Do seizures in children cause intellectual deterioration?

We studied whether the occurrence of seizures in childhood affected intellectual performance. We compared the full-scale IQs at seven years of age of children who had experienced one or more nonfebrile seizures with the IQs of their seizure-free siblings who were tested at the same age in a large longitudinal study. Among 98 children with seizures, the mean score on IQ tests at seven years was not significantly different from the mean score of their siblings. Mental retardation was more common among the children with seizures, but the excess was accounted for by children who had neurologic abnormalities before the first seizure. We also examined the IQ before and after the onset of seizures in 62 children whose first seizure occurred in the interval between psychometric examinations given at four and seven years of age. The IQ at seven years in the children with seizures did not differ significantly from that in controls matched for IQ (as determined at the four-year assessment), sex, race, and socioeconomic status. Thus, in both the sibling-control comparison and the comparisons made between controls and subjects before and after the onset of seizures, the occurrence of nonfebrile seizures was not associated with a significant change in full-scale IQ.     

Clinical detection of intellectual deterioration associated with brain damage

Leli and Filskov (1979) reported cross-validated classification accuracy that equalled 83% for a discriminant function derived on two measures of intellectual deterioration. This investigation made a preliminary assessment of the clinical utility of this function through a clinical-actuarial classification paradigm. Wechsler-Bellevue Intelligence Scale Form I protocols from 12 nonpsychotic nonimpaired and 12 cerebrally impaired individuals were used by experienced clinicians and predoctoral interns to identify the presence of intellectual deterioration associated with brain damage through their own clinical experience (Clinical Judgment condition) and, then, in conjunction with the discriminant function (Clinical-Actuarial condition). The classification accuracy from the discriminant function weights (Actuarial condition) and those from clinicians in the Clinical-Actuarial condition were statistically comparable and significantly above chance levels. These results indicate that the clinician who is assessing for the presence of intellectual deterioration associated with brain damage should rely heavily upon a valid actuarial index.     

Depression in hemodialysis patients

Psychiatric evaluation of depression in medically ill patients using DSM-III-R or Research Diagnostic Criteria (RDC) is difficult because these diagnostic systems have not been validated for this population. Diagnosis of depression has been especially problematic in patients with end-stage renal disease (ESRD). This study found a 17.7% prevalence of RDC-defined minor depression and a 6.5% prevalence of major depression in 124 ESRD patients treated with hemodialysis. Vegetative symptoms of depression were less useful for discriminating between those with and without depression than were the psychological symptoms of suicidal ideation, depressed mood, and discouragement.     

影响严重急性呼吸综合征患者临床预后的早期预测因素研究

目的 探寻影响严重急性呼吸综合征(SARS)患者临床预后的早期预测因素。方法 选取20例SARS死亡患者及40例治愈出院患者作为研究对象，收集发病早期临床资料及转归情况，应用多元Logistic回归及Cox比例风险模型分析早期预测因素。结果 单因素分析显示：临床恶化患者与预后良好患者之间在年龄、合并慢性疾病、心肌酶、血氧指标、淋巴细胞计数5方面差异有显著意义；多因素Logistic回归表明：高龄(P=0．009)及较低淋巴细胞计数(P=0．004)与临床恶化密切相关；Cox比例风险分析表明：在40例痊愈患者中淋巴细胞计数较低者(P=0．003)住院时间较长。结论 高龄、淋巴细胞计数下降与临床恶化关系密切，可用于预测SARS患者的临床预后。     

Viral hepatitis in hemodialysis patients

Hemodialysis patients are one of the high-risk groups for viral hepatitis, especially hepatitis C virus(HCV) infection. Although using recombinant human erythropoietin to treat anemia and introducing HCV testing of donated blood have been expected to reduce the incidence of HCV infection, occasional transmission of HCV to hemodialysis patients still occurs. The epidemiological and phylogenetic analysis provides the evidence for nosocomial infection of HCV in hemodialysis units. On the other hand, the discrepancy between results of anti-HCV antibody and HCV RNA is observed in some hemodialysis patients, indicating that the isolation of patients positive for anti-HCV antibody is not effective for the prevention of transmission of HCV. The strict enforcement of universal precaution such as carefully changing gloves should be more important for the prevention of nosocomial infection.     

Time in hemodialysis modulates the levels of genetic damage in hemodialysis patients

It is assumed that hemodialysis treatment can diminish the levels of genetic damage in circulating lymphocytes by cleaning the blood of uremic toxins that cause oxidative stress. However, the hemodialysis process by itself may also induce genomic damage by producing reactive oxygen species (ROS). We conducted a follow‐up study in a group of 70 hemodialysis patients followed for a mean time of 15 months. We investigated the effect of exposure time in hemodialysis on the levels of genetic damage in peripheral blood lymphocytes using the micronucleus assay. In addition, genetic damage after in vitro irradiation with 0.5 Gy was also analyzed to evaluate changes in radiosensitivity. Our results showed that, at the end of the study, there was a decrease in both the basal levels of genetic damage (9.9 ± 1.0 vs. 7.6 ± 0.7) and radiosensitivity values (38.5 ± 3.0 vs. 27.6 ± 2.4). We conclude that hemodialysis procedures may act as an ameliorating factor reducing the genetic damage present in chronic kidney disease patients. Environ. Mol. Mutagen. 55:363–368, 2014. © 2014 Wiley Periodicals, Inc.     

高通量血液透析对维持性血液透析患者细胞免疫功能的影响

目的探讨高通量血液透析对维持性血液透析（MHD）患者细胞免疫功能的影响。方法收集2012年3月至8月于本院门诊行MHD治疗的患者40例,随机数字表法分为血液透析（HD）组（n=20）和高通量血液透析（HFHD）组（n=20）,分别接受HD和HFHD治疗,均为每周透析3次,每次4h。透析前、透析后4、24、48h,流式细胞术检测两组患者外周血CD4＋．CD8＋、CD25＋,记录CD47CD8＋比值,酶联免疫吸附测定（ELISA）检测血清IL-2、可溶性IL-2受体（sIL．2R）;另设健康对照组（C组）20例,清晨空腹抽血检测上述指标。结果与C组比较,透析前HD组和HFHD组患者外周血CD4＋、CD25＋、CD4＋／CD8＋水平下降,血清IL．2水平下降,sIL．2R升高（均P〈0．05）。与透析前比较,HD组患者透析后4h外周血CD4＋、CD25＋、CD47CD8＋水平升高,血清IL-2水平升高,sIL-2R降低（均P〈0．05）,CD8＋差异无统计学意义（P〉O．05）;与透析前比较,HD组患者透析后24、48h上述各指标差异无统计学意义（均P〉0．05）。与透析前比较,HFHD组患者透析后4、24、48h外周血CD4＋、CD25＋、CD4VCD8＋水平升高,血清IL．2水平升高,slL-2R降低（均P〈0．05）,而CD8＋差异均无统计学意义（均P〉O．05）。与同时点HD组比较,HFHD组透析后4h各指标差异均无统计学意义（均P〉O．05）;透析后24、48h,HFHD组外周血CD4＋、CD25＋、CD4＋／CD8＋水平升高,血清IL．2水平升高,sIL．2R降低[CD4＋：（38．73±6．25）％比（34．92±5．84）％,（37．03±5．41）％比（32．62±5．79）％;CD25＋：（21．36±4．65）％比（15．29±4．72）％,（18．19±4．27）％比（13．94±5．05）％;CD4＋／CD8＋：1．42±0．31比1．23±0．29,1．38±0．30比1．20±0．33;IL-2：（22．03±5．18）m±L比（19．03±4．87）m#L,（20．54±5．92）mL比（18．26±4．96）mL;sIL-2R：（672．96±159．36）U／ml比（787．32±143．27）u,ml,（720．24±143．92）u,（858,42±172．13）U／ml,均P〈0．05],而CD8＋差异无统计学意义（均P〉O．05）。结论HD可短暂改善MHD患者的细胞免疫功能,HFHD可持续改善MHD患者的细胞免疫功能。     

Cardiovascular surgery in chronic hemodialysis patients

 Renal failure increases the morbidity and mortality of patients undergoing cardiac surgery. To investigate the adequacy of perioperative management and intraoperative techniques for cardiac operations, we retrospectively analyzed data from 25 patients (4 women and 21 men, with a mean age of 57.4 ± 7.7 years) with chronic renal failure who underwent cardiovascular surgery. The hospital mortality rate was 8.0%. Eleven postoperative complications were observed in 25 patients. The main complications were low cardiac output syndrome (with intraaortic balloon pump insertion in 4 cases), postoperative gastrointestinal tract bleeding (3 cases), and mediastinitis (2 cases). These results demonstrate that preoperative chronic renal failure increases mortality and morbidity; however, good operative outcome can be obtained with careful perioperative management. Received: February 23, 1999 / Accepted: July 16, 2002 Correspondence to:H. Shimpo     

Pruritus in patients on maintenance hemodialysis

Twenty-nine patients undergoing maintenance hemodialysis were examined for dermatologic symptoms. Nineteen patients (66%) complained of pruritus, which was classified as mild (34%), moderate (24%), and severe (8%). Patients with pruritus did not differ from those without pruritus regarding serum concentrations of creatinine, urea, calcium, alkaline phosphatase or aluminum, nor was there any difference in duration of hemodialysis, age or sex. In pruritic patients serum concentrations of parathyroid hormone were significantly higher when determined with a mid-region radioimmunoassay technique (p less than 0.01) and higher, although not significantly, when the intact parathyroid hormone molecule was measured. Serum concentrations of phosphate were significantly lower in patients with pruritus (p less than 0.05).     

Work capacity in patients on hemodialysis

The quality of life is considerably impaired in patients on regular hemodialysis has been changed. It is difficult to determine it because there are no general definitions or measuring instruments. There are objective and subjective components of the quality of life, one among them being occupational ability. During the progression of chronic renal disease (CRD) to terminal renal failure (TRF) physical activity of the patients becomes poorer. In this stage, their physical activity is by 40-60% below the value expected for the same healthy age cohort. The intention of this analysis was to determine occupational ability in patients on regular hemodialysis. The analysis included 161 patients on hemodialysis, 78 (48.5%) female and 83 (51.5%) male, mean age 61.2 +/- 13.1 years, and mean time on hemodialysis was 54 +/- 71.9 months. All patients filled-out a self-administered questionnaire on schooling and occupational ability. The cause of TRF was glomerulonephritis in 45 (26.8%), diabetes mellitus in 42 (26.3%), nephrosclerosis in 26 (16.1%), and pyelonephritis in 12 (7.4%) patients. Age distribution was as follows: 0-19 years 1 patient, 20-44 years 14 (8.7%); 45-64 years 64 (39.8%) and 65 years 82 (50.9%) patients. Educational structure: elementary school 65 (40.4%), secondary school 79 (49.1%), college 10 (6.2%), and university 6 (3.7%) patients. Occupational structure: retired 123 (76.4%), housekeeper 20 (12.4%), never employed 4 (2.5%), employed 10 (6.2%), unemployed 2 (1.2%), 1 child and 1 student. Among employed patients there were 7 men and 3 women. Their educational level was as follow: elementary school 1 patient, secondary school 8 patients, college 1 patient. At the beginning of hemodialysis their occupational status was: full-time employment 30 (18.6%) patients, part-time employment 1 patient, longer time on sick-leave payment (3.1%), retired 95 (59%), pupils and students 3, unemployed 2, and 1 child did not attended school. Time interval between the beginning of hemodialysis and retirement was: less than 1 year work 13 (36.1%) patients, 1-2 year work 6 (16.7%), three year work 2 patients, more than 8 year work 2 patients, and 10 year work only 3 patients, for 14, 18 and 26 years each. Two patients lost their job for employer bankruptcy. The judgment of patients regarding their occupational ability was as follows: out of 161 patients, 23 (14.3%) felt fit for work, 12 on full-time and 11 on part-time basis. Occupationally incapable were 46.6% of patients, and 63 felt unable to take care of another person. Some kind of additional activity, like working in garden or taking care of children was reported by 26 patients. The aforementioned results showed that 22.4% of the patients were occupationally active at the time of starting hemodialysis. Many patients were retired after hemodialysis had started. Only 6.2% of hemodialysis patients were occupationally active although 14.3% felt occupationally capable. The main reasons for such a low level of employment were advanced age, diminished physical activity due to the disease, and difficulties associated with the socioeconomic situation in the country.     

Dietary abuse in maintenance hemodialysis patients

Thirty-one patients on maintenance hemodialysis were studied for compliance to prescribed diet, as measured by weight gain between dialyses and changes in weekly predialysis serum potassium levels. Nineteen patients were poor compliers. Patients who remained vocationally active had a significantly higher percentage of good compliance.     

Cardiovascular risk markers in hemodialysis patients

Cardiovascular events are the main cause of death in hemodialysis patients. Nevertheless, acute myocardial infarction may be misdiagnosed in uremic patients, because typical markers have a high rate of false positivity. A recent two-year prospective study showed that predialytic high serum concentrations of troponin T and CK-MB mass were associated with high mortality, cardiac mortality, myocardial infarction and unstable angina (MACEs). We studied 16 uremic patients (13 M; 3 W) on standard HD and 6 patients (4 M; 2 W) on on-line HDF, who had been taking folic acid for at least three months. Patients who suffered from acute or chronic cardiac ischemic disease were excluded. Anthropometric parameters, pre and post-dialytic pH, HCO3 and electrolytes did not differ between the two groups. Kt/V and URR% were lower in conventional HD vs on-line HDF (p < 0.04; p < 0.04). ORR% was strongly elevated in on-line HDF compared with HD (p < 0.005). In conventional HD, ORR% was directly correlated with Kt/V and URR% (r = 0.49, p < 0.04; r = 0.48, p < 0.04, respectively). Even in on-line HDF ORR% was directly correlated with Kt/V and URR% (r = 0.79, p < 0.04; r = 0.76, p < 0.05, respectively). Troponin I and CK-MB mass were not significantly different in pre vs post-dialysis, both in standard HD and on-line HDF. Nevertheless, in standard HD postdialytic troponin I correlated with serum sodium concentration (r = 0.93, p < 0.000), potassium (r = 0.67, p < 0.004) and serum chlorine (r = 0.92, p < 0.92, p < 0.000). CK-MB mass showed a correlation with serum chlorine (r = 0.49, p < 0.05). Postdialytic CK-MB mass correlated with serum potassium in on-line HDF (r = 0.83, p < 0.03). Our data suggest that hemodialytic treatments, both standard HD and on-line HDF, do not modify serum troponin I and CK-MB mass. Consequently, we can use these parameters for the diagnostic approach in acute or chronic ischemic heart disease in hemodialysis patients.