Body Composition Analysis of Patients on Waiting List for Cadaveric Renal Transplantation: A Comparison of Hemodialysis and Peritoneal Dialysis Patients

BackgroundBioelectrical impedance analysis is a simple, noninvasive method of assessing body composition. Dialysis modality and selection of buffer type may have an impact on body composition. The aim of our study was to compare body compositions of patients from the waiting list for cadaveric renal transplantation according to the dialysis modality.MethodsWe examined a total of 152 (110 hemodialysis [HD] and 42 continuous ambulatory peritoneal dialysis [CAPD]) patients. Demographic data were collected from patient charts. The last 6 months routine laboratory evaluations including hemoglobin, serum creatinine, intact parathyroid hormone, albumin, C reactive protein, calcium, phosphorus were collected. Body compositions were measured using the Tanita BC-420MA Body Composition Analyzer (Tanita, Tokyo, Japan). We made a subanalysis of the CAPD group according to buffer choices as follows: lactate-buffered (n = 16) and bicarbonate/lactate–buffered (n = 26) solution users.ResultsThe body weight (P = .022), body mass index (BMI; 25.8 ± 4.7 vs 23.4 ± 4.9 kg/m², P = .009), muscle mass (P = .01), fat-free mass (P = .013), and visceral fat ratio (9.5 ± 5.4 vs 7.3 ± 4.1 %, P = .022) were significantly higher in the CAPD group. Total body water of CAPD patients were also higher (P = .003), but total body water ratios of HD and CAPD groups were similar. Fat and fat-free mass ratios of patient groups were also similar. Comparing CAPD subgroups we observed that patients using bicarbonate/lactate–buffered solutions had higher body weights (P = .038), BMI (27.1 ± 5 vs 23.7 ± 3.5 kg/m², P = .018) values, and visceral fat ratios (8.0 ± 5.2 vs 4.6 ± 2.5 %, P = .023). These patients also tend to have higher fat mass without statistical significance (P = .074). Fat, muscle, and fat-free mass total body water ratios of peritoneal dialysis subgroups were similar.ConclusionWe believe that body composition analysis should be used as a complementary method for assessing nutritional status of PD and CAPD patients as body weight or BMI measurements do not reflect fat, muscle masses, and visceral fat ratios in these patients. Stable, well nourished CAPD patients should be closely observed and be encouraged to increase daily exercise and/or decrease calorie intake from other sources to decrease risks associated with abdominal obesity.     

Dialysis Patients With the Metabolic Syndrome Need Less Recombinant Human Erythropoietin for Similar Hemoglobin Levels

IntroductionThe metabolic syndrome (MS) components, such as dyslipidemia, prothrombotic status, and increased blood pressure, are risk factors for patients with renal disease. Visceral fat mass is closely related to the MS and atherosclerosis. We investigated the effects of body compositions and MS on anemia parameters and recombinant human erythropoietin (rHuEPO) requirements in maintenance hemodialysis patients.MethodsBody composition (body mass index and bioimpedance analysis) and laboratory data were obtained from 110 dialysis patients. The MS was identified according to ATP-III criteria. Anemia parameters, hemoglobin (Hgb), albumin, C-reactive protein (CRP), calcium, phosphorus, parathormone levels, and rHuEPO requirements over the last 6 months were retrospectively analyzed.ResultsPatients with the MS seem to reach target Hgb levels more frequently (10–12 g/dL; 66.3% vs 84.8%; P = .03) without any difference in total intravenous iron therapy dosage. MS patients also required lower rHuEPO for reaching similar Hgb levels compared with patients without MS (2679.3 ± 1936.1 vs 3702.5 ± 2213.0 U/kg/6 mo; P = .02). There were no differences in serum CRP, albumin, or Hgb levels between the 2 groups (P > .05). We observed that patients with MS had significantly higher fat mass and visceral fat ratio, but similar muscle mass values compared with no-MS counterparts (P = .0001 and .001, respectively). However, when we compared the ratios of these parameters we observed a significant reduction in muscle ratios and a significant increase in fat ratios of MS patients (P = .0001).ConclusionOur results indicate that MS might be an advantage for reaching higher Hgb levels with lower rHuEPO dosages. The possible reason for this might be the good nutritional state and increased fat mass of patients with MS.     

Reduced antioxidant capacities in platelets from patients with autoimmune thrombocytopenia purpura (ITP)

Autoimmune thrombocytopenic purpura (ITP) is characterized by an abnormally low platelet count and bleeding risks. The exact triggering event remains elusive. Oxidative stress may play a role in several autoimmune diseases. A direct link between platelets in ITP and oxidative stress has not yet been addressed. The intracellular platelet antioxidant capacity (AOC) in ITP patients in the active phase (n?=?24) and remission (n?=?12), and 44 healthy controls were analysed with 2',7'-dichlorodihydrofluorescein diacetate, and in combination with hydrogen peroxide. Enzyme activities (EA) of serum glutathione peroxidase (GPx), glutathione reductase (GRed) and catalase (CAT) were investigated colourimetrically in patients and controls. The AOC of ITP patients in the active phase was drastically reduced, with significantly high mean fluorescence intensity values. Higher GPx activity was observed in both active phase and remission in comparison to healthy controls (p?相似文献   

Implementing an online tool for genome-wide validation of survival-associated biomarkers in ovarian-cancer using microarray data from 1287 patients

The validation of prognostic biomarkers in large independent patient cohorts is a major bottleneck in ovarian cancer research. We implemented an online tool to assess the prognostic value of the expression levels of all microarray-quantified genes in ovarian cancer patients. First, a database was set up using gene expression data and survival information of 1287 ovarian cancer patients downloaded from Gene Expression Omnibus and The Cancer Genome Atlas (Affymetrix HG-U133A, HG-U133A 2.0, and HG-U133 Plus 2.0 microarrays). After quality control and normalization, only probes present on all three Affymetrix platforms were retained (n=22,277). To analyze the prognostic value of the selected gene, we divided the patients into two groups according to various quantile expressions of the gene. These groups were then compared using progression-free survival (n=1090) or overall survival (n=1287). A Kaplan-Meier survival plot was generated and significance was computed. The tool can be accessed online at www.kmplot.com/ovar. We used this integrative data analysis tool to validate the prognostic power of 37 biomarkers identified in the literature. Of these, CA125 (MUC16; P=3.7×10(-5), hazard ratio (HR)=1.4), CDKN1B (P=5.4×10(-5), HR=1.4), KLK6 (P=0.002, HR=0.79), IFNG (P=0.004, HR=0.81), P16 (P=0.02, HR=0.66), and BIRC5 (P=0.00017, HR=0.75) were associated with survival. The combination of several probe sets can further increase prediction efficiency. In summary, we developed a global online biomarker validation platform that mines all available microarray data to assess the prognostic power of 22,277 genes in 1287 ovarian cancer patients. We specifically used this tool to evaluate the effect of 37 previously published biomarkers on ovarian cancer prognosis.     

Cost of treating diabetic foot ulcers in five different countries

Most estimates in the literature for the economic cost of treating a diabetic foot ulcer (DFU) are from industrialized countries. There is also marked heterogeneity between the complexity of cases considered in the different studies. The goal of the present article was to estimate treatment costs and costs to patients in five different countries (Chile, China, India, Tanzania, and the United States) for two hypothetical, but well-defined, DFUs at the extreme ends of the complexity spectrum. A co-author, who is a treating physician in the relevant country, was asked to choose treatment plans that represented the typical application of local resources to the DFU. The outcomes were pre-defined as complete healing in case 1 and trans-tibial amputation in case 2, but the time course of treatment was determined by each investigator in a manner that would be typical for their clinic. The costs, in local currencies, for each course of treatment were estimated with the assistance of local hospital administrators. Typical reimbursement scenarios in each country were used to estimate the cost burden to the patient, which was then expressed as a percentage of the annual per capita purchasing power parity-adjusted gross domestic product. There were marked differences in the treatment plans between countries based on the availability of resources and the realities of local conditions. The costs of treatment for case 1 ranged from Int$102 to Int$3959 in Tanzania and in the United States, respectively. The cost for case 2 ranged from Int$3060 to Int$188,645 in Tanzania and in the United States, respectively. The cost burden to the patient varied from the equivalent of 6 days of average income in the United States for case 1 to 5.7 years of average annual income for case 2 in India. Although these findings do not take cost-effectiveness into account, they highlight the dramatic economic burden of a DFU for patients in some countries.     

Different administration schedules of darbepoetin alfa affect oxidized and reduced glutathione levels to a similar extent in 5/6 nephrectomized rats

Background

The development of erythropoiesis-stimulating agents (ESAs) with extended serum half-lives has allowed marked prolongation of the administration intervals. The level of oxidative stress is increased in chronic kidney disease, and is reportedly decreased after long-term ESA treatment. However, the effect of different dosing regimens of ESAs on oxidative stress has not been elucidated.

Methods

Five-sixths nephrectomized (NX) rats received either 0.4 μg/kg darbepoetin alfa (DA) weekly or 0.8 μg/kg DA fortnightly between weeks 4 and 10. NX animals receiving saline and a sham-operated (SHAM) group served as controls. The levels of oxidized and reduced glutathione (GSSG, GSH) were followed from blood samples drawn fortnightly.

Results

During the follow-up, the ratios GSSG/GSH showed similar trends in both DA groups, levels being significantly lower than those in the SHAM group at weeks 8 and 10. GSSG levels were lower than the baseline throughout the study in all groups except for NX controls. The GSH levels were increased in all three NX groups (weeks 6–10) compared with both the baseline and the SHAM group

Conclusion

Our results suggest that the extent of oxidative stress is similar in response to different dosing regimens of DA in 5/6 NX rats when comparable hemoglobin levels are maintained. These findings remain to be confirmed in chronic kidney disease patients.     

Spinal MR imaging in Vitamin B12 deficiency: Case series; differential diagnosis of symmetrical posterior spinal cord lesions

We report three cases of Vitamin B12 deficiency with symmetrical posterior spinal cord lesions and discuss the differential diagnosis, some of which are not well known. Because the degree of resolution of the clinical symptoms in subacute combined degeneration depends on early detection, MRI findings should not be missed.     

The evaluation of metacognitive beliefs and emotion recognition in panic disorder and generalized anxiety disorder: effects on symptoms and comparison with healthy control

Abstract

Background: The impairments in metacognitive functions and emotion recognition are considered as liable factors in anxiety disorders.

Aims: The better understanding of these cognitive abilities might lead to develop more accurate treatment methods for patients who suffer from anxiety.

Methods: Forty-four patients with panic disorder (PD), 37 individuals with generalized anxiety disorder (GAD) and 44 healthy control (HC) were participated in our study. Metacognition questionnaire-30 (MCQ-30), Reading The Mind From The Eyes Test and symptom severity tests were administered.

Results: Statistical analyses estimated the dysfunctional metacognitive beliefs and disrupted emotion recognition in patients relative to HC. The ‘need to control thoughts’ aspect of metacognitive beliefs was accounted for symptom severity in GAD. Improper metacognitive beliefs were significantly predicted the PD and GAD. In addition, impoverished emotion recognition predicted the GAD.

Conclusions: Our study revealed the role of inconvenient metacognitive beliefs and distorted emotion recognition in PD and GAD. These findings might facilitate the treatment management in cognitive therapies of anxiety disorders via pointing out more reasonable targets across improper cognitive fields.