Study on vascular calcification in patients on continuous ambulatory peritoneal dialysis (CAPD): special reference to active vitamin D (VD) treatment

Cardiovascular complications, such as vascular calcification (VC), have been a major concern in patients undergoing chronic dialysis. The pathogenesis of this VC has been attributed to the altered calcium and phosphate metabolism, but the contributing factors have not been clarified. In order to investigate these factors, 38 CAPD patients were divided into two sub-groups according to the absence of aortic calcification (Group-A; n = 18) or the presence of aortic calcification (Group-B; n = 20). The number of elderly patients was larger and the duration of CAPD was longer in Group-B than in Group-A. Calcium and phosphate metabolism and serum lipids levels did not differ significantly between groups and the number of patients given VD was 8/18 in Group-A and 14/20 in Group-B. In order to explore the progression of VC in CAPD patients given long-term treatment with VD, 22 patients who were matched for the duration of CAPD were analyzed. These were divided into two sub-groups according to whether they were treated with VD (Group-C; n = 11) or not treated with VD (Group-D; n = 11). Radiological findings (such as the degree of aortic calcification), bone mineral content, divalent ions, parathyroid hormone levels and lipid profiles were examined. The prevalence of patients with aortic calcification was significantly higher in Group-D than in Group-C (7/11 v. s. 2/11, P < 0.05). However, lipids, mineral and endocrinological parameters did not differ between the sub-groups. No significant difference in the calcium and phosphate balance was observed. The bone mineral content revealed no difference between both of the sub-groups. VD administration by conventional mode, even without significant suppression of PTH or increase of bone mineral content, may enhance vessel calcification in patients on long-term CAPD.     

Outcome and complications in patients treated with continuous ambulatory peritoneal dialysis (CAPD) at a single centre during 11 years

During the past 15 years, advances in basic science related to periodontal biology, and clinical trials on prevention and treatment of periodontal disease, have dramatically changed many treatment concepts in periodontics. The most pertinent information for orthodontic practice from these studies is summarized. Also, recent advances in orthodontics, particularly regarding bonding of attachments to artificial tooth surfaces and improved long-term stabilization of orthodontic treatment results in adults by means of bonded lingual retainers have significant implications. This article outlines how recent research information from both dental specialties may be used by orthodontists to improve treatment planning, clinical management, and retention of their adult and elderly patients in whom different malocclusions are complicated by moderate to advanced periodontal destruction.     

Charge selectivity of peritoneal transport in CAPD patients under stable states and during peritonitis

To investigate charge selectivity of peritoneal transport in CAPD, dialysate/plasma concentration ratios (D/P) were calculated for creatinine (Cr) and 3 amino acids with almost the same molecular weight but quite different charges: glutamic acid (Glu: negatively charged), glutamine (Gln: near neutrally charged) and lysine (Lys: positively charged). The study population consisted of 23 stable patients and 11 patients with peritonitis on CAPD. In the stable patients, the samples of dialysate were taken at 2 and 4 hours and blood samples were obtained at 4 hours after the infusion of 2 liters of 2.27 or 2.5% glucose CAPD dialysate; the samples of patients with peritonitis were obtained at 4.1 +/- 1.1 hours of dwell time. In stable patients, D/P of Glu was much lower than the values for Gln, Lys and Cr at both 2 and 4 hours (p < 0.01), and D/P of Lys was significantly lower than that of Gln (p < 0.01). There was no significant difference in D/P between Gln and Cr. In patients with peritonitis, D/P of Glu was also significantly lower than the values for Gln and Cr (p < 0.05 and p < 0.01), however, no significant differences were found between D/P of Lys and the values of Glu and Gln. Ratios of both [D/P Glu]/[D/P Lys] and [D/P Glu]/[D/P Gln] were much higher in peritonitis patients than in stable patients. In conclusion, peritoneal transport in stable CAPD patients shows charge selectivity, and the order of molecular charge for transperitoneal mobility among small solutes is neutral > positive > negative. The selectivity, however, is decreased or lost during peritonitis.     

Measurement of oxidation in plasma Lp(a) in CAPD patients using a novel ELISA

BACKGROUND: LGE2 is produced by the cyclooxygenase- or free radical-mediated modification of arachidonate and is formed during the oxidation of low density lipoprotein (LDL) with subsequent adduction to lysine residues in apo B. We have developed a sensitive enzyme-linked sandwich immunosorbent assay (ELISA) for detection and measurement of LGE2-protein adducts as an estimate of oxidation of plasma LDL and Lp(a). METHODS: The assay employs rabbit polyclonal antibodies directed against LGE2-protein adducts that form pyrroles, and alkaline phosphatase-conjugated polyclonal antibodies specific for apo B or apo (a). It demonstrates a high degree of specificity, sensitivity and validity. RESULTS: Epitopes characteristic for LGE2-pyrroles were quantified in patients with end-stage renal disease (ESRD) that had undergone continuous ambulatory peritoneal dialysis (CAPD) and in a gender- and age-matched control population. In addition to finding that both LDL and Lp(a) levels were elevated in CAPD patients, we also found that plasma Lp(a) but not LDL was more oxidized in CAPD patients when compared to corresponding lipoproteins from healthy subjects. Using density gradient ultra-centrifugation of plasma samples, we found that modified Lp(a) floats at the same density as total Lp(a). CONCLUSIONS: The results of this study demonstrate that oxidation of plasma Lp(a) is a characteristic of ESRD patients undergoing CAPD. This ELISA may be useful for further investigations on oxidation of lipoproteins in the circulation of specific patient populations.     

Basic studies of adreno-sympathetic function test-glucagon test and histamine test (author''s transl)

Sera from 74 patients with polymyalgia rheumatica or giant cell arteritis or both were tested for immune complexes by using the Raji cell radioimmunoassay. Levels in patients with active disease were higher than in patients whose disease had become inactive. There was no difference in levels of immune complex-like materials between patients with polymyalgia rheumatica alone and those with giant cell arteritis. Density gradient analysis of one serum showed immune complex-like materials mainly in the 19S region. Immune complexes may be important in the pathogenesis of these conditions.     

Stability of the peritoneal membrane in long-term peritoneal dialysis patients

It is now well established that the formation of free radicals and oxidative stress-induced neuronal cell death can be involved in various neurodegenerative disorders, including Alzheimer's disease and Parkinson's disease. The pineal hormone melatonin has been suggested to be a neuroprotective antioxidant. To better understand the molecular mechanism of this activity, we compared the ability of melatonin and its precursor, N-acetyl-serotonin (normelatonin), to protect human neuroblastoma SK-N-MC cells and primary cerebellar granular neurons against oxidative stress. We found that normelatonin and melatonin have differential neuroprotective effects depending on the neuronal cell type. Normelatonin was more protective against hydrogen peroxide (H2O2) and glutamate-induced cell death in SK-N-MC cells compared to melatonin which was more effective to protect primary cerebellar granular neurons against the toxicity of H2O2, glutamate and N-methyl-D-aspartate when compared to normelatonin. At the molecular level, we tested the capacity of normelatonin and melatonin to inhibit the oxidative stress-induced NF-kappaB activation in both neuronal systems. Whereas normelatonin was more potent in the suppression of the activation of NF-kappaB by H2O2 in SK-N-MC cells compared to melatonin, no apparent differences in the extent of suppression could be detected in primary neurons. Normelatonin's and melatonin's neuroprotective activity in SK-N-MC neuroblastoma cells may be mediated by the suppression of NF-kappaB activation.     

Glycine conjugation of para-aminobenzoic acid (PABA): a quantitative test of liver function

N-Acetyl aspartate (NAA) is the second most abundant amino acid in the human brain. NAA is synthesized by L-aspartate N-acetyl transferase or by cleavage from N-acetyl aspartyl glutamate by N-acylated alpha-linked L-amino dipeptidase (NAALADase); and it is catabolized to acetate and aspartate by N-acetyl aspartate amino hydrolase (amino acylase II). NAA is localized primarily to neurons, where it is concentrated in the cytosol. Although NAA is devoid of neurophysiological effects, it serves as an acetyl donor, an initiator of protein synthesis or a carbon transfer source across the mitochondrial membrane. The concentration of NAA in human brain increases 3-fold between midgestation and adulthood. In Canavan's Disease, an autosomal recessive disorder due to a null mutation in amino acylase II, NAA levels in brain are markedly increased and disrupt myelination. NAA levels have been found to be reduced in neurodegenerative disorders, including Alzheimer's Disease and Huntington's Disease. Since endogenous NAA can be readily detected in human brain by magnetic resonance spectroscopy, it is increasingly being exploited as a marker for functional and structural integrity of neurons in an expanding number of disorders.     

测量系统分析(MSA)在化学分析管理中应用的探讨

探讨测量系统分析(MSA)在化学分析管理中应用(通常该方法在机械加工过程中使用)。本方法主要使用方差计算分析的方法对系统和个人的方差进行统计计算,并对铁精矿中TFe检验过程中系统的重复性、再现性、检验人员之间差异及系统测量能力作出分析,从而判定检验系统的状态、改进方向及系统可接受程度。该方法采用实际生产中的样品,排除以前使用标准样品带来的人为因素。通过对变差的方差分析和各变异分量情况、Xbar图、R控制图的分析系统的判定更客观。     

Diurnal alteration of platelet-free Ca2+ in subjects with normal renal function and patients undergoing CAPD]

We examined the relation of diurnal alteration of platelet-free Ca2+ to blood pressure and plasma vasoactive substances in 6 subjects with normal renal function (N group) (with both normal GFR and normal urine concentration, and with the renal biopsy finding of minor glomerular change) and 7 patients undergoing CAPD (CAPD group), then evaluated the pathophysiological difference in diurnal variations between both groups and the effect of native kidney function. Diurnal values of platelet basal-free Ca2+ concentration in N showed a positive correlation with the corresponding PRA levels. On the other hand, in CAPD they showed a positive correlation with the corresponding levels of plasma AVP. The larger increases in platelet-free Ca2+ concentration due to thrombin stimulation were observed in the daytime and the smaller increases in the nighttime in the N groups. The thrombin-induced changes showed a positive correlation with the diurnal levels of mean blood pressure in N (p < 0.004). However, in contrast, in CAPD the increase in platelet-free Ca2+ due to thrombin tended to be larger in the nighttime and showed a negative correlation with the daily mean blood pressure levels (p < 0.004). These findings suggest that there might be differences in the regulation of intracellular-free Ca2+ dynamics and the diurnal variation between subjects with normal renal function and patients undergoing CAPD. Those differences could affect the progression of vascular disturbance in CAPD patients.     

A dilemma in analysis: issues in the serial measurement of quality of life in patients with advanced lung cancer

Despite the availability of several instruments to evaluate quality of life (QL) over time in patients with lung cancer, barriers in measurement remain. This methodological study used LCSS data (Lung Cancer Symptom Scale, a disease- and site-specific QL measure) to examine analysis methods to quantify QL where data needed for serial evaluation may be missing. Data from two large randomized trials, conducted at 30 centers, of a new combination chemotherapy regimen incorporating a new agent for patients (n = 673) with Stage III and IV non-small cell lung cancer were obtained for this study. QL had been prospectively measured at baseline, day 29, and every six weeks thereafter using the LCSS. For the slope analysis (SA) and area under the curve (AUC) analyses, an adjustment score of zero was used to indicate QL on the day of death (mortality adjustment) and each subsequent day until the end of the assessment period. Significant differences in QL, symptom scores and known prognostic factors at baseline were found in the attrition group. SA and AUC analysis allowed inclusion of 581 patients, giving an adequacy rate of 86%. By using a mortality adjustment, an additional 45 patients were included, increasing the inclusion rate to 93%. With the use of the mortality adjustment, QL was shown to decline over the interval, as opposed to rise if the adjustment had not been performed. The conclusions of the study were: (1) analysis for serial data using SA and AUC provides useful, but differing information; (2) when attrition (caused by death) is a factor, a mortality adjustment presented a more accurate assessment of QL as an endpoint; (3) more frequent evaluations of QL will capture rapid changes in patient status and reduce the attrition bias; (4) all patients should be followed until they die; and (5) QL should be given full consideration as a primary endpoint separate from survival.     

Estimating urea clearance in patients on continuous ambulatory peritoneal dialysis: a multivariate analysis

The purpose of this study was to determine if Kt/V urea in continuous ambulatory peritoneal dialysis (CAPD) could be estimated by a multivariate model based upon simple clinical observations. The study included 439 clearance studies in 301 CAPD patients followed in 8 dialysis centers. Weekly urea clearance, 24 h urine volume and 24 h drain volume were normalized to body water by the formulae of Watson (Kt/V, UV/V and DV/V respectively). Adequate dialysis was defined as Kt/V > or = 2.0 weekly. Subjects at 2 units were used to derive the models, while others were used for model validation. Stepwise multiple linear regression was performed on the derivation set (DS) to identify the clinical variables that correlated with Kt/V. The model was then used to estimate Kt/V for the validation set (VS). In the DS, 110 clearance studies were performed in subjects with residual renal function. Multiple linear regression showed that weekly Kt/V was defined by the expression: Kt/V=1.48 + 24.1 (UV/V) + 2.92(DV/V) - 0.049 (serum creatinine) (r=0.750, p<0.001). In 204 VS studies, the correlation between estimated and measured Kt/V was 0.633. There were marked differences in the proportion of adequately dialyzed patients when Kt/V estimated from the formula shown was <2.0, between 2.0 and 2.3, and >2.3 weekly (7.9%, 54.7% and 79.7%, respectively; p2.3 weekly (8.1%, 68.8%, and 100%, respectively; p<0.001). The risk of low Kt/V can be estimated by multivariate linear models requiring only simple clinical measurements.     

Anorexigen (TNF-alpha, cholecystokinin) and orexigen (neuropeptide Y) plasma levels in peritoneal dialysis (PD) patients: their relationship with nutritional parameters

BACKGROUND: Malnutrition has definitely been related to mortality among dialysis patients. Persistent loss of appetite is one of the major symptoms found in these patients. It is also well recognized that several substances produce anorexia or disorders of the hunger-satiety cycle in several diseases. The aim of this study was to identify the role of anorexigen substances (TNF-alpha and cholecystokinin or CCK) and an orexigen substance (neuropeptide Y or NPY) in anorexia and malnutrition among 55 clinically stable peritoneal dialysis (PD) patients. RESULTS: High TNF-alpha plasma levels were found in 41 of 42 patients (97.6%) with a mean of 70.5+/-32.3 pg/ml. Patients with anorexia (n=11) or anorexia with nausea or vomiting (n=5) had higher TNF-alpha values than patients without these symptoms (75.9+/-34 vs 52.1 +/-24.5 pg/ml, P<0.05). Eight patients with a prior diagnosis of acid pylori disease showed higher TNF-alpha values (87.2+/-24.3) than 30 unaffected patients (63.6+/-30.5, P<0.05). TNF-alpha showed a significant negative linear correlation with retinol binding protein (RBP) (r=-0.37, n=34, P<0.05), and venous pH (r=-0.4, n=42, P<0.01); also, TNF-alpha values higher than 65 pg/ml were inversely associated with transferrin, cholesterol, blood urea nitrogen (BUN) and CCK. Patients with prealbumin levels lower than 30 mg/dl, a BMI lower than 30 kg/m2, nPCR lower than 1.1 g/kg/day and urea KT/V lower than 2.2 showed higher serum TNF-alpha levels. Patients who had been on CAPD treatment for longer periods showed higher TNF-alpha values. High plasma CCK levels were found in 38 of 45 patients (84%), mean 45.9+/-32.3 pg/ml. Patients with anorexia had no difference in CCK values compared with those without. A direct association was found between CCK levels and some nutritional markers (albumin, fibronectin, triglycerides, folic acid and nPCR in non diabetic patients). Although CCK has a recognized anorectic effect, this direct association might be because of an abnormal stimulation of CCK glucose feedback (trypsin) due to continuous peritoneal glucose absorption. This suggests that CCK could be an immediate food intake marker in PD patients. The NPY plasma levels were normal in 33 patients, high in 6 and low in 11. Patients with anorexia showed lower NPY levels than those without. NPY values greater than 50 pg/ml were directly associated with higher transferrin, prealbumin, RBP, nPCR and urea KT/V values. Importantly, a negative linear correlation between NPY and TNF-alpha was found (r=-0.42, n= 41, P<0.01). There was no significant relationship between residual renal clearance and the serum levels of the three peptides. CONCLUSION: In conclusion, our data suggest that high TNF-alpha and low NPY serum levels are associated with anorexia. High TNF-alpha, low CCK and low NPY serum levels are also related to a poor nutritional status. Further research on these circulating substances is required.     

Behaviour of ujoviridin exposure test (ICG) in conjunction with application of hormonal contraceptives (author's transl)

The effects of Ovosiston, Non-Ovlon, Anacyclin, Eugynon, and Deposiston, all oral hormonal contraceptives, on 75 women in fertile age and on the half-life of Ujoviridin (ICG - indocyanine green) were studied prior to treatment as well as late in the second, sixth, and twelfth cycles of treatment. ICG half-life was found to be extended in the adaptation phase only in response to Deposiston. ICG is recommended for time-related diagnosis of liver changes in women on hormonal contraceptives.     

Pituitary-gonadal function in male diabetic patients (author's transl)

Pituitary-gonadal function was studied in 50 male diabetic patients under 53 years of age. Forty-three had normal sexual activity and 7 were impotent. Plasma testosterone levels and urinary 17 ketosteroids, androsterone and dehydroepiandosterone levels were measured. LH and FSH levels before and after LHRH, and prolactin levels before and after TRH were also measured in plasma. No significant changes in pituitary-gonadal function were detected, irrespective of the patient's sexual activity. Neither the type and degree of control of diabetes nor the presence of absence of microangiopathy had any influence on the results. Basal LH and FSH levels were slightly higher in older patients. Prolactin levels after TRH were significantly higher in the later stages of the test in patients with microangiopathy.     

Detection of alcohol misusing patients in accident and emergency departments: the Paddington alcohol test (PAT)

The list of hepatitis viruses is increasing over the years. Now the viruses range from A to G. Hepatitis A virus is a short incubation RNA virus which is transmitted oro-faecally. It does not cause chronic illness but may be fatal in a few cases especially in pregnancy. It can now be prevented by vaccination. Hepatitis B virus is a long incubation DNA virus which is transmitted mainly through blood and blood products. It causes chronic illness and can lead to liver cancer in some cases. It can be prevented by vaccination and WHO is now recommending global vaccination of all infants irrespective of endemicity of hepatitis B virus. Hepatitis C virus is an RNA virus which used to be known as parenterally transmitted non A non-B virus. It leads to chronic illness and can lead to liver cancer. It is now responsible for most cases of post transfusion hepatitis in Europe, North America and Asia. Hepatitis Delta virus is a defective virus which requires hepatitis B virus for its existence. Thus it affects only those who have hepatitis B virus. Hepatitis E virus used to be known as the enterically transmitted non-A non-B virus. It is transmitted oro-faecally and seems not to lead to chronic illness. It is endemic in some areas like Middle East and parts of Africa. Hepatitis G virus is just being described. More information about it will soon be available.     

Hernia development in CAPD patients and the effect of 2.5 l dialysate volume in selected patients

Merkel cell carcinoma (MCC) of the skin is a rare, primary malignant skin neoplasm which can present as a cutaneous nodule. These neoplasms are seen primarily in the elderly and located in the head and neck area or extremities. Twenty-nine aspirates from primary and metastatic lesions obtained by percutaneous fine-needle aspiration in 19 patients have been studied. The cytomorphologic features, clinical information, and immunocytochemical (ICC) findings are detailed. Aspirate smears demonstrated small-to-intermediate-sized cells with a loosely cohesive pattern. Nuclei were round with finely granular chromatin and multiple, small nucleoli. Cells possessed a thin rim of cytoplasm, and infrequent pseudorosette formations were noted in cell groups. ICC results were universally positive for cytokeratin, which showed a paranuclear "dot-like" pattern. Neuron-specific enolase, epithelial membrane antigen, and S-100 protein were positive in varying degrees. Leukocyte common antigen was universally negative. The diagnosis of MCC of the skin by FNA can be made by applying cytologic features in addition to ancillary studies and clinical information.     

Mutation analysis of S182 (presenilin-I) in patients with familial Alzheimer''s disease and its biological function

OBJECTIVE: We studied the long-latency response of the orbicularis oris muscle elicited with transcranial magnetic stimulation in patients with hemifacial spasm (HFS) and evaluated the excitability of the facial nucleus. METHODS: We compared the thresholds on both sides in 8 normal volunteers and 7 patients with hemifacial spasm. The thresholds were determined as the lowest intensity required to produce motor evoked potentials with an amplitude of at least 50 microV in the orbicularis oris muscle. Average values were given as means +/- standard deviation. Wilcoxon's rank sum test was used for comparisons between the sides of normal subjects and of patients with HFS with respect to the threshold stimulus. RESULTS: There was no significant difference between the thresholds on the two sides of the normal subjects (mean 1.88+/-5.30%, P > 0.05). In patients with HFS, there was a significant difference between the thresholds on the spasm side and the normal side (mean 20.7+/-13.0%, P < 0.05) In one patient studied after MVD, the difference between both sides disappeared. CONCLUSION: The difference between the thresholds in patients with HFS and the normalization in threshold after MVD suggested that the mechanism of HFS was hyperexcitability of the facial nucleus.