Variable pump flow-based Doppler ultrasound method: a novel approach to the measurement of access flow in hemodialysis patients

Decreasing vascular access flow (Qa) is an important predictor of future access thrombosis and malfunction for hemodialysis (HD) patients. Among all of the methods for determining Qa, the variable pump flow (VPF) Doppler method measures Qa according to the change in Doppler signal between the arterial and the venous needles under different pump flow. After this technique was combined with spectral analysis of Duplex Doppler imaging, the variable pump flow-based Doppler ultrasound method (VPFDUM) for Qa measurement was developed. This study compared the reproducibility and correlation of Qa measurements for three different methods-VPFDUM, ultrasound dilution method (UDM), and conventional Doppler ultrasound method (CDUM)-in 55 HD patients. The mean value of Qa by VPFDUM (870.8 +/- 412.0 ml/min) was close to that by UDM (868.6 +/- 417.9 ml/min) but higher than that by CDUM (either of the above values versus 685.1 +/- 303.6 ml/min; P < 0.005). The mean values of coefficient of variation were similar by VPFDUM (1.6%) and UDM (1.4%) but lower than that by CDUM (either of the above values versus 6.8%; P < 0.01). The correlation coefficient and intraclass correlation coefficient of the repeated Qa measurements by VPFDUM (0.985 and 0.993; P < 0.001) were also similar to those by UDM (0.992 and 0.995; P < 0.001) but slightly higher than those by CDUM (0.917 and 0.948; P < 0.005). Either the reproducibility of VPFDUM (r=0.98, P < 0.0001) or the correlation between VPFDUM and UDM (r=0.99, P < 0.0001) in Qa measurements is good. The unassisted patency of vascular access at 6 mo was significantly poorer in patients with Qa <500 ml/min than those with Qa >500 ml/min (13.6% versus 92.2%; P < 0.0001). In conclusion, VPFDUM is a noninvasive, accurate, and reliable procedure for Qa measurement and prediction of the prognosis of vascular access in HD patients.     

Correlation of the dysmetabolic risk factors with different anthropometric measurements

Metabolic syndrome is a common disorder in Taiwan. For this study 431 subjects were randomly selected from visitors to the Department of Health Management. Blood pressure, blood glucose, lipid, uric acid levels and anthropometric measurements with immunoreactive insulin (IRI) and leptin levels were all correlated. We randomly selected 431 subjects who visited the Department of Health Management. Whole body three-dimensional (3-D) laser scanner scans were employed for the anthropometric measurements. The metabolic index (MI) was designed using anthropometric parameters. Of the 431 subjects, 50% had displayed a body mass index (BMI) equal to or exceeding 25 kg/m2. Pearson correlation coefficient and multiple regression analysis revealed that MI constituted another index for correlating metabolic parameters by comparing MI with BMI and waist circumference to hip circumference ratio (WHR). Most data related to metabolic syndrome showed statistically significant differences between high and low IRI groups, comprising uric acid, total cholesterol, fasting plasma glucose, triglyceride, LDL, Chol/HDL ratio, and LDL/HDL ratio. Both IRI and leptin revealed statistical association with BMI, WHR, waist cross section area to hip cross section area ratio (WHAR), and MI in the study. Hypercholesterolemia appeared in 14.6% of the subjects. Elevated low-density lipoprotein (> or = 130 mg/dL) affected 36.9% of the subjects. In conclusion, MI calculated from 3-D body scanner correlated with many important metabolic risk factors and associated with clinical disorders like DM, hyperlipidemia, hyperuricemia and hypertension.     

Hemangiosarcoma of the seminal vesicle: case report and literature review

We report the clinical, histological and ultrastructural findings of a primary seminal vesicle sarcoma that was proved to be a hemangiosarcoma, the first such case reported. Metastases to the lungs, pleura and peritoneum were discovered at autopsy.     

Arthrogryposis multiplex congenita. Search for prenatal factors in 66 sporadic cases

In a family and epidemiological survey of 66 cases of arthrogryposis multiplex congenita all cases were found to be sporadic and no family association with clubfoot, congenital dislocation of the hip, or hereditary neuromuscular disease was found. The mothers were significantly older than average. Oligohydramnios was noted in only one-third of cases but many other complications of pregnancy, including probable attempts at abortion, had occurred. It is likely that most cases of arthrogryposis are nongenetic and result from a defective intrauterine environment, whether hormonal, vascular, mechanical, or possibly infective.     

The effect of pH on the structural evolution of accelerated biomimetic apatite

The classic biomimetic apatite coating process can be accelerated by first immersing substrates into concentrated simulated body fluid, 5x SBF (SBF1), at 37 degrees C, to form an initial coating of precursor apatite spheres, and subsequently transferring to a second 5x SBF (SBF2) solution which is devoid of crystal growth inhibitors to promote phase transformation of SBF1-derived precursor apatite spheres into final crystalline apatite plates. Since SBF1 governs the formation kinetics and composition of the initial precursor spheres, we hypothesized that the pH of the SBF1 solution will also influence the final structure of the SBF2-derived crystalline apatite. To test this hypothesis, polystyrene substrates were immersed into SBF1 with different pH (5.8 or 6.5), and then immersed into the identical SBF2 (pH=6.0). The resultant apatites exhibited similar 2 theta XRD peaks; FTIR spectra in terms of hydroxyl, phosphate and carbonate groups; and Ca/P atomic ratio (1.42 for SBF1(5.8) apatite; 1.48 for SBF1(6.5) apatite). SEM, TEM and electron diffraction show that while SBF1(6.5) (pH 6.5) precursor spheres transform into larger, single crystals plates, SBF1(5.8) (pH 5.8) precursor spheres developed minute, polycrystalline plate-like structures over predominantly spherical precursor substrate.     

Sympathetic innervation of the tongue in rats

We employed a glyoxylic catecholaminergic histofluorescence method to study the sympathetic innervation present in the rat tongue. One percent neutral red was used as a counterstain. Many noradrenergic fibers were demonstrated around the blood vessels, muscles, glands and submucosa of the tongue, but not in the epithelium or papilla. In a group of rats following neurectomy, the superior cervical ganglia (SCG) were removed unilaterally or bilaterally. Changes in sympathetic innervation of the tongue were examined 14 days after SCG ganglionectomy. In those animals after unilateral SCG ganglionectomy, we found no noradrenergic histofluorescence in the ipsilateral anterior 2/3 of the tongue, although some scant fluorescence was found in the ipsilateral posterior 1/3 of the tongue. However, no noradrenergic histofluorescence could be observed in animal's bilateral SCG ganglionectomies. Our results indicate that sympathetic innervation of the tongue in rats originates in the SCG, with some cross-innervation of the sympathetic fibers occurring in the posterior 1/3 of the tongue.     

Alteration of autoantibodies against p53 in Taiwanese lung cancer patients undergoing chemotherapy

BACKGROUND: Correlation between p53 autoantibodies (p53 Abs) titers and the efficacy of Taiwanese lung cancer patients undergoing chemotherapy has never been investigated. Our present study aimed at evaluating putative possibility of using p53 Abs levels as a model system to monitor effect of chemotherapy and prognosis prediction of lung cancer. METHODS: The prevalence of p53 Abs in lung cancer patients and temporal alteration of p53 Abs titers in lung cancer patients carrying p53 Abs were investigated by using ELISA and Western blot analysis. RESULTS: p53 Abs was detected in 17 of 277 (6.14%) lung cancer patients, the positivity of p53 Abs in patients with small cell lung carcinoma and non-small cell lung carcinoma was 4.88% and 6.36%, respectively. No significant association between p53 Abs and patients' clinical manifestations was found. Titer of p53 Abs was decreased in 6 of 17 p53 Abs-carrying patients after chemotherapy. However, the decreasing p53 Abs titers were not correlated with patients' survival or chemotherapeutic efficacy. CONCLUSIONS: The prevalence of p53 Abs in Taiwanese lung cancer is much lower than that in Caucasians. It is unlikely that p53 Abs titer could be a monitoring indicator for the chemotherapeutic efficacy or a prognosis indicator of lung cancer.     

Reflections on the essence of family-centered care

The aim of this article is to explore the essence of family-centered care; what it is and what it is not. The article approaches the concept of family-centered care from the points of view of both epistemology and ontology. The new concept of family-centered care had its beginning in the consumer movement and feminism in the 1960s, when patients, families, and health professionals in departments of obstetrics and pediatrics began to be aware of the needs of patients whole families. The concept of family-centered care emphasizes respect, support, and collaborative partnership between family members and health professionals. The new knowledge developed out of a practical need, affecting the old paradigm of patient care. New concepts and new knowledge emerged, causing a paradigm shift that influenced both policies and research at the same time. The body of knowledge in the profession was then disseminated through the expansion of education.