Report of the American Society of Nephrology meetings

PURPOSE: We summarize presentations on topics of interest to the pediatric urologist from the annual meeting of the American Society of Nephrology, November 1996. MATERIALS AND METHODS: We reviewed all abstracts submitted for presentation and subsequently published in abstract form. Only those abstracts containing information pertinent to the field of pediatric urology were summarized for this report. RESULTS: A total of 24 abstracts addressing a variety of topics were summarized. Obstructive uropathy was represented by the greatest number of papers and reflects the multiple investigative efforts currently evaluating the cellular aspects of this disorder. The genetic basis of hypercalciuria and the impact of water metabolism on nephroliathisis were also discussed. CONCLUSIONS: Clinical and basic research activities that are of mutual interest to pediatric urologists and nephrologists are being conducted. The topic of obstructive uropathy has received the greatest attention during the last year. However, additional research, potentially collaborative in nature, on topics such as nephroliathisis and reflux nephropathy should be encouraged.     

Medical and health impact of complex emergencies: implications for the International Society of Nephrology Disaster Relief Task Force

The aim of the present study was to measure whole body glucose uptake (M) and oxidation rate by euglycaemic hyperinsulinaemic clamp and indirect calorimetry in 7 morbidly obese subjects (BMI > 40 kg/m2) at three time points: before bilio-pancreatic diversion (BPD) surgery (Ob); 3 months after surgery POI; and after reaching stable body weight, at least 2 years after surgery POII. A group of 7 control subjects (C), matched groupwise for sex, age and BMI with POII patients, was also studied. The M value at POI was significantly higher than at Ob (49.12 +/- 8.57 vs 18.14 +/- 8.57 mumol.kg-1.min-1). No statistical difference was observed between the POII and C groups. Similarly, glucose oxidation rate was significantly increased at POI with respect to Ob (24.2 +/- 7.23 vs 9.42 +/- 3.91 mumol.kg-1.min-1) and was not significantly different between POII and C. Basal levels of non-esterified fatty acids (NEFA) decreased significantly both from Ob to POI and from POI to POII (1517.1 +/- 223.9 vs 1039.6 +/- 283.4 vs 616.0 +/- 77.6 mumol.1(-1). The same applied to basal plasma triglycerides (2.07 +/- 0.77 vs 1.36 +/- 0.49 vs 0.80 +/- 0.19 g.1(-1). Weight decreased mainly in the late postoperative period (POI to POII 124.28 +/- 11.22 to 69.71 +/- 11.78, 83% of total decrement), rather than in the early postoperative period (Ob to POI 135.25 +/- 14.99 to 124.28 +/- 11.22 kg, 17% of total decrement). We also report the clinical case of a young woman of normal weight, who underwent BPD for chylomicronaemia (secondary to familial lipoprotein lipase deficiency), whose M value, plasma insulin and blood glucose levels were normalized upon normalization of serum NEFA and triglyceride levels as determined by the therapeutic lipid malabsorption. In conclusion, in obese diabetic patients lipid malabsorption induced by BPD causes a definite enhancement of insulin sensitivity and glucose tolerance. This improvement in metabolism is noticeable before the surgery has major effects on body weight. These observations suggest that lowered plasma lipids, rather than weight loss per se, are the cause of the reversibility of insulin resistance.     

Emergency medicine: the Italian experience

BACKGROUND: Studies using tacrolimus and corticosteroids or the combination of cyclosporine, mycophenolate mofetil, and corticosteroids have been shown to reduce the incidence of biopsy-proven acute rejection episodes in cadaveric kidney recipients compared with cyclosporine-based immunosuppression. The current study is a retrospective analysis of our experience with tacrolimus combined with mycophenolate mofetil and steroids as primary immunosuppression for kidney transplant recipients. METHODS: In a retrospective analysis, 72 patients who received primary therapy with tacrolimus, mycophenolate mofetil, and corticosteroids (triple therapy) were compared with a control group of 98 kidney recipients who received tacrolimus and corticosteroids (double therapy). RESULTS: There was a significant reduction in the incidence of biopsy-confirmed acute rejection in the triple therapy group (8.2%) compared with the double therapy group (21%; P=0.003). One-year patient and graft survival did not differ between groups. The incidence of posttransplant diabetes mellitus was 18% and 21% in the triple and double therapy groups, respectively. Leukopenia and gastrointestinal side effects were the most common cause for discontinuation of mycophenolate mofetil. CONCLUSIONS: The combination of tacrolimus with mycophenolate mofetil and corticosteroids is more effective at preventing early acute rejection than tacrolimus and corticosteroids alone. The use of mycophenolate mofetil was associated with a higher incidence of leukopenia and diarrhea, often leading to discontinuation of the drug.     

中医药治疗糖尿病视网膜病变进展

糖尿病视网膜病变(diabetic retinopathy,DR)是糖尿病严重并发症之一.美国对2005-2008年40岁以上的糖尿病患者进行调查发现,DR患病率为28.5%[1].几乎所有病程在20年以上的糖尿病患者都存在不同程度的视网膜病变[2].DR导致的失明占所有失明人数的8.9%[3].     

Toward a person-centered medicine: religious studies in the medical curriculum

The role of religious studies in the medical curriculum derives from three important aspects of people's engagement with religious belief and practice. These are (1) religion as a source of meaning, (2) religion as a source and framework for values, and (3) religion as an outstanding context for the appreciation of human diversity. By offering separate religious studies courses, or by introducing religious themes and content into students' other learning experiences, the curriculum can foster the student's respect for the individuality of the patient in his or her cultural context; heighten the student's awareness of the patient's--and his or her own--beliefs, values, and faith as resources for dealing with illness, suffering, and death; help students address any of the myriad value-laden aspects of everyday living that are part of the context of many doctor-patient encounters; and strengthen the student's commitment to a person-centered medicine that emphasizes the care of the suffering person rather than the biology of disease. The authors discuss the strengths and limitations of several settings for the teaching of religious issues in medicine, and suggest specific pedagogical approaches, readings, and resources.     

The ContiNet of the International Continence Society

We have examined the reversal of the regulatory effect of growth factors on calpain/calpastatin activity in transfected Schwann cells (tSc) after their subsequent withdrawal. Removal of nerve growth factor (NGF) or cyclic adenosine monophosphate (cAMP) from tSc resulted in a smaller loss of mu calpain (37%) and mcalpain (36.5 %) activity compared to treated cells from which the growth factors were not withdrawn. The mu calpain activity increased approximately 12% following withdrawal of acidic fibroblast growth factor (aFGF) and basic fibroblast growth factor (bFGF) at 24 hr, while the increased mcalpain activity was more than 30-40% compared with that of cells that were continuously treated. The activity of both isoforms returned to their normal levels (untreated) at 48-72 hr following withdrawal of various growth factors, including NGF, cAMP, aFGF, bFGF, platelet-derived growth factor aa (PDGFaa), and PDGFbb. The inhibitory activity of calpastatin was greater than control following withdrawal of NGF, cAMP, PDGFaa, or PDGFbb at 24 hr and this inhibitory activity was less with treatment by aFGF and bFGF. The control activity was restored at 48 hr following withdrawal of these factors. The intensity of the cytoplasmic calpain immunoreactivity was significantly decreased in the nuclear and non-nuclear regions of the cytoplasm, respectively, following withdrawal of cAMP at 144 hr. Removal of bFGF from the medium resulted in an increase of cytoplasmic calpain immunoreactivity in the nuclear regions and cytoplasm, while there was dramatic loss of myelin calpain immunoreactivity from both the nuclear region and cytoplasm. The changes in calpain activity and immunoreactivity in tSc following withdrawal of growth factors suggest that release of calpain from membrane to cytosol may be regulated by these factors.     

International Society of Exposure Analysis

OBJECTIVE: The aim of this study is to describe the efficacy and safety of risperidone, in the treatment of delusions of infestation. METHOD: The authors present a three-case series in which risperidone was used to treat delusions of infestation. RESULTS: All three patients responded to risperidone and experienced no extrapyramidal side effects. Two of our patients had failed treatment with haloperidol and another had failed treatment with pimozide. CONCLUSION: Risperidone was an effective and safe treatment in three cases of delusions of infestation. It is possible that 5-HT2 antagonism is essential for therapeutic benefit in this condition.     

Therapeutic change and the experience of joy: Toward a theory of curative processes.

This article builds an argument for a line of psychotherapy research aimed at uncovering the universal curative processes of change that can occur in many different circumstances, not only in psychotherapy. On the basis of theories and findings from psychological research on happiness, the experience of joy is regarded as a core indicator of therapeutic change leading to an increase in intrapsychic resources and life satisfaction. By studying experiences that trigger joy, a number of curative processes can be identified with a high potential for explaining why and how psychotherapy works. Hypothetical links between these curative processes and therapeutic interventions and conditions are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

International Microsurgical Society Thirteenth Congress: some historical highlights

Functional recovery following motor nerve injury and repair is directly related to the degree of muscle atrophy that takes place during the period of nerve regeneration. The extent of this muscle atrophy is related to a number of factors including the accuracy of nerve repair; the distance through which the nerve must regenerate; the age of the patient; and the type of nerve injury and other associated tendon and soft tissue and bony damage. Atrophy of muscle that is always associated with nerve injury is a combination of disuse and degeneration. Our hypothesis proposed the following question: "Would continuous electrical stimulation of the denervated muscle during the period of nerve regeneration maintain the integrity of the muscle fibers and hence their potential functional capacity?" We have completed a series of animal studies (rabbit and canine models) in our laboratory using a completely implantable system to provide continuous muscle stimulation following nerve injury and microsurgical repair. In several different experiments, the nerves under study were cut and repaired at 4 and 12 cm from the muscles to study the effects of short- and long-term recovery. In all experiments, a beneficial effect was demonstrated with improved morphology and functional capacity of the reinnervated stimulated muscles when compared with nonstimulated controls. In addition, electrical stimulation using this implantable system could be applied for extended periods without evidence of discomfort in the experimental animals.     

Toward ICD-11: Improving the clinical utility of WHO's International Classification of mental disorders.

This article describes the current revision by the World Health Organization (WHO) of the International Classification of Diseases and Related Health Problems (ICD-10). ICD-10 is the basis for ICD-10-CM, which will be introduced in 2013 as the official U.S. system. U.S. psychologists will be required to use ICD-10-CM for all third-party billing and reporting, but are generally not familiar with the ICD or WHO's role in global health classification. Although the U.S. lags behind other countries on the implementation of WHO's international classification systems, psychologists and other health professionals will be affected by ICD-11, so it is important to understand its development. WHO views the current revision as an important opportunity to improve the clinical utility of the classification system for mental disorders. Serious problems with the clinical utility of both the ICD and the DSM are widely acknowledged. Clinical utility affects the daily lives of practitioners and is also a global public health issue. Most people with mental disorders worldwide receive no treatment. A diagnostic system with greater clinical utility can be a tool to improve identification and treatment, helping WHO member countries to reduce the disease burden of mental disorders. Consistent with this goal, WHO's revision process is global, multilingual, and multidisciplinary and will produce different versions of the classification for clinical use, research, and primary care. A systematic program of studies being undertaken by WHO aimed at improving clinical utility is described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward an International Classification for Nursing Practice: a literature review & survey

In 1991 the International Council of Nurses (ICN) initiated a long-term project to develop an International Classification for Nursing Practice (ICNP). To identify existing classifications and nomenclatures of nursing, a literature search and survey of national nurses' associations and individuals involved in classification across the world were conducted, in addition to a pilot search for articles describing nursing nomenclatures and classifications in countries other than the US and Canada, the latter having provided most of the examples in the original ICNP proposals. Three sources of literature were examined: international conference proceedings, Med-Line and Exerpta Medica.     

Assessment of International Headache Society diagnostic criteria: a reliability study

In 1988 the International Headache Society (IHS) introduced new diagnostic criteria for headaches and craniofacial pain. Since headaches can be diagnosed solely on the basis of information provided by the patient, it is essential that the criteria are reproducible and consistent. Two neurologists evaluated the clinical records of 100 consecutive outpatients and transferred the data on headache and associated phenomena to a form designed to reflect the IHS criteria. Interobserver concordance (kappa statistics) in the application of the diagnostic criteria of primary headaches was: (i) "perfect" to "substantial" for the first IHS digit, being kappa = 1.0 for cluster headache and paroxysmal hemicrania; kappa = 0.88 for migraine; kappa = 0.75 for tension-type headache; (ii) "almost perfect" to "substantial" for the second digit (kappa = 0.94 for cluster headache; kappa = 0.90 for migraine with aura; kappa = 0.81 for episodic tension-type headache; kappa = 0.78 for migraine without aura; kappa = 0.71 for chronic tension-type headache; kappa = 0.66 for cluster headache-like disorder not fulfilling the criteria; (iii) "moderate" for migrainous disorder (kappa = 0.48) and headache of the tension-type (kappa = 0.43) not fulfilling the criteria. These results show that the IHS diagnostic criteria are satisfactorily applicable to high quality medical records abstracted by experienced neurologists.     

International perspectives on controversial practices in allergic diseases: the South American experience

A number of unconventional approaches, some of them autochthonous and some imported from other regions of the world, have been used for many years by practitioners and folk healers in Latin America. Most of these methods remain unproven and cannot be recommended for routine use today. However, it must be said that some of them look interesting and need further investigation, since they might provide additional information about the pathogenesis and new ways for the control of allergic diseases and asthma.     

Toward a (Dys)functional anthropology of drinking: ambivalence and the American Indian experience with alcohol

This article explores the complex and contradictory experiences of urban American Indian drinkers. While previous anthropological accounts have emphasized the functions served by American Indian drinking, the testimony of drinkers also documents their awareness of the destructive effects of heavy drinking, particularly the way in which it often interferes with their ability to meet social obligations. Nevertheless, people often continue to use alcohol, and this means that many are profoundly ambivalent about their drinking; they see it simultaneously as something that is embedded in certain important relationships, but also something that is destructive of much that they value. Drawing on interviews with 35 self-defined problem drinkers, this article details the ambiguous nature of the American Indian experience with alcohol, highlighting the need for a clinically sophisticated anthropology of alcohol.