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1.
Heparin is almost universally used as an anticoagulant during hemodialysis. Rare but serious side effects of heparin therapy include heparin‐induced thrombocytopenia (HIT) and anaphylaxis, and these may lead to significant mortality and morbidity if left unrecognized. We are reporting a patient who developed HIT followed by an anaphylactoid reaction. This 8‐year‐old girl with Joubert's syndrome developed end‐stage renal disease secondary to nephronophthisis. She had a Permacath double‐lumen hemodialysis catheter placed in the right internal jugular vein and was started on hemodialysis using an Asahi B10 65 Dialyzer on 1/28/03. The platelet count at that time was 246 × 103/mL. Beef lung heparin was used for anticoagulation. She was admitted for living related donor renal transplant on 2/10/03 but was found to be thrombocytopenic with a platelet count of 49 × 103/mL. The transplant was postponed, a sepsis work‐up was performed, and she was started on antibiotics pending culture results. Hemodialysis was continued with heparin anticoagulation, and despite an improvement in the platelet count she had an acute anaphylactoid reaction 2 days later. The reaction occurred 20 min after starting her hemodialysis treatment and presented as acute onset of bronchospasm, agitation, and chest discomfort. She improved with nebulized albuterol and subcutaneous epinephrine. A review of her records revealed that she had received 6 hemodialysis treatments. The platelet count on 2/3/03, after 3 hemodialysis treatments, had been 242 × 103/mL and on 2/8/03 after 5 treatments the platelet count was 72 × 103/mL. HIT with anaphylaxis was suspected. Heparin was discontinued and the platelet count had returned to normal within 2 days. The diagnosis was confirmed by a positive heparin‐associated antibody test. While HIT is recognized as a complication in 1–5% of patients treated with heparin and has been well described in the literature, we could only find 2 reported cases of heparin‐induced anaphylaxis and in both cases there was accompanying thrombocytopenia. This patient further illustrates a possible linkage between these two phenomena. HIT is an important cause of thrombocytopenia in a patient on hemodialysis and continued exposure to heparin may induce anaphylaxis.  相似文献   

2.
Nontraumatic, spontaneous parenchymal kidney rupture is a rare clinical entity that may cause extensive hemorrhage, hypovolemic shock, and death. Spontaneous nontraumatic kidney rupture is extremely rare in systemic lupus erythematosus (SLE) patients. Because of the high morbidity and mortality rates, an immediate establishment of the diagnosis and treatment are necessary. We present the case of a 30‐year‐old female with spontaneous parenchymal rupture of the right kidney who had renal failure due to SLE and presented with atraumatic sudden right flank pain during hemodialysis treatment. To our knowledge, this case is the second report of SLE manifesting as spontaneous kidney rupture in the literature.  相似文献   

3.
Iliopsoas abscess is a rare complication in hemodialysis patients that is mainly due to adjacent catheterization, local acupuncture, discitis, and bacteremia. Herein, we report a 47‐year‐old woman undergoing regular hemodialysis via a catheter in the internal jugular vein who presented with low back pain and dyspnea. A heart murmur suggested the presence of catheter‐related endocarditis, and this was confirmed by an echocardiogram and a blood culture of methicillin‐resistant Staphylococcus aureus. A computed tomography indicated a pulmonary embolism and an incidental finding of iliopsoas abscess. Following surgical intervention and intravenous daptomycin, the patient experienced full recovery and a return to usual activities. This case indicates that an iliopsoas abscess can be related to a jugular vein catheter, which is apparently facilitated by infective endocarditis. The possibility of iliopsoas abscess should be considered when a hemodialysis patient presents with severe low back pain, even when there is no history of adjacent mechanical intervention.  相似文献   

4.
The emergence of multidrug resistant bacteria has resulted in plenty of stubborn nosocomial infections and severely threatens human health. Developing novel bactericide and therapeutic strategy is urgently needed. Herein, mesoporous silica supported silver–bismuth nanoparticles (Ag‐Bi@SiO2 NPs) are constructed for synergistic antibacterial therapy. In vitro experiments indicate that the hyperthermia originating from Bi NPs can disrupt cell integrity and accelerate the Ag ions release, further exhibiting an excellent antibacterial performance toward methicillin‐resistant Staphylococcus aureus (MRSA). Besides, under laser irradiation, Ag‐Bi@SiO2 NPs at 100 µg mL?1 can effectively obliterate mature MRSA biofilm and cause a 69.5% decrease in the biomass, showing a better therapeutic effect than Bi@SiO2 NPs with laser (26.8%) or Ag‐Bi@SiO2 NPs without laser treatment (30.8%) groups. More importantly, in vivo results confirm that ≈95.4% of bacteria in abscess are killed and the abscess ablation is accelerated using the Ag‐Bi@SiO2 NPs antibacterial platform. Therefore, Ag‐Bi@SiO2 NPs with photothermal‐enhanced antibacterial activity are a potential nano‐antibacterial agent for the treatment of skin infections.  相似文献   

5.
Catheter and/or arteriovenous (A‐V) graft‐related bacteremia is an important cause of morbidity and mortality among hemodialysis (HD) patients. Endocarditis, septic arthritis, epidural abscess, septic embolism, and osteomyelitis are the most common complications of catheter and/or A‐V graft‐related bacteremia; however, endogenous endophthalmitis is rarely seen. To the best of our knowledge, Enterococcus faecalis is the first case report in this population. We hereby report a case of endogenous endophthalmitis caused by E. faecalis as a complication of catheter and/or A‐V graft‐related bacteremia in a diabetic patient, who was undergoing HD for 5 years. We also discuss the etiology, clinical features, and outcomes of endogenous endophthalmitis in HD patients with a brief review of the literature. Although broad‐spectrum parenteral (intravenous and intravitreal) antibiotics were used for 4 weeks, evisceration of the left eye could not be avoided. Endogenous endophthalmitis is a rare but rapidly blinding complication of catheter and/or A‐V graft‐related bacteremia in HD patients. It can develop as a result of silent catheter and/or A‐V graft infections, which may lead to recurrent bacteremia. E. faecalis should be considered as a pathogen in this population who had recent history of catheter or A‐V graft procedure.  相似文献   

6.
The ductile-brittle transition of an ethylene-hexene copolymer was measured from 80 to 24° C. The basic curves of stress against time to failure could all be unified in terms of a single equation based on normalizing the stress relative to the transition stress between the ductile and brittle regions and using a single thermal activation parameter. This unity is based on the observations which show that the ductile and brittle failure processes are both associated with a shear process. The unifying equation is $$\left( {\frac{\sigma }{{\sigma _{\text{c}} }}} \right)^n = \left( {\frac{{t_{\text{R}} }}{{t_{\text{f}} }}} \right){\text{ exp }}\left[ {{\text{85 500/}}R\left( {\frac{1}{T} - \frac{1}{{T_{\text{R}} }}} \right)} \right]$$ where σ c is the minimum stress for ductile failure at an arbitrary temperature, T R; t R is the time to failure at an arbitrary reference temperature T R; n equals 34 and 3.3 for the ductile and brittle regions, respectively and R is in J mol?1 K?1.  相似文献   

7.
End‐stage kidney disease (ESKD) patients are a commonly overlooked immunocompromised population that places them at risk for rare infections. We describe the case of a 78‐year‐old man with a history of ESKD managed with thrice weekly in‐center hemodialysis who had a prolonged episode of left elbow pain and drainage and was eventually found to have a skin and soft tissue infection from Actinomyces radingae. We review the bacteriology of Actinomyces spp. and the experiences of other providers who have treated actinomycosis in individuals with ESKD. The anatomic sites and demographics of these individuals are heterogeneous, but they all generally require a long antibiotic course with a beta‐lactam and portend to a good prognosis. High index of suspicion is needed to identify rare and atypical infections in the ESKD population.  相似文献   

8.
Integrating multiple strategies of antibacterial mechanisms into one has been proven to have tremendous promise for improving antimicrobial efficiency. Hence, dual‐valent platinum nanoparticles (dvPtNPs) with a zero‐valent platinum core (Pt0) and bi‐valent platinum shell (Pt2+ ions), combining photothermal and photodynamic therapy, together with “chemotherapy,” emerge as spatiotemporally light‐activatable platinum nano‐antibiotics. Under near‐infrared (NIR) exposure, the multiple antibacterial modes of dvPtNPs are triggered. The Pt0 core reveals significant hyperthermia via effective photothermal conversion while an immediate release of chemotherapeutic Pt2+ ions occurs through hyperthermia‐initiated destabilization of metallic interactions, together with reactive oxygen species (ROS) level increase, thereby resulting in synergistic antibacterial effects. The precise cooperative effects between photothermal, photodynamic, and Pt2+ antibacterial effects are achieved on both Gram‐negative Escherichia coli and Gram‐positive methicillin‐resistant Staphylococcus aureus, where bacterial viability and colony‐forming units are significantly reduced. Moreover, similar results are observed in mice subcutaneous abscess models. Significantly, after NIR treatment, dvPtNP exhibits a more robust bacteria‐killing efficiency than other PtNP groups, owing to its integration of dramatic damage to the bacterial membrane and DNA, and alteration to ATP and ROS metabolism. This study broadens the avenues for designing and synthesizing antibacterial materials with higher efficiency.  相似文献   

9.
The structure of a number of unidirectionally solidified Al-Al2Au alloys of eutectic and off-eutectic compositions has been investigated over a wide range of growth rates (1.6×10–4 to 1.66×10–2cm sec–1) using a thermal gradient of approximately 80 to 100 lamellar interface || (001)Al 2 Au || (01 1) Al [ 1 1 0 ]Al 2 Au || [ 1 0 0 ] Al growth direction of lamellae and rods || [ 1 1 0 ]Al2 Au || [ 1 0 0 ]Al \begin{gathered} lamellar interface \left\| {(001)_{Al_{ 2} Au} } \right.\left\| {(01 1)} \right._{Al} \hfill \\ \left[ {1 1 0} \right]_{Al_{ 2} Au} \left\| {\left[ {1 0 0} \right]} \right._{Al} \hfill \\ growth direction of \hfill \\ lamellae and rods \left\| {\left[ {1 1 0} \right]_{Al_2 Au} \left\| {\left[ {1 0 0} \right]_{Al} } \right.} \right. \hfill \\ \end{gathered}  相似文献   

10.
The midpoint rule provides a standard method to obtain symmetric, symplectic, and second‐order accurate variational integrators for mechanical systems whose configuration manifold is the vector space ?n. In this work, we discuss how to extend this rule to a generic finite‐dimensional Lie group G while retaining the same properties. We show that the function κG(g)=exp(½log(g)), gG plays a special role in the theory and, for G=SO(3), we give a compact formula to compute it. We also discuss sufficient conditions for the method to conserve momentum maps associated with left (or right) group actions. As an example, the variational integrator obtained from the midpoint rule is applied to simulating rigid body dynamics. The resulting integrator is compared with state‐of‐the‐art symmetric and second‐order accurate integrators for rigid body motion. Copyright © 2009 John Wiley & Sons, Ltd.  相似文献   

11.
Introduction: Patients with chronic kidney disease (CKD) commonly experience 25‐hydroxyvitamin D3 (25‐OH‐D3) deficiency, and these patients have a higher incidence of cardiovascular diseases (CVDs) due to endothelial dysfunction (ED). The aim of our study was to investigate the effect of 25‐OH‐D3 deficiency and its supplementation on ED in patients with CKD. Methods: Twenty‐nine uremic patients on dialysis and 20 healthy controls were evaluated for ED by high‐resolution Doppler ultrasonography of the brachial artery. In addition, 25‐OH‐D3‐deficient patients (25‐OH‐D3 < 30 nmol/L) with CKD and healthy controls were evaluated for ED before and after 8 weeks of oral vitamin D (cholecalciferol, 50,000 units) treatment. All subjects were evaluated for percent flow‐mediated dilatation (%FMD), percent endothelium‐independent nitroglycerin‐induced vasodilatation (%NID), and bilateral carotid intima‐media thickness (CIMT). Findings: Patients on dialysis had lower %FMD and %NID 6.11 [2.27–12.74] and 10.96 [5.43–16.4], respectively, than controls 15.84 [8.19–22.49] and 21.74 [12.49–29.4], respectively (P < 0.05). Patients on dialysis had higher left and right CIMT (0.79 ± 0.15 and 0.78 ± 0.14, respectively) than controls (0.60 ± 0.09 and 0.59 ± 0.09, respectively; P < 0.05). In 25‐OH‐D3‐deficient patients with CKD, after vitamin D treatment, %FMD was significantly increased in dialysis patients (10.25 [7.8–12.8]) compared to before supplementation (5.4 [2.77–6.15]; P < 0.001). Discussion: These results indicated that dialysis patients had significantly lower blood 25‐OH‐D3 levels and higher CIMT than healthy subjects. In addition, vitamin D supplementation improved ED and increased %FMD in dialysis patients. Our findings suggest that vitamin D supplementation in dialysis patients might prevent CVD.  相似文献   

12.
Although N‐methyl‐d ‐aspartate (NMDA) receptor antagonists may have beneficial influences on cognition in patients with alcohol‐related dementia (ARD), their effects on regional cerebral blood flow (rCBF) remain unknown. This study evaluated changes in rCBF in ARD patients after administration of NMDA receptor antagonist for 12 weeks using technetium‐99m ethyl cysteinate dimer (Tc‐99m ECD) single‐photon emission computed tomography (SPECT). Twenty‐eight ARD patients were administered memantine for 12 weeks and underwent clinical evaluations and brain SPECT scans at baseline and follow‐up. Whole‐brain changes in perfusion were examined on a voxel‐by‐voxel basis. At follow‐up, the patients showed reduced rCBF in the left medial frontal gyrus, left cingulate gyrus, left claustrum, right brainstem, left superior temporal gyrus, bilateral fusiform gyrus, and left cerebellum. On the other hand, increased rCBF was found in the bilateral uncus, left parahippocampal gyrus, bilateral superior frontal gyrus, right inferior parietal lobule, left cuneus, and left superior temporal gyrus. Perfusion increases in various brain areas including the superior frontal, parahippocampal, and inferior parietal areas, which may play important roles in the pathophysiology of ARD, suggest potential benefits of NMDA receptor antagonists on brain functions in patients with ARD.  相似文献   

13.
Acoustic droplet vaporization (ADV) has been introduced with the potential application of tumor treatment via occlusion and subsequent necrosis. New Zealand White rabbits were anesthetized, and their left kidney was externalized. An imaging array and single-element transducer were positioned in a tank with direct access to the kidney's vasculature and renal artery. Filtered droplet emulsions (diameter <6 microm) were injected intra-arterially (IA) into the left heart during insonification of the renal artery, and the extent of blood flow reduction by ADV was compared to the untreated right kidney. Flow cytometry (using colored microspheres) of kidney tissue samples and reference blood from the femoral artery allowed the quantitative estimation of regional blood flow. A maximum regional blood flow reduction in the treated region of >90% and an average organ perfusion reduction of >70% was achieved using ADV. After treatment of the left kidney, the control kidney on the contralateral side showed a maximum decrease in regional blood flow of 18% relative to the pre-ADV baseline. Image-based hyper-echogenicity from ADV of IA injections was monitored for approximately 90 minutes, and cortex perfusion was reduced by >60% of its original value for more than 1 hour. This could be enough time for the onset of cell death and possible tumor treatment via ischemic necrosis. Moreover, currently used radiofrequency tissue ablation-based tumor treatment could benefit from ADV due to the decreased heat loss via vascular cooling.  相似文献   

14.
The emergence of drug‐resistant bacteria and easy recurrence has been challenging in the clinical treatment of skin abscesses resulting from bacterial infections (e.g., by Staphylococcus aureus (S. aureus)). Herein, an antibacterial nanoagent capable of modulating the abscess microenvironment is designed to enhance photodynamic treatment of skin abscesses, and subsequently activate the immune system to effectively prevent abscess recurrence. In the system, manganese dioxide nanoparticles (MnO2 NPs) with high catalytic reactivity toward H2O2 are modified with photosensitizer chlorine e6 (Ce6) and coated with polyethylene glycol (PEG). The obtained Ce6@MnO2‐PEG NPs, by triggering the decomposition of lesion endogenous H2O2, are able to effectively relieve the hypoxic abscess microenvironment during S. aureus infection. The light‐triggered photodynamic bacterial killing effect could thus be remarkably enhanced, resulting in effective in vivo therapy of S. aureus‐induced skin abscesses. Interestingly, a notable pathogen‐specific immunological memory effect against future infection by the same species of bacteria is elicited after such treatment, owing to the release of bacterial antigens post photodynamic therapy (PDT) together with the adjuvant‐like function of manganese ions to activate the host immune system. This work thus presents a new type of photodynamic nanoagent particularly promising for highly effective light‐triggered abscess treatment and prevention of abscess recurrence.  相似文献   

15.
Understanding the nature and behavior of liquid metals requires accurate values of their physical properties (e.g., density, surface tension, viscosity). However, maintaining samples of matter in their liquid phases, in particular under supercooled conditions, is a great challenge when dealing with refractory metals. This is due mainly to their high melting temperatures (e.g., 3,695 K for W), their high vapor pressure, and the risk of melt contamination with a support or crucibles. Electrostatic levitation, laser heating in vacuum, and non-contact characterization techniques circumvented these difficulties and allowed the determination of the properties of several metals in their liquid state, above their melting temperature as well as in their supercooled phase. In this work, several thermophysical properties were successfully measured with an electrostatic levitation furnace under vacuum conditions. For the first time, density and viscosity data of yttrium were reported over large temperature intervals in the liquid phase. Over the 1,560 to 2,100 K temperature span, the density can be expressed as $\rho (T)=4.15\times 10^3-0.21\, (T - T_{\rm m})$ (kg·m???3) with T m = 1,796 K, yielding a volume expansion coefficient of 5.1 × 10???5 K???1. In addition, the surface tension can be expressed as $\sigma \left( T \right)=8.04\times 10^2-0.05\,(T - T_{\rm m})$ (mN·m???1) and the viscosity as $\eta \left( T \right)=0.00287\,\exp \left[ {{1.1\times 10^5} \mathord{\left/ {\vphantom {{1.1\times 10^5} {\left( {\mbox{RT}} \right)}}} \right. \kern-0em} {\left( {\mbox{RT}} \right)}} \right]$ mPa·s over the 1,830 to 2,070 K interval. The results, in particular those for viscosity, suggest that performing similar experiments in microgravity could improve the accuracy of the measurements.  相似文献   

16.
Heparin‐induced thrombocytopenia (HIT) is a potentially fatal clinical condition which can develop after exposure to unfractionated or low‐molecular‐weight heparins. Even small doses of heparin such as heparin flushes in hemodialysis catheter can induce the development of HIT. However, the true incidence of heparin lock‐related HIT is unknown. We report a 58‐year‐old woman with acute kidney injury because of obstructive uropathy who developed HIT after heparin‐free hemodialysis. She was found to have severe thrombocytopenia with deep vein thrombosis of left lower limb and arterial thrombosis of the right anterior and middle cerebral arteries. The heparin‐platelet factor 4 antibody was positive and she was put on plasmapharesis. However, her condition further deteriorated and succumbed shortly. Heparin lock solution in the hemodialysis catheter was believed to be the cause of HIT in our patient.  相似文献   

17.
We investigate the effects of quantum decoherence generated by the Unruh effect in non-inertial frames under an amplitude damping channel and a phase damping channel, respectively, when the Unruh single particle has right and left components. We not only consider the influence of acceleration on entanglement, but also consider the influence of different rates between right and left components of the Unruh single-particle state on entanglement. We find that when the Unruh single-particle state has right and left components, i.e. |1?U?=?q L|0?I|1?II?+?q R|1?I|0?II, |q R|2?+?|q L|2?=?1, with q L?≠?0, there appears the sudden death of entanglement, which occurs earlier under both the amplitude damping channel and the phase damping channel with the increase of acceleration than that when the Unruh single-particle state only has a right component (q R?=?1, q L?=?0). We also find that the initial entanglement decreases with decrease of q R from 1 to 1/21/2.  相似文献   

18.
Emphysematous pyelonephritis (EPN) is a life‐threatening renal infection caused by gas‐producing bacteria and fungi. It usually occurs in patients with diabetes and patients with urinary tract obstruction. A combination of systemic antibiotics, percutaneous catheter drainage, or open nephrectomy is typically required to achieve cure. Because of grim prognosis, resorting to interventional methods is frequently inevitable. We report the case of a 77‐year‐old woman with diabetes and end‐stage renal disease on chronic hemodialysis that presented with fever and left flank pain. A bubbly gas pattern inside the left kidney was demonstrated on abdominal computed tomography scan and blood cultures grew Escherichia coli. She was successfully treated solely with systemic antibiotics. This highlights the fact that prompt recognition of imaging findings associated with benign prognosis is essential for a favorable outcome. It allows for an effective management avoiding high‐risk interventions, especially in frail patients with multiple comorbidities. Finally, we review all published cases of EPN in chronic dialysis patients.  相似文献   

19.
Buttonhole cannulation is a method of cannulation of native arteriovenous fistulae traditionally practiced by self‐cannulators. At St Michael's Hospital, this method has been modified to allow its use in problematic fistulae by multiple cannulators. In a busy dialysis unit, the need for a few specific cannulators to establish the tunnel tracks in combination with the variable dialysis schedules creates logistical challenges. A new method of creating tunnel tracks with the use of the BioHole? device was evaluated. Buttonhole tracks were created in 12 patients using a peg of polycarbonated material with a holder (BioHole? kit). The peg was inserted into the path left by the hemodialysis sharp needle following the index cannulation. Four of the 12 patients had an alternate access. Buttonhole tracks were successfully created in all the patients, albeit in 2 patients, the initial attempt to establish buttonhole tracks was aborted due to complications and the procedure was rescheduled. Compared with the modified buttonhole technique, pain on cannulation following track creation was significantly less in the BioHole? group (P<0.001). Ease of cannulation was significantly improved in the BioHole? group (P<0.05) when compared with that in thrice‐weekly patients using the modified buttonhole technique. Hemostasis postdialysis did not differ between the study groups. The use of the BioHole? device is effective in the creation of tunnel tracks for buttonhole cannulation, is associated with less pain, and simplifies the logistics of arranging patient and nurses' schedules.  相似文献   

20.
LiNiPO4 compound was prepared by the conventional solid-state reaction. The sample was characterized by X-ray powder diffraction, infrared, Raman analysis spectroscopy and electrical impedance spectroscopy. The compound crystallizes in the orthorhombic system, space group Pnma with a = 10·0252(7) Å, b = 5·8569(5) Å and c = 4·6758(4) Å. Vibrational analysis was used to identify the presence of \( \mathrm{PO}_4^{3- } \) – group in this compound. The complex impedance has been measured in the temperature and frequency ranges 654–716 K and 242 Hz–5 MHz, respectively. The Z′ and Z″ vs frequency plots are well-fitted to an equivalent circuit consisting of series of combination of grains and grain boundary elements. Dielectric data were analysed using complex electrical modulus M* for the sample at various temperatures. The modulus plots are characterized by the presence of two peaks thermally activated. The frequency dependence of the conductivity is interpreted in terms of equation: \( {\sigma_{\mathrm{a}.\mathrm{c}.}}\left( \omega \right)=\left[ {{{{{\sigma_{\mathrm{g}}}}} \left/ {{\left( {1+{\tau^2}{\omega^2}} \right)}} \right.}+\left( {{{{{\sigma_{\infty }}{\tau^2}{\omega^2}}} \left/ {{1+{\tau^2}{\omega^2}}} \right.}} \right)+A{\omega^{\mathrm{n}}}} \right] \) . The near values of activation energies obtained from the analysis of M″, conductivity data and equivalent circuit confirms that the transport is through ion hopping mechanism dominated by the motion of Li+ in the structure of the investigated material.  相似文献   

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