate the effect of 6-month supplementation with omega-3 acids on selected markers of inflammation in patients with CKD stages 1–3. Methods. Six-month supplementation with omega-3 acids (2 g/day was administered to 87 CKD patients and to 27 healthy individuals. At baseline and after follow-up, blood was taken for C-reactive protein (CRP and monocyte chemotactic protein-1 (MCP-1 concentration and white blood cell (WBC count. Serum concentration of omega-3 acids—eicosapentaenoic acid (EPA, docosahexaenoic acid (DHA, and alpha-linolenic acid (ALA—was determined using gas chromatography. And 24-hour urinary collection was performed to measure MCP-1 excretion. Results. After six-month omega-3 supplementation, ALA concentration increased in CKD patients and in the reference group, while EPA and DHA did not change. At follow-up, a significant decrease in urinary MCP-1 excretion in CKD (p=0.0012 and in the reference group (p=0.001 was found. CRP, serum MCP-1, and WBC did not change significantly. The estimated glomerular filtration rate (eGFR did not change significantly in the CKD group. Conclusions. The reduction of urinary MCP-1 excretion in the absence of MCP-1 serum concentration may suggest a beneficial effect of omega-3 supplementation on tubular MCP-1 production. Trial Registration. This study was registered in ClinicalTrials.gov (identifier: NCT02147002.

  20. Adropin and irisin levels in relation to nutrition, body composition, and insulin resistance in patients with end-stage renal disease on chronic hemodialysis and peritoneal dialysis.

    Science.gov (United States)

    Kałużna, Małgorzata; Hoppe, Krzysztof; Schwermer, Krzysztof; Ibrahim, Aisha Y; Pawlaczyk, Krzysztof; Ziemnicka, Katarzyna

    2016-07-25

    INTRODUCTION    Newly discovered myokines, adropin, and irisin, are regulators of energy homeostasis and metabolism in humans. In end-stage renal disease (ESRD), the significance and role of irisin and adropin as metabolism regulators are still unclear. OBJECTIVES    The aim of this study was to evaluate serum adropin and irisin levels and establish their relation to insulin resistance, nutritional status, and hydration status in patients on chronic hemodialysis (HD) and on peritoneal dialysis (PD). PATIENTS AND METHODS    The study consisted of 71 subjects, including 48 patients (18 women, 30 men; median age, 56.5 years; range, 26-84 years) either on HD (n = 41) or PD (n = 7) and 36 healthy controls matched for age and sex. We measured the serum levels of adropin, irisin, creatinine, albumin, glucose, and insulin, as well as the plasma levels of lipids. The bioimpedance method was used to evaluate the body composition and overhydration in patients with ESRD. RESULTS    Irisin levels were significantly lower in patients with ESRD compared with controls, but there were no differences in adropin levels between both study groups. Adropin levels were inversely correlated with body mass, lean tissue mass, total, intracellular, and extracellular water, and albumin concentrations in patients with ESRD. Irisin levels were positively correlated with glucose levels and homeostasis model assessment of insulin resistance. No significant correlations were observed between adropin and irisin concentrations and overhydration. CONCLUSIONS    Adropin may be considered as a new marker of nutritional status in patients with ESRD. The significance and cause of low irisin levels characteristic for these patients are still unclear. Adropin and irisin should be further investigated as possible markers of cachexia and insulin resistance in patients with ESRD.

  1. Effects of Different Administration Protocols on the Plasma Concentration of Donepezil Hydrochloride in Dementia Patients with Stage 5 Chronic Kidney Disease

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    Chika Amano

    2013-06-01

    Full Text Available The prevalence of chronic kidney disease (CKD as well as Alzheimer's disease (AD increases with age. With the aging of the population in Japan, there is an increasing likelihood that patients with CKD will receive donepezil hydrochloride (DPZ, an antidementia drug, in the near future. Nevertheless, there have been few reports on how to use DPZ in patients with severe CKD. We report on 2 CKD stage 5 patients who received DPZ under different prescriptions. In case 1, 3 mg/day of DPZ was initially administered for 4 months, after which the dose was increased to 5 mg/day. In case 2, 5 mg was administered twice a week. The plasma concentration of DPZ was measured and the effectiveness was assessed using the Mini-Mental Health State Examination and the Hasegawa Dementia Rating Scale. We found that (1 only a slight increase in the plasma concentration of DPZ was observed with a dose of 3 mg daily, (2 there was a significant increase in the plasma concentration with a dose of 5 mg daily, and (3 when 5 mg of DPZ was administered twice a week, the plasma concentration did not differ significantly from healthy controls who had received 5 mg daily. Although cognitive function was improved best when the 5-mg dose was administered daily with no apparent side effects, the plasma concentration came close to reaching a toxic level at this dose. Careful follow-up may be essential when DPZ is used at 5 mg/day or greater in severe CKD patients.

  2. Relationship between vitamin D and lung function, physical performance and balance on patients with stage I-III chronic obstructive pulmonary disease

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    Tuncay Yumrutepe

    2015-04-01

    Full Text Available Summary Objectives: vitamin D is important for muscle function and it affects different aspects of muscle metabolism. This study aim to determine whether serum 25(OH D levels are related to lung functions, physical performance and balance in patients with chronic obstructive pulmonary disease (COPD. Methods: in 90 patients with COPD and 57 healthy controls lung function tests, physical performance tests (time up and go, gait velocity test, sit-to-stand test, isometric strength, isokinetic strength, static (functional reach test and dynamic (time up and go balance tests and the association of 25(OHD levels with lung functions, physical performance and balance were evaluated. Results: the COPD patients had significantly more deficit in physical function and balance parameters, and in dynamic balance test (p<0.005. Isokinetic knee muscle strength (flexor and extensor in COPD patients was significantly lower than in the controls (p<0.05; FEV1 (p=0.008, FVC (p=0.02, FEV1/FVC (p=0.04, TLC (p=0.01 were lower in COPD patients with vitamin D deficiency [25(OH D less than 15ng/mL] than in COPD patients without vitamin D deficiency. Hand grip test (p=0.000 and isokinetic knee muscle strength (flexor and extensor (p<0.05 were also lower in COPD patients with vitamin D deficiency. Vitamin D deficiency was more pronounced in patients with stage III COPD (p<0.05. Conclusion: patients with COPD had worst physical functioning, poor balance and less muscle strength. Severe disturbed lung and peripheral muscle functions are more pronounced in COPD patients with vitamin D deficiency.

  3. Treatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rate.

    Science.gov (United States)

    Goraya, Nimrit; Simoni, Jan; Jo, Chan-Hee; Wesson, Donald E

    2014-11-01

    Alkali therapy of metabolic acidosis in patients with chronic kidney disease (CKD) with plasma total CO2 (TCO2) below 22 mmol/l per KDOQI guidelines appears to preserve estimated glomerular filtration rate (eGFR). Since angiotensin II mediates GFR decline in partial nephrectomy models of CKD and even mild metabolic acidosis increases kidney angiotensin II in animals, alkali treatment of CKD-related metabolic acidosis in patients with plasma TCO2 over 22 mmol/l might preserve GFR through reduced kidney angiotensin II. To test this, we randomized 108 patients with stage 3 CKD and plasma TCO2 22-24 mmol/l to Usual Care or interventions designed to reduce dietary acid by 50% using sodium bicarbonate or base-producing fruits and vegetables. All were treated to achieve a systolic blood pressure below 130 mm Hg with regimens including angiotensin converting enzyme inhibition and followed for 3 years. Plasma TCO2 decreased in Usual Care but increased with bicarbonate or fruits and vegetables. By contrast, urine excretion of angiotensinogen, an index of kidney angiotensin II, increased in Usual Care but decreased with bicarbonate or fruits and vegetables. Creatinine-calculated and cystatin C-calculated eGFR decreased in all groups, but loss was less at 3 years with bicarbonate or fruits and vegetables than Usual Care. Thus, dietary alkali treatment of metabolic acidosis in CKD that is less severe than that for which KDOQI recommends therapy reduces kidney angiotensin II activity and preserves eGFR.

  4. Clinical practice recommendations for native vitamin D therapy in children with chronic kidney disease Stages 2-5 and on dialysis.

    Science.gov (United States)

    Shroff, Rukshana; Wan, Mandy; Nagler, Evi V; Bakkaloglu, Sevcan; Fischer, Dagmar-C; Bishop, Nicholas; Cozzolino, Mario; Bacchetta, Justine; Edefonti, Alberto; Stefanidis, Constantinos J; Vande Walle, Johan; Haffner, Dieter; Klaus, Günter; Schmitt, Claus Peter

    2017-07-01

    Vitamin D deficiency is widely prevalent and often severe in children and adults with chronic kidney disease (CKD). Although native vitamin D {25-hydroxyvitamin D [25(OH)D]} is thought to have pleiotropic effects on many organ systems, its skeletal effects have been most widely studied. The 25(OH)D deficiency is causally linked with rickets and fractures in healthy children and those with CKD, contributing to the CKD-mineral and bone disorder (MBD) complex. There are few studies to provide evidence for vitamin D therapy or guidelines for its use in CKD. A core working group (WG) of the European Society for Paediatric Nephrology (ESPN) CKD-MBD and Dialysis WGs have developed recommendations for the evaluation, treatment and prevention of vitamin D deficiency in children with CKD. We present clinical practice recommendations for the use of ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3) in children with CKD Stages 2-5 and on dialysis. A parallel document addresses treatment recommendations for active vitamin D analogue therapy. The WG has performed an extensive literature review to include meta-analyses and randomized controlled trials in healthy children as well as children and adults with CKD, and prospective observational studies in children with CKD. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system has been used to develop and grade the recommendations. In the absence of applicable study data, the opinion of experts from the ESPN CKD-MBD and Dialysis WGs is provided, but clearly GRADE-ed as such and must be carefully considered by the treating physician, and adapted to individual patient needs as appropriate. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  5. A nurse-coordinated model of care versus usual care for stage 3/4 chronic kidney disease in the community: a randomized controlled trial.

    Science.gov (United States)

    Barrett, Brendan J; Garg, Amit X; Goeree, Ron; Levin, Adeera; Molzahn, Anita; Rigatto, Claudio; Singer, Joel; Soltys, George; Soroka, Steven; Ayers, Dieter; Parfrey, Patrick S

    2011-06-01

    It is unclear how to optimally care for chronic kidney disease (CKD). This study compares a new coordinated model to usual care for CKD. A randomized trial in nephrology clinics and the community included 474 patients with median estimated GFR (eGFR) 42 ml/min per 1.73 m(2) identified by laboratory-based case finding compared care coordinated by a general practitioner (controls) with care by a nurse-coordinated team including a nephrologist (intervention) for a median (interquartile range [IQR]) of 742 days. 32% were diabetic, 60% had cardiovascular disease, and proteinuria was minimal. Guided by protocols, the intervention team targeted risk factors for adverse kidney and cardiovascular outcomes. Serial eGFR and clinical events were tracked. The average decline in eGFR over 20 months was -1.9 ml/min per 1.73 m(2). eGFR declined by ≥4 ml/min per 1.73 m(2) within 20 months in 28 (17%) intervention patients versus 23 (13.9%) control patients. Control of BP, LDL, and diabetes were comparable across groups. In the intervention group there was a trend to greater use of renin-angiotensin blockers and more use of statins in those with initial LDL >2.5 mmol/L. Treatment was rarely required for anemia, acidosis, or disordered mineral metabolism. Clinical events occurred in 5.2% per year. Patients with stage 3/4 CKD identified through community laboratories largely had nonprogressive kidney disease but had cardiovascular risk. Over a median of 24 months, the nurse-coordinated team did not affect rate of GFR decline or control of most risk factors compared with usual care.

  6. High levels of both serum gamma-glutamyl transferase and alkaline phosphatase are independent preictors of mortality in patients with stage 4-5 chronic kidney disease.

    Science.gov (United States)

    Caravaca-Fontán, Fernando; Azevedo, Lilia; Bayo, Miguel Ángel; Gonzales-Candia, Boris; Luna, Enrique; Caravaca, Francisco

    High serum gamma-glutamyl transferase (GGT) levels are associated with increased mortality in the general population. However, this association has scarcely been investigated in patients with chronic kidney disease (CKD). This study aims to investigate the clinical characteristics of CKD patients with abnormally elevated serum GGT, and its value for predicting mortality. Retrospective observational study in a population cohort of adults with stage 4-5 CKD not yet on dialysis. Demographic, clinical, and biochemical parameters of prognostic interest were recorded and used to characterise CKD patients with high levels of GGT (>36 IU/l). Cox proportional hazard regression models were used to analyse the influence of baseline serum GGT and alkaline phosphatase (ALP) levels on mortality for whatever reason. The study group consisted of 909 patients (mean age 65±15 years). Abnormally elevated GGT or ALP levels at baseline were observed in 209 (23%) and 172 (19%) patients, respectively, and concomitant elevations of GGT and ALP in 68 (7%). High GGT levels were associated with higher comorbidity burden, and a biochemical profile characterised by higher serum concentration of uric acid, triglycerides, alanine aminotransferase, ferritin, and C-reactive. During the study period, 365 patients (40%) died (median survival time=74 months). In adjusted Cox regression models, high levels of GGT (hazard ratio [HR]=1.39;CI 95%: 1.09-1.78, P=.009) and ALP (HR=1.31; CI95%: 1.02-1.68, P=.038) were independently associated with mortality. High serum levels of GGT are independent predictors of mortality in CKD patients. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  7. Higgs at 3.5 seconds into the melody

    CERN Multimedia

    Antonella Del Rosso

    2012-01-01

    Listen to the music… at 3.5 into the recording you will be able to “hear” the sound of the newly discovered boson. That’s the beauty of sonification, a technique that translates dry data into beautiful melodies.   Image edit by Katarina Anthony. Sonification is a computational technique that requires enormous amounts of networking and processing power to produce results. The sonification of data presented on 4 July by the ATLAS collaboration was performed using the pan-European GÉANT network and the Grid infrastructure. The result is a melody that at 3.5 seconds reproduces the bump corresponding to the new particle. “This sonification was carried out on the same grid infrastructure used by researchers to reconstruct their data and plot their graphs,” says Domenico Vicinanza of DANTE, who led the Higgs sonification project, collaborating with Mariapaola Sorrentino of ASTRA Project (Cambridge), who contributed to the sonific...

  8. Crystal structure of ebastinium 3,5-dinitrobenzoate

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    Mohammed A. E. Shaibah

    2017-10-01

    Full Text Available Ebastine, 4-(benzhydryloxy-1-[4-(4-tert-butylphenyl-4-oxobutyl]piperidine, reacts with 3,5-dinitrobenzoic acid in methanol solution to give the title 1:1 salt, ebastinium 3,5-dinitrobenzoate, C32H40NO2+·C7H3N2O6−. In the cation, the disubstituted aryl ring exhibits orientational disorder over two sets of atomic sites having occupancies 0.706 (4 and 0.294 (6, with a dihedral angle of 41.2 (5° between the two orientations: the bulky Ph2CH—O– substituent occupies an axial site on the piperidine ring. The two ions in the selected asymmetric unit are linked by a nearly linear N—H...O hydrogen bond and this, in combination with two C—H...O hydrogen bonds, links the ions into complex sheets.

  9. 3.5 TeV : a good start!

    CERN Multimedia

    2009-01-01

    To the pessimists out there, the 3.5 TeV starting energy of the LHC will be like a half-empty glass. However, the thousands of physicists working at the experiments certainly do not share these feelings. On the contrary, they are as excited as ever since they will be the first to observe what happens to matter in these (still) unprecedented conditions.

  10. Number & operations task & drill sheets : grades 3-5

    CERN Document Server

    Reed, Nat

    2011-01-01

    For grades 3-5, our Common Core State Standards-based combined resource meets the number & operations concepts addressed by the NCTM standards and encourages the students to review the concepts in unique ways. The task sheets introduce the mathematical concepts to the students around a central problem taken from real-life experiences, while the drill sheets provide warm-up and timed practice questions for the students to strengthen their procedural proficiency skills.

  11. [mRNA Expressions of T-bet, GATA-3, ROR γt and Foxp3 in peripheral blood of patients with chronic lymphocytic leukemia in different stages].

    Science.gov (United States)

    Yu, Jing-Jing; Chen, Gang; Pang, Nan-Nan; Guo, Xin-Hong; Wang, Lei; Zhao, Fang; Tan, Ming-Fang; Qu, Jian-Hua

    2015-02-01

    This study was to investigate the mRNA expression of T-bet, GATA-3, ROR γt and Foxp3 mRNA in peripheral blood of patients with chronic lymphocytic leukemia (CLL) in different stages and explore their potential role in the pathogenesis and clinical diagnosis. A total of 46 newly diagnosed and untreated patients with CLL was chosen as patient group, including 16 patients in the stage of Binet A, 15 in the stage of Binet B, and 15 in the stage of Binet C; 20 healthy persons were selected as controls. The quantitative fluorescence PCR was adopted to detect the mRNA expression of T-bet, GATA-3, RORγt and Foxp3 in peripheral blood mononuclear cell (PBMNC). (1) The expression of T-bet mRNA in patient group was lower than that in normal controls (P ROR γt, Foxp3 in CLL patients group were higher than that in normal controls (P < 0.05), and the ratio of T-bet/GATA-3 and RORγt/Foxp3 in CLL in patient group were lower than that in normal controls(P < 0.05); (2) The later the stage, the higher the mRNA expression of GATA-3 and Foxp3. The mRNA expression of GATA-3 in stage Binet B and stage Binet C of CLL patients were higher than that in stage Binet A (P < 0.05),and the mRNA expression of Foxp3 in stage Binet C was higher than that in stage of Binet A and Binet B (P < 0.05); the later the stage, the lower the ratio of T-bet/GATA-3 and RORγt/Foxp3. The ratio of T-bet/GATA-3 in stage of Binet A CLL patients was higher than that in stage Binet C (P < 0.05) and the ratio of RORγt/Foxp3 in stage of Binet A and stage of Binet B were higher than that in stage Binet C (P < 0.05). This study found in the level of transcription factors in CLL patients that with the process of disease, the balance shifts from Th1/Th2 and Th17/Treg to Th17 and Treg, and Treg cell may play a critical immunosuppressive role in the development of CLL.

  12. An Academic Response to Basel 3.5

    Directory of Open Access Journals (Sweden)

    Paul Embrechts

    2014-02-01

    Full Text Available Recent crises in the financial industry have shown weaknesses in the modeling of Risk-Weighted Assets (RWAs. Relatively minor model changes may lead to substantial changes in the RWA numbers. Similar problems are encountered in the Value-at-Risk (VaR-aggregation of risks. In this article, we highlight some of the underlying issues, both methodologically, as well as through examples. In particular, we frame this discussion in the context of two recent regulatory documents we refer to as Basel 3.5.

  13. Pb chains on ordered Si(3 3 5) surface

    International Nuclear Information System (INIS)

    Kisiel, M.; Skrobas, K.; Zdyb, R.; Mazurek, P.; Jalochowski, M.

    2007-01-01

    The electronic band structure of the Si(3 3 5)-Au surface decorated with Pb atoms was studied with angle resolved photoelectron spectroscopy (ARPES) in ultra high vacuum (UHV) conditions. The photoemission spectra were measured in two perpendicular directions, along and across the steps. In the direction parallel to the step edges the ARPES spectra show strongly dispersive electron energy band while in the perpendicular direction there is no electronic dispersion at all. This confirms one-dimensional character of the system. The theoretical band dispersion calculated within a tight-binding model was fitted to that obtained from the experiment

  14. Poly[diaqua(μ5-pyridine-3,5-dicarboxylatostrontium

    Directory of Open Access Journals (Sweden)

    Dan Li

    2012-06-01

    Full Text Available In the structure of the title compound, [Sr(C7H3NO4(H2O2]n, the SrII cation is eight-coordinated in form of a distorted dodecahedron by two water O atoms and by five O atoms and one N atom from five pyridine-3,5-dicarboxylate anions. The bridging mode of the anions leads to the formation of a layered network parallel to (100. O—H...O hydrogen bonding between the coordinating water molecules and the carboxylate groups of adjacent layers consolidates the crystal packing. Weak C—H...O interactions are also observed.

  15. Removing 3,5-Dichlorophenol from Wastewater by Alternative Adsorbents

    Directory of Open Access Journals (Sweden)

    Kobetičová Hana

    2014-12-01

    Full Text Available The main objective of this paper is to evaluate an efficiency of 3,5 - dichlorophenol removal from wastewater by using alternative adsorbents. Chlorophenols are organic compounds consisting of a benzene ring, OH groups and also atoms of chlorine. Chlorophenols may have a huge isomere variety that means there are differences in their chemical and physical properties. Due to their toxicity it is necessary to remove them from waste water and in this paper an alternative way of such process is described.

  16. 1-[4-(3,5-Difluorobenzyloxy-2-hydroxyphenyl]ethanone

    Directory of Open Access Journals (Sweden)

    Ya-Tuan Ma

    2010-09-01

    Full Text Available The title compound, C15H12F2O3, has been obtained by the reaction of 2,4-dihydroxylacetonephenone, potassium carbonate and 3,5-difluorobenzyl bromide. The hydroxy group is involved in an intramolecular O—H...O hydrogen bond in each of the two independent molecules in the asymmetric unit. The dihedral angle between the aromatic rings is 0.5 (2° in one molecule and 1.9 (2° in the other. In the crystal, weak C—H...O interactions link the molecules into tetrameric units aligned perpendicular to b.

  17. Spin Caloritronic Transport of 1,3,5-Triphenylverdazyl Radical

    International Nuclear Information System (INIS)

    Wu Qiu-Hua; Zhao Peng; Liu De-Sheng

    2016-01-01

    We investigate theoretically the spin caloritronic transport properties of a stable 1,3,5-triphenylverdazyl (TPV) radical sandwiched between Au electrodes through different connection fashions. Obvious spin Seebeck effect can be observed in the para-connection fashion. Furthermore, a pure spin current and a completely spin-polarized current can be realized by tuning the gate voltage. Furthermore, a 100% spin polarization without the need of gate voltage can be obtained in the meta-connection fashion. These results demonstrate that TPV radical is a promising material for spin caloritronic and spintronic applications. (paper)

  18. Delayed myelosuppression with acute exposure to hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) and environmental degradation product hexahydro-1-nitroso-3,5-dinitro-1,3,5-triazine (MNX) in rats

    Energy Technology Data Exchange (ETDEWEB)

    Jaligama, Sridhar; Kale, Vijay M.; Wilbanks, Mitchell S. [Department of Toxicology, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA 71209 (United States); Perkins, Edward J. [US Army Engineer Research and Development Center, Vicksburg, MS 39180 (United States); Meyer, Sharon A., E-mail: meyer@ulm.edu [Department of Toxicology, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA 71209 (United States)

    2013-02-01

    Hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX), a widely used munitions compound, and hexahydro-1-nitroso-3,5-dinitro-1,3,5-triazine (MNX), its N-nitroso product of anaerobic microbial nitroreduction, are contaminants of military sites. Previous studies have shown MNX to be the most acutely toxic among the nitroreduced degradation products of RDX and to cause mild anemia at high dose. The present study compares hematotoxicity with acute oral exposure to MNX with parent RDX. Both RDX and MNX caused a modest decrease in blood hemoglobin and ∼ 50% loss of granulocytes (NOAELs = 47 mg/kg) in female Sprague–Dawley rats observed 14 days post-exposure. We explored the possibility that blood cell loss observed after 14 days was delayed in onset because of toxicity to bone marrow (BM) progenitors. RDX and MNX decreased granulocyte/macrophage-colony forming cells (GM-CFCs) at 14, but not 7, days (NOAELs = 24 mg/kg). The earliest observed time at which MNX decreased GM-CFCs was 10 days post-exposure. RDX and MNX likewise decreased BM burst-forming units-erythroid (BFU-Es) at 14, but not 7, days. Granulocyte–erythrocyte–monocyte–megakaryocyte (GEMM)-CFCs were unaffected by RDX and MNX at 7 days suggesting precursor depletion did not account for GM-CFC and BFU-E loss. MNX added to the culture media was without effect on GM-CFC formation indicating no direct inhibition. Flow cytometry showed no differential loss of BM multilineage progenitors (Thy1.1{sup +}) or erythroid (CD71{sup +}) precursors with MNX suggesting myeloid and erythroid lineages were comparably affected. Collectively, these data indicate that acute exposure to both RDX and MNX caused delayed suppression of myelo- and erythropoiesis with subsequent decrease of peripheral granulocytes and erythrocytes. Highlights: ► Acute oral exposure to munitions RDX causes myelosuppression. ► Environmental degradation product MNX is comparable in effect. ► RDX and MNX are cytotoxic to both myeloid and erythroid

  19. Biosphere in 3.5 Ga submarine hydrothermal system

    Energy Technology Data Exchange (ETDEWEB)

    Ueno, Yuichiro [Tokyo Univ. (Japan). Dept. of Earth Science and Astronomy

    2003-04-01

    Abundant organic matter (kerogen) was identified in {approx}3.5 Ga hydrothermal silica dikes from the North Pole area in the Pilbara craton, Western Australia. The silica dikes developed in the uppermost 1000 m of the ancient oceanic crust. Thus, they would have been deposited in the 3.5 Ga sub-seafloor hydrothermal system. The carbon and nitrogen isotopic compositions of the kerogen were analyzed in this study. Their highly {sup 13}C-depleted isotopic compositions ({delta}{sup 13}C = -38 to -33 per mille) strongly suggest that they are originally derived from biologically produced organic matter. The remarkable similarity of the {delta}{sup 13}C values between the kerogen and modern hydrothermal vent organisms may suggest that the kerogen was derived from chemoautotrophic organisms. This idea is also consistent with their nitrogen isotopic compositions ({delta}{sup 15}N = -4 to +4 per mille). The silica dikes consist mainly of fine-grained silica with minor pyrite and sphalerite. These mineral assemblages indicate that the silica dike was deposited from relatively low-temperature (probably less than 150degC) reducing hydrothermal fluid. Thus, anaerobic thermophilic/hyperthermophilic organisms could have survived in the hydrothermal fluid, which formed the silica dikes. Therefore, it is plausible that a chemoautotrophic-based biosphere (possibly methanogenesis) probably existed in the Early Archean sub-seafloor hydrothermal system. (author)

  20. Neuromuscular electrostimulation: a new therapeutic option to improve radio-cephalic arteriovenous fistula maturation in end-stage chronic kidney disease patients.

    Science.gov (United States)

    Martinez, Lucia; Esteve, Vicent; Yeste, Montserrat; Artigas, Vicent; Llagostera, Secundino

    2017-09-01

    Radio-cephalic arteriovenous fistula (RCAVF) is the gold standard vascular access for end-stage chronic kidney disease patients. Exercises after arteriovenous fistula (AVF) creation improve maturation. No articles are published regarding neuromuscular electrostimulation (NMES) in AVF maturation. To assess the usefulness of a NMES programme on RCAVF maturation process. An 8-week single-centre prospective study. Two groups were established: control group (CG): underwent usual RCAVF forearm exercises and electrostimulation group (ESG): underwent RCAVF NMES programme. Handgrip (HG) measurement, preoperative Doppler ultrasonography (DUS) parameters, clinical and DUS maturation as well as surgical complications were assessed. Thirty-six patients (54% men). Mean age 67.9 ± 14.3 years; 12 ESG and 24 CG. Demographic data, comorbidities, medical treatment, HG and DUS measurement at baseline were similar. HG increased in both groups at the end of the study (CG 24.5 ± 9.5 vs. 26.1 ± 10.1 kg, p 0.048; ESG 25.8 ± 10.3 vs. 26.3 ± 11.6 kg, p 0.644). RCAVF forearm vein diameter (CG 3.1 ± 0.7 vs. 5.7 ± 1.1 mm; ESG 2.9 ± 0.8 vs. 6.1 ± 1.7 mm) and humeral artery blood flow rate (CG 110.5 ± 20.7 vs. 1053.4 ± 510.7 ml/min; ESG 118.2 ± 31.6 vs. 954.1 ± 542.2 ml/min) statistically increased for both groups. A significant increase in clinical maturation in ESG (62.5 vs. 91.7%, p 0.046) at 8 weeks was observed. Four patients in each group developed juxta-anastomotic stenosis and were surgically repaired. No adverse NMES effects were registered. NMES of forearm muscles is a safe and effective technique to improve RCAVF maturation and constitutes a novel alternative to forearm isometrics exercises. Nevertheless, further studies are required to confirm the potential effect of NMES in the vascular access maturation process.

  1. Preventative tele-health supported services for early stage chronic obstructive pulmonary disease: a protocol for a pragmatic randomized controlled trial pilot

    Directory of Open Access Journals (Sweden)

    Mountain Gail A

    2011-01-01

    Full Text Available Abstract Background Chronic Obstructive Pulmonary Disease (COPD is a prevalent debilitating long term condition. It is the second most common cause of emergency admission to hospital in the UK and remains one of the most costly conditions to treat through acute care. Tele-health monitoring offers potential to reduce the rates of re-hospitalisation and emergency department visits and improve quality of life for people with COPD. However, the current evidence base to support technology adoption and implementation is limited and the resource implications for implementing tele-health in practice can be very high. This trial will employ tele-health monitoring in a preventative capacity for patients diagnosed with early stage COPD following discharge from hospital to determine whether it reduces their need for additional health service support or hospital admission and improves their quality of life. Methods/Design We describe a pilot study for a two arm, one site randomized controlled trial (RCT to determine the effect of tele-health monitoring on self-management, quality of life and patient satisfaction. Sixty patients who have been discharged from one acute trust with a primary diagnosis of COPD and who have agreed to receive community clinical support following discharge from acute care will be randomly assigned to one of two groups: (a Tele-health supported Community COPD Service; or (b Usual Care. The tele-health supported service involves the patient receiving two home visits with a specialist COPD clinician (nurse or physiotherapist then participating in daily tele-monitoring over an eight week period. Usual care consists of six home visits to the patient by specialist COPD clinicians again over eight successive weeks. Health status and quality of life data for all participants will be measured at baseline, on discharge from the service and at six months post discharge from the service. Discussion The tele-health service under study is a

  2. Health-Related Quality of Life Impacts Mortality but Not Progression to End-Stage Renal Disease in Pre-Dialysis Chronic Kidney Disease: A Prospective Observational Study.

    Science.gov (United States)

    Jesky, Mark D; Dutton, Mary; Dasgupta, Indranil; Yadav, Punit; Ng, Khai Ping; Fenton, Anthony; Kyte, Derek; Ferro, Charles J; Calvert, Melanie; Cockwell, Paul; Stringer, Stephanie J

    2016-01-01

    Chronic kidney disease (CKD) is associated with reduced health-related quality of life (HRQL). However, the relationship between pre-dialysis CKD, HRQL and clinical outcomes, including mortality and progression to end-stage renal disease (ESRD) is unclear. All 745 participants recruited into the Renal Impairment In Secondary Care study to end March 2014 were included. Demographic, clinical and laboratory data were collected at baseline including an assessment of HRQL using the Euroqol EQ-5D-3L. Health states were converted into an EQ-5Dindex score using a set of weighted preferences specific to the UK population. Multivariable Cox proportional hazards regression and competing risk analyses were undertaken to evaluate the association of HRQL with progression to ESRD or all-cause mortality. Regression analyses were then performed to identify variables associated with the significant HRQL components. Median eGFR was 25.8 ml/min/1.73 m2 (IQR 19.6-33.7ml/min) and median ACR was 33 mg/mmol (IQR 6.6-130.3 mg/mmol). Five hundred and fifty five participants (75.7%) reported problems with one or more EQ-5D domains. When adjusted for age, gender, comorbidity, eGFR and ACR, both reported problems with self-care [hazard ratio 2.542, 95% confidence interval 1.222-5.286, p = 0.013] and reduced EQ-5Dindex score [hazard ratio 0.283, 95% confidence interval 0.099-0.810, p = 0.019] were significantly associated with an increase in all-cause mortality. Similar findings were observed for competing risk analyses. Reduced HRQL was not a risk factor for progression to ESRD in multivariable analyses. Impaired HRQL is common in the pre-dialysis CKD population. Reduced HRQL, as demonstrated by problems with self-care or a lower EQ-5Dindex score, is associated with a higher risk for death but not ESRD. Multiple factors influence these aspects of HRQL but renal function, as measured by eGFR and ACR, are not among them.

  3. QUANTITATIVE EVALUATION OF IMMUNOCYTES AND INTERLEUKIN-17 LEVELS IN SALIVA FROM SMOKERS AT THE EARLY STAGES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

    Directory of Open Access Journals (Sweden)

    E. I. Altynbaeva

    2010-01-01

    Full Text Available The study was focused on identification of disorders in immune homeostasis in the mucosalivary area, using cytofluorometric analysis of immune cell populations and quantitative enzyme immunoassay for interleukin-17 in saliva of radiochemical facility workers with a history of smoking, being at initial stages of chronic obstructive pulmonary diseases (COPD without exacerbations. We have observed a cohort of COPD patients (144 workers, as well as a group of 264 smoking individuals without any signs of COPD. The study and control groups have been matched by age, gender, working conditions, smoking index and clinical history. During the last ten years, the persons under study were subject to a regular follow-up. The current study included twenty-three patients from the main group and ten individuals from the group of comparison. Analysis of immunocytes in saliva was peformed by means of flow cytometry. The patients for laboratory studies were selected in a random manner. Total amounts of leukocytes was measured in saliva, providing a mean value of 2.4106/ml, followed by filtration of saliva through porous filters (Becton Dickinson. Cytofluorimetric analysis was performed be means of BD FACSCanto II machine, using a kit of appropriate monoclonal antibodies, thus allowing of a four-colour fluorescence analysis. The salivary immune cell subpopulations were scored with viable cells, positive for CD4+. A significant increase in amounts of CD+CD8- (25.85% versus 1.4% in the control group, p = 0.049 and in CD+CD+ (3.3% versus 0.6%, p = 0.049 was noted in COPD patients, hence presuming an increase in total amounts of T-lymphocytes and T-helpers, without any enhancement of cytotoxic cell populations in the mucosalivary region, being permanently exposed to tobacco smoke in the smokers with COPD. The obtained findings let us to assume an involvement of CD+CD+ lymphocytes in pathogenesis of inflammatory alterations at COPD. An increased level of IL-17 was

  4. Can renal nutrition education improve adherence to a low-protein diet in patients with stages 3 to 5 chronic kidney disease?

    Science.gov (United States)

    Paes-Barreto, Juliana Giglio; Silva, Maria Inês Barreto; Qureshi, Abdul Rashid; Bregman, Rachel; Cervante, Vicente Faria; Carrero, Juan Jesús; Avesani, Carla Maria

    2013-05-01

    Low adherence is frequently observed in patients with chronic kidney disease (CKD) who are following a low-protein diet. We have evaluated whether a specific nutrition education program motivates patients with CKD who do not yet receive dialysis to reduce their protein intake and whether such a program improves adherence to a low-protein diet over and above standard dietary counseling. This was a randomized controlled clinical trial conducted at the CKD outpatient clinic at Pedro Ernesto University Hospital, Rio de Janeiro, Brazil. This study included adult patients with an estimated glomerular filtration rate (eGFR) Patients were randomized to a normal counseling group (individualized dietary program: 0.6 to 0.75 g protein/kg/day or 0.6 to 0.8 g/kg/day for patients with diabetes and 25 to 35 kcal/kg/day with sodium restriction) or an intense counseling group (same dietary program plus nutrition education materials). The nutrition education material included 4 different actions to improve patient knowledge and understanding of the low-protein and low-sodium diet. Both groups were followed by means of individual monthly visits to the outpatient clinic for 4 months. We looked for a change in protein intake from baseline values as well as the adherence rate, assessed as a 20% decrease of the initial protein intake (by 24-hour food recall). Eighty-nine patients completed the study (normal counseling n = 46; intense counseling n = 43). The number of patients who adhered to a low-protein diet was high but did not differ between groups (in the last visit 69% vs. 48%; P = .48; intense vs. normal counseling, respectively). The reduction in protein intake from baseline values was greater for the intense counseling group compared with the normal counseling group (at the last visit, -20.7 g/day [-30.9%] vs. -10.5 g/day [-15.1%], intense vs. normal counseling, respectively; P = .04). An intense nutrition education program contributed to reducing protein intake in patients with

  5. Impact of anticoagulation and platelet antiaggregation on anaemia and haemorragic events in patients with chronic kidney disease stages 3 and 4.

    Science.gov (United States)

    García-Prieto, Ana; Goicoechea, Marian; Linares, Tania; Panizo, Nayara; García de Vinuesa, María Soledad; Verdalles, Úrsula; Verde, Eduardo; Pérez de José, Ana; Luño, José

    2018-03-01

    There is controversy concerning the risk/benefit of anticoagulation/antiaggregation in chronic kidney disease (CKD) patients. We analysed the impact of anticoagulation/antiaggregation on anaemia and haemorrhagic events in CKD patients. A total of 232 CKD patients stages 3 and 4 were followed during a mean follow-up time of 36.7 ± 11.6 months: 81 patients did not receive any anticoagulation or antiaggregation treatment, 91 received anticoagulation treatment and 60 patients received platelet antiaggregation. Haemorrhagic and cardiovascular events were recorded. Haemoglobin and ferritine levels were significantly higher in patients who did not receive anticoagulation or antiaggregation (Hb 13.7 ± 1.6, 13.3 ± 1.8 and 12.7±1.9g/dl, p=0.004; ferritine 170 ± 145, 140 ± 138, 105 ± 99μg/l, p=0.023). During follow up, 36 haemorrhagic events were registered: 4in the control group, 23 in the anticoagulation group and 9in the antiaggregation group (log rank 12.5; p=0.002). In a Cox model adjusted by age, renal function and haemoglobin levels, the anticoagulation increased the risk of bleeding by 4times (HR 4.180, 1.955-8.937); p=0,001) and antiaggregation by almost 3times (HR 2.780, 1.257-6.149, p=0.012). A total of 64 cardiovascular events were registered, 21 of which were classified as atherosclerotic events: 10 in the antiaggregation group, 8in the control group and 3in the anticoagulation group (log rank: 8.351; p=0.015). Anticoagulation treatment showed a reduction in the risk of atherosclerotic events (HR 0.136, 0.033-0.551, p=0.005) while platelet antiaggregation did not modified this risk (HR 1,566, 0.569-4.308). Anticoagulation and antiaggregation increase haemorrhagic risk in patients with CKD and worsen anaemia. Anticoagulation reduces atherosclerotic events by more than 85% while platelet antiaggregation does not modify this risk. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

  6. Very low-protein diet plus ketoacids in chronic kidney disease and risk of death during end-stage renal disease: a historical cohort controlled study.

    Science.gov (United States)

    Bellizzi, Vincenzo; Chiodini, Paolo; Cupisti, Adamasco; Viola, Battista Fabio; Pezzotta, Mauro; De Nicola, Luca; Minutolo, Roberto; Barsotti, Giuliano; Piccoli, Giorgina Barbara; Di Iorio, Biagio

    2015-01-01

    Very low-protein intake during chronic kidney disease (CKD) improves metabolic disorders and may delay dialysis start without compromising nutritional status, but concerns have been raised on a possible negative effect on survival during dialysis. This study aimed at evaluating whether a very low-protein diet during CKD is associated with a greater risk of death while on dialysis treatment. This is an historical, cohort, controlled study, enrolling patients at dialysis start previously treated in a tertiary nephrology clinic with a very low-protein diet supplemented with amino acids and ketoacids (s-VLPD group, n = 184) or without s-VLPD [tertiary nephrology care (TNC) group, n = 334] and unselected patients [control (CON) group, n = 9.092]. The major outcome was survival rate during end-stage renal disease associated to s-VLPD treatment during CKD. The propensity score methods and Cox regression model were used to match groups at the start of dialysis to perform survival analysis and estimate adjusted hazard ratio (HR). In s-VLPD, TNC and CON groups, average age was 67.5, 66.0 and 66.3 years, respectively (P = 0.521) and male prevalence was 55, 55 and 62%, respectively (P = 0.004). Diabetes prevalence differed in the three groups (P cardiovascular (CV) disease was found (P < 0.001), being similar in TNC and CON (31 and 25%) and higher in s-VLPD (41%). Median follow-up during renal replacement therapy (RRT) was 36, 32 and 36 months in the three groups. Adjusted HR estimated on matched propensity patients was 0.59 (0.45-0.78) for s-VLPD versus CON. Subgroup analysis showed a lower mortality risk in s-VLPD versus matched-CON in younger patients (<70 years) and those without CV disease. No significant difference in HRs was found between s-VLPD and TNC. s-VLPD during CKD does not increase mortality in the subsequent RRT period. © The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  7. Isolation and functional analysis of a homolog of flavonoid 3',5'-hydroxylase gene from Pericallis × hybrida.

    Science.gov (United States)

    Sun, Yi; Huang, He; Meng, Li; Hu, Ke; Dai, Si-Lan

    2013-10-01

    As the key enzyme in the biosynthesis of blue flower color pigments, flavonoid 3',5'-hydroxylase (F3'5'H) can catalyze the conversion of its major substrates, 2-S naringenin and dihydrokaempferol, into 3',4',5'-hydroxylated pentahydroxyflavanone and dihydromyricetin, respectively. Unlike other F3'5'Hs belonging to the CYP75A subfamily, Asteraceae-specific F3'5'Hs belong to the CYP75B subfamily. Furthermore, cineraria F3'5'H expressed in yeast exhibited not only F3'H (flavonoid 3'-hydroxylase) activity but also F3'5'H activity in vitro. In this study, Southern blotting showed that there was only one copy of a homolog of the F3'5'H gene PCFH in the Pericallis × hybrida genome. This gene could be detected by Northern blot in the primary developmental stages of ligulate florets of the purple- and blue-flowered cultivars, and its transcripts also accumulated in the leaves. Heterologous expression of PCFH could produce new delphinidin derivatives in the corollas of transgenic tobacco plants, increased the content of cyanidin derivatives and lead to the blue- and red-shifting of flower color in T₀ generation plants. These results indicate that cineraria F3'5'H exhibited both F3'5'H- and F3'H-activity in vivo. The types and contents of anthocyanins and flower color phenotypes of the T₁ generation were similar to those of T₀ generation plants. PCFH exhibited stable inheritance and normal functions between generations. This study supplies new evidence to understand Asteraceae-specific F3'5'Hs and provides important references for the further study of molecular breeding of blue-flowered chrysanthemums using the PCFH gene. © 2013 Scandinavian Plant Physiology Society.

  8. A new version of the DOT 3.5

    International Nuclear Information System (INIS)

    Sbaffoni, M.M.; Abbate, M.J.

    1985-01-01

    The use of code DOT 3.5 in calculations that involve neutron thermalization processes in systems with a strong upscattering effect, has shown several problems, i.e. arise of negative fluxes, instability of the solutions, and random convergence. Because of these undesirable results, a new version of the code was developed, which maintains the possibilites of the former one and adds, as option, the utilization of a new upscattering acceleration method, called 'differential method' or 'group by group'. It is more adequate for this kind of cases and solves, with the addition of a few other minor modifications, the above mentioned problems. Since this new version includes the original one, the modifications described in this report, in particular those of input and output features, are an addendum to the corresponding user's manual. (author) [es

  9. Dissociative electron attachment to the nitroamine HMX (octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine).

    Science.gov (United States)

    Postler, Johannes; Goulart, Marcelo M; Matias, Carolina; Mauracher, Andreas; Ferreira da Silva, Filipe; Scheier, Paul; Limão-Vieira, Paulo; Denifl, Stephan

    2013-05-01

    In the present study, dissociative electron attachment (DEA) measurements with gas phase HMX, octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine, C4H8N8O8, have been performed by means of a crossed electron-molecular beam experiment. The most intense signals are observed at 46 and 176 u and assigned to NO2(-) and C3H6N5O4(-), respectively. Anion efficiency curves for 15 negatively charged fragments have been measured in the electron energy region from about 0-20 eV with an energy resolution of ~0.7 eV. Product anions are observed mainly in the low energy region, near 0 eV, arising from surprisingly complex reactions associated with multiple bond cleavages and structural and electronic rearrangement. The remarkable instability of HMX towards electron attachment with virtually zero kinetic energy reflects the highly explosive nature of this compound. Substantially different intensity ratios of resonances for common fragment anions allow distinguishing the nitroamines HMX and royal demolition explosive molecule (RDX) in negative ion mass spectrometry based on free electron capture.

  10. Solution and Solid Hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) Ultraviolet (UV) 229 nm Photochemistry.

    Science.gov (United States)

    Gares, Katie L; Bykov, Sergei V; Brinzer, Thomas; Asher, Sanford A

    2015-05-01

    We measured the 229 nm deep-ultraviolet resonance Raman (DUVRR) spectra of solution and solid-state hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX). We also examined the photochemistry of RDX both in solution and solid states. RDX quickly photodegrades with a solution quantum yield of φ ~ 0.35 as measured by high-performance liquid chromatography (HPLC). New spectral features form over time during the photolysis of RDX, indicating photoproduct formation. The photoproduct(s) show stable DUVRR spectra at later irradiation times that allow standoff detection. In the solution-state photolysis, nitrate is a photoproduct that can be used as a signature for detection of RDX even after photolysis. We used high-performance liquid chromatography-high-resolution mass spectrometry (HPLC-HRMS) and gas chromatography mass spectrometry (GCMS) to determine some of the major solution-state photoproducts. X-ray photoelectron spectroscopy (XPS) was also used to determine photoproducts formed during solid-state RDX photolysis.

  11. Experimental oral transmission of chronic wasting disease to red deer (Cervus elaphus elaphus): Early detection and late stage distribution of protease-resistant prion protein

    Science.gov (United States)

    Chronic wasting disease CWD is the transmissible spongiform encephalopathy or prion disease of wild and farmed cervid ruminants, including Rocky Mountain elk (Cervus elaphus nelsoni), white tailed deer (Odocoileus virginianus), mule deer (Odocoileus hemionus), or moose (Alces alces). Reliable data ...

  12. Influence of late-stage chronic kidney disease on overall survival in patients with upper tract urothelial carcinoma following radical nephroureterectomy

    Directory of Open Access Journals (Sweden)

    Sheng-Chen Wen

    2015-06-01

    Conclusion: Patients with late-stage CKD had a higher risk of having poor OS. Patients with concomitant bladder tumor had a greater risk of having bladder cancer recurrence despite primary tumor stage. Concomitant bladder tumor, however, had no effect on OS and CSS in this study.

  13. Efficacy of salmeterol/fluticasone propionate by GOLD stage of chronic obstructive pulmonary disease: analysis from the randomised, placebo-controlled TORCH study

    DEFF Research Database (Denmark)

    Jenkins, Christine R; Jones, Paul W; Calverley, Peter M A

    2009-01-01

    disease. METHODS: TORCH was a 3-year, double-blind, placebo-controlled trial of 6112 patients with moderate/severe COPD with pre-bronchodilator FEV1 ... by GOLD stages, we conducted a post-hoc analysis of the TORCH dataset using baseline post-bronchodilator FEV1 to segment patients into three groups: moderate COPD (GOLD stage II and above: >or= 50%; n = 2156), severe COPD (GOLD stage III: 30% to ... propionate and SFC arms, compared with other treatments in all GOLD stages. CONCLUSION: In the TORCH study, SFC reduced moderate-to-severe exacerbations and improved health status and FEV1 across GOLD stages. Treatment with SFC may be associated with reduced mortality compared with placebo in patients...

  14. Toxicity of octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX) in three vertebrate species.

    Science.gov (United States)

    Johnson, Mark S; McFarland, Craig A; Bazar, Matthew A; Quinn, Michael J; LaFiandra, Emily May; Talent, Larry G

    2010-04-01

    The explosive, octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine or high-melting explosive (HMX), has been found in soils in areas used for testing and training by the military. Many of these areas contain habitat for valued wildlife species. In an effort to better understand the environmental consequences from exposure, a reptilian (western fence lizard [Sceloporus occidentalis]), an amphibian (red-backed salamander [Plethodon cinereus]), and a mammalian species (rabbit [Oryctolagus cuniculus]) were exposed to HMX under controlled laboratory conditions. Lizards and rabbits were exposed to HMX by way of corn oil through gavage, and salamanders were exposed to HMX in soil. Two deaths occurred from acute oral exposures to lizards to 5000 mg HMX/kg BW. Histological and gross pathologic assessment suggested gut impaction as a possible cause of death. Salamanders exposed to concentrations of HMX in soil HMX/kg soil for 10 days did not show adverse effects. Rabbits, however, showed neurologic effects manifested as hyperkinetic events with convulsions at > 24 h after oral exposures. An LD(50) for rabbits was calculated as 93 mg/kg (95% confidence interval 76-117). A subacute 14-day testing regime found a lowest observed effect level of 10 mg/kg-d and a no observed adverse effect level of 5 mg/kg-d based on hyperkinesia and seizure incidence, although changes suggesting functional hepatic alterations were also found. These data suggest that physiologic differences between species, particularly in gastrointestinal structure and function, can affect the absorption of HMX and hence lead to marked differences in toxicity from exposure to the same compound.

  15. 3.5 TeV: Patience pays dividends

    CERN Multimedia

    Rolf Heuer

    2010-01-01

    In my message this week, I’d like to congratulate the LHC team on accelerating two beams to 3.5 TeV in the early hours of this morning. The timing could not have been better. Coming during a week of CERN Council meetings, it allowed us to show delegates the great progress we’re making. The occasion also gave us the opportunity to set out again the prudent step-by-step approach that we’re taking to get the LHC up and running, and it was refreshing to hear one member of the Scientific Policy Committee declare on Monday that we should never forget that the LHC is not a turnkey machine.With the progress the LHC is making, that simple fact would be easy to overlook. The figures coming back from this first run are already quite remarkable. In Week 10, the LHC’s availability for the operators was over 65%: it usually takes a new accelerator years to reach that level. And over the last few weeks, operation of the LHC at 450 GeV has become routinely reproducible, which i...

  16. Rock Visualization System. Technical description (RVS v.3.5)

    Energy Technology Data Exchange (ETDEWEB)

    Curtis, P.; Elfstroem, M.; Markstroem, I. [FB Engineering, Goeteborg (Sweden)

    2004-03-01

    The Rock Visualization System (RVS) has been developed by SKB for use in visualizing geological and engineering data in 3D. The purpose of this report is to provide a technical description of RVS aimed at potential program users and interested parties as well as fulfilling the function of a more general RVS reference that can be cited when writing other technical reports. It is a description of RVS version 3.5. Updated versions of this report or addenda will be made available following further development of RVS and the release of subsequent versions of the program. The report covers the following main items: Technical description of the program with illustrations and examples; Limitations of the program and of functionality. For most RVS functions step-by-step tutorials are available describing how a particular function can be used to carryout a specific task. A complete set of updated tutorials is issued with each new version release of the RVS program. However, the tutorials do not cover all the possible uses of all the individual functions but rather give an overall view of their functionality. A detailed description of every RVS function and how it can be used is included in the RVS online Help system.

  17. Evolution of geochemical conditions in SFL 3-5

    International Nuclear Information System (INIS)

    Karlsson, Fred; Lindgren, M.; Skagius, K.; Wiborgh, M.; Engkvist, I.

    1999-12-01

    The evolution of geochemical conditions in the repository for long-lived low- and intermediate-level waste, SFL 3-5, and in the vicinity of the repository are important when predicting the retention of radionuclides and the long-term stability of engineered barriers. In this study the initial conditions at different repository sites at 300 - 400 m depth, the influence of repository construction and operation, the expected conditions after repository closure and saturation, and the evolution in a long-term perspective are discussed. Groundwaters that are found at these depths have near-neutral pH and are reducing in character, but the composition can vary from saline to non-saline water. The water chemistry in the near-field will mainly be influenced by the composition of the groundwater and by the large amounts of cementitious material that can be found in the repository. Disturbances caused during construction and operation are not expected to be permanent. Studies of old concrete indicate that leaching of concrete is a slow process. The geochemical conditions in the repository are therefore expected to be stable and prevail for hundreds of thousand years. However, the evolution of the surrounding environment may influence the conditions in long-term perspective

  18. The radioprotective potential of 3,5,4'-trihydroxystilbene

    International Nuclear Information System (INIS)

    Clemente, Mary Judith Q.; Gomez, Marlyn O.

    1999-03-01

    The radioprotective potential of 3,5,4'trihydroxystilbene or resveratrol, a compound abundant in grapes, was investigated using the micronucleus test. Gamma radiation (6 Gy) was used to induce micronucleus formation in 12-week old Swiss-Webster mice. Five groups with five mice each were used. Three groups were given corresponding treatments (low, normal, high doses of reservatrol) via oral gavage for one week. The negative control group was not given any radiation nor any compound while the positive control group was exposed to radiation but was not given any compound. The mean micronucleus frequencies arranged from highest to lowest are as follows: low dose, positive control, normal dose, high dose and negative control. Using the analysis of variance-complete random design followed by the Duncan multiple range test, it was proven that resveratrol was able to inhibit micronucleus formation in polychromatic erythrocytes of 12-week old Swiss-Webster mice at the normal (60 micrograms) and high (120 micrograms) concentrations assigned. This suggests that its radioprotective potential may follow a dose-dependent pattern. (Author)

  19. Evolution of geochemical conditions in SFL 3-5

    Energy Technology Data Exchange (ETDEWEB)

    Karlsson, Fred [Swedish Nuclear Fuel and Waste Management Co., Stockholm (Sweden); Lindgren, M.; Skagius, K.; Wiborgh, M. [Kemakta Konsult AB, Stockholm (Sweden); Engkvist, I. [Barsebaeck Kraft AB (Sweden)

    1999-12-01

    The evolution of geochemical conditions in the repository for long-lived low- and intermediate-level waste, SFL 3-5, and in the vicinity of the repository are important when predicting the retention of radionuclides and the long-term stability of engineered barriers. In this study the initial conditions at different repository sites at 300 - 400 m depth, the influence of repository construction and operation, the expected conditions after repository closure and saturation, and the evolution in a long-term perspective are discussed. Groundwaters that are found at these depths have near-neutral pH and are reducing in character, but the composition can vary from saline to non-saline water. The water chemistry in the near-field will mainly be influenced by the composition of the groundwater and by the large amounts of cementitious material that can be found in the repository. Disturbances caused during construction and operation are not expected to be permanent. Studies of old concrete indicate that leaching of concrete is a slow process. The geochemical conditions in the repository are therefore expected to be stable and prevail for hundreds of thousand years. However, the evolution of the surrounding environment may influence the conditions in long-term perspective.

  20. Relationships between static foot alignment and dynamic plantar loads in runners with acute and chronic stages of plantar fasciitis: a cross-sectional study

    Science.gov (United States)

    Ribeiro, Ana P.; Sacco, Isabel C. N.; Dinato, Roberto C.; João, Silvia M. A.

    2016-01-01

    BACKGROUND: The risk factors for the development of plantar fasciitis (PF) have been associated with the medial longitudinal arch (MLA), rearfoot alignment and calcaneal overload. However, the relationships between the biomechanical variables have yet to be determined. OBJECTIVE: The goal of this study was to investigate the relationships between the MLA, rearfoot alignment, and dynamic plantar loads in runners with unilateral PF in acute and chronic phases. METHOD: Cross-sectional study which thirty-five runners with unilateral PF were evaluated: 20 in the acute phase (with pain) and 15 with previous chronic PF (without pain). The MLA index and rearfoot alignment were calculated using digital images. The contact area, maximum force, peak pressure, and force-time integral over three plantar areas were acquired with Pedar X insoles while running at 12 km/h, and the loading rates were calculated from the vertical forces. RESULTS: The multiple regression analyses indicated that both the force-time integral (R 2=0.15 for acute phase PF; R 2=0.17 for chronic PF) and maximum force (R 2=0.35 for chronic PF) over the forefoot were predicted by an elevated MLA index. The rearfoot valgus alignment predicted the maximum force over the rearfoot in both PF groups: acute (R 2=0.18) and chronic (R 2=0.45). The rearfoot valgus alignment also predicted higher loading rates in the PF groups: acute (R 2=0.19) and chronic (R 2=0.40). CONCLUSION: The MLA index and the rearfoot alignment were good predictors of plantar loads over the forefoot and rearfoot areas in runners with PF. However, rearfoot valgus was demonstrated to be an important clinical measure, since it was able to predict the maximum force and both loading rates over the rearfoot. PMID:26786073

  1. Efficacy of salmeterol/fluticasone propionate by GOLD stage of chronic obstructive pulmonary disease: analysis from the randomised, placebo-controlled TORCH study

    Science.gov (United States)

    Jenkins, Christine R; Jones, Paul W; Calverley, Peter MA; Celli, Bartolome; Anderson, Julie A; Ferguson, Gary T; Yates, Julie C; Willits, Lisa R; Vestbo, Jörgen

    2009-01-01

    Background The efficacy of inhaled salmeterol plus fluticasone propionate (SFC) in patients with severe or very severe COPD is well documented. However, there are only limited data about the influence of GOLD severity staging on the effectiveness of SFC, particularly in patients with milder disease. Methods TORCH was a 3-year, double-blind, placebo-controlled trial of 6112 patients with moderate/severe COPD with pre-bronchodilator FEV1 TORCH dataset using baseline post-bronchodilator FEV1 to segment patients into three groups: moderate COPD (GOLD stage II and above: ≥ 50%; n = 2156), severe COPD (GOLD stage III: 30% to TORCH study, SFC reduced moderate-to-severe exacerbations and improved health status and FEV1 across GOLD stages. Treatment with SFC may be associated with reduced mortality compared with placebo in patients with GOLD stage II disease. The effects were similar to those reported for the study as a whole. Thus, SFC is an effective treatment option for patients with GOLD stage II COPD. Trial registration Clinicaltrial.gov registration NCT00268216; Study number: SCO30003 PMID:19566934

  2. Effect of an Educational Program on Adherence to Therapeutic Regimen among Chronic Kidney Disease Stage5 (CKD5) Patients under Maintenance Hemodialysis

    Science.gov (United States)

    Deif, Hala I. Abo; Elsawi, Khiria; Selim, Mohga; NasrAllah, Mohamed M.

    2015-01-01

    The burden of chronic disease on health care services worldwide is growing and the increased development of educational interventions which help patients to better manage their conditions is evident internationally. It has been recognized that poor adherence can be a serious risk to the health and wellbeing of patients. Adherence to fluid…

  3. Detection of Subarachnoid Hemorrhage at Acute and Subacute/Chronic Stages: Comparison of Four Magnetic Resonance Imaging Pulse Sequences and Computed Tomography

    Directory of Open Access Journals (Sweden)

    Mei-Kang Yuan

    2005-03-01

    Conclusion: FLAIR and GE T2* MRI pulse sequences, and CT scans, are all statistically significant indicators of acute SAH. GE T2*-weighted images are statistically significant indicators of subacute-to-chronic SAH, whereas other MRI pulse sequences, and CT scans, are not.

  4. Management of pregnancy in pancreas alone transplant recipient complicated with stage-4 chronic renal insufficiency and superimposed pre-eclampsia: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Yung-Shih Lee

    2017-10-01

    Conclusion: Child-bearing in solid organ transplantation recipients has become more promising nowadays, even for a difficult case of pancreas-alone transplant recipient complicated with chronic renal insufficiency and superimposed pre-eclampsia. Thorough antepartum counseling and cautious monitoring of maternal, fetal and graft conditions by multidisciplinary specialties are key to favorable pregnancy outcomes.

  5. Alterations of retinol-binding protein 4 species in patients with different stages of chronic kidney disease and their relation to lipid parameters

    DEFF Research Database (Denmark)

    Henze, Andrea; Frey, Simone K; Raila, Jens

    2010-01-01

    ) was assessed in serum of 45 healthy controls and 52 patients with stage 2-5 of CKD using ELISA and RBP4 immunoprecipitation with subsequent MALDI-TOF-MS analysis. A reduction of glomerular filtration rate was accompanied by a gradual elevation of RBP4 serum levels and relative amounts of RBP4-LL. Correlation...

  6. Macrosomia is the only reliable predictor of shoulder dystocia in babies weighing 3.5 kg or more.

    Science.gov (United States)

    Mansor, Asmah; Arumugam, Kulenthran; Omar, Siti Zawiah

    2010-03-01

    To determine if shoulder dystocia can be predicted in babies born weighing 3.5 kg or more. A case-control study nested in a perinatal database of 899 mothers and their babies who weighed 3.5 kg or more. All were term pregnancies and delivered vaginally. A case was defined as any baby that encountered shoulder dystocia at delivery. Controls were deliveries over the same period that were not complicated by shoulder dystocia. A logistic regression model was created with macrosomia, parity, previous delivery of more than 3.5 kg, diabetes in pregnancy, prolonged labor, prolonged second stage and instrumental delivery as the independent variables. The adjusted odds ratio and the receiver operator characteristics (ROC) curves were used to see if these variables, both individually and as a model, were associated with or were discriminative enough to predict shoulder dystocia; an ROC curve of more than 0.7 showing good prediction. There were 36 cases of shoulder dystocia during the study period, an incidence of 4%. Previous delivery of more than 3.5 kg, prolonged labor and prolonged second stage were not associated with shoulder dystocia. Although diabetes and instrumental delivery were independently and significantly associated with shoulder dystocia their importance as a predictor became relevant only in the presence of macrosomia. Macrosomia is the only reliable predictor of shoulder dystocia. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

  7. Efficacy and safety of direct-acting antivirals-based antiviral therapies for hepatitis C virus patients with stage 4-5 chronic kidney disease: a meta-analysis.

    Science.gov (United States)

    Li, Tao; Qu, Yundong; Guo, Ying; Wang, Yan; Wang, Lei

    2017-07-01

    The aim of this study was to assess the efficacy and safety of direct-acting antivirals (DAA)-based antiviral therapies for HCV patients with stage 4-5 chronic kidney disease. We conducted a systematic literature search in PubMed, EMBASE, Web of Science, and CENTRAL on the Cochrane Library without time and language limitations. The search strategy used was "(End stage renal disease OR chronic kidney failure OR severe renal impairment OR chronic kidney disease OR dialysis) AND (sofosbuvir OR simeprevir OR grazoprevir OR elbasvir OR ombitasvir OR paritaprevir OR ritonavir OR dasabuvir OR daclatasvir OR asuparevir OR direct-acting antiviral OR DAA)". Sustained virologic response at 12 weeks after the end of treatment (SVR12), adverse events (AEs) and/or serious adverse events (SAEs) with 95% confidence intervals (CI) were pooled. Eleven studies, comprising a total of 264 patients were included for our meta-analysis. The pooled SVR12 rate were 93.2% (95% CI 89.9%-95.9%, I 2 =0.0%), 89.4% (95% CI 82.0%-95.0%, I 2 =0.0%) and 94.7% (95% CI 91.0%-97.5%, I 2 =0.0%) in total population, patients with sofosbuvir-based therapies and patients with non-sofosbuvir-based therapies respectively. For HCV genotype 1 patients, the pooled SVR12 rate was 93.1% (95% CI 88.3%-96.7%, I 2 =20.0%). The pooled incidence of SAEs was 12.1% (95% CI 6.2%-19.7%, I 2 =55.0%). The pooled discontinuation rate because of AEs or SAEs in our meta-analysis was 2.2% (95% CI 0.8%-4.4%, I 2 =0.0%). DAA-based antiviral therapies are effective and well-tolerated for HCV patients with stage 4-5 chronic kidney disease. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Compensatory structural and functional adaptation after radical nephrectomy for renal cell carcinoma according to preoperative stage of chronic kidney disease. Choi DK, Jung SB, Park BH, Jeong BC, Seo SI, Jeon SS, Lee HM, Choi HY, Jeon HG.J Urol. 2015 Oct;194(4):910-5. [Epub 2015 Apr 28]. doi: 10.1016/j.juro.2015.04.093.

    Science.gov (United States)

    Jay, Raman; Jung, S B; Park, B H; Jeong, B C; Seo, S I; Jeon, S S; Lee, H M; Choi, H Y; Jeon, H G

    2017-03-01

    We investigated structural hypertrophy and functional hyperfiltration as compensatory adaptations after radical nephrectomy in patients with renal cell carcinoma according to the preoperative chronic kidney disease stage. We retrospectively identified 543 patients who underwent radical nephrectomy for renal cell carcinoma between 1997 and 2012. Patients were classified according to preoperative glomerular filtration rate as no chronic kidney disease-glomerular filtration rate 90ml/min/1.73m 2 or greater (230, 42.4%), chronic kidney disease stage II-glomerular filtration rate 60 to less than 90ml/min/1.73m 2 (227, 41.8%), and chronic kidney disease stage III-glomerular filtration rate 30 to less than 60ml/min/1.73m 2 (86, 15.8%). Computerized tomography performed within 2 months before surgery and 1 year after surgery was used to assess functional renal volume for measuring the degree of hypertrophy of the remnant kidney, and the preoperative and postoperative glomerular filtration rate per unit volume of functional renal volume was used to calculate the degree of hyperfiltration. Among all patients (mean age = 56.0y) mean preoperative glomerular filtration rate, functional renal volume, and glomerular filtration rate/functional renal volume were 83.2ml/min/1.73m 2 , 340.6cm 3 , and 0.25ml/min/1.73m 2 /cm 3 , respectively. The percent reduction in glomerular filtration rate was statistically significant according to chronic kidney disease stage (no chronic kidney disease 31.2% vs. stage II 26.5% vs. stage III 12.8%, P<0.001). However, the degree of hypertrophic functional renal volume in the remnant kidney was not statistically significant (no chronic kidney disease 18.5% vs. stage II 17.3% vs. stage III 16.5%, P = 0.250). The change in glomerular filtration rate/functional renal volume was statistically significant (no chronic kidney disease 18.5% vs. stage II 20.1% vs. stage III 45.9%, P<0.001). Factors that increased glomerular filtration rate/functional renal

  9. Adenosine 3':5'-cyclic monophosphate in higher plants: Isolation and characterization of adenosine 3':5'-cyclic monophosphate from Kalanchoe and Agave.

    Science.gov (United States)

    Ashton, A R; Polya, G M

    1977-07-01

    1.3':5'-Cyclic AMP was extensively purified from Kalanchoe daigremontiana and Agave americana by neutral alumina and anion- and cation-exchange column chromatography. Inclusion of 3':5'-cyclic [8-3H]AMP from the point of tissue extraction permitted calculation of yields. The purification procedure removed contaminating material that was shown to interfere with the 3':5'-cyclic AMP estimation and characterization procedures. 2. The partially purified 3':5'-cyclic AMP was quantified by means of a radiochemical saturation assay using an ox heart 3':5'-cyclic AMP-binding protein and by an assay involving activation of a mammalian protein kinase. 3. The plant 3':5'-cyclic AMP co-migrated with 3':5'-cyclic [8-3H]AMP on cellulose chromatography, poly(ethyleneimine)-cellulose chromatography and silica-gel t.l.c. developed with several solvent systems. 4. The plant 3':5'-cyclic AMP was degraded by ox heart 3':5'-cyclic nucleotide phosphodiesterase at the same rates as authentic 3':5'-cyclic AMP. 1-Methyl-3-isobutylxanthine (1 mM), a specific inhibitor of the 3':5'-cyclic nucleotide phosphodieterase, completely inhibited such degradation. 5. The concentrations of 3':5'-cyclic AMP satisfying the above criteria in Kalanchoe and Agave were 2-6 and 1 pmol/g fresh wt. respectively. Possible bacterial contribution to these analyses was estimated to be less than 0.002pmol/g fresh wt. Evidence for the occurrence of 3':5'-cyclic AMP in plants is discussed.

  10. Adenosine 3':5'-cyclic monophosphate in higher plants: Isolation and characterization of adenosine 3':5'-cyclic monophosphate from Kalanchoe and Agave.

    Science.gov (United States)

    Ashton, A R; Polya, G M

    1977-01-01

    1.3':5'-Cyclic AMP was extensively purified from Kalanchoe daigremontiana and Agave americana by neutral alumina and anion- and cation-exchange column chromatography. Inclusion of 3':5'-cyclic [8-3H]AMP from the point of tissue extraction permitted calculation of yields. The purification procedure removed contaminating material that was shown to interfere with the 3':5'-cyclic AMP estimation and characterization procedures. 2. The partially purified 3':5'-cyclic AMP was quantified by means of a radiochemical saturation assay using an ox heart 3':5'-cyclic AMP-binding protein and by an assay involving activation of a mammalian protein kinase. 3. The plant 3':5'-cyclic AMP co-migrated with 3':5'-cyclic [8-3H]AMP on cellulose chromatography, poly(ethyleneimine)-cellulose chromatography and silica-gel t.l.c. developed with several solvent systems. 4. The plant 3':5'-cyclic AMP was degraded by ox heart 3':5'-cyclic nucleotide phosphodiesterase at the same rates as authentic 3':5'-cyclic AMP. 1-Methyl-3-isobutylxanthine (1 mM), a specific inhibitor of the 3':5'-cyclic nucleotide phosphodieterase, completely inhibited such degradation. 5. The concentrations of 3':5'-cyclic AMP satisfying the above criteria in Kalanchoe and Agave were 2-6 and 1 pmol/g fresh wt. respectively. Possible bacterial contribution to these analyses was estimated to be less than 0.002pmol/g fresh wt. Evidence for the occurrence of 3':5'-cyclic AMP in plants is discussed. PMID:196595

  11. Assessing risk of fibrosis progression and liver-related clinical outcomes among patients with both early stage and advanced chronic hepatitis C.

    Directory of Open Access Journals (Sweden)

    Monica A Konerman

    Full Text Available Assessing risk of adverse outcomes among patients with chronic liver disease has been challenging due to non-linear disease progression. We previously developed accurate prediction models for fibrosis progression and clinical outcomes among patients with advanced chronic hepatitis C (CHC. The primary aim of this study was to validate fibrosis progression and clinical outcomes models among a heterogeneous patient cohort.Adults with CHC with ≥3 years follow-up and without hepatic decompensation, hepatocellular carcinoma (HCC, liver transplant (LT, HBV or HIV co-infection at presentation were analyzed (N = 1007. Outcomes included: 1 fibrosis progression 2 hepatic decompensation 3 HCC and 4 LT-free survival. Predictors included longitudinal clinical and laboratory data. Machine learning methods were used to predict outcomes in 1 and 3 years.The external cohort had a median age of 49.4 years (IQR 44.3-54.3; 61% were male, 80% white, and 79% had genotype 1. At presentation, 73% were treatment naïve and 31% had cirrhosis. Fibrosis progression occurred in 34% over a median of 4.9 years (IQR 3.2-7.6. Clinical outcomes occurred in 22% over a median of 4.4 years (IQR 3.2-7.6. Model performance for fibrosis progression was limited due to small sample size. The area under the receiver operating characteristic curve (AUROC for 1 and 3-year risk of clinical outcomes was 0.78 (95% CI 0.73-0.83 and 0.76 (95% CI 0.69-0.81.Accurate assessments for risk of clinical outcomes can be obtained using routinely collected data across a heterogeneous cohort of patients with CHC. These methods can be applied to predict risk of progression in other chronic liver diseases.

  12. [Cardiovascular protection of diabetic patient with chronic renal disease and particular case of end-stage renal disease in elderly patients].

    Science.gov (United States)

    Zaoui, P; Hannedouche, T; Combe, C

    2017-06-01

    Type 2 diabetes has an increasing prevalence. Life expectancy is dominated by cardiovascular risk, which is the leading cause of death in these patients. Up to one third of diabetic patients will develop diabetic nephropathy related to micro-angiopathy. Renal impairment further increases cardiovascular risk. Reducing cardiovascular morbidity and mortality is a major public health issue, as well as early preventing and managing chronic kidney disease (CKD). Good glycemic control prevents the micro-vascular complications of the disease (retinopathy, nephropathy, etc.) and, more recently recognized through prolonged monitoring of the VADT cohort, prevents cardiovascular complications. Control of blood pressure and dyslipidemia are essential in primary or secondary cardiovascular prevention. In addition, the blockers of the renin-angiotensin system slow down the progression of the MRC. Elderly patients with chronic kidney disease (CKD) form another growing group of the nephrologist daily patient pool. Especially for very elderly patients with comorbidities, the question of favoring conservative treatment rather than starting or pursuing dialysis may arise. Survival and quality of life are indeed not necessarily better in elderly patients undergoing dialysis, complications can occur eventually leading to discontinuation, and are occasionally associated with a feeling of stubbornness. Creation of prognostic score is a useful tool to help the decision-making process. However, dialogue with the patient and his/her family, as well as multidisciplinary collaboration remain fundamentals to determine the most suitable care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. The effectiveness of a multidisciplinary pain management programme managing chronic pain on pain perceptions, health-related quality of life and stages of change--A non-randomized controlled study.

    Science.gov (United States)

    Dysvik, Elin; Kvaløy, Jan Terje; Stokkeland, Ragnhild; Natvig, Gerd Karin

    2010-07-01

    Cognitive behavioural therapy (CBT) has been useful in the treatment of chronic pain conditions for many years. Given the increasing number of persons with chronic pain and associated psychosocial problems, the development and implementation of effective interventions based on CBT is warranted. The aim of this study is to evaluate the effects of a multidisciplinary pain management programme on health-related quality of life (HRQL), as measured by the Short Form Health Survey (SF-36), pain perception as measured by the Brief Pain Inventory (BPI), and readiness-to-change as measured by the Pain Stages of Change Questionnaire (PSOCQ). A pretest-post-test quasi-experimental design, with waiting list controls and baseline and post-test measures, was used. The study was conducted in the rehabilitation unit of a university hospital. Of 117 people suffering from chronic pain, 113 completed the 8-week multidisciplinary pain management programme. The patients were consecutive referrals. Inclusion criteria were: adults (18-67 years), pain lasting over 6 months, motivation and no ongoing litigation. Exclusion criteria were affected by major mental disorders or major medical conditions requiring treatment. The intervention was based on a cognitive behavioural approach. Therapeutic dialogues and training, combined with physical activity, were provided to a fixed plan, including homework. The programme has several features that directly address psychosocial aspects of chronic pain. Statistical and clinical significance are considered. The findings suggest that this programme has the potential to improve HRQL, reduce pain intensity and interference, and contribute to improvement in readiness-to-change. Statistically significant results are supplemented by results showing their clinical significance. Improvements in HRQL, pain-related disability, and readiness-to-change suggest that the vicious cycle of chronic pain may be alleviated by our programme. As we see it, effective

  14. One-third of an Archivial Series of Papillary Thyroid Cancer (Years 2007–2015 Has Coexistent Chronic Lymphocytic Thyroiditis, Which Is Associated with a More Favorable Tumor-Node-Metastasis Staging

    Directory of Open Access Journals (Sweden)

    Antonio Ieni

    2017-12-01

    Full Text Available The significance and impact of the coexistence of chronic lymphocytic thyroiditis (CLT with thyroid cancer is still debated. To verify the influence of CLT on papillary thyroid cancer (PTC, we retrospectively collected 505 PTC cases and analyzed age at diagnosis, sex, size, lymph node status, and staging. We found that CLT was present in 168 PTC (33.3%. Compared with the 337 patients without CLT (non-CLT, CLT patients were younger (44.42 ± 13.72 vs. 47.21 ± 13.76 years, P = 0.03, had smaller tumors (9.39 ± 6.10 vs. 12 ± 9.71 mm, P = 0.002, and lower rate of lymph node metastases (12.5 vs. 21.96%, P = 0.01, OR = 0.508. Tumor-node-metastasis (TNM staging (T1a through T4 was more favorable for the CLT group compared to the non-CLT group (for instance, T1a = 65.5 vs. 49.8%, T3 = 4.8 vs. 23.4%. This study shows that one in three patients with PTC harbors CLT, which is associated with a more favorable TNM staging, consistently with a favorable outlook of PTC.

  15. Lesões crônicas de tendões flexores na mão: reconstrução em dois estágios Chronic flexor tendon lesions: reconstruction in two stages

    Directory of Open Access Journals (Sweden)

    Samuel Ribak

    2002-06-01

    Full Text Available Os autores apresentam resultados de tratamento de lesões crônicas dos tendões flexores na mão, usando técnica em dois estágios. O primeiro pelo implante de prótese de silicone e o segundo com enxerto de tendão. Dão detalhes de técnica, e analisam seus resultados comparando-os com os da literatura. Chegam a conclusão que a técnica dá resultados satisfatórios na maioria dos casos.The authors present the results of a two-stage treatment of chronic flexor tendon injuries of the hand. In the first stage a silicone prosthesis is implanted and in the second stage a tendon graft. Details of the technique and results of the analysis are presented and compared with the scientific literature. The authors concluded that satisfactory results were achieved in most of the cases.

  16. Determination and thermodynamic modeling of solid–liquid phase equilibrium for 3,5-dichloroaniline in pure solvents and ternary 3,5-dichloroaniline + 1,3,5-trichlorobenzene + toluene system

    International Nuclear Information System (INIS)

    Li, Rongrong; Du, Cunbin; Meng, Long; Han, Shuo; Wang, Jian; Zhao, Hongkun

    2016-01-01

    Highlights: • Solubility of 3,5-dichloroaniline in seven organic solvents were determined. • Solid–liquid phase equilibrium for ternary system was measured. • The binary and ternary phase diagrams were constructed. • The phase diagrams were correlated with thermodynamic models. - Abstract: The solid–liquid phase equilibrium data for 3,5-dichloroaniline in n-propanol, isopropanol, n-butanol, isobutanol, toluene, ethyl acetate and acetone at (283.15 to 308.15) K were determined experimentally by gas chromatography under 101.3 kPa. The solubility of 3,5-dichloroaniline in these solvents decreased according to the following order: ethyl acetate > (acetone, toluene) for the solvents of ethyl acetate, acetone, and toluene; and for the other solvents, (isopropanol, n-butanol) > n-propanol > isobutanol. According to the solubility of 3,5-dichloroaniline in pure solvents, the solid–liquid phase equilibrium for the ternary mixture of 3,5-dichloroaniline + 1,3,5-trichlorobenzene + toluene were measured by using an isothermal saturation method at three temperatures of 283.15, 293.15, and 303.15 K under 101.3 kPa, and the corresponding isothermal phase diagrams were constructed. Two pure solids were formed in the ternary system at a fixed temperature, which were pure 3,5-dichloroaniline and pure 1,3,5-trichlorobenzene and were identified by Schreinemakers’ method of wet residue. The temperature dependence of 3,5-dichloroaniline solubility in pure solvents was correlated by the modified Apelblat equation, λh equation, Wilson model and NRTL model; and the ternary solid–liquid phase equilibrium of 3,5-dichloroaniline + 1,3,5-trichlorobenzene + toluene were described by the Wilson model and NRTL model. Results showed that calculated solubility values with these models agreed well with the experimental ones for the studied binary and ternary systems. The solid–liquid equilibrium and the thermodynamic models for the binary and ternary systems can offer the

  17. Multinational observational study on clinical practices and therapeutic management of mineral and bone disorders in patients with chronic kidney disease stages 4, 5, and 5D: The OCEANOS study

    Directory of Open Access Journals (Sweden)

    Faissal A. M. Shaheen

    2016-01-01

    Full Text Available Our aim is to assess the current clinical practices in monitoring and treatment patterns of chronic kidney disease (CKD-mineral bone disorder and the degree to which these practices met the kidney disease improving global outcome (KDIGO guidelines. This was an international, multi-center, cross-sectional, observational study in adult patients diagnosed with CKD Stages 4, 5, and 5D. Patients were enrolled from Middle East, South Asia, Eurasia, and Africa; patients with estimated glomerular filtration rate ≥30 mL/min/1.73 m 2 or with any medical/surgical conditions precluding their participation were excluded. Frequency of measurements, levels of serum calcium (Ca, phosphorus and parathormone (parathyroid hormone [PTH], and presence vascular/valvular calcification were recorded. Of the 2250 patients enrolled, data on 2247 patients were evaluated. Overall, only a small percentage of patients met all three target KDIGO ranges of serum Ca, phosphorus, and PTH (13.7% [95% confidence interval: 12.0; 15.4], with a higher proportion among CKD Stage 5D patients (14.8% than CKD Stage 4 and 5 (5.6% patients. Majority (84.3% of the patients received treatment with phosphorous binders, of whom 85.5% received Ca-based phosphate binders. Overall, 57.0% of patients received Vitamin D treatment with a similar frequency among patients with CKD Stages 4, 5, and 5D. Over half (65.7% of the patients were screened for vascular/valvular calcification; of these, 58.8% had ≥1 calcification. Diabetes status, P, PTH, and low density lipoprotein-cholesterol had significant impact on the prescription pattern of phosphorous binders. The current practices for the management of bone and mineral metabolism in CKD patients in the study region fall far short of meeting the KDIGO target range.

  18. GENE EXPRESSION CHANGES IN ARABIDOPSIS THALIANA SEEDLING ROOTS EXPOSED TO THE MUNITION HEXAHYDRO-1,3,5-TRINITRO-1,3,5-TRIAZINE

    Science.gov (United States)

    Arabidopsis thaliana root transcriptome responses to the munition, hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX), were assessed using serial analysis of gene expression (SAGE). Comparison of the transcriptional profile for the RDX response to a profile previously described for Ar...

  19. Influence of Diet Balanced with Essential Amino Acids / Keto Acid Analogs and High-Nutrient Blend on the Progression of Renal Failure in Patients in the Pre-Dialysis Stage of Chronic Kidney Disease Caused by Systemic Autoimmune Diseases

    Directory of Open Access Journals (Sweden)

    I.I. Aleksandrova

    2013-09-01

    Full Text Available The aim of the study was to evaluate the effect of a low protein diet (LPD balanced with essential amino acids (EAA / keto acid analogs (KAA and protein “SUPRO-XT 219D” in the composition of the high-energy nutrient blend (HENB for slow down of renal failure in patients in the pre-dialysis stage of chronic kidney disease (CKD induced by systemic autoimmune diseases (SAD.Material and Methods: In this study, 46 patients (35 with systemic lupus erythematosus and 15 with various forms of systemic vasculitis with CKD in stages 3-4 were randomized into three groups. Group 1 (18 patients: 10 with CKD stage 3 and 8 with CKD stage 4 was given LPD (0.6 g protein per kg of body weight per day comprising 0.3 g of vegetable protein and 0.3 g of animal protein balanced with EAA/KAA (Diet #1; Group 2 (18 patients: 9 with CKD stage 3 and 9 with CKD stage 4 was given the same LPD, but with an increased vegetable protein content (purified soy protein SUPRO-XT 219D up to 0.4 g/kg/day in the composition of HENB (Diet #2; Group 3, comparison group, (10 patients: 7 with CKD stage 3 and 3 with CKD stage 4 was given a free diet (Diet #3 based on the patient’s personal preferences. Both options of LPD were offered to all the patients of Groups 1 and 2 regardless of their baseline nutritional status (NS. The duration of the observation was 24-48 months. The NS was evaluated based on the bioelectrical impedance analysis. The protein and calorie intake was calculated from the 3-day food diary.Results: Among the 46 patients with CKD stages 3-4, NS impairment was detected in almost half the patients (45.7%. Both forms of LPD were well tolerated. The correction of the nutritive impairment was achieved in patients with baseline impaired NS; the remaining patients of Groups 1 and 2 demonstrated the safety of NS against LPD. At the same time, among Group 3 patients, during the progression of renal disorders, the NS rate was observed to increase by 1.5 times (from 40% to 60

  20. 1,3,5-Triethylbenzene Transformation Reactions Compared to Its Transalkylation Reaction with Ethylbenzene

    KAUST Repository

    Akhtar, M. Naseem

    2009-08-20

    The transalkylation of 1,3,5-triethylbenzene (1,3,5-TEB) with ethylbenzene (EB) has been studied over USYtype catalysts using a riser simulator that mimics the operation of a fluidized-bed reactor. The reaction mixture EB and 1,3,5-TEB was used at a molar ratio of 1:1, which is equivalent to 40:60 wt % of EB/1,3,5-TEB, respectively. The reaction temperature was varied from 350 to 500 °C with a time on stream ranging from 3-15 s. The effect of reaction conditions on 1,3,5-TEB conversion, DEB selectivity, and isomerization of 1,3,5-TEB is reported. The transalkylation of 1,3,5-TEB with EB has been compared to the transformation reaction of pure 1,3,5-TEB and EB. The experimental results have revealed that reactivity of 1,3,5-TEB and selectivity of DEB is increased during the transalkylation reaction (EB + 1,3,5-TEB) as compared to the transformation reaction of pure EB or 1,3,5-TEB. The 1,3,5-TEB undergoes isomerization and a cracking reaction to produce DEB and EB but does not undergo any appreciable disproportionation reaction. The isomerization of 1,3,5-TEB is more active at low temperatures, while cracking is more active at high temperatures. © 2009 American Chemical Society.

  1. [Effects of different variants of low-protein diet on progression of chronic renal failure and indices of nutritional status in predialysis stage].

    Science.gov (United States)

    Riabov, S I; Kucher, A G; Grigor'eva, N D; Kaiukov, I G; Ermakov, Iu A

    2001-01-01

    To investigate effects of different variants of low-protein diet (LPD) (standard and with soy bean protein isolates) on inhibition of chronic renal failure (CRF) progression and prevention of protein-energy insufficiency in predialysis patients. 150 patients with CRF were divided into three groups 50 patients each. Group 1 patients were given combined LPD with addition of soy bean isolate (0.4 g of protein per 1 kg of recommended body mass a day with standard diet and 0.2 g/kg with protein isolate SUPRO 760). Group 2 patients were given standard LPD without additives (0.6 g/kg a day). Patients of group 3 received free diet. All the patients were normally supplied with energy (at least 30-35 kcal/day). In the course of 26 months, clinical, laboratory, anthropometric, expected and functional parameters were measured each 4 months. Progression of CRF inhibited in patients with restricted protein provision. LPD had no negative effect on laboratory indices. Soy bean isolate LPD was more effective in inhibition of the disease progression than the standard one. LPD can be used for a long time for inhibition of the progression of CRF provided energy requirements are met. LPD with food additives (soya bean protein isolates) hold perspective for correction of metabolic disorders.

  2. Effect of tiotropium on lung function decline in early-stage of chronic obstructive pulmonary disease patients: propensity score-matched analysis of real-world data.

    Science.gov (United States)

    Lee, Ha Youn; Choi, Sun Mi; Lee, Jinwoo; Park, Young Sik; Lee, Chang-Hoon; Kim, Deog Kyeom; Lee, Sang-Min; Yoon, Ho Il; Yim, Jae-Joon; Kim, Young Whan; Han, Sung Koo; Yoo, Chul-Gyu

    2015-01-01

    Tiotropium failed to slow the annual rate of forced expiratory volume in 1 second (FEV1) decline in chronic obstructive pulmonary disease (COPD) patients with pulmonary tuberculosis, pulmonary resection, or long-term use of a short-acting muscarinic antagonist. The annual lung function decline in patients using tiotropium was compared with that in patients not using the drug. Of the 587 patients enrolled in the study, 257 took tiotropium. Following propensity score matching, 404 patients were included in the analysis. The mean annual rate of post-BD FEV1 decline was 23.9 (tiotropium) and 22.5 (control) mL/yr (P=0.86); corresponding pre-BD values were 30.4 and 21.9 mL/yr (P=0.31), respectively. Mean annual rate of post-BD FVC decline was 55.1 (tiotropium) and 43.5 (control) mL/yr (P=0.33); corresponding pre-BD values were 37.1 and 33.3 mL/yr (P=0.13). Therefore, tiotropium does not reduce the rate of lung function decline in COPD patients with FEV1≥70%.

  3. Incidence, mortality, and prevalence of end-stage chronic renal disease in the Bajo Lempa region of El Salvador: A ten-year community registry.

    Science.gov (United States)

    García-Trabanino, Ramón; Hernández, Carolina; Rosa, Adrián; Domínguez Alonso, Jesús

    The Bajo Lempa is an impoverished rural coastal region of El Salvador affected by the chronic kidney disease (CKD) epidemic known as Mesoamerican nephropathy. The local community organisation Fondo Social de Emergencia para la Salud (FSES) (Emergency social fund for health) is helping to fight the epidemic in 42 communities of the region (19,223 inhabitants; average age 26.7 years; 48.5% male; 40.2% social security and 1 in the military health system. 246 patients died (annual average 24.6 deaths; 89.4% male; average age 56.1 years; 92.3% at home). Average annual mortality rate: 128/100,000 population. Prevalence of patients receiving RRT in 2013: 1300.5 pmp (N=25; 84% male; average age 51 years). This region has a high incidence of ESRD. Few receive RRT. Patient mortality is high even with RRT. Most patients are male (9:1). Social determinants influence the high mortality. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  4. Stage design

    International Nuclear Information System (INIS)

    Shacter, J.

    1975-01-01

    A method is described of cycling gases through a plurality of diffusion stages comprising the steps of admitting the diffused gases from a first diffusion stage into an axial compressor, simultaneously admitting the undiffused gases from a second diffusion stage into an intermediate pressure zone of said compressor corresponding in pressure to the pressure of said undiffused gases, and then admitting the resulting compressed mixture of diffused and undiffused gases into a third diffusion stage

  5. Chronic pancreatitis

    Science.gov (United States)

    Chronic pancreatitis - chronic; Pancreatitis - chronic - discharge; Pancreatic insufficiency - chronic; Acute pancreatitis - chronic ... abuse over many years. Repeated episodes of acute pancreatitis can lead to chronic pancreatitis. Genetics may be ...

  6. Biological stereoselective reduction of 3,3,5-trimethylcyclohexanone by Glomerella cingulata.

    Science.gov (United States)

    Okamura, S; Kameoka, H; Miyazawa, M

    2001-01-01

    The microbial transformation of 3,3,5-trimethylcyclohexanone was investigated using the plant pathogenic fungus, Glomerella cingulata. With this organism 3,3,5-trimethylcyclohexanone gave the corresponding cis- and trans-3,3,5-trimethylcyclohexanols with the ratio of 20:1 forming the cis-isomer highly stereoselectively, upon 5 days incubation together with 3,3,5-trimethyl-2-cyclohexen-1-one (isophrone) as a minor product.

  7. Clinical practice recommendations for treatment with active vitamin D analogues in children with chronic kidney disease Stages 2-5 and on dialysis.

    Science.gov (United States)

    Shroff, Rukshana; Wan, Mandy; Nagler, Evi V; Bakkaloglu, Sevcan; Cozzolino, Mario; Bacchetta, Justine; Edefonti, Alberto; Stefanidis, Constantinos J; Vande Walle, Johan; Ariceta, Gema; Klaus, Günter; Haffner, Dieter; Schmitt, Claus Peter

    2017-07-01

    In patients with chronic kidney disease (CKD), renal synthesis of active vitamin D [1,25-dihydroxyvitamin D (1,25(OH)2D)] declines and is associated with hypocalcaemia, secondary hyperparathyroidism and the spectrum of CKD-mineral and bone disorder (MBD). In advanced CKD, active vitamin D analogues, including alfacalcidol, calcitriol and paricalcitol, are routinely administered. There are few studies on the use of vitamin D analogues in children with CKD and on dialysis. It is difficult to define bone-specific outcomes that can guide treatment with active vitamin D analogues in children with CKD-MBD. A core working group (WG) of the European Society for Paediatric Nephrology (ESPN) CKD-MBD and Dialysis WGs has developed recommendations for the use of active vitamin D therapy in children with CKD and on dialysis. A second document in parallel with this one covers treatment recommendations for native vitamin D therapy. The WGs have performed an extensive literature review to include systematic reviews and randomized controlled trials in adults and children with CKD and prospective observational studies in children with CKD. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system was used to develop and grade the recommendations. In the absence of applicable study data, the opinion of experts from the ESPN CKD-MBD and Dialysis WGs is provided, but clearly GRADE-ed as such and must be carefully considered by the treating physician and adapted to individual patient needs as appropriate. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  8. Chronic Exposure of Early Stages of Development of Japanese Oyster to Contaminants from the Industry in the English Channel. Stress Markers at Integrated and Molecular Level

    International Nuclear Information System (INIS)

    Devos, Alexandre

    2013-01-01

    This thesis explores the effects of pollutants from the industry in the English Channel, in particular radionuclides, on the early stages of development of the Japanese oyster Crassostrea gigas. Original experimental devices were designed to study in laboratory controlled conditions the growth of a large number of larvae and spats. Emphasis was given to a joint use of stress markers at integrated and molecular levels. First exposures to non-radioactive pollutants revealed a highly sensitive response of the growth of juveniles exposed to a metal (zinc). Thereafter, juveniles were exposed for several weeks to dose rates of ionizing radiation and radionuclide activities several orders of magnitude higher than the levels likely to be encountered in the marine environment. An eco-geno-toxicological approach contributed to the understanding of the effects of ionizing radiations on DNA. The results strongly suggest that biochemical mechanisms act efficiently against radio-induced damages as early as the first days of life of the Japanese oyster. It still remains a lack of information about the long-term effects of DNA damages to higher level of biological organization. (author) [fr

  9. High Intensity Interval Training Favourably Affects Angiotensinogen mRNA Expression and Markers of Cardiorenal Health in a Rat Model of Early-Stage Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Patrick S. Tucker

    2015-01-01

    Full Text Available The majority of CKD-related complications stem from cardiovascular pathologies such as hypertension. To help reduce cardiovascular complications, aerobic exercise is often prescribed. Emerging evidence suggests high intensity interval training (HIIT may be more beneficial than traditional aerobic exercise. However, appraisals of varying forms of aerobic exercise, along with descriptions of mechanisms responsible for health-related improvements, are lacking. This study examined the effects of 8 weeks of HIIT (85% VO2max, versus low intensity aerobic exercise (LIT; 45–50% VO2max and sedentary behaviour (SED, in an animal model of early-stage CKD. Tissue-specific mRNA expression of RAAS-related genes and CKD-related clinical markers were examined. Compared to SED, HIIT resulted in increased plasma albumin (p=0.001, reduced remnant kidney weight (p=0.028, and reduced kidney weight-body weight ratios (p=0.045. Compared to LIT, HIIT resulted in reduced Agt mRNA expression (p=0.035, reduced plasma LDL (p=0.001, triglycerides (p=0.029, and total cholesterol (p=0.002, increased plasma albumin (p=0.047, reduced remnant kidney weight (p=0.005, and reduced kidney weight-body weight ratios (p=0.048. These results suggest HIIT is a more potent regulator of several markers that describe and influence health in CKD.

  10. Addition of Rice Bran Arabinoxylan to Curcumin Therapy May Be of Benefit to Patients With Early-Stage B-Cell Lymphoid Malignancies (Monoclonal Gammopathy of Undetermined Significance, Smoldering Multiple Myeloma, or Stage 0/1 Chronic Lymphocytic Leukemia): A Preliminary Clinical Study.

    Science.gov (United States)

    Golombick, Terry; Diamond, Terrence H; Manoharan, Arumugam; Ramakrishna, Rajeev

    2016-06-01

    Hypothesis Prior studies on patients with early B-cell lymphoid malignancies suggest that early intervention with curcumin may lead to delay in progressive disease and prolonged survival. These patients are characterized by increased susceptibility to infections. Rice bran arabinoxylan (Ribraxx) has been shown to have immunostimulatory, anti-inflammatory, and proapoptotic effects. We postulated that addition of Ribraxx to curcumin therapy may be of benefit. Study design Monoclonal gammopathy of undetermined significance (MGUS)/smoldering multiple myeloma (SMM) or stage 0/1 chronic lymphocytic leukemia (CLL) patients who had been on oral curcumin therapy for a period of 6 months or more were administered both curcumin (as Curcuforte) and Ribraxx. Methods Ten MGUS/SMM patients and 10 patients with stage 0/1 CLL were administered 6 g of curcumin and 2 g Ribraxx daily. Blood samples were collected at baseline and at 2-month intervals for a period of 6 months, and various markers were monitored. MGUS/SMM patients included full blood count (FBC); paraprotein; free light chains/ratio; C-reactive protein (CRP)and erythrocyte sedimentation rate (ESR); B2 microglobulin and immunological markers. Markers monitored for stage 0/1 CLL were FBC, CRP and ESR, and immunological markers. Results Of 10 MGUS/SMM patients,5 (50%) were neutropenic at baseline, and the Curcuforte/Ribraxx combination therapy showed an increased neutrophil count, varying between 10% and 90% among 8 of the 10 (80%) MGUS/SMM patients. An additional benefit of the combination therapy was the potent effect in reducing the raised ESR in 4 (44%) of the MGUS/SMM patients. Conclusion Addition of Ribraxx to curcumin therapy may be of benefit to patients with early-stage B-cell lymphoid malignancies. © The Author(s) 2016.

  11. Risk Score to Predict 1-Year Mortality after Haemodialysis Initiation in Patients with Stage 5 Chronic Kidney Disease under Predialysis Nephrology Care

    Science.gov (United States)

    Onishi, Yoshihiro

    2015-01-01

    Background Few risk scores are available for predicting mortality in chronic kidney disease (CKD) patients undergoing predialysis nephrology care. Here, we developed a risk score using predialysis nephrology practice data to predict 1-year mortality following the initiation of haemodialysis (HD) for CKD patients. Methods This was a multicenter cohort study involving CKD patients who started HD between April 2006 and March 2011 at 21 institutions with nephrology care services. Patients who had not received predialysis nephrology care at an estimated glomerular filtration rate (eGFR) of approximately 10 mL/min per 1.73 m2 were excluded. Twenty-nine candidate predictors were selected, and the final model for 1-year mortality was developed via multivariate logistic regression and was internally validated by a bootstrapping technique. Results A total of 688 patients were enrolled, and 62 (9.0%) patients died within one year of HD initiation. The following variables were retained in the final model: eGFR, serum albumin, calcium, Charlson Comorbidity Index excluding diabetes and renal disease (modified CCI), performance status (PS), and usage of erythropoiesis-stimulating agent (ESA). Their β-coefficients were transformed into integer scores: three points were assigned to modified CCI≥3 and PS 3–4; two to calcium>8.5 mg/dL, modified CCI 1–2, and no use of ESA; and one to albumin7 mL/min per 1.73 m2, and PS 1–2. Predicted 1-year mortality risk was 2.5% (score 0–4), 5.5% (score 5–6), 15.2% (score 7–8), and 28.9% (score 9–12). The area under the receiver operating characteristic curve was 0.83 (95% confidence interval, 0.79–0.89). Conclusions We developed a simple 6-item risk score predicting 1-year mortality after the initiation of HD that might help nephrologists make a shared decision with patients and families regarding the initiation of HD. PMID:26057129

  12. Prevalence of osteoporosis in patients with chronic kidney disease (stages 3–5 in comparison with age- and sex-matched controls: A study from Kashmir Valley Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    M Saleem Najar

    2017-01-01

    Full Text Available Chronic kidney disease (CKD is associated with a range of metabolic bone diseases. Fracture rates are higher in CKD patients than age-matched controls throughout all the five stages of CKD. Dialysis patients have 4 times as many hip fractures as expected for their age. CKD forms an independent risk factor for osteoporosis, even in the absence of traditional risk factors. This study was carried out at the nephrology unit in a tertiary care center of Kashmir to know the prevalence of osteoporosis in CKD patients having glomerular filtration rate (GFR <60 mL/min (stages 3–5. Among the 151 cases studied, the average estimated GFR was 16.78 ± 10.714 mL/min. There were 98 males (64.9% and 53 females (35.1%. Their mean age was 51.01 ± 14.138 years. Osteoporosis based on femoral neck T-Score was seen in 31 patients (31.6% while 43 patients (28.5% had osteoporosis at L1, L2 lumbar vertebrae. The prevalence of osteoporosis based on femoral neck T-Score as well as osteopenia was highest in stage-5 CKD. In our study, the body mass index (BMI had a positive correlation with osteoporosis; low BMI patients were at higher risk for osteoporosis (P = 0.014. In the Kashmir valley, the prevalence of osteoporosis was 31.8% in CKD patients against 22% in controls. Thus, CKD forms an important risk factor for osteoporosis even in the absence of traditional risk factors. We recommend early screening, detection, and management of osteoporosis to reduce the burden of morbidity and mortality in this subset of patients.

  13. Exit site and tunnel infections in children on chronic peritoneal dialysis: findings from the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative.

    Science.gov (United States)

    Swartz, Sarah J; Neu, Alicia; Skversky Mason, Amy; Richardson, Troy; Rodean, Jonathan; Lawlor, John; Warady, Bradley; Somers, Michael J G

    2018-02-26

    The Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative is a quality improvement initiative to reduce dialysis-associated infections. The frequency of peritoneal dialysis (PD) catheter exit site infection (ESI) and variables influencing its development and end result are unclear. We sought to determine ESI rates, to elucidate the epidemiology, risk factors, and outcomes for ESI, and to assess for association between provider compliance with care bundles and ESI risk. We reviewed demographic, dialysis and ESI data, and care bundle adherence and outcomes for SCOPE enrollees from October 2011 to September 2014. ESI involved only the exit site, only the subcutaneous catheter tunnel, or both. A total of 857 catheter insertions occurred in 734 children over 10,110 cumulative months of PD provided to these children. During this period 207 ESIs arose in 124 children or 0.25 ESIs per dialysis year. Median time to ESI was 392 days, with 69% of ESIs involving exit site only, 23% involving the tunnel only, and 8% involving both sites. Peritonitis developed in 6%. ESI incidence was associated with age (p = 0.003), being the lowest in children aged  0 at prior month's visit (p renal disease etiology, exit site orientation, catheter cuff number or mobilization, and presence of G-tube, stoma, or vesicostomy were unassociated with ESI incidence. Of the ESIs reported, 71% resolved with treatment, 24% required hospitalization, and 9% required catheter removal, generally secondary to tunnel infection. Exit site infections occur at an annualized rate of 0.25, typically well into the dialysis course. Younger patient age and documented review of site care are associated with lower ESI rates. Although most ESIs resolve, hospitalization is frequent, and tunnel involvement/catheter loss complicate outcomes.

  14. Experience of Percutaneous Versus Surgically Placed Catheter for Continuous Ambulatory Peritoneal Dialysis in Children with Chronic Kidney Disease Stage-V.

    Science.gov (United States)

    Afroz, S; Ferdaus, T; Khondokar, S A; Khan, M H; Hanif, M

    2016-10-01

    The lifespan and outcome of end stage renal disease (ESRD) children have dramatically improved since the development of continuous ambulatory peritoneal dialysis (CAPD), it offers several advantages over hemodialysis. Percutaneous placement of CAPD catheters in children is minimally invasive, reliable, safe and cost-effective method. Percutaneous method of CAPD catheter insertion can be used in children to avoid the complications of general anesthesia and surgery. This study was done to evaluate the efficacy of CAPD in children, to find out the complication profile of CAPD & to compare the advantages of surgical versus percutaneously placed CAPD catheters in children. This prospective longitudinal comparative study was carried out in the department of Pediatric Nephrology, Dhaka Medical College Hospital (DMCH), Bangladesh from July 2011 to June 2014. A total of 8 children with ESRD were included (Age 5-14 year, M: F=1: 1). All underwent CAPD, Group I = surgically placed CAPD catheter (N=5), Group II = percutaneously placed CAPD catheter (N=3). Average duration of CAPD in Group I and Group II were 31.6 vs. 9 (months) with a total of 158 vs. 27 patient months of CAPD respectively. The rate of complications of the 2 groups and their outcome were compared. Common complications being observed were peritonitis 1 episode per 12.1 vs. 1.8 patient months (pchildren (pchildren, but percutaneous method of catheter insertion is associated with higher rate of complications. Placement of catheter by surgical method with elective omentectomy will reduce catheter related complications. Early detection of peritonitis and prompt therapy is essential for a favourable outcome.

  15. Radioimmunoassay for 3,3',5'-triiodo-L-thyronine in unextracted serum: method and clinical results

    International Nuclear Information System (INIS)

    Nicod, P.; Burger, A.; Staeheli, V.; Vallotton, M.B.

    1976-01-01

    Serum 3,3',5'-triiodothyronine (rT 3 ) was measured with a radioimmunoassay in unextracted serum. The assay was specific and reproducible. The coefficients of variation for three different sera known for high, normal, and low rT 3 concentrations between assays were 4, 6, and 9 percent and within assays 4, 9, and 7 percent, respectively. In euthyroid subjects 20 to 60 years old, rT 3 was 450 +- 200 pg/ml (mean +- SD, n = 83). Serum rT 3 was found to be increased in hyperthyroidism (range: 762 to 2581 pg/ml; n = 11) but also in acute and chronic illness (up to 2400 pg/ml; n = 24) and in anorexia nervosa (536 to 1058 pg/ml; n = 7). In the latter two situations there was mostly an inverse change in serum 3,5,3'-triiodothyronine (T 3 ) which was in the low normal range or decreased. These findings suggest a metabolic control of thryoxine deiodination. A low serum rT 3 was found in 9 of 12 hypothyroid patients and in the serum of one chronically ill patient. Long-term treatment (1 to 7 years) with lithium carbonate slightly reduced serum rT 3 , although the changes were inside the normal range. Kidney function was not found to be necessary for its production, as anephric patients had normal rT 3 values. In addition, hemodialysis increased serum rT 3 , which is probably due to the heparin therapy

  16. The association between bioimpedance analysis and quality of life in pre-dialysis stage 5 chronic kidney disease, hemodialysis and peritoneal dialysis patients.

    Science.gov (United States)

    Yongsiri, Somchai; Thammakumpee, Jiranuch; Prongnamchai, Suriya; Dinchuthai, Pakaphan; Chueansuwan, Rachaneeporn; Tangjaturonrasme, Siriporn; Chaivanit, Pechngam

    2014-03-01

    Protein-energy wasting is a significant problem in End stage renal disease (ESRD) patients. Furthermore, it compromises the patient's Quality of life (QOL). Multifrequency Bioimpedance Spectroscopy (BIS) is a validated method to assess body composition in dialysis patients. There has been no data on the relationship between body composition and QOL in ESRD patients who were treated with different modalities. To explore the association between body composition as assessed by BIS and QOL in ESRD patients who received different treatment modalities. The present study is a cross sectional, descriptive analytic study of the association between QOL and BIS in ESRD patients in Burapha University, Chonburi, Thailand. QOL was assessed by WHOQOL-BREF questionnaire, body composition was measured by BIS technique. The difference between groups was tested by one-way ANOVA test, relationship between groups was tested with Pearson correlation test. Eighteen predialysis-CKD5, 26 peritoneal dialysis (PD), and 34 hemodialysis (HD) patients were included in the present study. All PD patients had weekly Kt/V > or = 1.7 per week and all HD patients had weekly Kt/V > or = 3.6 per week. There were no statistically difference in baseline characteristics including Charlson comorbidity index, dietary intake, BMI, and blood pressure between groups. Mean QOL scores in each group were in the middle range and not significantly difference. PD patients had more over hydration when compare to HD patients (16.18 +/- 11.24 vs. 2.36 +/- 11.07 %OH/ECW p < 0.0001). There were inversed correlation between overhydration and physical health in HD patients (r = -0.372, p = 0.033) but not in PD and CKD5 patients. CKD5 patients had more lean tissue index (LTI) than PD and HD patients (LTI = 14.34 +/- 3.13, 12.26 +/- 3.65, 11.48 +/- 3.48 kg/m2 respectively, p = 0.023). There were correlation between LTI and overall QOL in CKD5 (r = 0.690, p = 0.002) and PD patients (r = 0.498, p = 0.010). In HD patients, LTI

  17. Trading stages

    DEFF Research Database (Denmark)

    Steiner, Uli; Tuljapurkar, Shripad; Coulson, Tim

    2012-01-01

    because they are hard to use and interpret, and tools for age and stage structured populations are missing. We present easily interpretable expressions for the sensitivities and elasticities of life expectancy to vital rates in age-stage models, and illustrate their application with two biological......Interest in stage-and age structured models has recently increased because they can describe quantitative traits such as size that are left out of age-only demography. Available methods for the analysis of effects of vital rates on lifespan in stage-structured models have not been widely applied...... examples. Much of our approach relies on trading of time and mortality risk in one stage for time and risk in others. Our approach contributes to the new framework of the study of age- and stage-structured biodemography....

  18. Growth impairment in children with pre-dialysis chronic kidney disease in Japan.

    Science.gov (United States)

    Hamasaki, Yuko; Ishikura, Kenji; Uemura, Osamu; Ito, Shuichi; Wada, Naohiro; Hattori, Motoshi; Ohashi, Yasuo; Tanaka, Ryojiro; Nakanishi, Koichi; Kaneko, Tetsuji; Honda, Masataka

    2015-12-01

    Growth impairment is a major complication of chronic kidney disease (CKD) in children. However, no cohort studies have examined the growth of Asian children with pre-dialysis CKD. We sent cross-sectional surveys to 113 Japanese medical institutions that were treating 447 children with CKD stages 3-5 in 2010 and 2011. Of 447 children included in our survey conducted in 2010, height and CKD stage were evaluable for 297 children in 2011, and height standard deviation score (height SDS) was calculated in these children. Height SDS decreased with increasing CKD stage (P kidney and urinary tract (P growth impairment included CKD stages 4 and 5 (relative to stage 3), being small-for-date, and asphyxia at birth. Among children with a height SDS ≤-2.0, growth hormone was used in 19.5, 31.0, and 25.0 % of children with CKD stages 3, 4, and 5, respectively. This prospective cohort study revealed marked growth impairment in Japanese children with CKD stages 3-5 relative to healthy children. CKD-related risk factors for growth impairment included advanced CKD (stages 4 and 5), being small-for-date, and asphyxia at birth. Growth hormone was infrequently used in this cohort of children with pre-dialysis CKD.

  19. Chronic Diarrhea

    Science.gov (United States)

    ... infections that cause chronic diarrhea be prevented? Chronic Diarrhea What is chronic diarrhea? Diarrhea that lasts for more than 2-4 ... represent a life-threatening illness. What causes chronic diarrhea? Chronic diarrhea has many different causes; these causes ...

  20. Estimated Visceral Adipose Tissue, but Not Body Mass Index, Is Associated with Reductions in Glomerular Filtration Rate Based on Cystatin C in the Early Stages of Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Ana Karina Teixeira da Cunha França

    2014-01-01

    Full Text Available Information on the association between obesity and initial phases of chronic kidney disease (CKD is still limited, principally those regarding the influence of visceral adipose tissue. We investigated whether the visceral adipose tissue is more associated with reductions in glomerular filtration rate (GFR than total and abdominal obesity in hypertensive individuals with stage 1-2 CKD. A cross-sectional study was implemented which involved 241 hypertensive patients undergoing treatment at a primary health care facility. GFR was estimated using equations based on creatinine and cystatin C levels. Explanatory variables included body mass index (BMI, waist circumference (WC, and estimated visceral adipose tissue (eVAT. The mean age was 59.6±9.2 years old and 75.9% were female. According to BMI, 28.2% of subjects were obese. Prevalence of increased WC and eVAT was 63.9% and 58.5%, respectively. Results from the assessment of GFR by BMI, WC, and eVAT categories showed that only women with increased eVAT (≥150 cm2 had a lower mean GFR by Larsson (P=0.016, Levey 2 (P=0.005, and Levey 3 (P=0.008 equations. The same result was not observed when the MDRD equation was employed. No association was found between BMI, WC, eVAT, and GFR using only serum creatinine. In the early stages of CKD, increased eVAT in hypertensive women was associated with decreased GFR based on cystatin C.

  1. [Impact of anemia correction on the production of the circulating morphogenetic protein α-Klotho in patients with Stages 3B-4 chronic kidney disease: A new direction of cardionephroprotection].

    Science.gov (United States)

    Milovanov, Yu S; Mukhin, N A; Kozlovskaya, L V; Milovanova, S Yu; Markina, M M

    2016-01-01

    To investigate the impact of anemia correction with erythropoiesis stimulants on the serum level of the circulating morphogenetic protein α-Klotho in patients with Stages 3B--4 chronic kidney disease (CKD). 64 patients aged 42±8 years with Stages 3B--4 nondiabetic CKD were examined and divided into 2 groups: 1) 32 patients with anemia (the target hemoglobin levels could be achieved and kept with erythropoietin and iron saccharate in 20 patients (Group A) and those could not be done in 12 patients (Group 1B). A control group (Group 2) consisted of 32 non-anemic patients matched for gender, age, and degree of a glomerular filtration rate (GFR) reduction. Along with iron exchange indicators, the time course of changes in serum Klotho levels were examined in all the 64 patients during screening and one year after the end of the study. For correction of anemia, 32 patients with this condition (Groups 1A and 1B) took short-acting epoetin (hypodermic recormon 2,000 IU thrice per week + iron (intravenous venofer 5 ml of 100 mg once per week)) under control of hemoglobin levels and serum transferrin iron and ferritin saturation. After achieving the target hemoglobin level of 110-120 g/l, for its keeping, all the patients received, instead of short-acting epoetin, long-acting hypodermic darbepoetin-α 1.5 µg once every 2 months and intravenous iron saccharate 100 mg once every 2 weeks. Among the 32 anemic patients in Group 1, 20 (63%) (Group 1 A) could achieve the target hemoglobin level (110--120 g/l) and maintain it within this range, by performing therapy with epoitin-β + iron saccharate; anemia (the hemoglobin level of anemia, left ventricular hypertrophy, and heart failure), but also a pathogenetic factor of CKD progression. Anemia correction with erythropoiesis stimulants has been shown to enhance the renal and extrarenal production of α-Klotho.

  2. Effect of Drying on Particle Size and Sensitivities of Nano hexahydro-1,3,5-trinitro-1,3,5-triazine

    OpenAIRE

    Jie Liu; Wei Jiang; Jiang-bao Zeng; Qing Yang; Yu-jiao Wang; Feng-sheng Li

    2014-01-01

    Nano hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) was prepared using a bi-directional rotation mill and dried under different conditions (liquid, temperature and drying). It shows that the samples cake seriously and the particles grow up obviously by ordinary drying in different liquids at 70 °C, which occurs again after vacuum drying. With the increase of temperature, the degrees of caking and aggregation are enhanced. Well dispersed sample maintaining constant particle size is extracted by...

  3. Roles for PI(3,5)P2 in nutrient sensing through TORC1

    Science.gov (United States)

    Jin, Natsuko; Mao, Kai; Jin, Yui; Tevzadze, Gela; Kauffman, Emily J.; Park, Sujin; Bridges, Dave; Loewith, Robbie; Saltiel, Alan R.; Klionsky, Daniel J.; Weisman, Lois S.

    2014-01-01

    TORC1, a conserved protein kinase, regulates cell growth in response to nutrients. Localization of mammalian TORC1 to lysosomes is essential for TORC1 activation. Phosphatidylinositol 3,5-bisphosphate (PI(3,5)P2), an endosomal signaling lipid, is implicated in insulin-dependent stimulation of TORC1 activity in adipocytes. This raises the question of whether PI(3,5)P2 is an essential general regulator of TORC1. Moreover, the subcellular location where PI(3,5)P2 regulates TORC1 was not known. Here we report that PI(3,5)P2 is required for TORC1 activity in yeast and regulates TORC1 on the vacuole (lysosome). Furthermore, we show that the TORC1 substrate, Sch9 (a homologue of mammalian S6K), is recruited to the vacuole by direct interaction with PI(3,5)P2, where it is phosphorylated by TORC1. Of importance, we find that PI(3,5)P2 is required for multiple downstream pathways via TORC1-dependent phosphorylation of additional targets, including Atg13, the modification of which inhibits autophagy, and phosphorylation of Npr1, which releases its inhibitory function and allows nutrient-dependent endocytosis. These findings reveal PI(3,5)P2 as a general regulator of TORC1 and suggest that PI(3,5)P2 provides a platform for TORC1 signaling from lysosomes. PMID:24478451

  4. Staging atmospheres

    DEFF Research Database (Denmark)

    Bille, Mikkel; Bjerregaard, Peter; Sørensen, Tim Flohr

    2015-01-01

    The article introduces the special issue on staging atmospheres by surveying the philosophical, political and anthropological literature on atmosphere, and explores the relationship between atmosphere, material culture, subjectivity and affect. Atmosphere seems to occupy one of the classic...

  5. Angiotensin receptor blockers are associated with lower mortality than ACE inhibitors in predialytic stage 5 chronic kidney disease: A nationwide study of therapy with renin-angiotensin system blockade.

    Directory of Open Access Journals (Sweden)

    Chih-Ching Lin

    Full Text Available Dual renin angiotensin system (RAS blockade using angiotensin-receptor blockers (ARBs in combination with angiotensin converting enzyme inhibitors (ACEIs is reported to improve proteinuria in both diabetic and non-diabetic patients. However, its renoprotective effect and safety remain uncertain in patients with advanced chronic kidney disease (CKD. From January 1, 2000 through June 30, 2009, we enrolled 14,117 pre-dialytic stage 5 CKD patients with serum creatinine >6mg/dL and hematocrit <28% under the treatment with erythropoiesis stimulating agents and RAS blockade. We used Cox proportional hazards regression models to estimate the hazard ratios (HRs against the commencement of long-term dialysis and all-cause mortality for ACEI/ARB users. Over a median follow-up of 7 months, 9,867 patients (69.9% required long-term dialysis and 2,805 (19.9% died before progression to end-stage renal disease requiring dialysis. In comparison with the ARB-only users, dual blockade with ACEIs and ARBs was associated with a significantly higher risk of (1 death in all CKD patients (HR = 1.49, [95%CI, 1.30-1.71]; P = 0.02 and in diabetic subgroup (HR = 1.58, [95%CI, 1.34-1.86]; P = 0.02; (2 composite endpoint of long-term dialysis or death in diabetic subgroup (HR = 1.10, [95%CI, 1.01-1.20]; P = 0.04; (3 hyperkalemia-associated hospitalization in non-diabetic subgroup (HR, 2.74, [95%CI, 1.05-7.15]; P = 0.04. However, ACEIs users were associated with higher mortality than ARBs users in all CKD patients (HR = 1.17, [95%CI, 1.07-1.27]; P = 0.03 and in diabetic subgroup (HR = 1.32, [95%CI, 1.18-1.48]; P = 0.03. Monotherapy of RAS blockade, especially ARB, is more effective and safer than dual RAS blockade in pre-dialytic stage 5 CKD patients.

  6. Comparison of clinical outcomes of coronary artery stent implantation in patients with end-stage chronic kidney disease including hemodialysis for three everolimus eluting (EES) stent designs: Bioresorbable polymer-EES, platinum chromium-EES, and cobalt chrome-EES.

    Science.gov (United States)

    Sato, Takao; Hatada, Katsuharu; Kishi, Syohei; Fuse, Koichi; Fujita, Satoshi; Ikeda, Yoshio; Takahashi, Minoru; Matsubara, Taku; Okabe, Masaaki; Aizawa, Yoshifusa

    2017-11-22

    New-generation bioresorbable polymer-everolimus eluting stents (BP-EES) are available. This study aimed to compare the clinical outcomes for BP-EES compared to more established stent designs, namely the platinum chromium-EES (PtCr-EES) and cobalt chrome-EES(CoCr-EES) in patients with the end-stage chronic kidney disease (CKD) including hemodialysis (HD). One-hundred-forty-one consecutive stents (BP-EES [n = 44], PtCr-EES [n = 45], and CoCr-EES [n = 52]) were implanted in 104 patients with CKD. All patients underwent a follow-up coronary angiography at 12 months after implantation. End-stage CKD was defined as an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m 2 , or the need for HD. The following outcome variables were compared among the three stent groups after implantation and the 12-month follow-up: target lesion revascularization (TLR), stent thrombosis (ST), and major adverse cardiac event (MACE). Minimal stent diameter (MSD) and %diameter-stenosis (%DS) were measured using quantitative coronary angiography. The overall rate of TLR and MACE was 14.6% and 30.8%, respectively, with no incidence of ST. Immediately after implantation, the MSD (P = 0.22) and %DS (P = 0.42) were equivalent among the three groups. However, at the 12-month follow-up, a tendency towards higher TLR was observed for the BP-EES group (22.7%) compared with the PtCr-EES (8.8%) and CoCr-EES (9.6%) groups (P = 0.07). Late loss in lumen diameter was also significantly greater for the BP-EES (0.51 ± 0.64 mm) group than either the PtCr-EES (0.20 ± 0.61 mm) and CoCr-EES (0.25 ± 0.70 mm) groups (P = 0.03). BP-EES might increase the risk of in-stent restenosis in patients with end-stage of CKD or the need for HD. © 2017, Wiley Periodicals, Inc.

  7. Experimental Evidence for Linear Metal-Azide Coordination: The Binary Group 5 Azides [Nb(N3)5], [Ta(N3)5], [Nb(N3)6], and [Ta(N3)6], and 1:1 Acetonitrile Adducts [Nb(N3)5(CH3CN)] and (Ta(N3)5(CH3CN))

    Science.gov (United States)

    2006-03-20

    significantly longer than the equatorial ones, as expected from VSEPR argu- ments.[29] In contrast, the axial M-N-N arrangements in [Nb(N3)5] and [Ta(N3)5...Int. Ed. 2000, 39, 2108. [29] a) R. J. Gillespie, I. Hargittai, The VSEPR Model of Molecular Geometry, Allyn and Bacon, Needham Heights, MA, 1991; b

  8. Experimental Evidence for Linear Metal-Azide Bonds. The Binary Group 5 Azides Nb(N3)5, Ta(N3)5, [Nb(N3)6]- and [Ta(N3)6]-, and 1:1 Adducts of Nb(N3)5 and [Ta(N3)5 with CH3CN] (POSTPRINT)

    Science.gov (United States)

    2006-04-27

    the equatorial ones, as expected from VSEPR argu- ments.[29] In contrast, the axial M-N-N arrangements in [Nb(N3)5] and [Ta(N3)5] are calculated to be...2108. [29] a) R. J. Gillespie, I. Hargittai, The VSEPR Model of Molecular Geometry, Allyn and Bacon, Needham Heights, MA, 1991; b) R. J. Gillespie, P

  9. Resonance Raman investigation of the radical cation of 1,3,5-hexatriene

    DEFF Research Database (Denmark)

    Keszhelyi, T.; Wilbrandt, R.; Cave, R.J.

    1994-01-01

    The resonance Raman spectrum of the 1,3,5-hexatriene radical cation generated by gamma-irradiation in a Freon glass is reported. The spectrum is excited at 395 nm in resonance with the second absorption band. Identical spectra are obtained from ionized (E)- and (Z)-1,3,5-hexatriene. The presence...

  10. Ultrastructural analysis of the structure and distribution of the adherens junctions in the rats’ ventricular myocardium during postnatal stages of ontogeny after the infl uence of chronic prenatal hypoxia

    Directory of Open Access Journals (Sweden)

    N. S. Petruk

    2013-12-01

    Full Text Available Background. Antenatal and prenatal hypoxia causes changes in all the organs of fetuses and newborns and in the heart, particularly. Hypoxic damage of the cardiovascular system occurs in 40-70% of newborns. Currently we observe the increase of meaning of the morphological studies for the prenatal diagnosis of human’s heart diseases. It’s known that in adaptive remodeling of cardiomyocytes in the postnatal cardiogenesis of rat redistribution of diffusely located intercellular junctions from the periphery to the terminal areas of the cell occurs. The formation of a definitive pattern of intercellular junctions is completed at the puberty. But how chronic prenatal hypoxia influences the specialized adherens junctions in the rats’ ventricular myocardium is completely unknown and this requires further study. Objective. To provide complex qualitative and quantitative comparative ultrastructural analysis of the intercellular connection changes in rat ventricular myocardium on the stages of postnatal ontogenesis in the norm and under the chronic fetal hypoxia. Materials and methods. We have conducted ultrastructural analysis and distribution of the adherens junctions in the rats’ ventricles on the 1st, 3rd, 7th, 14th, 30th days during postnatal ontogeny and among mature animals in the normal development and under the chronic fetal hypoxia. Experimental chronic hypoxia was modeled by intraperitoneal injection of 1% aqueous solution of the NaNO2 in a daily dose of 50 mg/kg of body weight in the term from 10th to 21st days of pregnancy. Transmission electron microscopy, morphometric and statistical methods were applied. Pairwise comparisons between means of different groups were performed using a Student t-test where, for each couple of normally distributed populations, the null hypothesis that the means are equal was verified. Results. Pronounced increase (80,6%; p <0,05 of the content of desmosomes in the intercalated disk in the period from 7th

  11. Chronic Pain

    Science.gov (United States)

    ... people who have chronic pain may also have low self-esteem, depression, and anger. Symptoms of chronic pain Chronic ... itself often leads to other symptoms. These include low self-esteem, anger, depression, anxiety, or frustration. What causes chronic ...

  12. Liquid chromatography/electrospray ionization tandem mass spectrometry analysis of octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX).

    Science.gov (United States)

    Pan, Xiaoping; Zhang, Baohong; Tian, Kang; Jones, Lindsey E; Liu, Jun; Anderson, Todd A; Wang, Jia-Sheng; Cobb, George P

    2006-01-01

    A quantitative liquid chromatography/electrospray ionization tandem mass spectrometry (LC/ESI-MS/MS) method was developed for the analysis of the explosive, octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX). In negative ionization mode, HMX forms an acetate adduct ion [M + CH(3)COO](-), m/z 355, in the presence of a small amount of acetic acid in the mobile phase. The ESI collision-induced dissociation (CID) spectrum of m/z 355 was acquired and the transitions m/z 355 --> 147 and m/z 355 --> 174 were chosen for the determination of HMX in samples. Using this quantification technique, the method detection limit was 1.57 microg/L and good linearity was achieved in the range 5-500 microg/L. This method will help to unambiguously analyze environmentally relevant concentrations of HMX. Copyright (c) 2006 John Wiley & Sons, Ltd.

  13. Comparative outcome of bidirectional Glenn shunt in patients with pulmonary vascular resistance > or = 3.5 woods units versus < 3.5 woods units.

    Science.gov (United States)

    Hussain, Arif; Arfi, Amin Muhammed; Hussamuddin, Muhammed; Haneef, Ali A; Jamjoom, Ahmad; Al-Ata, Jameel; Mo, Galal

    2008-10-01

    Moderate to severe pulmonary hypertension is considered to be an absolute contraindication to the performance of bidirectional Glenn (BDG) shunting. However, BDG shunting has been performed in young children with pulmonary hypertension associated with unrestricted pulmonary blood flow. In this study, the medical records of patients who underwent BDG starting from October 2000 to March 2004 were reviewed. Patients were divided into 2 groups on the basis of indexed pulmonary vascular resistance (PVRI) measured in room air: a high-risk group (n = 12) with PVRI > or = 3.5 Woods units (WU)/m(2) and a low-risk group (n = 28) with PVRI Glenn shunting was PVRI >3.5 WU/m(2) on 100% oxygen. Hospital mortality was 17% (2 of 12) in the high-risk group and 4% (1 of 28) in the low-risk group. Of 10 survivors in the high-risk group, 1 had undergone a Kawashima procedure, 7 had undergone Fontan procedures (with 1 death), and 2 were awaiting the completion of Fontan procedures as of this writing. In conclusion, these preliminary data suggest that in young children with increased pulmonary flow, BDG shunting can be safely performed, despite the apparent elevation of pulmonary arterial pressure to inoperable levels, provided PVRI decreases to < or = 3.5 WU/m(2) on 100% oxygen.

  14. Porous anodic film formation on an Al-3.5 wt % Cu alloy

    Directory of Open Access Journals (Sweden)

    Páez, M. A.

    2003-12-01

    Full Text Available The morphological development of porous anodic films in the initial stages is examined during anodizing an Al-3.5 wt % Cu alloy in phosphoric acid. Using transmission electron microscopy a sequence of ultramicrotomed anodic sections reveals the dynamic evolution of numerous features in the thickening film in the initial stages of anodizing. The morphological changes in the anodic oxide in the initial stages of its formation appears related to the formation of bubbles during film growth. From Rutherford backscattering spectroscopy (RBS analysis of the film, the formation of the bubbles is associated with the enrichment of copper in the alloy due to growth of the anodic oxide. On the other hand, during constant current anodizing of Al-Cu in phosphoric acid, the current efficiency is considerably less than that for anodizing superpure aluminium under similar conditions. From the contrasting results between the charge consumed calculated from RBS and the real charge consumed during anodizing, oxygen gas bubbles generation and copper oxidation seem to be of less importance on the low efficiency for film formation. It is apparent that the main cause of losing efficiency for film growth on Al-Cu is associated with generation of oxygen at residual second phase, with the development of stresses in the film and, the consequence of these effects on film cracking during film growth.

    En este trabajo se examinó el desarrollo morfológico de películas anódicas porosas en los estados iniciales de la anodización de una aleación de aluminio Al-3,5 % p/p Cu. La observación de una secuencia de secciones ultramicrotomadas del metal y su película anódica, por microscopía electrónica de transmisión, revela la evolución dinámica de numerosos detalles morfológicos durante los inicios del crecimiento de la película anódica. Los cambios morfológicos en el óxido anódico, en los inicios de su formación, aparecen relacionados a la formación de

  15. Secondary hyperparathyroidism prevalence and profile, between diabetic and non-diabetic patients with stage 3 to 4 chronic kidney disease attended in internal medicine wards. MiPTH study.

    Science.gov (United States)

    Arévalo-Lorido, José Carlos; Carretero-Gómez, Juana; García-Sánchez, Francisco; Maciá-Botejara, Enrique; Ramiro-Lozano, José Manuel; Masero-Carretero, Antonio; Robles, Nicolás Roberto; Bureo-Dacal, Juan Carlos

    2016-01-01

    Secondary hyperparathyroidism (SHPTH) is a leading cause of renal osteodystrophy, and an independent risk factor for all-cause and cardiovascular mortality. Our aim is to establish differences in prevalence and profile of SHPTH, regarding diabetics or non-diabetics with chronic kidney disease (CKD). Cross-sectional multicenter study which included patients with stages 3 to 4 CKD. SHPTH was considered when the intact PTH levels (iPTH) were equal or higher than 70pg/ml. We divided the sample into two groups (diabetics and non-diabetics). We used robust statistical methods. 409 patients (214 diabetics) were studied. HPTH was found in 60.4% of diabetics vs 65% of non-diabetics (P=0.42). Diabetics with HPTH were younger (79.5 vs 82.3 years-old, P=0.005), and had more hypertension (P=0.0014), dyslipidemia (P=0.0001) and comorbidities. In multivariate analysis, we found a significant relationship in case of diabetics, with age (OR: 1.04, 95%CI 1.005-1.09 P=0.02 ), and with statins treatment (OR 2.3, 95%CI 1.17-4.54, P=0.01). The prevalence of SHPTH between the groups was similar, however, diabetics had more presence of hypertension and dyslipidemia, and SHPTH in this case was also related with moderate microalbuminuria and lower levels of vitamin D. An association with statins was also found in this group. Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  16. ÿþO l a 4 P r o u d 3 5 0 - 3 5 4 . c d r

    African Journals Online (AJOL)

    ÿþU s e r

    HBeAg (anti-HBe) and viral DNA. Positvity of these markers could be significant in the determination of subjects that would require antiviral therapy . Values between 11.9%- ... institution of antiviral therapy in some patients with chronic hepatitis B ..... definition of actual presence of the HBV pre-core mutant among Nigerian ...

  17. High Power Mid-IR Laser Development 2.8 to 3.5 Microns

    Data.gov (United States)

    National Aeronautics and Space Administration — Advance the state of the art in continuous wave and pulsed IR distributed feedback (DFB) and optical parametric generation (OPG) lasers between 2.8 and 3.5 μm to...

  18. APACHE POINT OBSERVATORY 3.5M AGILE OBSERVATIONS OF LCROSS

    Data.gov (United States)

    National Aeronautics and Space Administration — This archive contains observations of the 2009-10-09 impact of the LCROSS spacecraft on the moon by the AGILE instrument on the Apache Point Observatory 3.5m...

  19. [Metabolic transformations of the trimethyl - 3,5,5, cyclohexene-2, one-1 (isophorone) (author's transl)].

    Science.gov (United States)

    Dutertre Catella, H; Phu Lich, N; Quoc Quan, D; Truhaut, R

    1978-07-01

    In the rabbit, isophorone alpha is partly eliminated, unchanged in the expired air and in the urine and, for another part, metabolized in the organism and excreted in the urine. The metabolites which have been characterized are : dimethyl-5,5, cyclohexen-1, one-3, carboxylic-1 acid, deriving from isophorone by methyloxidation, isophorol (trimethyl-3,5,5 cyclohexen-2, ol-1) formed by the reduction of the ketonic group into a secondary alcohol and eliminated as a glucuronide, dihydroisophorone (trimethyl-3,5,5, cyclohexanone) proceeding from the hydrogenation of the cyclohexen cycle and cis and trans trimethyl-3,5,5, cyclohexanols-1. These latter compounds, found in small quantities, are very likely issued from dihydroisophorone which is transformed in the organism into isophorone alpha and cis and trans trimethyl-3,5,5, cyclohexanols-1, according to a process of dismutation.

  20. Structure and redox properties of hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX and octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX adsorbed on a silica surface. A DFT M05 computational study

    Directory of Open Access Journals (Sweden)

    Liudmyla K. Sviatenko

    2017-11-01

    Full Text Available Adsorption of hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX and octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX on (001 surface of α-quartzwas studiedat the M05/tzvp level using cluster approximation. Hydrogen bonds between nitramines and silica surface were analyzed by atoms in molecules (AIM method. Electron attachment causes significant change in geometry of adsorbed complexes. Redox properties of adsorbed RDX and HMX were compared with those of gas-phase and hydrated species by calculation of the ionization potential, electron affinity, oxidation and reduction Gibbs free energies, oxidation and reduction potentials. Calculations show that adsorbed RDX and HMX have lower ability to undergo redox transformations than hydrated ones.

  1. DOG -II input generator program for DOT3.5 code

    International Nuclear Information System (INIS)

    Hayashi, Katsumi; Handa, Hiroyuki; Yamada, Koubun; Kamogawa, Susumu; Takatsu, Hideyuki; Koizumi, Kouichi; Seki, Yasushi

    1992-01-01

    DOT3.5 is widely used for radiation transport analysis of fission reactors, fusion experimental facilities and particle accelerators. We developed the input generator program for DOT3.5 code in aim to prepare input data effectively. Formar program DOG was developed and used internally in Hitachi Engineering Company. In this new version DOG-II, limitation for R-Θ geometry was removed. All the input data is created by interactive method in front of color display without using DOT3.5 manual. Also the geometry related input are easily created without calculation of precise curved mesh point. By using DOG-II, reliable input data for DOT3.5 code is obtained easily and quickly

  2. Experimental Evidence for Linear Metal-Azide Bonds. The Binary Group 5 Azides Nb(N3)5, Ta(N3)5, [Nb(N3)6]- and [Ta(N3)6]-, and 1:1 Adducts of Nb(N3)5 and Ta(N3)5 with CH3CN (PREPRINT)

    Science.gov (United States)

    2006-03-20

    than the equatorial ones, as expected from VSEPR arguments.[29] In contrast, the axial M-N-N bonds in Nb(N3)5 and Ta(N3)5 are calculated to be almost...Angew. Chem. Int. Ed. 2000, 39, 2108. [29] (a) R. J. Gillespie, I. Hargittai, The VSEPR Model of Molecular Geometry, Allyn and Bacon, A Division of

  3. Chronic renal disease is not chronic kidney disease: implications for use of the QRISK and Joint British Societies risk scores.

    Science.gov (United States)

    Stevens, Sarah L; Stevens, Richard J; Hobbs, F D Richard; Lasserson, Daniel S

    2016-02-01

    Chronic kidney disease (CKD) is a major risk factor for cardiovascular disease (CVD) and European guidelines advocate assessment of CVD risk. QRISK and JBS3 risk calculators do not use the consensus definition of CKD stages 3-5 but instead use a definition referring to renal pathologies and CKD stages 4 and 5. Consequently, there is potential for doctors to misclassify their patients when using these risk calculators. To quantify the number of people who may be affected by such misclassifications. Database analysis using the Clinical Practice Research Datalink (CPRD).We identified 2512053 adults aged 25-84 without prior history of CVD on 1st January 2014. We identified those with 'chronic renal disease' and/or CKD by searching medical event history data. The study population was 48.7% male with mean age of 50.2 years. A total of 80718 had diagnostic READ codes for CKD stages 3, 4 or 5. Of these, 6585 individuals (8.2%) were classified as having 'chronic renal disease' according to the updated QRISK 2014, up from 3365 according to QRISK 2013. Whilst the updated QRISK definition of 'chronic renal disease' in total identified 62% more people than previously and had improved sensitivity for CKD stages 3 to 5, sensitivity remained poor (8.16%; 95% CI: 7.97-8.35%). Misuse of risk scores by general practitioners could result in clinically important differences in risk estimates. Users of risk scores should recognize the potential for error and developers should aim to label risk factors more clearly. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  4. Reversal of Trimethyltin-Induced Learning and Memory Deficits by 3,5-Dicaffeoylquinic Acid

    Directory of Open Access Journals (Sweden)

    Jin Yong Kang

    2016-01-01

    Full Text Available The antiamnesic effect of 3,5-dicaffeoylquinic acid (3,5-diCQA as the main phenolic compound in Artemisia argyi H. extract on cognitive dysfunction induced by trimethyltin (TMT (7.1 μg/kg of body weight; intraperitoneal injection was investigated in order to assess its ameliorating function in mice. In several behavioral tests, namely, the Y-maze, passive avoidance, and Morris water maze (MWM test, 3,5-diCQA significantly ameliorated learning and memory deficits. After the behavioral tests, brain tissues from the mice were analyzed to characterize the basis of the neuroprotective effect. Acetylcholine (ACh levels increased, whereas the activity of acetylcholinesterase (AChE decreased upon administration of 3,5-diCQA. In addition, 3,5-diCQA effectively protected against an increase in malondialdehyde (MDA content, an increase in the oxidized glutathione (GSH ratio, and a decline of total superoxide dismutase (SOD level. 3,5-diCQA may prevent neuronal apoptosis through the protection of mitochondrial activities and the repression of apoptotic signaling molecules such as p-Akt, BAX, and p-tau (Ser 404.

  5. The ML1Nx2 Phosphatidylinositol 3,5-Bisphosphate Probe Shows Poor Selectivity in Cells.

    Science.gov (United States)

    Hammond, Gerald R V; Takasuga, Shunsuke; Sasaki, Takehiko; Balla, Tamas

    2015-01-01

    Phosphatidylinositol (3,5)-bisphosphate (PtdIns(3,5)P2) is a quantitatively minor phospholipid in eukaryotic cells that plays a fundamental role in regulating endocytic membrane traffic. Despite its clear importance for cellular function and organism physiology, mechanistic details of its biology have so far not been fully elucidated. In part, this is due to a lack of experimental tools that specifically probe for PtdIns(3,5)P2 in cells to unambiguously identify its dynamics and site(s) of action. In this study, we have evaluated a recently reported PtdIns(3,5)P2 biosensor, GFP-ML1Nx2, for its veracity as such a probe. We report that, in live cells, the localization of this biosensor to sub-cellular compartments is largely independent of PtdIns(3,5)P2, as assessed after pharmacological, chemical genetic or genomic interventions that block the lipid's synthesis. We therefore conclude that it is unwise to interpret the localization of ML1Nx2 as a true and unbiased biosensor for PtdIns(3,5)P2.

  6. Staging Mobilities

    DEFF Research Database (Denmark)

    Jensen, Ole B.

    In recent years, the social sciences have taken a “mobilities turn.” There has been a developing realisation that mobilities do not “just happen.” Mobilities are carefully and meticulously designed, planned and staged (from above). However, they are equally importantly acted out, performed and li......, the book asks: what are the physical, social, technical, and cultural conditions to the staging of contemporary urban mobilities?...... that mobility is more than movement between point A and B. It explores how the movement of people, goods, information, and signs influences human understandings of self, other and the built environment. Moving towards a new understanding of the relationship between movement, interaction and environments...

  7. The phosphatidylinositol 3,5-bisphosphate (PI(3,5)P2)-dependent Tup1 conversion (PIPTC) regulates metabolic reprogramming from glycolysis to gluconeogenesis.

    Science.gov (United States)

    Han, Bong-Kwan; Emr, Scott D

    2013-07-12

    Glucose/carbon metabolism is a fundamental cellular process in living cells. In response to varying environments, eukaryotic cells reprogram their glucose/carbon metabolism between aerobic or anaerobic glycolysis, oxidative phosphorylation, and/or gluconeogenesis. The distinct type of glucose/carbon metabolism that a cell carries out has significant effects on the cell's proliferation and differentiation. However, it is poorly understood how the reprogramming of glucose/carbon metabolism is regulated. Here, we report a novel endosomal PI(3,5)P2 lipid-dependent regulatory mechanism that is required for metabolic reprogramming from glycolysis to gluconeogenesis in Saccharomyces cerevisiae. Certain gluconeogenesis genes, such as FBP1 (encoding fructose-1,6-bisphosphatase 1) and ICL1 (encoding isocitrate lyase 1) are under control of the Mig1 repressor and Cyc8-Tup1 corepressor complex. We previously identified the PI(3,5)P2-dependent Tup1 conversion (PIPTC), a mechanism to convert Cyc8-Tup1 corepressor to Cti6-Cyc8-Tup1 coactivator. We demonstrate that the PIPTC plays a critical role for transcriptional activation of FBP1 and ICL1. Furthermore, without the PIPTC, the Cat8 and Sip4 transcriptional activators cannot be efficiently recruited to the promoters of FBP1 and ICL1, suggesting a key role for the PIPTC in remodulating the chromatin architecture at the promoters. Our findings expand our understanding of the regulatory mechanisms for metabolic reprogramming in eukaryotes to include key regulation steps outside the nucleus. Given that Tup1 and the metabolic enzymes that control PI(3,5)P2 are highly conserved among eukaryotes, our findings may provide important insights toward understanding glucose/carbon metabolic reprogramming in other eukaryotes, including humans.

  8. The Phosphatidylinositol 3,5-Bisphosphate (PI(3,5)P2)-dependent Tup1 Conversion (PIPTC) Regulates Metabolic Reprogramming from Glycolysis to Gluconeogenesis*

    Science.gov (United States)

    Han, Bong-Kwan; Emr, Scott D.

    2013-01-01

    Glucose/carbon metabolism is a fundamental cellular process in living cells. In response to varying environments, eukaryotic cells reprogram their glucose/carbon metabolism between aerobic or anaerobic glycolysis, oxidative phosphorylation, and/or gluconeogenesis. The distinct type of glucose/carbon metabolism that a cell carries out has significant effects on the cell's proliferation and differentiation. However, it is poorly understood how the reprogramming of glucose/carbon metabolism is regulated. Here, we report a novel endosomal PI(3,5)P2 lipid-dependent regulatory mechanism that is required for metabolic reprogramming from glycolysis to gluconeogenesis in Saccharomyces cerevisiae. Certain gluconeogenesis genes, such as FBP1 (encoding fructose-1,6-bisphosphatase 1) and ICL1 (encoding isocitrate lyase 1) are under control of the Mig1 repressor and Cyc8-Tup1 corepressor complex. We previously identified the PI(3,5)P2-dependent Tup1 conversion (PIPTC), a mechanism to convert Cyc8-Tup1 corepressor to Cti6-Cyc8-Tup1 coactivator. We demonstrate that the PIPTC plays a critical role for transcriptional activation of FBP1 and ICL1. Furthermore, without the PIPTC, the Cat8 and Sip4 transcriptional activators cannot be efficiently recruited to the promoters of FBP1 and ICL1, suggesting a key role for the PIPTC in remodulating the chromatin architecture at the promoters. Our findings expand our understanding of the regulatory mechanisms for metabolic reprogramming in eukaryotes to include key regulation steps outside the nucleus. Given that Tup1 and the metabolic enzymes that control PI(3,5)P2 are highly conserved among eukaryotes, our findings may provide important insights toward understanding glucose/carbon metabolic reprogramming in other eukaryotes, including humans. PMID:23733183

  9. Anaerobic transformation of octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX) by ovine rumen microorganisms.

    Science.gov (United States)

    Perumbakkam, Sudeep; Craig, A M

    2012-01-01

    Explosives such as octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX) provide a challenge in terms of bioremediation. In the present study, sheep rumen was studied for its potential to detoxify HMX using analytical chemistry and molecular microbial ecology tools. Results indicated significant loss (p HMX at 8 h post-incubation and complete disappearance of the parent molecule after 16 h. Qualitative LC-MS/MS analysis provided evidence for the formation of 1-NO-HMX and MEDINA metabolites. A total of 1006 16S rRNA-V3 clones were sequenced and the Classifier tool of the RDPII database was used to sort the sequences at their phylum level. Most sequences were associated with either the phylum Bacteroidetes or Firmicutes. Significant differences at the phylum level (p HMX treatments. Using LibCompare analysis, 8 h HMX treatment showed enrichment of clones (p HMX. Copyright © 2012 Institut Pasteur. Published by Elsevier Masson SAS. All rights reserved.

  10. Performance of mesophilic anaerobic granules for removal of octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX) from aqueous solution.

    Science.gov (United States)

    An, Chun-jiang; He, Yan-ling; Huang, Guo-he; Liu, Yong-hong

    2010-07-15

    The performance of mesophilic anaerobic granules to degrade octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX) was investigated under various conditions. The results of batch experiments showed that anaerobic granules were capable of removing HMX from aqueous solution with high efficiency. Both biotic and abiotic mechanisms contributed to the removal of HMX by anaerobic granules under mesophilic conditions. Adsorption appeared to play a significant role in the abiotic process. Furthermore, HMX could be biodegraded by anaerobic granules as the sole substrate. After 16 days of incubation, 99.04% and 96.42% of total HMX could be removed by 1g VSS/L acclimated and unacclimated granules, respectively. Vancomycin, an inhibitor of acetogenic bacteria, caused a significant inhibition of HMX biotransformation, while 2-bromoethanesulfonic acid, an inhibitor of methanogenic bacteria, only resulted in a slight decrease of metabolic activity. The presence of the glucose, as a suitable electron donor and carbon source, was found to enhance the degradation of HMX by anaerobic granules. Our study showed that sulfate had little adverse effects on biotransformation of HMX by anaerobic granules. However, nitrate had significant inhibitory effect on the extent of HMX removal especially in the initial period. This study offered good prospects of using high-rate anaerobic technology in the treatment of munition wastewater. 2010 Elsevier B.V. All rights reserved.

  11. In silico kinetics of alkaline hydrolysis of 1,3,5-trinitro-1,3,5-triazinane (RDX): M06-2X investigation.

    Science.gov (United States)

    Sviatenko, L K; Gorb, L; Leszczynska, D; Okovytyy, S I; Shukla, M K; Leszczynski, J

    2017-03-22

    Alkaline hydrolysis of RDX (hexahydro-1,3,5-trinitro-1,3,5-triazine), as one of the most promising methods for nitrocompound remediation, was investigated computationally at the PCM(Pauling)/M06-2X/6-311++G(d,p) level of theory. Computational simulation shows that RDX hydrolysis is a highly exothermic multistep process involving initial deprotonation and nitrite elimination, cycle cleavage, further transformation of cycle-opened intermediates to end products caused by a series of C-N bond ruptures, hydroxide attachments, and proton transfers. Computationally predicted products of RDX hydrolysis such as nitrite, nitrous oxide, formaldehyde, formate, and ammonia correspond to experimentally observed ones. Accounting of specific hydration of hydroxide is critical to create an accurate kinetic model for alkaline hydrolysis. Simulated kinetics of the hydrolysis are in good agreement with available experimental data. A period of one month is necessary for 99% RDX decomposition at pH 10. Computations predict significant increases of the reaction rate of hydrolysis at pH 11, pH 12, and pH 13.

  12. Biotransformation of hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) by a prospective consortium and its most effective isolate Serratia marcescens

    Energy Technology Data Exchange (ETDEWEB)

    Young, D.M.; Ogden, K.L. [Univ. of Arizona, Tucson, AZ (United States). Dept. of Chemical and Environmental Engineering; Unkefer, P.J. [Los Alamos National Lab., NM (United States). Chemical Science and Technology Div.

    1997-03-05

    The biotransformation of hexahydro-1,3,5-trinitro-1,3,5 triazine (RDX) has been observed in liquid culture by a consortium of bacteria found in horse manure. Five types of bacteria were found to predominate in the consortium and were isolated. The most effective of these isolates at transforming RDX was Serratia marcescens. The biotransformation of RDX by all of these bacteria was found to occur only in the anoxic stationary phase. The process of bacterial growth and RDX biotransformation was quantified for the purpose of developing a predictive type model. Cell growth was assumed to follow Monod kinetics. All of the aerobic and anoxid growth parameters were determined: {mu}{sub max}, K{sub s}, and Y{sub x/s}. RDX was found to competitively inhibit cell growth in both atmospheres. Degradation of RDX by Serratia marcescens was found to proceed through the stepwise reduction of the three nitro groups to nitroso groups. Each of these reductions was found to be first order in both component and cell concentrations. The degradation rate constant for the first step in this reduction process by the consortium was 0.022 L/g cells {center_dot} h compared to 0.033 L/g cells {center_dot} h for the most efficient isolate.

  13. Performance of mesophilic anaerobic granules for removal of octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX) from aqueous solution

    International Nuclear Information System (INIS)

    An Chunjiang; He Yanling; Huang Guohe; Liu Yonghong

    2010-01-01

    The performance of mesophilic anaerobic granules to degrade octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX) was investigated under various conditions. The results of batch experiments showed that anaerobic granules were capable of removing HMX from aqueous solution with high efficiency. Both biotic and abiotic mechanisms contributed to the removal of HMX by anaerobic granules under mesophilic conditions. Adsorption appeared to play a significant role in the abiotic process. Furthermore, HMX could be biodegraded by anaerobic granules as the sole substrate. After 16 days of incubation, 99.04% and 96.42% of total HMX could be removed by 1 g VSS/L acclimated and unacclimated granules, respectively. Vancomycin, an inhibitor of acetogenic bacteria, caused a significant inhibition of HMX biotransformation, while 2-bromoethanesulfonic acid, an inhibitor of methanogenic bacteria, only resulted in a slight decrease of metabolic activity. The presence of the glucose, as a suitable electron donor and carbon source, was found to enhance the degradation of HMX by anaerobic granules. Our study showed that sulfate had little adverse effects on biotransformation of HMX by anaerobic granules. However, nitrate had significant inhibitory effect on the extent of HMX removal especially in the initial period. This study offered good prospects of using high-rate anaerobic technology in the treatment of munition wastewater.

  14. Monte Carlo calculations of the elastic moduli and pressure-volume-temperature equation of state for hexahydro-1,3,5-trinitro-1,3,5-triazine

    International Nuclear Information System (INIS)

    Sewell, Thomas D.; Bennett, Carl M.

    2000-01-01

    Isothermal-isobaric Monte Carlo calculations were used to obtain predictions of the elastic coefficients and derived engineering moduli and Poisson ratios for crystalline hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX). The elastic coefficients were computed using the strain fluctuation formula due to Rahman and Parrinello [J. Chem. Phys. 76, 2662 (1982)]. Calculations were performed as a function of temperature (218 K≤T≤333 K) and hydrostatic pressure (0 GPa≤p≤4 GPa). The predicted values of the moduli and Poisson ratios under ambient conditions are in accord with general expectations for molecular crystals and with a very recent, unpublished determination for RDX. The moduli exhibit a sensitive pressure dependence whereas the Poisson ratios are relatively independent of pressure. The temperature dependence of the moduli is comparable to the precision of the results. However, the crystal does exhibit thermal softening for most pressures. An additional product of the calculations is information about the pressure-volume-temperature (pVT) equation of state. We obtain near-quantitative agreement with experiment for the case of hydrostatic compression and reasonable, but not quantitative, correspondence for thermal expansion. The results indicate a significant dependence of the thermal expansion coefficients on hydrostatic pressure. (c) 2000 American Institute of Physics

  15. Effect of Drying on Particle Size and Sensitivities of Nano hexahydro-1,3,5-trinitro-1,3,5-triazine

    Directory of Open Access Journals (Sweden)

    Jie Liu

    2014-03-01

    Full Text Available Nano hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX was prepared using a bi-directional rotation mill and dried under different conditions (liquid, temperature and drying. It shows that the samples cake seriously and the particles grow up obviously by ordinary drying in different liquids at 70 °C, which occurs again after vacuum drying. With the increase of temperature, the degrees of caking and aggregation are enhanced. Well dispersed sample maintaining constant particle size is extracted by supercritical drying, especially freeze drying. Furthermore, the mechanical sensitivities of I-RDX, O-RDX and F-RDX, of which the average sizes are 88.03 μm, 15.32 μm and 0.16 μm, respectively, are evaluated. Compared with I-RDX, the friction, impact and shock sensitivities of O-RDX are slightly lower. However, the friction, impact and shock sensitivities of F-RDX are reduced by 30%, 99.0% and 59.9%, respectively.

  16. Percutaneous Nephrolithotomy and Chronic Kidney Disease

    DEFF Research Database (Denmark)

    Sairam, Krish; Scoffone, Cesare M; Alken, Peter

    2012-01-01

    by glomerular filtration rate, including chronic kidney disease stages 0/I/II-greater than 60, stage III-30 to 59 and stages IV/V-less than 30 ml/minute/1.73 m(2). Patient characteristics, operative characteristics, outcomes and morbidity were assessed. RESULTS: Estimated glomerular filtration rate data were...... available on 5,644 patients, including 4,436 with chronic kidney disease stages 0/I/II, 994 with stage III and 214 with stages IV/V. A clinically significant minority of patients with nephrolithiasis presented with severe chronic kidney disease. A greater number of patients with stages IV/V previously...... underwent percutaneous nephrolithotomy, ureteroscopy or nephrostomy and had positive urine cultures than less severely affected patients, consistent with the higher incidence of staghorn stones in these patients. Patients with chronic kidney disease stages IV/V had statistically significantly worse...

  17. Observation of vibronic emission spectrum of jet-cooled 3,5-difluorobenzyl radical.

    Science.gov (United States)

    Lee, Seung Woon; Yoon, Young Wook; Lee, Sang Kuk

    2010-09-02

    We applied the technique of corona-excited supersonic expansion using a pinhole-type glass nozzle to observe the vibronic emission spectrum of jet-cooled benzyl-type radicals from the corona discharge of precursor 3,5-difluorotoluene seeded in a large amount of inert helium carrier gas. The vibronically well-resolved emission spectrum was recorded with a long-path monochromator in the visible region. After subtracting the vibronic bands originating from isomeric difluorobenzyl radicals from the observed spectrum, we identified for the first time the bands belonging to the 3,5-difluorobenzyl radical, from which the electronic energy and vibrational mode frequencies of the 3,5-difluorobenzyl radical were accurately determined in the ground electronic state by comparison with those of the precursor and with those from an ab initio calculation.

  18. DOG-II:input data generator program for DOT3.5 code

    International Nuclear Information System (INIS)

    Koizumi, Kouichi; Takatsu, Hideyuki; Seki, Yasushi; Sato, Satoshi; Hayashi, Katsumi; Handa, Hiroyuki; Yamada, Kohbun; Kamogawa, Susumu.

    1992-08-01

    Personal-computer-base input data generator program DOG-II for two dimensional discrete ordinates transport code DOT3.5 was developed. DOG-II consists of two parts, one is geometry-related routine and the other is parameter input routine. Especially DOG-II is effective for complicated geometry because geometry input generation is designed to be simple and easy. Geometry and other input data of the existing DOT3.5 input deck is easily checked and revised on the screen. Complete input deck for DOT3.5 code is obtained in card image data by this program. This report summarizes the function of the program and running instructions. (author)

  19. A presença de tireoidite linfocitária crônica influencia o estadiamento tumoral do carcinoma diferenciado da tireoide? Does chronic lymphocytic thyroiditis influence the staging of differentiated thyroid carcinoma?

    Directory of Open Access Journals (Sweden)

    Marcos Antonio Nemetz

    2011-02-01

    Full Text Available A associação entre carcinoma diferenciado de tireoide (CDT e tireoidite linfocitária crônica (TLC tem sido relatada na literatura. OBJETIVO: Avaliar a incidência desta associação e determinar se a TLC pode influenciar no estadiamento tumoral do CDT quando associada a outras variáveis de risco. FORMA DE ESTUDO: Coorte histórica (retrospectiva. MATERIAL E MÉTODO: Avaliaram-se 52 prontuários e laudos de pacientes portadores de CDT, no período de 1999 a 2009, divididos em dois grupos. O primeiro, composto de 35 pacientes portadores de CDT sem TLC; o segundo, com 17 pacientes, associado à TLC. O tratamento instituído para todos os pacientes foi a tireoidectomia total. Variáveis comuns a ambos os grupos como idade, gênero, padrão histológico, diâmetro tumoral, metástase locorregional e à distância, invasão extratireoidiana, multifocalidade e presença de cápsula tumoral foram comparadas. Aplicou-se os testes t-Student e Qui-quadrado para análise dos dados. RESULTADOS: A incidência de CDT isolado foi maior do que a de CDT+TLC (p=0,0126. Nenhuma diferença estatística quanto às variáveis comuns analisadas foi observada. CONCLUSÕES: A presença de TLC ocorreu em 33% dos pacientes com CDT. Todos os casos de CDT eram em estádios iniciais.The association between differentiated thyroid carcinoma (DTC and chronic lymphocytic thyroiditis (CLT has been reported in literature. AIM: To evaluate the incidence of this association and to determine whether the CLT may influence on the early initial staging of DTC when associated with other variable risks. STUDY DESIGN: Historical (retrospective cohort. MATERIALS AND METHODS: Fifty two patients with DTC were evaluated from 1999 to 2009. They were divided into two groups. The first group had 35 patients with DTC without DLT; the second had 17 patients with CLT. Total thyroidectomy was the treatment chosen for all patients. Similarities shared in both groups such as age, gender

  20. pHresh 3.5: a new low pH liquid skin cleanser.

    Science.gov (United States)

    Shellow, W V

    1981-01-01

    pHresh 3.5, a new low pH liquid skin cleanser, was evaluated for safety and efficacy in four clinical studies. In 5- and 21-day predictive patch tests the cleanser was rated mild compared to four other widely used cleansers. As a degreasing agent it was found effective during a 4-week study period, especially in subjects with severe facial oiliness. Daily use of the product for a month in tretinoin-treated acne patients failed to indicate any lack of compatability of the two agents. Resolution of pre-existing skin irritation was not impaired by pHresh 3.5 usage.

  1. Accumulation and effects of octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX) exposure in the green anole (Anolis carolinensis).

    Science.gov (United States)

    McMurry, S T; Jones, L E; Smith, P N; Cobb, G P; Anderson, T A; Lovern, M B; Cox, S; Pan, X

    2012-03-01

    Environmental contamination by energetic compounds is an increasing international concern, although little is known of their accumulation in and affect on wildlife. Reptiles are often good models for contaminants studies due to natural history traits that increase their potential for exposure. We report a study to assess accumulation and effects of octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX, High Melting Explosive) in green anoles (Anolis carolinensis). Acute oral toxicity (LD(50)) was estimated to exceed 2000 mg/kg body weight in adult male and female anoles using a standard up-and-down method. Accumulation of HMX was assessed in adult females via dietary exposure and into eggs by two routes (directly from the soil and via maternal transfer). HMX readily accumulated into adult females in a dose-dependent manner and into eggs following both exposure pathways. However, total HMX in soil-exposed eggs was up to 40-times greater than those exposed via maternal transfer. Although there was a suggestion of an HMX-induced reduction in body weight in adult females, overall there were no effects observed over the 12 week exposure period. The only significant effect on eggs was a 50% reduction in hatching success for eggs exposed to 2000 mg/kg HMX in the soil during incubation. Growth and survival of hatchlings was not affected by HMX exposure. Our results demonstrate that HMX accumulates through the food chain and into eggs from the soil, but likely poses minimal threat to lizards except to hatching success in eggs incubated in soils with HMX levels near maximum environmental concentrations.

  2. In Vitro and in Vivo Assays of 3,5-Disubstituted-Tetrahydro-2H-1,3,5-Thiadiazin-2-Thione Derivatives against Trypanosoma cruzi

    Directory of Open Access Journals (Sweden)

    Muelas Susana

    2002-01-01

    Full Text Available Cytotoxicity assays of 24 new 3,5-disubstituted-tetrahydro-2H-1,3,5-thiadiazin-2-thione derivatives were performed. The 17 compounds with higher anti-epimastigote activity and lower cytotoxicity were, thereafter, screened against amastigote of Trypanosoma cruzi. Out of these 17 derivatives S-2d was selected to be assayed in vivo, because of its remarkable trypanocidal properties. To determine toxicity against J774 macrophages, a method based on quantification of cell damage, after 24 h, was used. Cell respiration, an indicator of cell viability, was assessed by the reduction of MTT [3-(4,5-dimethylthiazol-2-yl-2,5-diphenyltetrazolium bromide] to formazan. Anti-amastigote activity was estimated after 48 h by microscopic counts of May Grünwald-Giemsa-stained monolayers. Nifurtimox and benznidazole were used as reference drugs. For the in vivo experiences, mice were infected with 10(4 blood trypomastigotes and then treated during 15 days with S-2d or nifurtimox by oral route. All of the compounds were highly toxic at 100 mg/ml for macrophages and a few of them maintained this cytotoxicity even at 10 mg/ml. Of the derivatives assayed against amastigotes 3k and S-2d showed an interesting activity, that was held even at 1mg/ml. It is demonstrated that the high anti-epimastigote activity previously reported is mainly due to the non-specific toxicity of these compounds. In vivo assays assessed a reduction of parasitemia after administration of S-2d to infected mice.

  3. Response of mesenchymal stem cells in mice to 3.5 Gy X-ray irradiation

    International Nuclear Information System (INIS)

    Su Wenxia; Liu Huimin; Chen Yonghong; Zeng Wen; Liu Wenli; Sun Hanying

    2011-01-01

    Objective: To investigate the response of mesenchymal stem cells in mice to medium-dose X-ray irradiation in vitro. Methods: The mouse mesenchymal stem cell line C3H10T1/2 was submitted to 3.5 Gy X-ray irradiation. Hoechst33258 staining of adherent cells and Annexin V-FITC staining and flow cytometry analysis of suspension cells were performed respectively to assess cellular apoptosis at 3, 6, 12, 24, 48, 72 h and 1 week after irradiation. SA-β-gal staining was performed to analyze the cellular senescence at 24, 48, 72 h and 1 week after irradiation. The mRNA level of both Fas with its ligand FasL and p53 with its downstream target p21 WAF1 were measured by Real-Time PCR analysis. The expression of Fas protein was determined by immunofluorescence staining. Results: An increased apoptosis was observed at 3 h after irradiation with apoptosis rate 11.72% ± 1.61% (t=9.01, P<0.01), the apoptosis rate reached the peak level at 12 h 20.52% ± 1.96% (t=16.27, P<0.01), and then declined progressively to normal level at 48 h 4.93% ±0.46% (t=2.26, P>0.05). The SA-β-gal positive rate of post-radiation cells at 72 h was 53.33% ± 5.62%, significantly higher than that of normal control 3.24% ± 0.39% (t=17.77, P<0.01). The level of Fas, FasL mRNA was found to be elevated 3 h after irradiation with a peak at 12 h, and no differences were found l week later. The level of Fas protein was observed to reach the peak at 12 h after irradiation. The occurrence of peak level of Fas/FasL mRNA and protein was consistent with that of apoptosis of C3H10T1/2 cell. A transient up-regulation of p53, p21 WAF1 mRNA expression was found at 12 h after irradiation followed by a significant increase later at 72 h after irradiation. The occurrence of the two peaks of p53, p21 WAF1 mRNA expression were coincident with that of cellular apoptosis and senescence, respectively. The levels of p53, p21 WAF1 mRNA in senescence group were significantly higher than those of apoptosis group (t=17.85, 13

  4. Speaking a Tone Language Enhances Musical Pitch Perception in 3-5-Year-Olds

    Science.gov (United States)

    Creel, Sarah C.; Weng, Mengxing; Fu, Genyue; Heyman, Gail D.; Lee, Kang

    2018-01-01

    Young children learn multiple cognitive skills concurrently (e.g., language and music). Evidence is limited as to whether and how learning in one domain affects that in another during early development. Here we assessed whether exposure to a tone language benefits musical pitch processing among 3-5-year-old children. More specifically, we compared…

  5. Carbon dioxide capture by planar (AlN)nclusters (n=3-5).

    Science.gov (United States)

    Guo, Chen; Wang, Chong

    2017-09-26

    Searching for materials and technologies of efficient CO 2 capture is of the utmost importance to reduce the CO 2 impact on the environment. Therefore, the (AlN) n clusters (n = 3-5) are researched using density functional theoretical calculations. The results of the optimization show that the most stable structures of (AlN) n clusters all display planar configurations at B3LYP and G3B3 methods, which are consistent with the reported results. For these planar clusters, we further systematically studied their interactions with carbon dioxide molecules to understand their adsorption behavior at the B3LYP/6-311+G(d,p) level, including geometric optimization, binding energy, bond index, and electrostatic. We found that the planar structures of (AlN) n (n = 3-5) can capture 3-5 CO 2 molecules. The result indicates that (AlN) n (n = 3-5) clusters binding with CO 2 is an exothermic process (the capture of every CO 2 molecule on (AlN) n clusters releases at least 30 kcal mol -1 in relative free energy values). These analysis results are expected to further motivate the applications of clusters to be efficient CO 2 capture materials.

  6. Rat liver microsomal cytochrome P450-dependent oxidation of 3,5-disubstituted analogues of paracetamol

    NARCIS (Netherlands)

    Bessems, J.G.M.; Koppele, J.M. te; Dijk, P.A. van; Stee, L.L.P. van; Commandeur, J.N.M.; Vermeulen, N.P.E.

    1996-01-01

    1. The cytochrome P450-dependent binding of paracetamol and a series of 3,5-disubstituted paracetamol analogues (R = -F, -Cl, -Br, -I, -C(H)3, -C2H5, -iC3H7) have been determined with β-naphthoflavone (βNF)-induced rat liver microsomes and produced reverse type I spectral changes. K(s,app) varied

  7. Novel fluorinated polymer materials based on 2,3,5,6-tetrafluoro-4-methoxystyrene

    DEFF Research Database (Denmark)

    Hvilsted, Søren; Borkar, Sachin; Siesler, HW

    2003-01-01

    2,3,5,6-Tetrafluoro-4-methoxystyrene (TFMS) has been polymerized in bulk and in xylene solution by Atom Transfer Radical Polymerization (ATRP) in a conventional protocol at 110 degreesC. Relatively good control has been achieved with number-average molecular mass (M) up to 17,000 and correspondin...

  8. Rethinking the demarcation of Malachi 2:17-3:5 | Snyman | Acta ...

    African Journals Online (AJOL)

    emarcating a unit remains important for the interpretation and understanding of the particular unit in a (Biblical) book. In the case of the book of Malachi, the majority of scholars adhere to the traditional demarcation of the fourth unit in the book of Malachi (2:17-3:5). Closer investigation reveals that the matter is not as settled ...

  9. A Fast Liquid Chromatography Tandem Mass Spectrometric Analysis of PETN (Pentaerythritol Tetranitrate), RDX (3,5-Trinitro-1,3,5-triazacyclohexane) and HMX (Octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine) in Soil, Utilizing a Simple Ultrasonic-Assisted Extraction with Minimum Solvent.

    Science.gov (United States)

    Anilanmert, Beril; Aydin, Muhammet; Apak, Resat; Avci, Gülfidan Yenel; Cengiz, Salih

    2016-01-01

    Direct analyses of explosives in soil using liquid chromatography tandem mass spectrometry (LC-MS/MS) methods are very limited in the literature and require complex procedures or relatively high amount of solvent. A simple and rapid method was developed for the determination of pentaerythritol tetranitrate (PETN), 3,5-trinitro-1,3,5-triazacyclohexane (RDX) and octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX), which are among the explosives used in terrorist attacks. A one-step extraction method for 1.00 g soil with 2.00 mL acetonitrile, and a 8-min LC-MS/MS method was developed. The detection limits for PETN, RDX and HMX were 5.2, 8.5 and 3.4 ng/g and quantitation limits were 10.0, 24.5, 6.0 ng/g. The intermediate precisions and Horwitz Ratio's were between 4.10 - 13.26% and 0.24 - 0.98, in order. This method was applied to a model post-blast debris collected from an artificial explosion and real samples collected after a terrorist attack in Istanbul. The method is easy and fast and requires less solvent use than other methods.

  10. 1,3,5-Trimethylpyrazolium chloride based ionogel as an efficient and ...

    Indian Academy of Sciences (India)

    1,3,5-Trimethylpyrazolium chloride based ionogel as an efficient and ... Catalytic activity of ionogel was compared with silica coated with ionic liquid (silica-IL) and it ..... cost-effective. Supplementary Information. Supplementary file contains details on preparation of the ionic liquid and its characterization, preparation of.

  11. Poly[tetraaqua-μ3-pyridine-3,5-dicarboxylato-strontium(II

    Directory of Open Access Journals (Sweden)

    Shirin Daneshvar

    2008-02-01

    Full Text Available The reaction of strontium(II nitrate with the proton-transfer compound (pdaH2(py-3,5-dc·H2O (where pda = propane-1,3-diamine and py-3,5-dcH2 = pyridine-3,5-dicarboxylic acid leads to the formation of the title polymeric compound, [Sr(C7H3NO4(H2O4]n. The propane-1,3-diaminium cation is not incorporated in this crystal structure. The SrII atom lies on an inversion centre and is eight-coordinated by four O atoms from three py-3,5-dc ligands and four O atoms from four coordinated water molecules. The coordination polyhedron of the SrII atom is a distorted dodecahedron. These binuclear units are connected via the carboxylate O atoms to build a one-dimensional polymeric chain. In the crystal structure, non-covalant interactions consisting of hydrogen bonds (X—H...O, with X = O and C and π–π stacking interactions [3.4604 (19 Å] connect the various components to form a supramolecular structure.

  12. New liquid crystals in the series of 1, 3, 5-triazine compounds ...

    African Journals Online (AJOL)

    The Series of compounds were prepared by nucleophilic addition of the primary amino nucleophile to 1,3,5-triazine electrophilic ring via alkyl spacers in presence of potassium carbonate as hydrochloride acceptor. Differencial scanning calorimetry (DSC), polarizing optical microscopy and x-ray diffraction confirmed Smectic ...

  13. Galvanostatic response of AA2024 aluminium alloy in 3.5% NaCl ...

    Indian Academy of Sciences (India)

    s12034-016-1301-0. Galvanostatic response of AA2024 aluminium alloy in 3.5% NaCl solution. U DONATUS. ∗ and G E THOMPSON. Corrosion and Protection Centre, School of Materials, The University of Manchester, Manchester M13 9PL, UK.

  14. Chemistry of the pyrazolidines. 26. Alkylation of 4-benzyliden-1-phenyl-3,5-dioxopyrazolidines

    International Nuclear Information System (INIS)

    Moldarev, B.L.; Aronzon, M.E.; Adanin, V.M.; Zyakun, A.M.

    1986-01-01

    The reaction of 4-benzyliden-1-phenyl-3,5-dioxopyrazolidines with alkyl halides in the presence of sodium alkoxide gave 1-phenyl-2-alkyl-4-benzyliden- and 1-phenyl-2,4-dialkyl-4-(α-alkoxybenzyl)-3,4-dioxopyrazolines. The structures of these compounds were confirmed by UV, IR, and PMR spectroscopy, and by mass-spectrometry

  15. Toxicity of 2,3,5,6-tetrachlorophenol to willow trees (Salix viminalis)

    DEFF Research Database (Denmark)

    Clausen, Lauge Peter Westergaard; Jensen, Christian Kjær; Trapp, Stefan

    2018-01-01

    Chlorinated phenols have been intensively investigated from an eco-toxicological point of view, however almost nothing is known about toxicity of tetrachlorophenol (TeCP) to higher terrestrial plants. This paper applied the willow tree acute toxicity test to study the toxicity of 2,3,5,6-Te...

  16. Investigation of Unexpected Reaction Intermediates in the Alkaline Hydrolysis of Methyl 3,5-Dinitrobenzoate

    Science.gov (United States)

    Silva, Clesia C.; Silva, Ricardo O.; Navarro, Daniela M. A. F.; Navarro, Marcelo

    2009-01-01

    An experimental project aimed at identifying stable reaction intermediates is described. Initially, the studied reaction appears to involve the simple hydrolysis, by aqueous sodium hydroxide, of methyl 3,5-dinitrobenzoate dissolved in dimethyl sulfoxide. On mixing the substrates, however, the reaction mixture unexpectedly turns an intense red in…

  17. 1, 3, 5-Triazine-2, 4, 6-triyltrisulfamic acid (TTSA): A new organic ...

    Indian Academy of Sciences (India)

    Melamine reacted with chlorosufonic acid (ClSO3H) to form a new sulfamic-type acid, 1,3,5-triazine-2,4,6-triyltrisulfamic acid (TTSA). Both nitrosation of secondary amines and oxidation of urazoles were accomplished by using TTSA/NaNO2 system under mild and heterogeneous conditions with good to excellent yields.

  18. Developing Essential Understanding of Multiplication and Division for Teaching Mathematics in Grades 3-5

    Science.gov (United States)

    Otto, Albert; Caldwell, Janet; Hancock, Sarah Wallus; Zbiek, Rose Mary

    2011-01-01

    This book identifies and examines two big ideas and related essential understandings for teaching multiplication and division in grades 3-5. Big Idea 1 captures the notion that multiplication is usefully defined as a scalar operation. Problem situations modeled by multiplication have an element that represents the scalar and an element that…

  19. Design, synthesis and characterization of 1H-pyridin-4-yl-3,5 ...

    Indian Academy of Sciences (India)

    Keywords. 1H-pyridin-4-yl-3,5-disubstituted indazoles; Suzuki reaction; Akt kinase activity. 1. Introduction. In organic synthesis, Palladium-catalysed new carbon– carbon bond formation from aryl halides with organo boronic acids via Suzuki coupling reaction has been proved to be an important method. The 2010 Nobel.

  20. DETERMINATION OF 3,5,6-TRICHLORO-2-PYRIDINOL (TCP) BY ELISA

    Science.gov (United States)

    A sensitive, competitive enzyme-linked immunosorbent assay (ELISA) for 3,5,6-trichloro-2pyridinol (TCP) has been developed to quantitate parts per billion (ppb) amounts of the analyte in urine. TCP is a major metabolite and environmental degradation product of the insecticide c...

  1. A New Copper (I) Complex Based on 4-amino-3, 5-bis (3-pyridyl)-1 ...

    Indian Academy of Sciences (India)

    Home; Journals; Journal of Chemical Sciences; Volume 129; Issue 2. A New Copper(I) Complex Based on 4-amino-3,5-bis(3-pyridyl)-1,2,4-triazole: Synthesis, Crystal Structure, Theoretical Study, Thermal Behavior and Luminescence. CHEN AI-HUA MENG SU-CI ZHOU KAI WANG CONG-CONG ZHAO WEI WANG AI-JIAN ...

  2. Synthesis and fungicidal properties of 2,4-diaza-1,3,5 ...

    African Journals Online (AJOL)

    The preparation of 2,4-diaza-1,3,5-pentanetrione compounds were described. The fungicidal effects of these compounds on the mycelial growth of the isolate, Phoma eupyrena were carried out by in vitro experiment. The results show that the response to treatment depended not only on the concentration of the compounds ...

  3. Design, synthesis and characterization of 1 H-pyridin-4-yl-3, 5 ...

    Indian Academy of Sciences (India)

    Home; Journals; Journal of Chemical Sciences; Volume 127; Issue 3. Design, synthesis and characterization of 1 H-pyridin-4-yl-3, 5-disubstituted indazoles and their anti-inflammatory and analgesic activity. Arava Veera Reddy Surendrareddy Gogireddy P K Dubey Madhava Reddy B Veeresh B. Regular Articles Volume ...

  4. Transfer and effects of 1,2,3,5,7-pentachloronaphthalene in an experimental food chain

    DEFF Research Database (Denmark)

    Slootweg, Tineke; Segner, Helmut; Mayer, Philipp

    2015-01-01

    of this study was to gain insights into the biomagnification and effects of 1,2,3,5,7-pentachloronaphthalene (PeCN52) in an experimental food chain consisting of benthic worms and juvenile rainbow trout. Worms were contaminated with PeCN52 by passive dosing from polydimethylsiloxane silicone. The contaminated...

  5. Ebola virus requires phosphatidylinositol (3,5) bisphosphate production for efficient viral entry.

    Science.gov (United States)

    Qiu, Shirley; Leung, Anders; Bo, Yuxia; Kozak, Robert A; Anand, Sai Priya; Warkentin, Corina; Salambanga, Fabiola D R; Cui, Jennifer; Kobinger, Gary; Kobasa, Darwyn; Côté, Marceline

    2018-01-01

    For entry, Ebola virus (EBOV) requires the interaction of its viral glycoprotein with the cellular protein Niemann-Pick C1 (NPC1) which resides in late endosomes and lysosomes. How EBOV is trafficked and delivered to NPC1 and whether this is positively regulated during entry remain unclear. Here, we show that the PIKfyve-ArPIKfyve-Sac3 cellular complex, which is involved in the metabolism of phosphatidylinositol (3,5) bisphosphate (PtdIns(3,5)P 2 ), is critical for EBOV infection. Although the expression of all subunits of the complex was required for efficient entry, PIKfyve kinase activity was specifically critical for entry by all pathogenic filoviruses. Inhibition of PIKfyve prevented colocalization of EBOV with NPC1 and led to virus accumulation in intracellular vesicles with characteristics of early endosomes. Importantly, genetically-encoded phosphoinositide probes revealed an increase in PtdIns(3,5)P 2 -positive vesicles in cells during EBOV entry. Taken together, our studies suggest that EBOV requires PtdIns(3,5)P 2 production in cells to promote efficient delivery to NPC1. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. A 3-5GHz UWB CMOS Receiver with Digital Control Technique

    DEFF Research Database (Denmark)

    Han, Bo; Liu, Mengmeng; Ge, Ning

    2010-01-01

    This article presents a CMOS receiver that works for 3-5GHz low band SC-UWB. The receiver contains PLL, Mixer, and VGA. Double down conversion is adopted in the receiver to overcome the orthogonal clock design difficulty; digital assisted RF control method is used to increase the stability...

  7. 1,3,5-Triazine-2,4,6-triyltrisulfamic acid (TTSA)

    Indian Academy of Sciences (India)

    Melamine reacted with chlorosufonic acid (ClSO3H) to form a new sulfamic-type acid, 1,3,5-triazine-2,4,6-triyltrisulfamic acid (TTSA). Both nitrosation of secondary amines and oxidation of urazoles were accomplished by using TTSA/NaNO2 system under mild and heterogeneous conditions with good to excellent yields.

  8. The remarkable effect of organic salts on 1,3,5-trioxane synthesis

    Directory of Open Access Journals (Sweden)

    Liu-Yi Yin

    2016-10-01

    Full Text Available Abstract The effects of organic salts on 1,3,5-trioxane synthesis were investigated through batch reaction and continuous production experiments. The organic salts used include sodium methanesulfonate (CH3NaO3S, sodium benzenesulfonate (C6H5NaO3S, sodium 4-methylbenzenesulfonate (C7H7NaO3S, and sodium 3-nitrobenzene sulfonate (C6H4NNaO5S. It was shown that the effects of organic salts on the yield of 1,3,5-trioxane in reaction solution and distillate follow the order CH3NaO3S < C6H5NaO3S < C7H7NaO3S < C6H4NNaO5S, which is inversely related to the charge density of the anions of the organic salts. In comparison with Cl−-based salts such as magnesium chloride, organic salts have the advantages of less formic acid generation and low corrosion. Studies on water activity revealed that the effect of organic salts on the activity of water was quite small at low concentration of organic salts. UV–visible spectroscopy and vapor–liquid equilibrium experiments were performed to uncover the mechanisms that govern such effects. The results showed that the effect of organic salts on the yield of 1,3,5-trioxane relies primarily on their ability to increase the catalytic activity of sulfuric acid and increase the relative volatilities of 1,3,5-trioxane and water and of 1,3,5-trioxane and oligomers.

  9. MMP-3 (5A/6A) polymorphism does not influence human smooth muscle cell invasion.

    Science.gov (United States)

    Maqbool, Azhar; Keswani, Anita; Galloway, Stacey; O'Regan, David J; Ball, Stephen G; Turner, Neil A; Porter, Karen E

    2012-06-15

    Stromelysin (MMP-3) is an important regulator of vascular smooth muscle cell (SMC) invasion, a key contributor to saphenous vein (SV) bypass graft failure. The 5A allele of the common -1612 MMP-3 5A/6A promoter polymorphism reportedly confers increased promoter activity, MMP-3 tissue expression, and susceptibility to a number of vascular pathologies. The aim of this study was to determine whether the MMP-3 5A/6A polymorphism directly influences endogenous MMP-3 expression levels and, consequently, cell invasion, in SV-derived SMC cultured from patients with different genotypes. Genotyping of 226 patients revealed -1612 MMP-3 5A/6A genotype frequencies of 20.8% 5A/5A, 52.7% 5A/6A, and 26.5% 6A/6A. Using a standardized, controlled protocol, we investigated cytokine- and growth factor-induced MMP-3 expression (real-time polymerase chain reaction [RT-PCR], ELISA) and SV-SMC invasion (Boyden chamber with Matrigel barrier) using cultured SV-SMC from patients with different MMP-3 genotypes. Despite observing a strong correlation between MMP-3 mRNA levels and MMP-3 protein secretion, no significant differences were apparent in MMP-3 expression levels or cell invasion between cells with different MMP-3 5A/6A genotypes. Our data suggest that the MMP-3 5A/6A promoter polymorphism in isolation does not influence levels of MMP-3 secretion or cellular invasion in human SV-SMC. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. Chimeric thermostable DNA polymerases with reverse transcriptase and attenuated 3'-5' exonuclease activity.

    Science.gov (United States)

    Schönbrunner, Nancy J; Fiss, Ellen H; Budker, Olga; Stoffel, Susanne; Sigua, Christopher L; Gelfand, David H; Myers, Thomas W

    2006-10-24

    The synthesis of accurate, full-length cDNA from low-abundance RNA and the subsequent PCR amplification under conditions which provide amplicon that contains minimal mutations remain a difficult molecular biological process. Many of the challenges associated with performing sensitive, long RT/PCR have been alleviated by using a mixture of DNA polymerases. These mixtures have typically contained a DNA polymerase devoid of 3'-5' exonuclease, or "proofreading", activity blended with a small amount of an Archaea DNA polymerase possessing 3'-5' exonuclease activity, since reverse transcriptases lack 3'-5' exonuclease activity and generally have low fidelity. To create a DNA polymerase with efficient reverse transcriptase and 3'-5' exonuclease activity, a family of mutant DNA polymerases with a range of attenuated 3'-5' exonuclease activities was constructed from a chimeric DNA polymerase derived from Thermus species Z05 and Thermotoga maritima DNA polymerases. These "designer" DNA polymerases were fashioned using structure-based tools to identify amino acid residues involved in the substrate-binding site of the exonuclease domain of a thermostable DNA polymerase. Mutation of some of these residues resulted in proteins in which DNA polymerase activity was unaffected, while proofreading activity ranged from 60% of the wild-type level to undetectable levels. Kinetic characterization of the exonuclease activity indicated that the mutations affected catalysis much more than binding. On the basis of their specificity constants (kcat/KM), the mutant enzymes have a 5-15-fold stronger preference for a double-stranded mismatched substrate over a single-stranded substrate than the wild-type DNA polymerase, a desirable attribute for RT/PCR. The utility of these enzymes was evaluated in a RT/PCR assay to generate a 1.7 kb amplicon from HIV-1 RNA.

  11. Oral Magnesium Supplementation in Chronic Kidney Disease Stages 3 and 4: Efficacy, Safety, and Effect on Serum Calcification Propensity—A Prospective Randomized Double-Blinded Placebo-Controlled Clinical Trial

    Directory of Open Access Journals (Sweden)

    Iain Bressendorff

    2017-05-01

    Discussion: Oral Mg supplementation was safe and well tolerated in CKD stages 3 and 4 and improved T50, but did not increase intracellular Mg. Further studies are needed to investigate the long-term effects of Mg supplementation in CKD stage 3 and 4 and whether improvement in calcification propensity is related to clinical endpoints.

  12. [Dismutation as a metabolic pathway : transformation of the trimethyl 3,5,5, cyclohexanone (author's transl)].

    Science.gov (United States)

    Truhaut, R; Lich, N P; Cluet, J L; Dutertre-Catella, H

    1979-03-01

    Besides novel routes of biotransformation of xenobiotic substances recently reported, such as N-glucuronidation of teritary amines and quaternary ammonium componds, N-glucosylation, N-carbamylglucuronide formation from a primary amine, C-glucuronidation, conjugation with long-chain fatty acids, with polypeptides, carbon-chain elongation, stereospecific inversion of configuration at a satured carbon atom, formation of methylthio metabolites, the authors have described a new metabolic pathway: dismutation, in the case of 3,5,5, - trimethylcyclohexanone (dihydroisophorone). As a matter of fact, this compound leads, in vivo, to the formation of isophorone alpha and of cis and trans 3,5,5, - trimethyl cyclohexanols. These compounds, extracted from the urine of treated rats and rabbits, have been identified by gas-liquid chromatography and thin-layer chromatography.

  13. Effect of desmethyldiazepam and chlordesmethyldiazepam on 3',5'-cyclic guanosine monophosphate levels in rat cerebellum.

    Science.gov (United States)

    Govoni, S; Fresia, P; Spano, P F; Trabucchi, M

    1976-11-24

    Three different ben,odia,epines (diazepam, its pharmacologically active metabolite desmethyldiazepam, and the derivative chlordesmethyldiazepam) have been compared in our study for their effects on 3',5'-guanosine monophosphate (cGMP) cerebellar levels. Desmethyldiazepam and chlordesmethyldiazepam are several-fold more potent than diazepam in decreasing rat cyclic cGMP cerebellar concentrations. None of the three drugs induces detectable changes of cerebellar cyclic 3',5'-adenosine monophosphate (cAMP). On the other hand, the three compounds did not modify the levels of cGMP in cerebellum of newborn rats, where Purkinje cell and dendrites lack synaptic contacts. However, injection of gamma aminobutyric acid (GABA) in the newborn is still able, as in the adult, to decrease cGMP concentration in cerebellum. Our data support the hypothesis that cGMP cerebellar concentrations may be reliable biochemical marker of the clinical activity of benzodiazepines.

  14. Dependence of magnetic properties on different buffer layers of Mn3.5Ga thin films

    Science.gov (United States)

    Takahashi, Y.; Sato, K.; Shima, T.; Doi, M.

    2018-05-01

    D022-Mn3.5Ga thin films were prepared on MgO (100) single crystalline substrates with different buffer layer (Cr, Fe, Cr/Pt and Cr/Au) using an ultra-high-vacuum electron beam vapor deposition system. From XRD patterns, a fundamental (004) peak has clearly observed for all samples. The relatively low saturation magnetization (Ms) of 178 emu/cm3, high magnetic anisotropy (Ku) of 9.1 Merg/cm3 and low surface roughness (Ra) of 0.30 nm were obtained by D022-Mn3.5Ga film (20 nm) on Cr/Pt buffer layer at Ts = 300 °C, Ta = 400 °C (3h). These findings suggest that MnGa film on Cr/Pt buffer layer is a promising PMA layer for future spin electronics devices.

  15. Spectral and thermal behaviours of rare earth element complexes with 3,5-dimethoxybenzoic acid

    Directory of Open Access Journals (Sweden)

    JANUSZ CHRUŚCIEL

    2003-10-01

    Full Text Available The conditions for the formation of rare earth element 3,5-dimethytoxybenzoates were studied and their quantitative composition and solubilities in water at 293 K were determined. The complexes are anhydrous or hydrated salts and their solubilities are of the orders of 10-5 – 10-4 mol dm-3. Their FTIR, FIR and X-ray spectra were recorded. The compounds were also characterized by thermogravimetric studies in air and nitrogen atmospheres and by magnetic measurements. All complexes are crystalline compounds. The carboxylate group in these complexes is a bidentate, chelating ligand. On heating in air to 1173 K, the 3,5-dimethoxybenzoates of rare earth elements decompose in various ways. The hydrated complexes first dehydrate to form anhydrous salts which then decompose in air to the oxides of the respective metals while in nitrogen to mixtures of carbon and oxides of the respective metals. The complexes are more stable in air than in nitrogen.

  16. Gas generation in SFL 3-5 and effects on radionuclide release

    International Nuclear Information System (INIS)

    Skagius, K.; Lindgren, M.; Pers, K.

    1999-12-01

    A deep repository, SFL 3-5, is presently planned for disposing of long-lived low- and intermediate-level waste. In this study the amounts of gas that can be generated in the waste packages and in the vaults are estimated. The potential gas pressure build-up, the displacement of contaminated water and the consequences on radionuclide release from the engineered barriers in the repository are also addressed. The study is focussed on the repository design and waste inventory that was defined for the prestudy of SFL 3-5. Since the reporting of the prestudy the design of the repository has been modified and the waste inventory has been updated and a preliminary safety assessment of the repository has been carried out based on the new design and updated waste inventory. The implications on gas generation and release of these modifications in design and waste inventory are briefly addressed in this study

  17. Experimental Evidence for Linear Metal-Azide Bonds. The Binary Group 5 Azides Nb(N3)5, Ta(N3)5, [Nb(N3)6]- and [Ta(N3)6]-, and 1:1 Adducts of Nb(N3)5 and Ta(N3)5 with CH3CN

    Science.gov (United States)

    2005-04-27

    bonds are significantly longer than the equatorial ones, as expected from VSEPR arguments.[29] In contrast, the axial M-N-N bonds in Nb(N3)5 and Ta...Klapötke, H. Nöth, T. Schütt, M. Warchhold, Angew. Chem. Int. Ed. 2000, 39, 2108. [29] (a) R. J. Gillespie, I. Hargittai, The VSEPR Model of

  18. Controlling Costs: The 6-3-5 Method - Case Studies at NAVSEA and NATO

    Science.gov (United States)

    2016-04-30

    implemented, during which time and money are consumed . The 6-3-5 Method uses past performance measurements or characteristically similar data (determined by...Providing this context ensures management knows how to deploy and maintain the previously described six metadata tags to optimize spending control and...deliverables were defined in Task Planning Sheets (TPSs), the focus was on documenting workflow and defining FTE hours consumed . For both branches

  19. Solid phase microextraction-high performance liquid chromatographic determination of octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX) and hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) in the presence of sodium dodecyl sulfate surfactant.

    Science.gov (United States)

    Malik, Ashok Kumar; Rai, Parmod Kumar

    2008-07-01

    A simple and sensitive method has been developed using preconcentration technique solid phase microextraction (SPME) and analytical technique HPLC-UV for the determination of octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX) and hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) from the environmental samples. Aqueous solution of anionic surfactant SDS was used for the extraction of both nitramine high explosives, viz., HMX and RDX from soil samples which were subsequently sorbed on SPME fiber. The static desorption was carried out in the desorption chamber of the SPME-HPLC interface in the presence of mobile phase ACN/methanol/water (30:35:35) and the subsequent chromatographic analysis at a flow rate of 0.5 mL/min and detection at 230 nm. For this purpose, a C(18), 5 microm RP analytical column was used as a separation medium in this method. Several parameters relating to SPME, e.g., adsorption/desorption time, concentration of salt, stirring rate, etc., were optimized. The method was linear over the range of 20-400 ng/mL for HMX and RDX standards in the presence of surfactant in aqueous phase, respectively. The correlation coefficient (R(2)) for HMX and RDX are 0.9998 and 0.9982, respectively. With SPME, the detection limits (S/N = 3) in ng/mL are 0.05 and 0.1 for HMX and RDX, respectively in the presence of the SDS surfactant. The developed method has been applied successfully to the analysis of real environmental samples like bore well water, river water, and ground alluvial soil.

  20. AC Induced Corrosion of Carbon Steel in 3.5wt% NaCl Electrolyte

    OpenAIRE

    Strandheim, Espen Oldeide

    2012-01-01

    This paper deals with alternating current (AC) corrosion of low alloy carbon steel in 3.5 wt% NaCl electrolyte. Accelerated corrosion rates have been reported when exposed to AC and the corrosion mechanism is not well understood. Electrical heating of subsea pipelines, applied to avoid hydrate formation and waxing of multiphase hydrocarbon well streams has made this topic increasingly relevant in recent years. To study the effect of AC on corrosion rates, weight loss experiments under a wide ...

  1. Five strands of math drills big book : grades 3-5

    CERN Document Server

    Reed, Nat; Forest, Chris

    2011-01-01

    For grades 3-5, our Common Core State Standards-based resource meets the five strands of math concepts addressed by the NCTM standards and encourages the students to review the concepts in unique ways. Included are warm-up and timed drill activities which will push the boundaries of critical thought and demonstrate to students the importance of mathematical problems in Number & Operations, Geometry, Measurement, Data Analysis & Probability and Algebra using real world situations.

  2. 3,5,7-Tripropyl-1-azaadamantane-4,6,10-triol

    Directory of Open Access Journals (Sweden)

    Jens Hasserodt

    2008-05-01

    Full Text Available The title compound, C18H33NO3, was prepared according to a highly diastereoselective hydrogenation procedure from 3,5,7-triallyl-1-azaadamantane-4,6,10-trione. The crystal structure of the title compound contains two crystallographically independent molecules (Z′ = 2, which are linked by intermolecular hydrogen bonding into chains. In contrast to the azaadamantanones, the azaadamantanetriol core of the title compound does not show any particular C—C bond elongation.

  3. Symmetrical trimeric star-shaped mesogens based on 1,3,5 ...

    Indian Academy of Sciences (India)

    joined to the 1,3,5-position of phloroglucinol to yield the symmetrical three-armed star-shaped molecules. The acronyms used to refer the two series of star-shaped mesogens in this article are PSB-X-n and PAZ-X-n, in which PSB-X-n is referred to the star-shaped mesogen incorporating Schiff base moieties while PAZ-X-n is.

  4. Microwave-Assisted Synthesis of Some 3,5-Arylated 2-Pyrazolines

    Directory of Open Access Journals (Sweden)

    Hassan Ghasemnejad

    2003-07-01

    Full Text Available Condensation of 2-acetylnaphthalene with benzaldehydes under microwave irradiation affords chalcones which undergo facile and clean cyclizations with hydrazines RNHNH2 (R= H, Ph, Ac to afford 3,5-arylated 2-pyrazolines in quantitative yields, also under microwave irradiation and in the presence of dry AcOH as cyclizing agent. The results obtained indicate that, unlike classical heating, microwave irradiation results in higher yields, shorter reaction times (2-12 min. and cleaner reactions.

  5. Liquid and Gas Chromatographic Determination of 1,3,5-Trinitrobenzene in Water

    Science.gov (United States)

    1986-04-01

    Investigations conducted at the U.S. Army Medical Bioengineering Research and Development Laboratory ( Aquatic Toxicology Section) have shown that...1,3,5-trinitrobenzene (TNB) is toxic to freshwater aquatic organisms. Further investigations are now being performed by the Aquatic Toxicology Section to...determine the relative effects of TNB in constant and fluctuating applications on the water flea Daphia magna. In support of the Aquatic Toxicology Section

  6. Magnetic properties of a TbFe3.5Al8.5 single crystal

    NARCIS (Netherlands)

    Brommer, P.E.; de Boer, F.R.; Duong, N.P.; Buschow, K.H.J.; Brück, E.H.

    2004-01-01

    We have studied the magnetic behaviour of a (tetragonal) TbFe3.5Al8.5 single crystal extending earlier work on a TbFe4.4Al7.6 one. At 5K, the magnetisation curve measured along the [0 0 1] direction points to easy-plane behaviour, whereas that along the [1 0 0] direction shows a strong hysteresis,

  7. Compilation of data for the analysis of radionuclide migration from SFL 3-5

    Energy Technology Data Exchange (ETDEWEB)

    Skagius, K.; Pettersson, Michael; Wiborgh, M. [Kemakta Konsult AB, Stockholm (Sweden); Albinsson, Yngve; Holgersson, Stellan [Chalmers Univ. of Technology, Goeteborg (Sweden). Dept. of Nuclear Chemistry

    1999-12-01

    A preliminary safety assessment of the deep repository for long-lived, low and intermediate level waste, SFL 3-5, has been made. This report contains a compilation of data selected for the calculations of the migration of radionuclides and toxic metals from the waste to the biosphere. It also contains the data needed for the next step, which is to calculate dose to man from the far-field release figures. In the preliminary safety assessment it is assumed that SFL 3-5 is located in connection to the deep repository for spent fuel. This makes it possible to utilise site-specific information derived within the safety assessment of the deep repository for spent fuel, SR 97, for the sites Aberg, Beberg and Ceberg. When information from SR 97 is utilised, the values selected are as far as possible those proposed as a 'reasonable estimate' for the migration calculations in SR 97. The selection of values for parameters specific for the calculation of migration from the SFL 3-5 repository is in general on the pessimistic side. The uncertainty in the selected values is discussed and if possible also quantified.

  8. 4-[(4-Aminophenylsulfonyl]aniline–3,5-dinitrobenzoic acid (1/1

    Directory of Open Access Journals (Sweden)

    Graham Smith

    2012-03-01

    Full Text Available The title compound, C7H4N2O6·C12H12N2O2S, is a 1:1 cocrystal of the drug dapsone with 3,5-dinitrobenzoic acid. The dihedral angle between the two aromatic rings of the dapsone molecule is 75.4 (2°, and the dihedral angles between these rings and that of the 3,5-dinitrobenzoic acid are 64.5 (2 and 68.4 (2°. A strong intermolecular carboxylic acid O—H...Namine hydrogen bond is found, together with intermolecular amine N—H...O hydrogen-bonding associations with carboxyl, nitro and sulfone O-atom acceptors. In addition, weak π–π interactions between one of the dapsone benzene rings and the 3,5-dinitrobenzoic acid ring [ring centroid separation = 3.774 (2 Å] results in a two-dimensional network structure.

  9. Our FABulous VACation: a decade of phosphatidylinositol 3,5-bisphosphate.

    Science.gov (United States)

    Dove, Stephen K; Johnson, Zoë E

    2007-01-01

    PtdIns(3,5)P2 was discovered about a decade ago and much of the machinery that makes, degrades and senses it has been uncovered. Despite this, we still lack a complete understanding of how the pieces fit together but some patterns are beginning to emerge. Molecular functions for PtdIns(3,5)P2 are also elusive, but the identification of effectors offers a way into some of these processes. An examination of the defects associated with loss of synthesis of PtdIns(3,5)P2 in lower and higher eukaryotes begins to suggest a unifying theme; this lipid regulates membrane retrieval via retrograde trafficking from distal compartments to organelles that are more proximal in the endocytic/lysosomal system. Another unifying theme is stress signalling to organelles, possibly both to change their morphology in response to external insults and to maintain the lumenal pH or membrane potential of organelles. The next few years seem likely to uncover details of the molecular mechanisms underlying the biology of this fascinating lipid. This review also highlights some areas where further research is needed.

  10. Structure and applications of metal-organic framework based on cyanide and 3,5-dichloropyridine

    Science.gov (United States)

    Etaiw, Safaa El-din H.; El-bendary, Mohamed M.

    2013-06-01

    The reaction of the aqueous/acetonitrile solutions of K3[Cu(CN)4] and 3,5-dichloropyridine (3,5-dClpy), in the presence of Me3SnCl affords a new metal-organic framework (MOF), 3∞[(CuCN)2·(3,5-dClpy)2], 1. The structure of the MOF 1 was characterized by IR, UV-visible, TGA and X-ray single crystal analysis. The structure of MOF 1 consists of CuCN building blocks which are connected by CN group forming 1D-zig-zag chains. Each chain is bridged to another chain by hydrogen bonding organizing 2D-sheets. The structure of 1 is further close packed by hydrogen bonds, π-π stacking and lp-π interactions creating 3D-network. The emission spectra and the thermodynamic parameters from TGA of the MOF 1 were discussed. The MOF 1 was used as heterogeneous catalyst for the oxidative discoloration of methylene blue dye (MB) by dilute solution of hydrogen peroxide as oxidant. The in vitro cytotoxic activity has been evaluated against the human breast cancer cell lines MCF-7. The cytotoxic effect of the MOF 1 on the viability of MCF-7 cells was determined by MTT assay.

  11. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Nathan R Hill

    Full Text Available Chronic kidney disease (CKD is a global health burden with a high economic cost to health systems and is an independent risk factor for cardiovascular disease (CVD. All stages of CKD are associated with increased risks of cardiovascular morbidity, premature mortality, and/or decreased quality of life. CKD is usually asymptomatic until later stages and accurate prevalence data are lacking. Thus we sought to determine the prevalence of CKD globally, by stage, geographical location, gender and age. A systematic review and meta-analysis of observational studies estimating CKD prevalence in general populations was conducted through literature searches in 8 databases. We assessed pooled data using a random effects model. Of 5,842 potential articles, 100 studies of diverse quality were included, comprising 6,908,440 patients. Global mean(95%CI CKD prevalence of 5 stages 13·4%(11·7-15·1%, and stages 3-5 was 10·6%(9·2-12·2%. Weighting by study quality did not affect prevalence estimates. CKD prevalence by stage was Stage-1 (eGFR>90+ACR>30: 3·5% (2·8-4·2%; Stage-2 (eGFR 60-89+ACR>30: 3·9% (2·7-5·3%; Stage-3 (eGFR 30-59: 7·6% (6·4-8·9%; Stage-4 = (eGFR 29-15: 0·4% (0·3-0·5%; and Stage-5 (eGFR<15: 0·1% (0·1-0·1%. CKD has a high global prevalence with a consistent estimated global CKD prevalence of between 11 to 13% with the majority stage 3. Future research should evaluate intervention strategies deliverable at scale to delay the progression of CKD and improve CVD outcomes.

  12. Urinary Fractional Excretion of Phosphorus in Dogs with Spontaneous Chronic Kidney Disease.

    Science.gov (United States)

    Martorelli, Cínthia Ribas; Kogika, Márcia Mery; Chacar, Fernanda Chicharo; Caragelasco, Douglas Segalla; de Campos Fonseca Pinto, Ana Carolina Brandão; Lorigados, Carla Aparecida Batista; Andrade, Lúcia Conceição

    2017-12-14

    The increase of urinary fractional excretion of phosphorus (uFEP) may indicate phosphorus retention before the onset of hyperphosphatemia in the early stages of chronic kidney disease (CKD). The hypothesis of this study is whether uFEP may increase during the early stage of CKD as a compensatory mechanism to prevent hyperphosphatemia as well as whether hyperphosphatemia in the late stages is associated with increase or decrease in uFEP in dogs with naturally occurring CKD; therefore, the aim of this study was to determine the uFEP in CKD dogs with different stages. Forty-nine CKD dogs were included, and they were divided into stage 1 (serum creatinine 5.0 mg/dL), according to the IRIS staging criteria. The stage 3 was subdivided into stage 3-A (serum creatinine 2.1 to 3.5 mg/dL) and stage 3-B (serum creatinine 3.6 to 5.0 mg/dL). The control group comprised 10 dogs, and uFEP ≤ 40% was considered as normal. A progressive increase in uFEP along the progression of CKD was found. However, similar results of uFEP levels were observed in late CKD, since there were no differences between stages 3 (A, B) and 4. Interestingly, some CKD dogs with stage 4 showed normal or reduced uFEP, besides hyperphosphatemia; conversely, some dogs in early CKD had increased uFEP values and normophosphatemia. Our findings suggest that uFEP may act as a compensatory mechanism to avoid the onset of hyperphosphatemia in early CKD, but not in later stages. uFEP assessment may be considered as an additional tool for the diagnostic and monitoring of phosphate disorders in dogs with CKD, since it may help to identify disturbances of phosphorus balance. More studies are needed to elucidate the role of uFEP in phosphorus homeostasis in dogs with CKD.

  13. Managing an Acute and Chronic Periprosthetic Infection

    Directory of Open Access Journals (Sweden)

    Cristian Barrientos

    2017-01-01

    Full Text Available A case report of a 65-year-old female with a history of right total hip arthroplasty (THA in 2007 and left THA in 2009 was presented. She consulted with our institution for the first time, on December 2013, for right hip pain and fistula on the THA incision. It was managed as a chronic infection, so a two-stage revision was performed. First-time intraoperative cultures were positive for Staphylococcus aureus (3/5 and Proteus mirabilis (2/5. Three weeks after the second half of the review, it evolved with acute fever and pain in relation to right hip. No antibiotics were used, arthrocentesis was performed, and a coagulase-negative staphylococci multisensible was isolated at the 5th day. Since the germ was different from the first revision, it was decided to perform a one-stage revision. One year after the first review, the patient has no local signs of infection and presents ESV and RPC in normal limits. The indication and management of periprosthetic infections are discussed.

  14. Association between serum interleukin-6 and serum 3,5,3'-triiodothyronine in nonthyroidal illness

    NARCIS (Netherlands)

    Boelen, A.; Platvoet-ter Schiphorst, M. C.; Wiersinga, W. M.

    1993-01-01

    Increased serum concentrations of FFA, bilirubin, and carboxyl-methyl-propyl-furanpropionic acid, accumulating in chronic renal failure in direct relationship with serum creatinine, have all been implicated in the pathogenesis of the low T3 syndrome during illness. Cytokines may also be involved in

  15. Chronic kidney disease and bleeding risk in patients at high cardiovascular risk: a cohort study.

    Science.gov (United States)

    Ocak, G; Rookmaaker, M B; Algra, A; de Borst, G J; Doevendans, P A; Kappelle, L J; Verhaar, M C; Visseren, F L

    2018-01-01

    Essentials The association between chronic kidney disease and bleeding is unknown. We followed 10 347 subjects at high cardiovascular risk for bleeding events. Chronic kidney disease was associated with a 1.5-fold increased bleeding risk. Especially albuminuria rather than decreased kidney function was associated with bleeding events. Background There are indications that patients with chronic kidney disease have an increased bleeding risk. Objectives To investigate the association between chronic kidney disease and bleeding in patients at high cardiovascular risk. Methods We included 10 347 subjects referred to the University Medical Center Utrecht (the Netherlands) from September 1996 to February 2015 for an outpatient visit with classic risk factors for arterial disease or with symptomatic arterial disease (Second Manifestation of Arterial disease [SMART] cohort). Patients were staged according to the KDIGO guidelines, on the basis of estimated glomerular filtration rate (eGFR) and albuminuria, and were followed for the occurrence of major hemorrhagic events until March 2015. Hazard ratios (HRs) with 95% confidence intervals (CIs) for bleeding were calculated with Cox proportional hazards analyses. Results The incidence rate for bleeding in subjects with chronic kidney disease was 8.0 per 1000 person-years and that for subjects without chronic kidney disease was 3.5 per 1000 person-years. Patients with chronic kidney disease (n = 2443) had a 1.5-fold (95% CI 1.2-1.9) increased risk of bleeding as compared with subjects without chronic kidney disease (n = 7904) after adjustment. Subjects with an eGFR of Chronic kidney disease is a risk factor for bleeding in patients with classic risk factors for arterial disease or with symptomatic arterial disease, especially in the presence of albuminuria. © 2017 University Medical Center Utrecht. Journal of Thrombosis and Haemostasis © 2017 International Society on Thrombosis and Haemostasis.

  16. Characterization of a newly isolated highly effective 3,5,6-trichloro-2-pyridinol degrading strain Cupriavidus pauculus P2.

    Science.gov (United States)

    Cao, Li; Liu, Hongming; Zhang, Hao; Huang, Ke; Gu, Tao; Ni, Haiyan; Hong, Qing; Li, Shunpeng

    2012-09-01

    A bacterial strain P2 capable of degrading 3,5,6-trichloro-2-pyridinol (TCP) was isolated and characterized. Phylogenetic analysis based on 16S rRNA gene sequence indicated that it belonged to the genus of Cupriavidus, because it showed the highest sequence similarity to Cupriavidus pauculus LMG 3413(T) (99.7 %) and DNA-DNA relatedness value between strain P2 and C. pauculus LMG 3413(T) was 76.8 %. In combination with morphological, physiological and biochemical characters, strain P2 was identified as C. pauculus. It could use TCP as the sole carbon source and energy source for its growth. It showed a high average degradation rate of 10 mg/L h in mineral salt medium amended with TCP (50-800 mg/L). During TCP degradation, chloridion was released into the medium in two obvious discontinuous stages. Along with this, two colorful metabolites were produced. Finally, the molarity of the total released chloridion was three times that of the initial TCP in the medium. This is the first report of TCP-degrading strain from the genus of Cupriavidus and the detection of two colorful metabolites during TCP degradation. Strain P2 might be a promising candidate for its application in the bioremediation of TCP-polluted environments.

  17. Sequential Injection/Electrochemical Immunoassay for Quantifying the Pesticide Metabolite 3, 5, 6-Trichloro-2-Pyridinol

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Guodong; Riechers, Shawn L.; Timchalk, Chuck; Lin, Yuehe

    2005-12-04

    An automated and sensitive sequential injection electrochemical immunoassay was developed to monitor a potential insecticide biomarker, 3, 5, 6-trichloro-2-pyridinol. The current method involved a sequential injection analysis (SIA) system equipped with a thin-layer electrochemical flow cell and permanent magnet, which was used to fix 3,5,6-trichloro-2-pyridinol (TCP) antibody coated magnetic beads (TCP-Ab-MBs) in the reaction zone. After competitive immunoreactions among TCP-Ab-MBs, TCP analyte, and horseradish peroxidase (HRP) labeled TCP, a 3, 3?, 5, 5?-tetramethylbenzidine dihydrochloride and hydrogen peroxide (TMB-H2O2) substrate solution was injected to produce an electroactive enzymatic product. The activity of HRP tracers was monitored by a square wave voltammetric scanning electroactive enzymatic product in the thin-layer flow cell. The voltammetric characteristics of the substrate and the enzymatic product were investigated under batch conditions, and the parameters of the immunoassay were optimized in the SIA system. Under the optimal conditions, the system was used to measure as low as 6 ng L-1 (ppt) TCP, which is around 50-fold lower than the value indicated by the manufacturer of the TCP RaPID Assay? kit (0.25 ug/L, colorimetric detection). The performance of the developed immunoassay system was successfully evaluated on tap water and river water samples spiked with TCP. This technique could be readily used for detecting other environmental contaminants by developing specific antibodies against contaminants and is expected to open new opportunities for environmental and biological monitoring.

  18. An explanation for the universal 3.5 power-law observed in currency markets

    Directory of Open Access Journals (Sweden)

    Nicholas A. Johnson

    Full Text Available We present a mathematical theory to explain a recent empirical finding in the Physics literature (Zhao et al., 2013 in which the distributions of waiting-times between discrete events were found to exhibit power-law tails with an apparent universal exponent: α∼3.5. This new theory provides the first ever qualitative and quantitative explanation of Zhao et al.’s surprising finding. It also provides a mechanistic description of the origin of the observed universality, assigning its cause to the emergence of dynamical feedback processes between evolving clusters of like-minded agents. Keywords: Complex systems, Econophysics, Collective, Power law

  19. KARAKTERISTIK KELUARGA, KESIAPAN MENIKAH ISTRI, DAN PERKEMBANGAN ANAK USIA 3-5 TAHUN

    OpenAIRE

    Nurlita Tsania; Euis Sunarti; Diah Krisnatuti

    2015-01-01

    Marital readiness was considered as an important indicator for successful marriage and also could enhance child development, espeially for early phase of family and early childhood. However, the study about marital readiness and child development were still limited. The study was a retrospective and cross sectional design of 120 families whose children aged 3-5 years old. Samples were selected by stratified nonproportional simple random sampling in two areas in Ratu Jaya and Bojong Pondok Ter...

  20. An explanation for the universal 3.5 power-law observed in currency markets

    Science.gov (United States)

    Johnson, Nicholas A.; Johnson, Neil F.

    We present a mathematical theory to explain a recent empirical finding in the Physics literature (Zhao et al., 2013) in which the distributions of waiting-times between discrete events were found to exhibit power-law tails with an apparent universal exponent: α ∼ 3.5 . This new theory provides the first ever qualitative and quantitative explanation of Zhao et al.'s surprising finding. It also provides a mechanistic description of the origin of the observed universality, assigning its cause to the emergence of dynamical feedback processes between evolving clusters of like-minded agents.

  1. Commissioning Results of the 2nd 3.5 Cell SRF Gun for ELBE

    Energy Technology Data Exchange (ETDEWEB)

    Arnold, A [HZDR, Dresden, Germany; Freitag, M [HZDR, Dresden, Germany; Murcek, Petr [HZDR, Dresden, Germany; Teichert, Jochen [HZDR, Dresden, Germany; Vennekate, H [HZDR, Dresden, Germany; Xiang, R [HZDR, Dresden, Germany; Ciovati, Gianluigi [JLAB; Kneisel, Peter K. [JLAB; Turlington, Larry D, [JLAB

    2014-12-01

    As in 2007 the first 3.5 cell superconducting radio frequency (SRF) gun was taken into operation, it turned out that the specified performance has not been achieved. However, to demonstrate the full potential of this new type of electron source, a second and slightly modified SRF gun II was built in collaboration with Thomas Jefferson National Accelerator Facility (TJNAF). We will report on commissioning and first results of the new gun, which includes in particular the characterization of the most important RF properties as well as their comparison with previous vertical test results.

  2. Meeting report:Iraq oil ministry needs assessment workshop.3-5 Septemner 2006

    Energy Technology Data Exchange (ETDEWEB)

    Littlefield, Adriane C.; Pregenzer, Arian Leigh

    2006-11-01

    Representatives from the U.S. Department of Energy, the National Nuclear Security Administration, and Sandia National Laboratories met with mid-level representatives from Iraq's oil and gas companies and with former employees and senior managers of Iraq's Ministry of Oil September 3-5 in Amman, Jordan. The goals of the workshop were to assess the needs of the Iraqi Oil Ministry and industry, to provide information about capabilities at DOE and the national laboratories relevant to Iraq, and to develop ideas for potential projects.

  3. Mechanical alloying of Cu-xCr (x = 3, 5 and 8 wt.%) alloys

    Energy Technology Data Exchange (ETDEWEB)

    Aguilar, C., E-mail: ceaguilar@uach.c [Instituto de Materiales y Procesos Termomecanicos, Facultad de Ciencias de la Ingenieria, Universidad Austral de Chile, General Lagos 2086, Valdivia (Chile); Ordonez, S. [Departamento de Ingenieria Metalurgica, Facultad de Ingenieria, Universidad de Santiago de Chile, Av. L. Bernardo O' Higgins 3363, Santiago (Chile); Guzman, D. [Departamento de Metalurgia, Facultad de Ingenieria, Universidad de Atacama, Av. Copayapu 485, Copiapo (Chile); Rojas, P.A. [Escuela de Ingenieria Mecanica, Facultad de Ingenieria, Pontificia Universidad Catolica de Valparaiso, Av. Los Carrera 01567, Quilpue (Chile)

    2010-08-13

    This work studies the structural evolution of Cu-xCr (x = 3, 5 and 8 wt.%) alloys processed by mechanical alloying using X-ray diffraction profiles, scanning microscopy and microhardness analysis. X-ray diffraction analysis using the modified Williamson-Hall and Warren-Averbach methods were used to determine structural properties, such as crystallite size, stacking fault probability and energy, dislocation density, lattice parameters and crystallite size distribution of metallic powder as a function of Cr amount and milling time. Lattice defects increase the Gibbs free energy and the Gibbs free energy curves shift upward, therefore the solubility limit change.

  4. A New Class of Heterocycles: 1,4,3,5-Oxathiadiazepane 4,4-dioxides

    Directory of Open Access Journals (Sweden)

    Amel Bendjeddou

    2012-02-01

    Full Text Available This work reports the synthesis of novel 1,4,3,5-oxathiadiazepanes 4,4-dioxides from the reaction of N’-benzyl-N-(2-hydroxyethyl-sarcosine or proline sulfamide with aromatic aldehydes under acid catalysis. To prepare the starting materials N-Boc-sulfamide derivatives of sarcosine or proline were alkylated with benzyl alcohol under Mitsunobu reaction conditions, the Boc group was removed chemoselectively by acidolysis, and the resulting product reduced to the corresponding alcohol in good yields.

  5. Syntheses, Characterization and Antimicrobial Evaluation of Some 1, 3, 5-Trisubustituted Pyrazole Derivatives

    Directory of Open Access Journals (Sweden)

    Vertika Gautam

    2010-01-01

    Full Text Available A series of 1, 3, 5-trisubustituted pyrazole derivatives were synthesized and screened for antimicrobial activity. The compounds (2j-o were evaluated against two gram-positive and two gram-negative bacteria and one fungus, at concentrations of 10 µg/mL and 50 µg/mL. The compounds were founds to be inactive against P. aeruginosa and A. niger but exhibited moderate activity against B. subtilis, E. coli and S. aureus. It can be concluded that the newly synthesized compounds possess promising antimicrobial activity.

  6. Crevice corrosion resistance of high alloyed materials in 3.5 % NaCl solution

    International Nuclear Information System (INIS)

    Alar, Vesna; Stojanovic, Ivan; Simunovic, Vinko

    2014-01-01

    The effects of applied torque on the corrosion behaviour of W.-Nr. 1.4404 and 1.4462 stainless steels and W.-Nr. 2.4605 and 2.4858 nickel alloys with crevices were investigated using the cyclic potentiodynamic polarization method. Crevice corrosion (material-to-polytetrafluoroethylene) was tested in 3.5 % NaCl solution at 22 C. The corroded surface was examined using scanning electron microscopy. The results indicate similar trends in susceptibility to crevice corrosion with increasing torque. Among the four specimens, the W.-Nr. 1.4404 is the most susceptible to crevice corrosion. (orig.)

  7. Chronic cholecystitis

    Science.gov (United States)

    Cholecystitis - chronic ... Most of the time, chronic cholecystitis is caused by repeated attacks of acute (sudden) cholecystitis. Most of these attacks are caused by gallstones in the gallbladder. These ...

  8. Chronic Pain

    Science.gov (United States)

    ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. × ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. ...

  9. Understanding cancer staging

    Science.gov (United States)

    ... detailed information about the cancer stage. TNM Staging System The most common system for staging cancer in the form of solid tumor is the TNM system. Most providers and cancer centers use it to stage ...

  10. RESIKO TERJADINYA KEGEMUKAN PADA ANAK USIA 3-5 TAHUN DENGAN STATUS GIZI PENDEK DI INDONESIA

    Directory of Open Access Journals (Sweden)

    Nur Handayani Utami

    2016-03-01

    Full Text Available Based on Basic Health Research 2007-2013, stunting and overweight in children have a tendency to increase. Some previous analysis found that there was a relationship between stunting and overweight. This analysis aimed to analyze the relationship between stunting and overweight in children aged 3-5 years in Indonesia. Data were taken from the national survey conducted in 2013. A total of 25.107 children aged 3-5 years from all provinces in Indonesia were become sample in this analysis. The relationship between stunting and the occurrence of overweight in children was analyzed using logistic regression.  Analysis showed that the stunted status had become a risk of overweight in children with OR of 2,54 (CI 2,24 to 2,89 after correction by socioeconomic factors, sex of the child, father's education, and nutritional status of the father.  The risk of stunted child of becoming overweight make the importance of dietary habit and proper diet for children who are stunted, so they will not become obese in later life.

  11. Design and realization of a planar ultrawideband antenna with notch band at 3.5 GHz.

    Science.gov (United States)

    Azim, Rezaul; Islam, Mohammad Tariqul; Misran, Norbahiah; Yatim, Baharudin; Arshad, Haslina

    2014-01-01

    A small antenna with single notch band at 3.5 GHz is designed for ultrawideband (UWB) communication applications. The fabricated antenna comprises a radiating monopole element and a perfectly conducting ground plane with a wide slot. To achieve a notch band at 3.5 GHz, a parasitic element has been inserted in the same plane of the substrate along with the radiating patch. Experimental results shows that, by properly adjusting the position of the parasitic element, the designed antenna can achieve an ultrawide operating band of 3.04 to 11 GHz with a notched band operating at 3.31-3.84 GHz. Moreover, the proposed antenna achieved a good gain except at the notched band and exhibits symmetric radiation patterns throughout the operating band. The prototype of the proposed antenna possesses a very compact size and uses simple structures to attain the stop band characteristic with an aim to lessen the interference between UWB and worldwide interoperability for microwave access (WiMAX) band.

  12. Synthesis and photo-physical properties of fluorescent 1,3,5-triazine styryl derivatives

    Directory of Open Access Journals (Sweden)

    Padalkar Vikas S

    2011-12-01

    Full Text Available Abstract Background Organic fluorophore contains well-defined D-π-A (Donor-π system-Acceptor push-pull system have wide application in the field of NLO, OLED and high tech application. Electron donor diphenyl, triphenyl and carbazole conjugated with electron acceptor terminal through π-system were reported recently for high-tech applications. N,N-Dialkyl substituted 1,3,5-triazine also acts as donor keeping this idea in mind we developed D-π-A styryl dyes. Results Novel "Y"-shaped acceptor-π-donor-π-acceptor type of compounds were synthesized from 4,4'-((6-(4-(diethylaminophenyl-1,3,5-triazine-2,4diylbis(oxy dibenzaldehyde (DIPOD as electron donors and different active methylene compounds as electron acceptors by conventional Knoevenagel condensation reaction. Their photophysical and thermal properties were investigated. Conclusion It was found that the strong electron acceptor-donor chromophoric system of these compounds showed high Stoke's shift and excellent thermal stability. Compounds showed positive solvatofluorism behavior from nonpolar to polar solvent. All compounds have good thermal stability.

  13. Maxillary Arch Dimension Changes of 3-5 Years Old Filipino Children

    Directory of Open Access Journals (Sweden)

    Abdol Hamid Zafarmand

    2014-11-01

    Full Text Available Background: The purpose of this study was to assess the dental arch dimensions in primary dentition of 3-5 years old Filipino children and determining the existence of sexual dimorphism.Materials and Methods: In this descriptive study, 60 Filipino preschool children aged 3-5 years old were selected from Manila city. Study casts were used for measurements of 3 arch dimensions: bicanine width, bimolar width, and arch length. The analyses were performed to compare values within age-groups and within gender-groups, besides reporting mean and standard deviations. The data were subjected to One-way ANOVA and Student t-test.Results: Significant differences were observed regarding dental arch dimensions among different ages and genders (p<0.05. Comparison between genders showed a statistically significant difference in bicanine width at the age of 4 (p=0.04, in bimolar width at age of 5 (p=0.006, and in arch length at age of 4 (p=0.03 and 5 (p=0.02. Differences within male group for different ages showed only arch length dimension was statistically significant (p=0.021. In females, however the comparison between age-groups also revealed a statistically significant difference in bicanine (p= 0.016 and bimolar widths (p=0.027 dimensions.Conclusion: The present study showed that dental arch dimensions, vary among different ages and genders of children. It also showed that a sexual dimorphism does exist between the gender groups.

  14. Validation of CATHENA MOD-3.5/Rev0 for single-phase water hammer

    International Nuclear Information System (INIS)

    Beuthe, T.G.

    2000-01-01

    This paper describes work performed to validate the system thermalhydraulics code CATHENA MOD-3.5c/Rev0 for single-phase water hammer. Simulations were performed and are compared quantitatively against numerical tests and experimental results from the Seven Sisters Water Hammer Facility to demonstrate CATHENA can predict the creation and propagation of pressure waves when valves are opened and closed. Simulations were also performed to show CATHENA can model the behaviour of reflected and transmitted pressure waves at area changes, dead ends, tanks, boundary conditions, and orifices in simple and more complex piping systems. The CATHENA results are shown to calculate pressure and wave propagation speeds to within 0.2% and 0.5% respectively for numerical tests and within 3.3% and 5% for experimental results respectively. These results are used to help validate CATHENA for use in single-phase water hammer analysis. They also provide assurance that the fundamental parameters needed to successfully model more complex forms of water hammer are accounted for in the MOD-3.5c/Rev0 version of CATHENA, and represent the first step in the process to validate the code for use in modelling two-phase water hammer and condensation-induced water hammer. (author)

  15. [A chronic problem-the chronic headache patient].

    Science.gov (United States)

    Straube, A

    2004-10-01

    Chronic daily headache is a frequent problem which affects 3-5% of the population. Until the 2nd edition of the IHS headache classification, the diagnosis of chronic headache was synonymous with the diagnosis of chronic tension type headache. Now one has to differentiate, not only in symptomatic headache, but also between other primary headache syndromes, such as chronic migraine, hemicrania continua and acute persisting daily headache. Epidemiological studies point to a particular importance of chronic migraine and headache due to chronic analgetica use, since both types of headache are responsible for more than 60% of all cases with chronic headache. Although the mechanisms which cause chronification of headache are not well understood, the new headache classification prompts some direct therapeutical consequences: 1) the indication for drug withdrawal and 2) the indication for a migraine preventive therapy. In general, as with other chronic pain syndromes, there is increasing evidence that a multimodal therapy, consisting of patient education, behavioral therapy and pharmacological therapy, is more successful than a singular therapy.