Recovery of Renal Function among ESRD Patients in the US Medicare Program

Background

Patients started on long term hemodialysis have typically had low rates of reported renal recovery with recent estimates ranging from 0.9–2.4% while higher rates of recovery have been reported in cohorts with higher percentages of patients with acute renal failure requiring dialysis.

Study Design

Our analysis followed approximately 194,000 patients who were initiated on hemodialysis during a 2-year period (2008 & 2009) with CMS-2728 forms submitted to CMS by dialysis facilities, cross-referenced with patient record updates through the end of 2010, and tracked through December 2010 in the CMS SIMS registry.

Results

We report a sustained renal recovery (i.e no return to ESRD during the available follow up period) rate among Medicare ESRD patients of > 5% - much higher than previously reported. Recovery occurred primarily in the first 2 months post incident dialysis, and was more likely in cases with renal failure secondary to etiologies associated with acute kidney injury. Patients experiencing sustained recovery were markedly less likely than true long-term ESRD patients to have permanent vascular accesses in place at incident hemodialysis, while non-White patients, and patients with any prior nephrology care appeared to have significantly lower rates of renal recovery. We also found widespread geographic variation in the rates of renal recovery across the United States.

Conclusions

Renal recovery rates in the US Medicare ESRD program are higher than previously reported and appear to have significant geographic variation. Patients with diagnoses associated with acute kidney injury who are initiated on long-term hemodialysis have significantly higher rates of renal recovery than the general ESRD population and lower rates of permanent access placement.     

Allelic Analyses of the Arabidopsis YUC1 Locus Reveal Residues and Domains Essential for the Functions of YUC Family of Flavin Monooxygenases

Flavin monooxygenases(FMOs) play critical roles in plant growth and development by synthesizing auxin and other signaling molecules.However,the structure and function relationship within plant FMOs is not understood.Here we defined the important residues and domains of the Arabidopsis YUC1 FMO,a key enzyme in auxin biosynthesis.We previously showed that simultaneous inactivation of YUC1 and its homologue YUC4 caused severe defects in vascular and floral development.We mutagenized the yuc4 mutant and screene...     

PP-1催化亚基（PP-1c）在成体小白鼠不同组织器官中的分化表达与定位

为了确定蛋白磷酸酶-1(protein phosphatase-1)的催化亚基(PP 1c)在小白鼠不同器官组织(肌肉、卵巢、肾、胃、 脾、大脑、心、肝、肺及乳腺)中的表达模式,运用RT-PCR、Western 印迹及荧光免疫组织化学技术等实验手段进行了检测 和分析.结果表明,在mRNA水平, PP-1c在大脑中表达最高,卵巢及肺中表达次之,在肌肉、肾、心、肝中表达较低,在胃 和乳腺中表达最低;在蛋白质水平,肝中表达最高,肾、大脑、肺和乳腺中表达较高,而肌肉、卵巢、心和脾中表达相对较 低,胃中表达最低.免疫荧光组织化学实验结果显示,PP 1c的表达也具有明显的组织特异性和细胞特异性.这些结果为进一 步探讨PP 1在哺乳动物不同组织器官中的功能提供了重要的实验依据.     

表土孢粉模拟的中国生物群区

根据中国第四纪孢粉数据库提供的 6 41个表土孢粉资料 ,利用孢粉生物群区化方法 ,建立了具有 6 86个孢粉类群、31类植物功能型和 14种生物群区的孢粉生物群区化模型。经过检验 ,该模型在模拟中国生物群区、生物群区垂直分异和水平梯度分析方面均取得理想结果。模型已实现了计算机程序化 ,为重建过去地质历史时期的古生物群区和古气候分析 ,提供客观、准确的模型工具。     

Evaluation of 16S rDNA-based community profiling for human microbiome research

The Human Microbiome Project will establish a reference data set for analysis of the microbiome of healthy adults by surveying multiple body sites from 300 people and generating data from over 12,000 samples. To characterize these samples, the participating sequencing centers evaluated and adopted 16S rDNA community profiling protocols for ABI 3730 and 454 FLX Titanium sequencing. In the course of establishing protocols, we examined the performance and error characteristics of each technology, and the relationship of sequence error to the utility of 16S rDNA regions for classification- and OTU-based analysis of community structure. The data production protocols used for this work are those used by the participating centers to produce 16S rDNA sequence for the Human Microbiome Project. Thus, these results can be informative for interpreting the large body of clinical 16S rDNA data produced for this project.     

Inappropriate gonadotropin secretion in the polycystic ovary syndrome

In this study was investigated the diagnostic significance of double stimulation test with (that is of 25 micrograms rapid injection intravenously twice at an interval of 120 minutes and the misure of maximal net increment of serum LH after the first GnRH injection expressed as delta 1 and after the second injection, expressed as delta 2) to discriminate patients with idiopatic hirsutism. This test was effectuated on 8 patients with PCO (presence of polycystic ovaries on Ecografya and/or Laparoscopy) and 8 patients with idiopatic hirsutism (presence of normal morphology ovaries). Basal LH, FSH, E1, E2 and delta 4 levels were also measured. The value of LH delta 2 were more elevated in patients with PCO (p less than 0,0002) than the patients with idiopatic hirsutism. Consequently it as been value of LH delta 2 to discriminate the two different groups of patients. In PCO patients were also found: -a positive linear correlation between LH delta 1 and basal concentration serum of E2 (p less than 0,001); -a significant increase of basal levels serum of delta 4 (p less than 0,02); while the values of basal LH and LH delta 1 were found superior only on 4 of the initial 8 patients, the basal values of E1 and E2 were at the superior found of the norm and basal FSH, FSH delta 1 and FSH delta 2 values were found normals.     

The effect of prostaglandin synthesis inhibition on the direct stimulation of renin release from rabbit renal cortical slices

Prostaglandins have been hypothesized to have several mechanistic functions in sympathetically mediated release of renin. The rabbit renal cortical slice system was chosen to examine the prostaglandin dependency of renin release directly stimulated by either a direct adenylate cyclase activator, forskolin, or a β-agonist, isoproterenol. In this study, we demonstrate that with forskolin (1 × 10⁻⁵M) or isoproterenol (1 × 10⁻⁶M), renin release was elevated 2–3 fold above control, and that this increase was shown to accompany a substantial increase in the tissue levels f cAMP (19.5 fold and 3.5 fold respectively). We also demonstrate that the increase in renin release produced by these compounds was not inhibited by cyclooxygenase inhibitors, indomethacin (25 uM) or eicosatetraynoic acid (30 ug/ml), nor was it inhibited by the selective prostacyclin synthesis inhibitor, U-51605 (30 ug/ml). Each of these inhibitors was demonstrated to block the synthesis of prostaglandins in the cortical slices at the concentrations used. Thus we propose that prostaglandins do not play a role in the induction of renin release resulting from elevated cyclic nucleotide levels or β-adrenergic stimulation.     

Prostaglandin D2, another renal prostaglandin?

Prostaglandin (PG) D₂ was biosynthesized by rabbit renal papillae incubates in vitro. Quantification of the renal prostaglandins by gas chromatography-mass spectroscopy demonstrated that the concentration of PGD₂ generated by renal papillae was to the amount of PGE₂ or about 1 μg/g tissue/30 min. Infusion of the sodium salt of PGD₂ into the renal artery of the dog produced a dose related increase in renal blood flow and urine flow, free water clearance, sodium excretion and potassium excretion without changes in systemic hemodynamics. At low doses PGD₂ increased renal blood flow to all cortical zones. Higher concentrations of PGD₂ produced a shift in the intrarenal distribution of blood flow toward the juxtamedullary nephrons.