Peritoneal clearances with different dialysis regimens in children undergoing continuous cycling peritoneal dialysis

Peritoneal clearances and dialysate protein losses occurring in paediatric patients undergoing different continuous cycling peritoneal dialysis (CCPD) regimens have not been well defined. We, therefore, evaluated 10 children aged 15.8 +/- 2.5 (SD) years who were maintained on home peritoneal dialysis for 20.5 +/- 10 months. All patients had at least 3 months of CCPD. The patients were admitted to the Clinical Research Center for 48 hours and allocated to five different dialysis protocols. In protocol I, the frequency of exchanges was 10 per 10 hours; in Protocol II it was 5 per 10 hours; and in Protocol III it was 3 per 10 hours. Protocol II D and III D had, in addition, a daytime dwell of one-half the night-time volume. A 1.5% glucose dialysate solution was used for night-time dialysis, and 4.25% glucose dialysate solution for the daytime dwell. The mean inflow dialysate volume per exchange was 36.7 +/- 5.6 ml/kg body weight and was constant in each patient for each study protocol. BUN and creatinine clearances for each protocol were calculated and dialysate protein losses were measured. The data indicate that hourly night-time dialysis (Protocol I) provides best solute clearance. A daytime dwell further enhances the total solute clearance and should be used preferably in anuric patients. Residual urine output contributes significantly to the total solute clearance. Protein losses are maximum with low-frequency exchanges and a daytime dwell. No significant differences in the serum albumin concentrations were found during the different protocols; however, the long-term effect of the protein loss on the nutritional status of the patients requires further evaluation.     

支气管哮喘患儿Th1/Th2细胞免疫平衡变化研究

目的探讨支气管哮喘患儿Th1/Th2细胞免疫平衡变化及其机制。方法选择急性发作期支气管哮喘患儿30名作为发作组,选择30名缓解期支气管哮喘患儿作为缓解组,选择30名健康小儿作为对照组,采用流式细胞仪检测各组静脉血Th1、Th2表达情况,采用酶联免疫吸附法检测三组患儿血清IL-4、IL-10、IFN-γ水平,比较各组患者Th1/Th2及血清IL-4、IL-10、IFN-γ表达变化水平。结果发作组静脉血Th1/Th2低于对照组及缓解组,血清IL-4、IL-10水平高于对照组及缓解组,IFN-γ水平低于对照组及缓解组。缓解组静脉血Th1/Th2低于对照组,血清IL-4、IL-10水平高于对照组,血清IFN-γ水平低于对照组。结论支气管哮喘患儿存在Th1/Th2免疫失衡,其可能是小儿支气管哮喘的发病机制之一。     

Unilateral hydrothorax in small children on chronic continuous peritoneal dialysis

Three small children whose weights were under 15kg and who were on continuous ambulatory peritoneal dialysis or continuous cycling peritoneal dialysis developed massive unilateral hydrothorax. The occurrence of hydrothorax was late, 3–22 months after the initiation of dialysis. Two of the three fluid collections were leftsided. Each episode was preceded by retention of dialysate. After drainage of the hydrothorax a modified peritoneal dialysis regimen was successful in sustaining patients for a few weeks until further therapy for end-stage renal disease could be pursued.Presented to the 5th National Conference on CAPD, 7 February 1985, Kansas City, Kansas, USA     

IgG subclass levels in pediatric patients on chronic peritoneal dialysis

Patients maintained on chronic peritoneal dialysis (CPD) have been reported to have a variety of abnormalities of humoral immunity, including hypogammaglobulinemia, altered response to vaccination, and selective absence of IgG2. We measured serum immunoglobulin and IgG subclass levels in 22 pediatric CPD patients followed at our institution; 8 patients had low total IgG; 4 of these had low levels of IgG2 and 3 also had low IgG1, but IgG2 levels were detected in all patients. Thus, many pediatric CPD patients may have low IgG, and some may have low IgG1 and IgG2 as a reflection of low total IgG. However, we did not demonstrate a selective absence of IgG2 in these patients.     

Impact of primary omentectomy on longevity of peritoneal dialysis catheters in children

Background

The purpose of this study was to determine the impact of omentectomy on peritoneal dialysis catheter failure rates in pediatric patients with renal failure.

Methods

A retrospective review of children undergoing peritoneal catheter placement was performed over a 22-year period. Children were segregated into those undergoing catheter placements with omentectomy or without.

Results

One hundred sixty-three patients were reviewed, with a 1:1.03 ratio of male to female patients. The mean age was 6.25 ± 5.58 years. Fifty-three percent underwent omentectomy. Catheter failure was observed in 63 children (39%). Catheter obstruction was identified in 36%. Peritonitis led to failure in 9.8%. Catheter failure rate was significantly reduced with the performance of omentectomy (23% without omentectomy vs 15% with omentectomy, P = .0054). Differences in time to catheter failure did not reach statistical significance in the omentectomy group (759 vs 280 days, P = .13).

Conclusions

Omentectomy conferred improved utility of peritoneal catheters in children. Omentectomy appears useful in children undergoing peritoneal dialysis catheter placement.     

Oxalate elimination via hemodialysis or peritoneal dialysis in children with chronic renal failure

. Oxalate elimination and oxalate dialysance via hemodialysis (HD) or peritoneal dialysis (CAPD) has not been studied in detail in pediatric patients. We studied plasma oxalate, oxalate elimination, and oxalate dialysance in 15 infants and children undergoing CAPD (9 female, 6 male, aged 9 months to 18 years) and in 10 children on HD (4 female, 6 male, aged 7 – 18 years). Two children in each group had primary hyperoxaluria (PH). The mean duration of dialysis prior to examination was 12±11 months in CAPD and 31±23 months in HD patients. Bicarbonate HD was performed 5 h three times a week, CAPD consisted of five daily exchanges in 5 patients and four changes in the remaining 10 children (dwell volume 40 ml/kg body weight, 2.3 g/l glucose). Although oxalate dialysance was significantly higher in HD (mean 115.6 ml/min per 1.73 m² in HD versus 7.14 ml/min in CAPD), mean oxalate elimination per week was not different between both renal replacement therapies (3,478 μmol/1.73 m² surface area/week in CAPD versus 3,915 μmol/1.73 m² per week in HD). Oxalate elimination in patients with PH was between 6,650 and 9,900 μmol/week. Plasma oxalate remained elevated in both procedures [28 – 84 μmol/l in CAPD (92/148 in PH) and 33 – 101 μmol/l in HD (70/93 in PH)]. Oxalate elimination can be increased by a more frequent hemodialysis regimen. Received May 24, 1995; received in revised form and accepted October 31, 1995     

Naturally occurring prostate cancer antigen-specific T cell responses of a Th1 phenotype can be detected in patients with prostate cancer

BACKGROUND: Cytotoxic T cells (CTL) are considered one of the primary effector cell populations in antitumor immunity. Recent studies, however, have demonstrated the critical importance of helper T cells (Th), specifically interferon gamma (IFN gamma)-secreting Th1 cells, either by supporting an appropriate CTL environment or by recruiting other effector cells. We evaluated whether patients with prostate cancer have naturally occurring Th-cell responses specific for two prostate cancer-associated antigens, prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP), and whether Th1-type responses to these antigens could be detected. METHODS: Peripheral blood mononuclear cells (PBMC) were collected from 80 patients with prostate cancer and 20 male controls without prostate disease. Th-cell responses were evaluated by measuring antigen-specific proliferation. IFN gamma and IL-5 secretion in response to antigen stimulation was determined by enzyme-linked immunosorbent assay. RESULTS: T cell proliferative responses specific for PSA and PAP could be detected in patients with prostate cancer. Six percent (5/80) of patients had T cell responses specific for PSA and 11% (9/80) for PAP. T cell responses specific for PSA were more prevalent in patients with metastatic disease (P = 0.02), whereas responses specific for PAP could be detected in patients irrespective of disease stage. IFN gamma-producing Th cells, specific for both PSA and PAP, could be identified in patients with prostate cancer. CONCLUSIONS: Patients with prostate cancer can have detectable Th-cell responses specific for the prostate cancer-associated proteins PSA and PAP. The presence of antigen-specific Th1 immune responses in prostate cancer patients suggests that an immune environment capable of supporting antigen-specific CTL may exist in vivo. Prostate 47:222-229, 2001.     

Leptin and plasminogen activator inhibitor-1 levels in children on chronic dialysis

Abstract

Purpose: In this study, it is aimed to compare the serum leptin and PAI-1 levels and evaluate their relationship in children on hemodialysis (HD) and peritoneal dialysis (PD). Method: Thirty-six patients on HD (mean age: 15.0?±?2.8 years), 19 patients on PD (mean age: 13.0?±?3.5 years) and 15 healthy subjects (mean age: 14.5?±?2.7 years) were included in the study. Laboratory investigations included blood count, biochemical parameters, serum iron, iron binding capacity, parathormone, erythrocyte sedimentation rate, C-reactive protein (CRP), prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, serum leptin and PAI-1 levels. Results: Serum leptin levels were significantly higher in HD group than in control group when the effects of BMI and sex were controlled, while PD and control groups had similar leptin levels. PAI-1 levels were also significantly higher in HD group than in control group, while there was no statistically significant difference in PAI-1 levels of PD and control group. PAI-1 levels and leptin levels were significantly correlated, which was independent of the effect of BMI in both HD and PD groups when they are evaluated separately. Conclusion: Results of our study showed that HD patients had higher leptin and PAI-1 levels and leptin and PAI-1 levels were correlated significantly in both patient groups. The effect of elevated serum leptin and PAI-1 levels on the cardiovascular complications remains to be established.     

成骨肉瘤患者TH1/TH2亚群漂移研究

观察成骨肉瘤患者辅助性Ｔ淋巴亚群中Ｔｈ１／Ｔｈ２亚群的变化,为细胞因子免疫治疗提供依据。方法应用放射免疫法以及酶联免疫吸附法检测成骨肉瘤患者血清中ＩＬ－２、ＩＬ－４、ＩＬ－６、ＴＮＦ－α的含量,检测外周血单个核细胞培养上清中ＩＬ－２、ＩＬ－４含量。结果成骨肉瘤血清中及培养上清中ＩＬ－２减少,而ＩＬ－４、ＩＬ－６、ＴＮＦ－α含量增加。结论成骨肉瘤患者中存在有Ｔｈ１／Ｔｈ２平衡失调,其中Ｔｈ１亚群功能抑制,Ｔｈ２亚群功能亢进,它们与肿瘤在宿主体内生长密切相关。     

Protein Z and natural anticoagulants in children on peritoneal dialysis and hemodialysis

Hemostatic alterations due to abnormalities in the coagulation and fibrinolytic system may occur in dialysis patients. Protein Z (PZ) is a vitamin K-dependent coagulation protein promoting assembly of thrombin with phospholipid vesicles. The aim of this study was to investigate PZ and natural anticoagulants in children on hemodialysis (HD) and peritoneal dialysis (PD). Protein Z, protein C (PC), protein S (PS), antithrombin III (AT III), and fibrinogen levels were studied in 24 PD, 13 HD patients and 23 controls. Plasma PZ levels in patients on HD were significantly higher than those on PD and control group (p = 0.04, p = 0.03). We observed elevated PC, PS and AT III activities in children on PD when compared to controls (p = 0.011, p = 0.003, p < 0.001). In HD patients, only PS activity was increased compared to controls (p = 0.016). PC and PS activities did not differ between PD and HD patients whereas AT III activity was higher in PD patients compared to HD patients (p < 0.001). Normal/high levels of PC, PS and AT III suggest that children on PD or HD treatment do not seem to have an increased risk of thrombogenesis due to reduction of these proteins. Increased PZ levels, however, might contribute to the hemostatic alterations in children on HD treatment along with other well known abnormalities.     

T lymphocyte subsets and Th1/Th2 balance after laparoscopy-assisted distal gastrectomy

Background: Laparoscopic surgery provides for a less invasive procedure than open surgery in patients with gastric cancer, but the immune responses after laparoscopic surgery for early gastric cancer remain unknown. Methods: Peripheral blood mononuclear cells from 20 patients with early gastric cancer who underwent laparoscopy-assisted distal gastrectomy (LADG) or open distal gastrectomy (ODG) were obtained; the cell surface molecules and intracellular cytokines (IFN-gamma and IL-4) were measured by flow cytometry. Results: The populations of T lymphocytes after LADG, including CD3-, 4-, 8-, 57-, and HLA-DR-positive lymphocytes, showed patterns similar to those after ODG. The production of IFN-gamma as Th1 cell function decreased significantly on the third postoperative day after ODG but increased after LADG. The production of IL-4, representing Th2 cell function, increased postoperatively after ODG but not after LADG. Conclusions: When compared with ODG, LADG contributes to the preservation of postsurgical Th1 cell-mediated immune function.     

Physical function,muscle strength and muscle mass in children on peritoneal dialysis

The aim of this study was to examine the physical function and muscle strength of children on peritoneal dialysis (PD) and to assess whether the muscle structure alterations influence physical function and muscle strength in these children. Twenty-two children on PD and 16 healthy children were enrolled into the study. A 6-min walk distance and gait speed tests were used to evaluate physical performance. Quadriceps muscle strength (QMS) was measured with a hand-held dynamometer. Magnetic resonance imaging was used to determine the cross-sectional area (CSA) and T2 signal intensity of the quadriceps muscle. Significant differences in the performance of these functional tests were found between PD patients and controls. Quadriceps muscle strength was significantly lower in PD patients than in controls. The CSA corrected for the body mass index (CSA/BMI) was not different between groups, whereas T2 signal intensity was significantly higher in PD patients than in the controls. Physical functioning tests and QMS had a close relationship with muscle CSA/BMI and with T2 signal intensity. In conclusion, along with the other previously documented mechanisms, increased fat in muscles may contribute to the decreased physical functioning and muscle strength in PD patients.     

可溶性Tie2融合蛋白对尿毒症腹膜透析大鼠血管新生的影响

目的 观察可溶性Tie2融合蛋白(sTie2/Fc)对尿毒症腹膜透析大鼠腹膜血管新生的影响.方法 48只雄性SD大鼠,按随机数字表法分为以下6组:正常对照组、假手术组、尿毒症非腹透组、4.25％腹透组、sTie2/Fc 2.5 μg/kg干预组、sTie2/Fc 5.0 μg/kg干预组.腹透组按照4.25％腹透液30...     

Effect of rifampin onStaphylococcus aureus colonization in children on chronic peritoneal dialysis

The efficacy of rifampin in eliminatingStaphylococcus aureus colonization was evaluated in a pediatric peritoneal dialysis population. Six children with documented nasal colonization were treated for 7 days with rifampin and cloxacillin. Although antimicrobial therapy eliminated nasal carriage in all patients, recolonization occurred in 66%. Exit site colonization proved difficult to eradicate with negative cultures documented in only 3 of 5 children after rifampin/cloxacillin therapy. AlthoughS. aureus carriage is a risk factor forS. aureus infections, efforts to eradicate carriage with rifampin are hindered by rapid recolonization.     

下调LSD1表达对于外周血Th1/Th2分化格局的影响

目的 探讨shLSD1转染人外周血CD4+T细胞后,LSD1的脱甲基酶活性对辅助性T细胞亚群1和亚群2(Th1/Th2)分化格局的影响.方法 收集并利用磁珠分离纯化人外周血CD4+T细胞,PHA刺激活化48 h后,shLSD1和化学抑制剂TCP抑制2种方法抑制LSD1的表达,采用流式细胞术和RT-PCR对人外周血T淋巴细胞亚群及CD4+T细胞功能亚型Th1、Th2的代表细胞因子IFN-γ、IL-4进行检测.结果 体外分离培养外周血CD4+T细胞并用转染shLSD1或TCP处理48 h后,流式细胞对胞内基因表达检测显示,shLSD1和TCP组细胞IFN-γ+T细胞比例(26.13±1.89)％和(27.01±1.18)％明显高于对照组(14.67±0.65) ％(P ＜0.05),而IL-4+T细胞比例与对照组无显著差异(P＞0.05);RT-PCR检测显示,shLSD1和TCP组IFN-γ mRNA表达明显高于对照组(P＜0.05),IL-4基因表达则没有改变(P＞0.05).结论 LSD1可以引起CD4+T细胞向Th1/Th2分化方向改变,促进Th1方向分化,对Th2方向无明显影响.     

Evidence for IFN-gamma up- and IL-4 downregulation late post-transplant in patients with good kidney graft outcome

Abstract:  We found recently that patients with good graft outcome showed higher IFN-γ and IL-2, and lower IL-10 plasma levels late post-transplant than early post-transplant. In this retrospective study, we compared cytokine plasma levels in 33 symptom-free outpatients with those of 33 renal transplant recipients with early acute rejection (EAR), 29 with chronic rejection (CR), and 34 healthy controls (HC) to assess whether there is evidence for Th1 activation late post-transplant in patients with good graft outcome. Cytokines were measured pre-transplant, one wk, one month, six months, one yr, and two yr after transplantation. Twelve and 24 months post-transplant, IFN-γ plasma levels were significantly higher (p = 0.001; p = 0.001, respectively) and IL-4 plasma levels significantly lower (p = 0.028; p = 0.003, respectively) in patients with stable graft function than those in controls. Six, 12, and 24 months post-transplant, patients with stable graft function had similar IFN-γ and IL-4 plasma levels as patients with successfully treated EAR (p = n.s.), and higher IFN-γ (p = 0.013; p = 0.001; p = 0.0005, respectively) and lower IL-4 (p = 0.007; p = 0.417; p = 0.0001, respectively) plasma levels than patients with CR. These data suggest that increased plasma IFN-γ and decreased plasma IL-4 late post-transplant might be involved in the induction of mechanisms that facilitate good long-term graft outcome.     

水孔蛋白1在人腹膜组织的表达及腹膜透析对其表达的影响

目的 观察水孔蛋白1（aquaporin-1,AQP1)在人腹膜组织的表达以及腹膜透析（腹透）对其表达的影响。以期探讨长期腹透后腹膜超滤功能下降的可能机制。方法 采用Western blot，免疫组织化学（组化）以及RT-PCR等技术观察正常对照者，尿毒症非透析患者以及腹透患者的腹膜活检标本AQP1在蛋白质和基因水平表达。结果 各组腹膜均有AQP1表达。除了毛细血管和小静脉内皮细胞外，腹膜间皮细胞也表达AQP1。半定量分析表明各组AQP1蛋白和mRAN的表达量差异均没有显著性意义。结论 本研究支持AQP1是腹膜转运超小孔的分子结构。研究结果提示腹膜间皮细胞可能也参与了腹膜跨细胞的水转运。腹透对腹膜AQP1的表达量没有明显影响。因此进一步深入研究AQP1结构或分布的改变，以及与超滤衰竭的关系可能对探讨腹膜超滤衰竭的发生机制具有一定意义。     

The imbalance in the ratio of Th1 and Th2 helper lymphocytes in uraemia is mediated by an increased apoptosis of Th1 subset.

BACKGROUND: In uraemia there is a reduction in the total number of T lymphocytes and an imbalance in the ratio of Th1/Th2 T-helper (Th) lymphocytes. A higher rate of apoptosis in T lymphocytes has been reported in haemodialysis patients. The aims of the present study were to assess the Th1/Th2 pattern in uraemia and to evaluate whether a relative increase in Th1 apoptosis may explain the Th1/Th2 imbalance observed in uraemic patients. METHODS: Seventeen non-dialysed uraemic patients were evaluated; eight healthy volunteers served as controls. Intracellular interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) were measured by direct intracellular immunofluorescence and flow cytometry. Apoptosis was determined by flow cytometry using annexin V or TUNEL. Mechanisms of apoptosis were assessed by determination of Fas and Bcl-2 expression. RESULTS: Cell production of cytokines is significantly higher in uraemic patients than in controls. In addition, in uraemic patients only 5.1+/-2.1% of the T lymphocytes contained IFN-gamma (Th1 cells) while 61.9 +/- 14.8% contained IL-4 (Th2 cells) (P < 0.0001). The percentage of apoptosis was 29.6 +/- 6.3% and 4.7 +/- 1.6% in Th1 and Th2 lymphocytes, respectively (P < 0.001). Fas expression was higher in Th1 than in Th2 cells and the expression of Bcl-2 was lower in Th1 than in Th2 cells. The apoptosis induced by anti-Fas antibodies was similar in both types of lymphocytes. CONCLUSIONS: In uraemia there is a reduction in the proportion of Th1 lymphocytes due to a higher rate of apoptosis in this subset of lymphocytes. Th1 from uraemic patients show a higher expression of Fas and a lower expression of Bcl-2 than Th2. This makes uraemic Th1 cells more susceptible to apoptosis. The Th1/Th2 imbalance may contribute to alterations in cellular immunity observed in chronic kidney disease patients.     

The role of Th1/Th2 cell chemokine expression in hypertrophic scar

The aim of this study was to study the role of Th1/Th2 cell‐associated chemokines in the formation of hypertrophic scars in rabbit ears. Twenty‐six New Zealand white rabbits were used to establish the hypertrophic scar model of rabbit ear and the normal scar model of rabbit's back. Two rabbits were sacrificed on days 0 and 21, 28, 35, 42, 49, 56, and 63 after operation. The specimens were stained with haematoxylin‐eosin (HE). Scar elevation index (SEI) was used to detect the expression of 10 chemokines related to Th1/Th2 cells in both scar formation expressions. Real‐time polymerase chain reaction (PCR) results showed that two chemokines (CXCL10, CXCL12) were highly expressed during the formation of normal scar, and there was almost no expression during the formation of hypertrophic scar (*P < 0.05). The chemokines (CCL2, CCL3, CCL4, CCL5, CCL7, CCL13, CX3CL1) were almost non‐expressed in the formation of normal scars but were expressed for a long time in the formation of hypertrophic scars. The four chemokines, CCL2, CCL4, CCL5, and CX3CL1, maintained a long‐term high expression level during the formation of hypertrophic scars (P < 0.01). There were also three chemokines (CCL14, CCL19, CCL21) that were almost undetectable in normal scarring, but there was transiently low‐level expression (P < 0.05) only during the peak proliferative phase in proliferative scarring. Th1/Th2 cell‐associated chemokines are different in the type, quantity and expression, and maintenance time of rabbit ear hypertrophic scars.