Peritoneal Dialysis in Chronic Renal Failure

The long-term results of intermittent peritoneal dialysis in long-term treatment of renal disease have yet to equal those of intermittent hemodialysis. However, further exploration and refinement of this technique is justified.Performed in acute stages of disease, both peritoneal dialysis and hemodialysis relieve the symptoms of uremia and specifically “buy time” for the patient so that proper medical or surgical therapy may be instituted. In acute situations, peritoneal dialysis is the procedure of choice, and is an important adjunct to more conventional treatment for chronic renal disease. It may be useful sometimes even in chronically hemodialyzed patients—for example, when the hemodialysis cannula for one reason or another is inaccessible because of clots, replacement, or infection. It is especially valuable when the hemorrhagic complications of uremia contraindicate hemodialysis treatment.Its use in chronic uremia remains sharply limited in time, but for brief periods chronic peritoneal dialysis appears to be a reasonably satisfactory means of prolonging life while awaiting homotransplant or decision for maintenance hemodialysis therapy.     

Increased Serum Al Levels in Hemodialysis Patients Kept Enhanced during a 2-Year Prospective Study

The regulation of mineral homeostasis is altered in hemodialysis patients with renal insufficiency, producing increased risk for secondary diseases like cardiovascular ones. We hypothesized that risen serum aluminum (Al) concentration in hemodialysis patients kept enhanced during a 2-year longitudinal study is associated with enhanced cardiovascular risk and influenced by medical treatments. This study reports the prospective monitoring of serum Al levels in six-monthly samplings over 2 years in 116 hemodialysis patients and a control group of 50 healthy adults. The influence of other factors like sex, age, kidney transplant, disease etiology, and drug consumption was also considered. At each sampling, serum Al levels were significantly higher in the patients than in the healthy controls (P < 0.05). Levels in the patient group were statistically significantly lower at the third and fourth versus first and second samplings, which may be related to Al accumulation in tissues. Increased Al levels in patients were positively and significantly related to serum calcium (Ca) and uric acid levels. Serum Al concentrations were significantly lower in patients receiving vasodilators and diuretics. Higher serum Al levels in hemodialyzed patients administered with phosphate binders or anti-hyperkalemics are attributable to their usual Al salt content. The consumption of antianemic drugs increases Al absorption by forming more bioavailable complexes with the compounds in these drugs. In conclusion, this is the first study to indicate that cardiovascular problems associated with elevated serum Al levels in hemodialysis patients may be in part mitigated by administrating vasodilators and diuretics, which reduce these levels.     

不同护理模式对维持性血液透析患者透析依从性与生活质量的影响

目的探讨不同护理模式对维持性血液透析患者透析治疗依从性与生活质量的影响。方法将行维持性血液透析的患者80例,根据护理模式的不同分为对照组与研究组各40例,对照组采用常规护理模式,研究组采用协同护理模式,两组均干预4个月,并对两组患者干预前后进行透析依从性量表、简明健康调查表(SF-36)、护理满意度进行问卷调查,分析干预前后两组患者透析依从性、生活质量变化及对护理满意度情况。结果与干预前比较,干预后研究组患者在透析依从性评分、SF-36评分及护理满意度方面均明显升高,差异有统计学意义(均P0.01);而且与对照组比较差异亦有显著统计学意义(均P0.01)。结论协同护理模式可显著提高维持性血液透析患者的血透治疗依从性及生活质量,提高了护理满意度,值得临床推广应用。     

Factors Associated with Quality of Life among Hemodialysis Patients in Malaysia

Although hemodialysis treatment has greatly increased the life expectancy of end stage renal disease patients, low quality of life among hemodialysis patients is frequently reported. This cross-sectional study aimed to determine the relationship between medical history, hemodialysis treatment and nutritional status with the mental and physical components of quality of life in hemodialysis patients. Respondents (n=90) were recruited from Hospital Kuala Lumpur and dialysis centres of the National Kidney Foundation of Malaysia. Data obtained included socio-demography, medical history, hemodialysis treatment and nutritional status. Mental and physical quality of life were measured using the Mental Composite Summary (MCS) and Physical Composite Summary (PCS) of the Short-Form Health Survey 36-items, a generic core of the Kidney Disease Quality of Life Short Form. Two summary measures and total SF-36 was scored as 0–100, with a higher score indicating better quality of life. Approximately 26 (30%) of respondents achieved the body mass index (24 kg/m²) and more than 80% (n=77) achieved serum albumin level (>35.0 mg/dL) recommended for hemodialysis patients. The majority of respondents did not meet the energy (n=72, 80%) and protein (n=68,75%) recommendations. The total score of SF-36 was 54.1±19.2, while the score for the mental and physical components were 45.0±8.6 and 39.6±8.6, respectively. Factors associated with a higher MCS score were absence of diabetes mellitus (p=0.000) and lower serum calcium (p=0.004), while higher blood flow (p=0.000), higher serum creatinine (p=0.000) and lower protein intake (p=0.006) were associated with a higher PCS score. To improve the overall quality of life of hemodialysis patients, a multidisciplinary intervention that includes medical, dietetic and psychosocial strategies that address factors associated with mental and physical quality of life are warranted to reduce further health complications and to improve quality of life.     

基于7所三甲医院数据的血液透析成本测算与分析

目的 通过对7所三级甲等医院血液透析医疗成本的测算和成本构成分析,找出成本构成的主要因素。方法 回顾性调查,分别采用传统成本法和作业成本法对血液透析的直接医疗成本和间接医疗成本进行测算。结果 成本构成中直接医疗成本占总医疗成本的比重最大,为36.68%,其中6所医院的血液透析收费标准低于成本,是血液透析成本的89.35%（均值）。结论 透析液和一次性材料应成为成本控制的重点,调整血液透析收费标准和调整支付方式已经成为可能。     

Perturbations sexuelles liees a l’insuffisance renale. Considérations cliniques et prise en charge sexologique

The sexual problems of the patients with renal failure seem to us a good example of the relationship between sexology and somatic diseases. Multidisciplinary work seems necessary, between somatic physicians, psychologists and sexologists to bring, when survival is secured, quality of survival which is the main claim of the patients. Due to the remarkable progresses achieved by nephrology, more than 100.000 patients with renal failure survive thanks to hemodialysis, while more than 30.000 have been transplanted. That explains the growing interest regarding the sexuality of these patients whose numbers are regularly increasing     

Blood volume-monitored regulation of ultrafiltration in fluid-overloaded hemodialysis patients: study protocol for a randomized controlled trial

ABSTRACT: BACKGROUND: Data generated with the body composition monitor (BCM, Fresenius) show, based on bioimpedance technology, that chronic fluid overload in hemodialysis patients is associated with poor survival. However, removing excess fluid by lowering dry weight can be accompanied by intradialytic and postdialytic complications. Here, we aim at testing the hypothesis that, in comparison to conventional hemodialysis, blood volume-monitored regulation of ultrafiltration and dialysate conductivity (UCR) and/or regulation of ultrafiltration and temperature (UTR) will decrease complications when ultrafiltration volumes are systematically increased in fluid-overloaded hemodialysis patients. Methods/design BCM measurements yield results on fluid overload (in liters), relative to extracellular water (ECW). In this prospective, multicenter, triple-arm, parallel-group, crossover, randomized, controlled clinical trial, we use BCM measurements, routinely introduced in our three maintenance hemodialysis centers shortly prior to the start of the study, to recruit sixty hemodialysis patients with fluid overload (defined as [greater than or equal to]15% ECW). Patients are randomized 1:1:1 into UCR, UTR and conventional hemodialysis groups. BCM-determined, 'final' dry weight is set as 7% ECW postdialysis, and reached by reducing the previous dry weight, in steps of 0.1 kg per 10 kg body weight, during 12 hemodialysis sessions (one study phase). In case of intradialytic complications, dry weight reduction is decreased, according to a prespecified algorithm. A comparison of intra- and post-dialytic complications among study groups constitutes the primary endpoint. In addition, we will assess relative weight reduction, changes in residual renal function, quality of life measures, and predialysis levels of various laboratory parameters including C-reactive protein, troponin T, and N-terminal pro-B-type natriuretic peptide, before and after the first study phase (secondary outcome parameters). DISCUSSION: Patients are not requested to revert to their initial degree of fluid overload after each study phase. Therefore, the crossover design of the present study merely serves the purpose of secondary endpoint evaluation, for example to determine patient choice of treatment modality. Previous studies on blood volume monitoring have yielded inconsistent results. Since we include only patients with BCM-determined fluid overload, we expect a benefit for all study participants, due to strict fluid management, which decreases the mortality risk of hemodialysis patients. Trial registration ClinicalTrials.gov, NCT01416753.     

糖尿病肾病维持性血液透析患者低血糖发生情况及其影响因素的Logistic回归分析

摘要 目的：探讨糖尿病肾病（DN）维持性血液透析患者低血糖发生情况,并分析其影响因素。方法：选择2018年7月~2021年2月期间收治的100例DN维持性血液透析患者,记录低血糖发生情况,按照是否发生低血糖将患者分为低血糖组（n=47）和无低血糖组（n=53）。收集两组患者的临床资料,采用多因素Logistic回归分析DN维持性血液透析患者低血糖发生的影响因素。结果：100例患者1个月内共检测血糖 1200次,其中有47例出现低血糖症状,低血糖发生率为47.00%（47/100）,53例患者未发生低血糖。DN维持性血液透析患者低血糖发生与性别、婚姻状况、工作状况、医保类型、维持性血液透析方式、收缩压、空腹血糖（FBG）、内生肌酐清除率（Ccr）、低密度脂蛋白胆固醇（LDL-C）、三酰甘油（TG）无关（P>0.05）,而与年龄、DN病程、体质量指数、文化程度、尿微量蛋白尿排泄率（UAER）、用药依从性、自我管理能力、照护能力有关（P<0.05）。多因素logistic回归性分析结果显示：年龄偏大、DN病程偏长、体质量指数偏低、UAER偏高是DN维持性血液透析患者低血糖发生的危险因素,而用药依从性、照护能力良好则是DN维持性血液透析患者低血糖发生的保护因素（P<0.05）。结论：DN维持性血液透析患者低血糖发生率较高,其中年龄偏大、DN病程偏长、体质量指数偏低、UAER偏高是DN维持性血液透析患者低血糖发生的危险因素,而用药依从性、照护能力良好则是其保护因素。     

Computer-aided decision support in clinical medicine

This paper reviews the problems and prospects involved in providing computer-aided decision support in clinical medicine. First, the evaluation of medical innovation is discussed. It is suggested that there are three criteria by which an innovation may be judged, namely (1) a need for the innovation, (2) the ability of the innovation to fulfil that need and (3) the ability to do so without transgressing practical, ethical or legal boundaries. These problems are addressed in turn. The paper suggests, taking one area of clinical medicine as an example (acute abdominal pain) there is a clear need for decision support — since the area is not handled well by doctors in current practice. Evidence is adduced to suggest that the computer can provide decision support and do so without transgressing professional, ethical or legal boundaries. The obstacles to progress, which stand in the way of widespread implementation are briefly discussed. These are lack of medical terminology, poor man-machine interface and above all a lack of co-ordination. Finally, it is suggested that the most valuable facet of current systems is the discipline and precision in data collection they impose upon practicing doctors.     

Distributed Network,Wireless and Cloud Computing Enabled 3-D Ultrasound; a New Medical Technology Paradigm

Medical technologies are indispensable to modern medicine. However, they have become exceedingly expensive and complex and are not available to the economically disadvantaged majority of the world population in underdeveloped as well as developed parts of the world. For example, according to the World Health Organization about two thirds of the world population does not have access to medical imaging. In this paper we introduce a new medical technology paradigm centered on wireless technology and cloud computing that was designed to overcome the problems of increasing health technology costs. We demonstrate the value of the concept with an example; the design of a wireless, distributed network and central (cloud) computing enabled three-dimensional (3-D) ultrasound system. Specifically, we demonstrate the feasibility of producing a 3-D high end ultrasound scan at a central computing facility using the raw data acquired at the remote patient site with an inexpensive low end ultrasound transducer designed for 2-D, through a mobile device and wireless connection link between them. Producing high-end 3D ultrasound images with simple low-end transducers reduces the cost of imaging by orders of magnitude. It also removes the requirement of having a highly trained imaging expert at the patient site, since the need for hand-eye coordination and the ability to reconstruct a 3-D mental image from 2-D scans, which is a necessity for high quality ultrasound imaging, is eliminated. This could enable relatively untrained medical workers in developing nations to administer imaging and a more accurate diagnosis, effectively saving the lives of people.     

Is parainfluenza virus a threatening virus for human cancer cell lines?

Immortalized cell lines, such as human cancer cell lines, are an indispensable experimental resource for many types of biological and medical research. However, unless the cell line has been authenticated prior to use, interpretation of experimental results may be problematic. The potential problems this may cause are illustrated by studies in which authentication of cell lines has not been carried out. For example, immortalized cell lines may unknowingly be infected with viruses that alter their characteristics. In fact, parainfluenza virus type 5 (PIV5) poses a threat to the use of immortalized cell lines in biological and medical research; PIV5 infection significantly alters cellular physiology associated with the response to interferon. If PIV5 infection is widespread in immortalized cell lines, then a very large number of published studies might have to be re-evaluated. Fortunately, analyses of a large number of immortalized cell lines indicate that PIV5 infection is not widespread.     

Unprofessional Physicians—Some Correlative Data

In the background of those physicians who have problems in medical practice serious enough to attract attention by the licensing body, there are factors that apparently can help predict such behavior. As a candidate for medical school the applicant more likely to have future problems has the following profile: (1) older than the average applicant with a lower grade point average; (2) more likely to have used tobacco; (3) did not receive a baccalaureate degree; (4) no military service; (5) turned in a sloppy handwritten application form, and (6) received a less than ideal character reference by the college from which applying. Furthermore, after admission to medical school the person more prone to future problems tends to be a poorer student than his peers and to receive a poorer rating in his first postgraduate year. The Loma Linda University graduate who has had such problems is also more likely to have settled in Southern California and to be in general practice.     

Methodology in medical research; the need for controlled clinical studies

Too many medical researchers vitiate their work by ignoring the problem of uncontrolled variables. They therefore publish clinical impressions "dressed up" in scientifically meaningless numbers. A prototypical example of this practice is contrasted with a controlled study, each employing the same (small) number of patients. It is shown how the use of controls can convert a meaningless experiment into one that has assessable scientific significance.A survey of current literature revealed that in only 21 of 100 articles studied were adequately controlled experimental conditions employed. Since they usually deal with very complex systems, it is urged that medical researchers exercise more scientific rigor with regard to control problems.     

Mass spectrometry of nucleic acids in molecular medicine

A stable streamlining trend in the field of medical diagnostics by practical adoption of high-tech and knowledge-intensive analytical systems providing for molecular level studies has appeared during the last few decades. An illustrative example of such technologies is mass spectrometry methods for analyzing biomolecules. This review is intended to brief the potential of the state-of-the-art inventory of spectrometry equipment and illustrate the application of mass spectrometry of nucleic acids (DNA and RNA) for solving practical problems related to the analysis of human genomic DNA and clinically significant microorganisms of bacterial and viral natures.     

Diagnostic Accuracy of Computer Tomography Angiography and Magnetic Resonance Angiography in the Stenosis Detection of Autologuous Hemodialysis Access: A Meta-Analysis

Purpose

To compare the diagnostic performances of computer tomography angiography (CTA) and magnetic resonance angiography (MRA) for detection and assessment of stenosis in patients with autologuous hemodialysis access.

Materials and Methods

Search of PubMed, MEDLINE, EMBASE and Cochrane Library database from January 1984 to May 2013 for studies comparing CTA or MRA with DSA or surgery for autologuous hemodialysis access. Eligible studies were in English language, aimed to detect more than 50% stenosis or occlusion of autologuous vascular access in hemodialysis patients with CTA and MRA technology and provided sufficient data about diagnosis performance. Methodological quality was assessed by the Quality Assessment of Diagnostic Studies (QUADAS) instrument. Sensitivities (SEN), specificities (SPE), positive likelihood ratio (PLR), negative likelihood values (NLR), diagnostic odds ratio (DOR) and areas under the receiver operator characteristic curve (AUC) were pooled statistically. Potential threshold effect, heterogeneity and publication bias was evaluated. The clinical utility of CTA and MRA in detection of stenosis was also investigated.

Result

Sixteen eligible studies were included, with a total of 500 patients. Both CTA and MRA were accurate modality (sensitivity, 96.2% and 95.4%, respectively; specificity, 97.1 and 96.1%, respectively; DOR [diagnostic odds ratio], 393.69 and 211.47, respectively) for hemodialysis vascular access. No significant difference was detected between the diagnostic performance of CTA (AUC, 0.988) and MRA (AUC, 0.982). Meta-regression analyses and subgroup analyses revealed no statistical difference. The Deek’s funnel plots suggested a publication bias.

Conclusion

Diagnostic performance of CTA and MRA for detecting stenosis of hemodialysis vascular access had no statistical difference. Both techniques may function as an alternative or an important complement to conventional digital subtraction angiography (DSA) and may be able to help guide medical management.     

Constructing a local district telepathology network in Japan. Diagnosis of intraoperative frozen sections via telepathology over an integrated service digital network and the National Television Standard Committee System

OBJECTIVE: To construct a local telepathology network between the Department of Pathology, Tohoku University Hospital, and Koritu Kesennuma Hospital, about 150 km away. STUDY DESIGN: Tohoku University Hospital is connected with Koritu Kesennuma Hospital by an integrated service digital network for telepathology using the National Television Standard Committee system. The cases submitted for telepathology were limited to those in which a rapid intraoperative diagnosis was made on frozen sections. RESULTS: At this writing, more than 200 cases were diagnosed during a period of 2.5 years. The cases submitted increased with time, amounting to 150 in 1996. In some cases the use of telepathology proved to be fairly advantageous. For example, in one case a radical operation was avoided because of a diagnosis on intraoperative frozen sections. DISCUSSION: There are problems to be solved before telepathology becomes available for practical use: (1) misdiagnosis due to poor quality of instruments, including the transmission cable and pictures; (2) cost-benefit ratio, (3) protection of patients' privacy, and (4) overwork for pathologists. The Japanese government will officially accept telepathology as a means of medical examination in the future. Despite some problems left, telepathology is a promising technology.     

The use of the artificial pancreas in uremic diabetic patients.

Maintenance hemodialysis and renal transplantation are increasingly used for treating diabetic patients with end-stage renal failure. The use of the artificial pancreas is able to prevent large blood glucose fluctuations in these patients with atherosclerosis, advanced retinopathy or neuropathy in which hyper- and hypoglycemia are potentially deleterious. For this purpose, we have developed and are utilizing an artificial pancreas easily utilizable without special training by the staff of a dialysis unit. This artificial pancreas uses a polarographic glucose electrode with a fast response time (45 to 90 seconds), a terminal display for operator communication, and a continuous digital and analogyl display for control of the running operation. There is also a printer to display in tabular and graphical form the values at any time during the operation. In this preliminary study, 7 patients have been studied: five under repetitive hemodialysis for four hours, 3 times a week; one treated by peritoneal dialysis for 12 hours, twice a week and one controlled during, and 48 hours after, renal transplantation. The macroscopic pancreas normalizes blood glucose under these circumstances, helps in a better understanding of blood glucose homeostasis in uremic patients under dialysis, leads to a more precise evaluation of insulin needs, may help to improve the nutritional status of the patients, and has an educational value for the patient and the medical staff.     

Some remarks on definition and validity of terms used in models for infectious disease spread.

The epidemiology of infectious diseases makes use of a number of terms, such as exposure, infected, carrier, attack rate, and immunity. Researchers who intend to model the spread of epidemics should be aware of the problems with some of these terms. The role played by inapparent, or subclinical, infections is receiving increased attention in infectious disease epidemiology. Patients with such infections may never be reported as cases, which could give rise to problems when, for example, data from national surveillance bodies are being used for modeling. The assignment of patients to different transmission groups must, in most cases, rely on self-reported data from the medical interview. This possible source of bias should be recognized.     

METHODOLOGY IN MEDICAL RESEARCH—The Need for Controlled Clinical Studies

Too many medical researchers vitiate their work by ignoring the problem of uncontrolled variables. They therefore publish clinical impressions “dressed up” in scientifically meaningless numbers. A prototypical example of this practice is contrasted with a controlled study, each employing the same (small) number of patients. It is shown how the use of controls can convert a meaningless experiment into one that has assessable scientific significance.A survey of current literature revealed that in only 21 of 100 articles studied were adequately controlled experimental conditions employed.Since they usually deal with very complex systems, it is urged that medical researchers exercise more scientific rigor with regard to control problems.     

Homology modelling and spectroscopy, a never-ending love story

Homology modelling is normally the technique of choice when experimental structure data are not available but three-dimensional coordinates are needed, for example, to aid with detailed interpretation of results of spectroscopic studies. Herein, the state of the art of homology modelling will be described in the light of a series of recent developments, and an overview will be given of the problems and opportunities encountered in this field. The major topic, the accuracy and precision of homology models, will be discussed extensively due to its influence on the reliability of conclusions drawn from the combination of homology models and spectroscopic data. Three real-world examples will illustrate how both homology modelling and spectroscopy can be beneficial for (bio)medical research.