WAA apheresis registry in the Czech Republic: Two centers experience

Introduction

Hemaphereses are sophisticated procedures performed for many indications even in severely ill patients. Many authors consider quite necessary to register as many details as possible of treatments with therapeutic apheresis. WAA meets the requirement to compare data with centers not performing apheresis for the same diagnosis. In Czech Republic hemaphereses are used in a broad spectrum of indications. Since the year 2004 data on hemaphereses done in Czech Republic have been registered. In this paper we present a survey of our to date recordings.

Patients and methods

Data of performed therapeutic hemaphereses (plasma exchange, erythrocytapheresis, leukapheresis, thrombocytapheresis, photopheresis, immunopheresis, and rheopheresis) have been entered in WAA registry with many details. We have been evaluated 1289 procedures in 216 patients done in our two centers (center I, center II).

Results

Center I registered 129 procedures in 41 patients, center II 1260 procedures in 175 patients. The patients are divided according to centers specialization (center II has registered 12 long-term treated patients with LDL-apheresis; mean time of therapy 7.1 years and a median of 34 procedures/patient. Side-effects registered in center I and center II were 3.1% and 5.6% of the procedures, respectively. Most frequent side-effects were citrate toxicity, neurovegetative lability, problems with venous access and hypotension. All were easy to treat, no serious events or death occurred.

Conclusions

In Czech Republic hemaphereses are performed in a broad scale of indications and now it is nearly 5 years that data are registered in our two university centers. In 2004 we entered WAA registry because it meets the requirement to compare data with centers that do not perform aphereses for the same diagnosis. This comparison would certainly improve efficacy of the hemapheresis therapy even further. To enter WAA registry is easy, at no expense and without any problems.     

CAPV方案化疗治疗55例晚期NSCLC临床观察

目的　研究CPAV方案治疗晚期非小细胞肺癌的疗效及毒性。方法　选择 1995年 7月～ 2 0 0 1年 6月晚期非小细胞肺癌患者 5 5例 ,采用CAPV方案予以治疗 ,观察有效率及毒副反应。结果　完全缓解(CR) 3例 ,部分缓解 (PR) 2 8例 ,总有效率 (CR +PR) 5 6 .3% ,其中腺癌 4 4例 ,CR3例 ,PR2 3例 ,有效率 5 9% ,鳞癌 11例 ,PR5例 ,有效率 4 5 .5 %。结论　CAPV方案治疗晚期非小细胞肺癌疗效较高 ,毒副作用可耐受 ,可作为治疗NSCLC的一线方案。     

How understandable are the patient education materials about flat foot on the Internet for parents?

Flat foot is a common reason for parents to visit orthopedic clinics. As the Internet has become an easy-search platform, parents often seek online educational materials before seeking out a professional. The aim of this study was to investigate the quality, readability, and understandability of such online materials for parents. An Internet search was performed for “flat foot” and “pes planus” using the Google search engine. The readability was evaluated using 6 different grading systems: Flesch Reading Ease Score, Flesch–Kincaid Grade Level, Simple Measure of Gobbledygook, Fry Readability score, Gunning Fog Index tests, and Automated Readability Index. The Patient Education Materials Assessment Tool test was used to assess the understandability. For quality assessment, the Journal of American Medical Association benchmark criteria and Health on the Net code were applied. One hundred nine websites were included and evaluated for readability, understandability, and quality. The mean readability grade for all websites was 10.5 ± 2.0. The mean Gunning Fog Index tests and Flesch–Kincaid Grade Level scores for all websites were 12.4 ± 2.2 and 9.7 ± 2.1 sequentially. The mean Coleman–Liau index score was 10.0 ± 1.5, and the average Fry Readability score was 9.9 ± 2.0. The automated readability index for all websites was 10.3 ± 2.5. The average Flesch Reading Ease score for all educational materials was 59.3 ± 10.1. The average Patient Education Materials Assessment Tool score for all educational materials was 81% (range, 70–87%). The mean Journal of American Medical Association benchmark criterion for all websites was 1.0, with a range from 1.0 and 2.0. Eighteen (16.5%) websites had Health on the Net certificates. Readability, understandability, and quality of patient education materials about flat feet on the Internet vary and are often worse than professional recommendations.     

Effects of dithiocarbamates on cadmium distribution and excretion in chronically exposed rats

One month after termination of a 3-mo exposure of rats to cadmium (Cd in drinking water at a concentration of 50 mg/l), the effects of dithiocarbamate analogs on the excretion and distribution of the cadmium were determined. Sodium salts of three dithiocarbamates [sodium bis(hydroxyethyl) dithiocarbamate, DEDTC; sodium N-methyl-D-glucamine dithiocarbamate, MGDTC; and sodium 4-carboxamidopiperidine dithiocarbamate, INADTC] were given to rats ip 2 times at 2.46 mmol/kg. In the following administration of the first injection of DEDTC, cadmium excretion via the urine amounted to 15.8 micrograms and via bile amounted to 124.4 micrograms Cd. Following administration of MGDTC, the urinary and biliary excretions of cadmium were 14.5 and 47 micrograms, respectively, while in the case of INADTC the corresponding values were 23.6 and 7.9 micrograms cadmium. In control animals the urinary and biliary excretion per 12 h reached 0.09 and 0.12 micrograms Cd. Gel permeation chromatography (GPC) analysis of bile revealed differences in the distribution of Cd in the elution fractions after the first injections of the individual dithiocarbamates. For all three dithiocarbamates, significant decreases of the concentrations of cadmium in the liver and kidney were found. DEDTC (but neither of the other compounds) increased the concentration of cadmium in the brain from control levels of 49 +/- 5 ppb to 105 +/- 16 ppb.     

Analysis of the Urea Generation Rate and the Protein Catabolic Rate in Hemodialyzed Patients

Abstract: The urea generation rate (G) and the protein catabolic rate (PCR) have been investigated in two groups of hemodialyzed patients over a whole week cycle, one with zero residual renal function (Kr= 0) dialyzed thrice weekly and the other dialyzed twice weekly with nonzero residual renal function. The two-pool model of urea kinetics was used. No relationship between patients' age and the PCR was found, and also no difference in the PCR between males and females was seen. All patients with a PCR < 0.8 g/kg/day had a midweek predialysis plasma urea level well below 25 mmol/L, which clearly documents the value of a kinetic approach in early detection of patients at risk for malnutrition. In the thrice weekly dialyzed group, a statistically significant relationship was found between PCR and KT/V: PCR = 0.582 + 0.253 ×KT/V, r = 0.374 with p < 0.05. In the twice weekly dialyzed group with nonzero Kr, contribution of the residual renal function had to be included into KT/V to reach a level of statistical significance of PCR = 0.697 + 0.18 ×KT/V, r = 0.481 with p < 0.05. With regard to values of Kr encountered in the investigated group (0–3.5 ml/min), its influence upon PCR is higher than a volumetrically equal increase in excretorial efficacy of the artificial kidney. The G in the thrice weekly dialyzed group was found to be dependent on the length of the interdialytic interval over which it was evaluated. Over the intervals Friday-Monday, Monday-Wednesday, and Wednesday-Friday the following mean values of G were obtained: 0.155, 0.180, and 0.188 mmol/min, respectively. This finding suggests a physiological link between urea generation and its excretion, possibly mediated via its concentration in body fluids. The time constant of this link is apparently quite short, on the order of hours or a few tens of hours. It also indicates that the metabolic status of a dialyzed patient may be influenced not only by the dialysis dose as defined by the KT/V value but also by the overall time schedule of treatment.     

BQ-123, a specific endothelin (ETA) receptor antagonist,prevents ischemia-reperfusion injury in kidney transplantation

We studied the effects of the specific endothelin (ET_A) receptor antagonist, BQ-123, on reperfusion injury in a rat model of kidney transplantation. First, Sprague-Dawley rats were divided into three groups: a sham nephrectomy (SNEPH), an autotransplantation (AUTO-Tx), and an allotransplantation (ALLO-Tx) group. In a fourth group, ALLO-Tx+BQ, allografts were flushed with 20 g BQ-123 containing cold Ringer's lactate before transplantation. For the allograft groups, kidneys from white Wistar albino rats were transplanted into allogeneic Sprague Dawley recipients. Grafts were allowed 120 min of reperfusion after 40 min of cold ischemia. ET-1,2 plasma concentrations in the renal venous blood, and kidney tissue prostaglandin (PG) E₂ and leukotriene (LT) B₄ levels were studied. Diene conjugates (DC), hydroxyalkanals (HAA), hydroxyalkenals (HAE) and malondialdehyde (MDA) levels, as the products of lipid peroxidation, and protein carbonyls (PC) and protein sulphydryls (PS), as the parameters of protein oxidation, were also analyzed in the kidney tissue. Plasma ET concentrations increased significantly in the AUTO-Tx and ALLO-Tx groups (P<0.05 and P<0.01, respectively) but this increase was reversed in the ALLO-Tx+BQ group. None of the lipid peroxidation products except DCs (P<0.05) increased in the AUTO-Tx group, whereas they all increased in the ALLO-Tx group (P<0.01). Protein oxidation parameters also changed significantly (P<0.01) in the ALLO-Tx group but did not in the AUTO-Tx group (P<0.05). The differences in PGE₂ and LTB₄ levels were not significant. Histopathologic examination revealed prominent glomerular and tubular injury in the AUTO-Tx and ALLO-Tx groups but less in the ALLO-Tx+BQ group. In the last group, all parameters of lipid peroxidation (P<0.001 for all) and PCs decreased, and PSs were preserved (P<0.001 for both) when compared with the AUTO-Tx and ALLO-Tx groups. We conclude that BQ-123, in addition to inhibiting the binding of ET-1,2 to the ET_A receptor, may also inhibit the release and/or synthesis of ET-1,2 and prevent reperfusion injury in kidney transplantation.     

Surgical management of elongated styloid process: intraoral or transcervical?

The purpose of this study is to compare the results of surgical approaches in management of elongated styloid process. Eight patients with Eagle’s syndrome due to elongated styloid process were included in this study. All necessary preoperative diagnostic work-ups were done and four of them were operated transorally and four were operated extraorally. Preoperative and postoperative symptoms and postoperative patient satisfaction were investigated. No early or late postoperative complications were encountered in transoral group. One of the patients who was operated transcervically experienced a transient weakness in the marginal mandibular branch of facial nerve which resolved spontaneously within 2 weeks. Complete remission of symptoms was achieved in seven patients at the final follow-up, only one of the patients, who was operated intraorally, had partial remission. Only one of the patients who had unilateral excision of elongated styloid process transcervically complained about the permanent scar. Transoral approach is a safe surgical alternative achieving adequate treatment. The advantages of intraoral approach include less surgical travma, less surgical time and lack of servical scar, with similar outcomes when compared with transcervical approach.