Sleep Disturbance in Chronic Hemodialysis Patients: The Impact of Depression and Anemia

Background. Many patients with end-stage renal disease who are undergoing chronic hemodialysis suffer from sleep disturbance. This paper was designed to study the severity and prevalence of sleep disorders and the factors affecting the syndromes in this unique patient group. Methods. We conducted this study by the use of questionnaires. Included in this study were a total of 245 patients at our center who had end-stage renal disease (ESRD) and who received hemodialysis thrice weekly for more than three months. Their demographic data and biochemical and hematologic parameters were analyzed. All patients were asked to complete two questionnaires (in a Chinese version) of the Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory second edition (BDI-II), either by themselves or with assistance from the medical staff. Results. One hundred and sixty-four patients completed both questionnaires with a response rate of 70.4%. Their mean age was 57.9 ± 11.8 (ranging from 23.1 to 83.7) years old. They had been receiving hemodialysis for an average of 49.1 ± 50.9 months before the study. The male to female ratio was 77:87. Seventy six (46.3%) patients had diabetes mellitus. The prevalence of sleep disturbance was 74.4% (122/164), defined as PSQI scores >5. The poor sleepers had higher BDI scores and a higher ratio of females comparing to the good sleepers. By a multivariate analysis, the BDI scores and female sex were the independent predictors of the patients being poor sleepers. In analyzing the poor sleepers, the BDI scores, durations of hemodialysis and hemoglobin levels were the independent factors for predicting the global PSQI scores. Conclusion. The questionnaire showed a high prevalence of insomnia in the dialytic population. The study also attributes a predictive role in sleep quality to gender, depression, dialytic duration, and hemoglobin levels. The data indicate that in the management of insomnia in this patient group, anemia and depression, both of which are potentially correctable, should be assessed.     

白花蛇舌草-半枝莲药对组分对结肠腺癌Lovo细胞生物学行为的影响

摘要:目的　探讨白花蛇舌草-半枝莲药对组分对结肠腺癌Lovo细胞增殖、侵袭、迁移和凋亡的影响及作用机制。方法　将白花蛇舌草、半枝莲按质量1∶1进行3次煎煮,获得水提物,后取适量浸膏用石油醚回流脱脂,再以乙酸乙酯进行多次萃取,获得白花蛇舌草-半枝莲药对组分,并计算得率。实验分为对照组（正常培养Lovo细胞）、白花蛇舌草-半枝莲药对组分低剂量组（10 mg/L）、中剂量组（30 mg/L）及高剂量组（50 mg/L）。通过噻唑蓝比色法（MTT）检测各组细胞培养24、48、72 h后的增殖抑制率。各组细胞培养48 h后,流式细胞仪检测细胞周期分布;Transwell实验检测细胞侵袭能力;划痕实验检测细胞迁移能力;TUNEL法检测细胞凋亡情况;Western blot法检测Grb2相关结合蛋白1（Gab1）、血管内皮生长因子受体2（VEGFR-2）、磷脂酰肌醇3-激酶（PI3K）、苏氨酸激酶（Akt）、基质金属蛋白酶-9（MMP-9）、B淋巴细胞瘤-2基因（Bcl-2）、Bcl-2相关X蛋白（Bax）蛋白表达情况。结果　化学萃取后的白花蛇舌草-半枝莲药对中主要含有对羟基苯乙酮、野黄芩苷、木犀草素和芹菜素4种化合物,组分得率为0.61%。与对照组相比,低、中、高剂量组细胞增殖抑制率升高,G1期肿瘤细胞比例增加,细胞凋亡指数增高,侵袭细胞数和划痕闭合率明显减小（均P＜0.05）,细胞中Gab1、VEGFR-2、PI3K、Akt、MMP-9、Bcl-2蛋白表达降低,Bax表达升高（均P＜0.05）,且存在剂量依赖性。结论　白花蛇舌草-半枝莲药对组分可抑制结肠腺癌Lovo细胞的增殖,降低其迁移和侵袭能力,诱导细胞凋亡,其机制可能与抑制Gab1/VEGFR-2/PI3K/Akt信号通路活化有关。     

Combined effect of titanium dioxide nanoparticles and glucose on the blood glucose homeostasis in young rats after oral administration

Titanium dioxide nanoparticles (TiO₂ NPs) were usually consumed with a high content of sugar, and children were identified as having the highest exposures due to sweet food preferences. Research on the combined effect of ingested TiO₂ NPs and glucose has great significance, particularly in young people. We examined young Sprague-Dawley rats administered TiO₂ NPs (0, 2, 10 and 50 mg/kg) orally with and without glucose (1.8 g/kg) for 90 days. Blood glucose homeostasis was assessed by monitoring blood glucose and detecting glycoproteins. Glucose tolerance was also evaluated by the oral glucose tolerance test. The levels of blood glucose-related hormones such as insulin, C-peptide and glucagon were measured. We found that subchronic co-exposure of TiO₂ NPs and glucose caused slight imbalance of blood glucose homeostasis in vivo. Mild and temporary hypoglycemia, impaired glucose tolerance and changes of glucose-regulating hormones were shown in the exposure groups. The combined effect of TiO₂ NPs and glucose was more apparent than that of TiO₂ NPs alone, which may be due to the effects of excess glucose and the interactions between TiO₂ NPs and glucose. The antagonistic effect of TiO₂ NPs with glucose did exist in the level of glycosylated hemoglobin in female rats. Gender differences were apparent in these effects induced by TiO₂ NPs and glucose. Female rats seemed to be more susceptible for blood glucose disorders. Co-exposure of TiO₂ NPs and excessive glucose could induce gender-dependent imbalance of blood glucose homeostasis in rats. It may be the reason that these consumers face greater health risks glycosylated hemoglobin.     

Factors Associated with Osteoid Osteoma Recurrence after CT-Guided Radiofrequency Ablation

PurposeTo identify clinical and imaging variables associated with symptomatic recurrence of osteoid osteomas (OOs) treated with computerized tomography (CT)–guided radiofrequency (RF) ablation.Materials and MethodsSeventy-one patients treated with the use of CT-guided RF ablation for OO at a single institution from July 2005 to May 2018 were included in this retrospective cohort analysis. Clinical data, including patient age, sex, race, and clinical outcomes, were collected from institutional electronic health records and telephone follow-up. Imaging variables regarding tumor characteristics were gathered from imaging reports and a blinded review of preprocedural images by an experienced musculoskeletal radiologist. Logistic regression, Cox proportional hazards, and Kaplan-Meier analyses were used to identify variables that are significantly associated with symptomatic recurrence, which was defined as pain occurring > 2 weeks after RF ablation.ResultsTen patients (14.1%) experienced symptomatic recurrence at a median of 21.5 months after RF ablation. Univariable logistic regression classified young age (≤ 13 years), female sex, maximum tumor length, and “eccentricity index” (EI) ≥ 3 as predictive variables significantly associated with symptomatic recurrence. Multivariable logistic regression identified female sex and EI ≥ 3 to be significant predictors for symptomatic recurrence. A multivariable proportional hazards Cox regression of time to recurrence revealed EI ≥ 3 to be the only significant predictor of symptomatic recurrence.ConclusionsFemale patients with OOs with an EI ≥ 3 have a greater risk of symptomatic recurrence following RF ablation. The EI is a useful tool to identify OOs with elongated 3-dimensional morphology, which may warrant more extensive ablation.     

An enzymatic approach to configurationally rare trans‐androsteronyl‐α‐glucoside and Its potential anticancer application

Enzymatic glycosylation of sterols/steroids with glycosyltransferase HP0421 shows protein plasticity on generation of configurationally rare steryl‐α‐glucosides. Investigation of trans‐androsteronyl‐α‐glucoside on tamoxifen‐treated MCF‐7 breast cancer cells shows dose‐dependent depression of cell viability and enhanced drug effectiveness, illustrating a new avenue for the production of novel steryl‐α‐glucosides with useful biological activities.     

Comparing long-term outcomes between early and delayed initiation of peritoneal dialysis following catheter implantation

Aim: The aim of this study was to compare peritonitis rates, peritoneal dialysis technique survival and patient survival between patients who started peritoneal dialysis earlier than 14 days (early starters) and 14 days or more (delayed starters) after insertion of a Tenckhoff catheter. Methods: Observational analysis was performed for all patients who underwent insertion of a Tenckhoff catheter at Far Eastern Memorial Hospital between 1 January 2006 and 31 December 2012. The patients were divided into two groups: early and delayed starters. The rate and outcomes of peritonitis were recorded. Peritoneal dialysis technique survival and patient survival were analyzed using the Kaplan–Meier method. Cox regression analysis was performed for peritoneal dialysis technique failure and patient mortality. Results: There were 80 early starters and 69 delayed starters. The peritonitis rate was 0.18 episodes per year in early starters and 0.13 episodes per year in delayed starters. There was no significant difference of peritonitis free survival (p?=?0.146), peritoneal dialysis technique survival (p?=?0.273) and patient survival (p?=?0.739) at 1, 3, 5 years between early starters and delayed starters. After adjustment with age, albumin and diabetes, early starters did not have an increased risk of peritonitis, technique failure and mortality compared to delayed starters. Conclusion: Compared to the patients who started peritoneal dialysis 14 days or more after catheter implantation, the patients who started earlier did not have an increased risk of peritonitis, peritoneal dialysis technique failure and mortality.     

The floating cardiac fat pad—sign of occult pneumothorax

Pneumothoraces are a possible sequela of chest trauma with potential morbidity and mortality if not recognized and treated promptly. A portable supine chest radiograph is frequently the first radiologic study performed in the setting of trauma. While large pneumothoraces can be readily recognized on these radiographs, smaller pneumothoraces are missed in up to 15 % of trauma patients. There are many radiographic signs of occult pneumothoraces, and we are presenting a new radiographic sign of occult pneumothorax. The floating cardiac fat pad sign occurs when pleural air collects anteriorly and superiorly in the most non-dependent portion of the chest lifting the pericardial fat pad off the diaphragm. Lung markings are still seen surrounding the pericardial fat pad due to the inflated lower lobe of the lung resting dependently. Rapid and accurate identification of pneumothoraces is critical but often difficult on chest radiographs. Although there are many existing radiographic signs for identification of pneumothorax, prospective identification of small pneumothoraces is still relatively poor. Here, we describe an additional sign which aides in the detection of pneumothoraces, the floating cardiac fat pad. When present, this should prompt further evaluation with chest CT or upright chest radiograph.     

International standards for tuberculosis care: relevance and implications for laboratory professionals

On World Tuberculosis (TB) Day 2006, the International Standards for Tuberculosis Care (ISTC) was officially released and widely endorsed by several agencies and organizations. The ISTC release was the culmination of a year long global effort to develop and set internationally acceptable, evidence-based standards for tuberculosis care. The ISTC describes a widely endorsed level of care that all practitioners, public and private, should seek to achieve in managing individuals who have or are suspected of having, TB and is intended to facilitate the effective engagement of all healthcare providers in delivering high quality care for patients of all ages, including those with smear-positive, smear-negative and extra-pulmonary TB, TB caused by drug-resistant Mycobacterium tuberculosis and TB/HIV coinfection. In this article, we present the ISTC, with a special focus on the diagnostic standards and describe their implications and relevance for laboratory professionals in India and worldwide. Laboratory professionals play a critical role in ensuring that all the standards are actually met by providing high quality laboratory services for smear microscopy, culture and drug susceptibility testing and other services such as testing for HIV infection. In fact, if the ISTC is widely followed, it can be expected that there will be a greater need and demand for quality assured laboratory services and this will have obvious implications for all laboratories in terms of work load, requirement for resources and trained personnel and organization of quality assurance systems.