Sodium removal and sodium concentration during peritoneal dialysis: effects of three methods of sodium measurement.

BACKGROUND: Sodium removal (NaR) may have a major impact on the survival of peritoneal dialysis patients. The dialysate/plasma sodium concentration ratio (D/P(Na)) is an indirect index of transcellular water transport by aquaporin channels, and thus of ultrafiltration. Sodium concentration can be assessed by means of flame photometry (F), and direct (D-ISE) or indirect ion-selective electrodes (I-ISE), but these methods have different properties. I-ISE is being used increasingly in clinical laboratories. The aim of this study was to evaluate NaR and D/P(Na) using the three different measurement methods. METHODS: We performed peritoneal equilibration tests (PETs) in 44 peritoneal dialysis patients and calculated the NaR. We also calculated D/P(Na) during the test; plasma and dialysate sodium concentrations were measured by F, D-ISE and I-ISE. RESULTS: NaR was lower (P<0.001) with D-ISE (69+/-29 mmol) than with F (81+/-29 mmol) or I-ISE (79+/-28 mmol). D/P(Na) was also lower at baseline (0.92+/-0.02 vs 0.95+/-0.02 and 0.95+/-0.02; P<0.001), after 60 min (0.87+/-0.03 vs 0.90+/-0.03 and 0.90+/-0.03; P<0.001) and at the end of PET (0.88+/-0.04 vs 0.92+/-0.04 and 0.92+/-0.04; P<0.001) when measured by D-ISE in comparison with F and I-ISE, respectively. CONCLUSIONS: NaR and D/P(Na) were lower when measured by the D-ISE method compared with the F and I-ISE methods. NaR and D/P(Na) were similar when measured by F or I-ISE. I-ISE can be used reliably in the evaluation of NaR and D/P(Na) in everyday clinical practice of peritoneal dialysis.     

Low sodium haemodialysis reduces interdialytic fluid consumption but paradoxically increases post-dialysis thirst.

BACKGROUND: Interdialytic weight gain (IDWG) can be reduced by lowering the dialysate sodium concentration ([Na]) in haemodialysis patients. It has been assumed that this is because thirst is reduced, although this has been difficult to prove. We compared thirst patterns in stable haemodialysis patients with high and low IDWG using a novel technique and compared the effect of low sodium dialysis (LSD) with normal sodium dialysis (NSD). METHODS: Eight patients with initial high IDWG and seven with low IDWG completed hourly visual analogue ratings of thirst using a modified palmtop computer during the dialysis day and the interdialytic day. The dialysate [Na] was progressively reduced by up to 5 mmol/l over five treatments. Dialysis continued at the lowest attained [Na] for 2 weeks and the measurements were repeated. The dialysate [Na] then returned to baseline and the process was repeated. RESULTS: Baseline interdialytic day mean thirst was higher than the dialysis day mean for the high IDWG group (49.9+/-14.0 vs 36.2+/-16.6) and higher than the low weight gain group (49.9+/-14.0 vs 34.1+/-14.6). This trend persisted on LSD, but there was a pronounced increase in post-dialysis thirst scores for both groups (high IDWG: 46+/-13 vs 30+/-21; low IDWG: 48+/-24 vs 33+/-18). The high IDWG group demonstrated lower IDWG during LSD than NSD (2.23+/-0.98 vs 2.86+/-0.38 kg; P<0.05). CONCLUSIONS: Our results indicate that patients with high IDWG experience more intense feelings of thirst on the interdialytic day. LSD reduces their IDWG, but paradoxically increases thirst in the immediate post-dialysis period.     

Epidemiology,pathophysiology and putative genetic basis of carbamazepine‐ and oxcarbazepine‐induced hyponatremia

The use of carbamazepine (CBZ) and oxcarbazepine (OXC) as first‐line antiepileptic drugs in the treatment of focal epilepsy is limited by hyponatremia, a known adverse effect. Hyponatremia occurs in up to half of people taking CBZ or OXC and, although often assumed to be asymptomatic, it can lead to symptoms ranging from unsteadiness and mild confusion to seizures and coma. Hyponatremia is probably due to the antidiuretic properties of CBZ and OXC that are, at least partly, explained by stimulation of the vasopressin 2 receptor/aquaporin 2 pathway. No known genetic risk variants for CBZ‐ and OXC‐induced hyponatremia exist, but likely candidate genes are part of the vasopressin water reabsorption pathway.     

Comparison of Foaming Properties Between the Shirasu Porous Glass Membrane Device and Tessari’s Three-way Stopcock Technique for Polidocanol and Ethanolamine Oleate Foam Production: A Benchtop Study

PurposeTo compare the characteristics of polidocanol (POL) and ethanolamine oleate (EO) sclerosing foams produced by a Shirasu porous glass membrane (SPGM) device with those made using a 3-way stopcock (3WSC).Materials and MethodsFoam half-life times were measured in an ex-vivo benchtop study. Computed tomography (CT) images of each foam were obtained over the time course, and a CT texture analysis was conducted. The bubble size in each foam was measured by an optical microscope.ResultsMedian foam half-life times were longer in the SPGM group than in the 3WSC group (POL: 198 vs 166 s, P = .02; EO: 640 vs 391 s, P < .01). In the CT texture analysis, median standard deviation (SD) and entropy (randomness) were lower, and median energy (uniformity) and gray-level cooccurrence matrix (GLCM) homogeneity were higher in the SPGM group than in the 3WSC group (POL SD: at 30 s and 50–300 s; POL entropy: at 0–60 s; EO SD: at 0–600 s; EO entropy: at 0–460 s; POL energy: at 0–40 s; POL GLCM homogeneity: at 0–250 s; EO energy: at 0–360 s; EO GLCM homogeneity: at 0–480 s; all P < .05). Median bubble diameters in the SPGM group and in the 3WSC group were 69 and 83 μm (P < .01), respectively, in the POL foam; and 36 and 36 μm (P = .45), respectively, in the EO foam.ConclusionsPOL and EO foams had greater uniformity and longer foam half-life time when prepared with an SPGM device than with a 3WSC.     

Assessing the Effects of Geniculate Artery Embolization in a Nonsurgical Animal Model of Osteoarthritis

PurposeTo create a nonsurgical animal model of osteoarthritis (OA) to evaluate the effects of embolotherapy during geniculate artery embolization (GAE).Materials and MethodsFluoroscopy-guided injections of 700 mg of sodium monoiodoacetate were performed into the left stifle in 6 rams. Kinematic data were collected before and after induction. At 10 weeks after induction, Subjects 1 and 4–6 underwent magnetic resonance (MR) imaging with dynamic contrast enhancement (DCE) and Subjects 1, 3, and 4–6 underwent angiography with angiographic scoring to identify regions with greatest disease severity for superselective embolization (75–250-μm microspheres). Target vessel size was measured. At 24 weeks after angiography, DCE-MR imaging, angiography, and euthanasia were performed, and bilateral stifles were harvested. Medial/lateral tibial and femoral condylar, patellar, and synovial samples were cut, preserved, decalcified, and scored using the Osteoarthritis Research Society International criteria. The stifle and synovium Whole-Organ Magnetic Resonance Imaging Score and Multicenter Osteoarthritis Study score were determined. The volume transfer constant (K_trans) and extracellular volume fraction (v_e) were calculated from DCE-MR imaging along the lateral synovial regions of interest.ResultsThe mean gross and microscopic pathological scores were elevated at 38 and 61, respectively. Mean synovitis score was elevated at 9.2. Mean pre-embolization and postembolization angiographic scores were 5 and 3.8, respectively. Mean superior, transverse, and inferior geniculate artery diameters were 3.1 mm ± 1.21, 2.0 mm ± 0.50, and 1.6 mm ± 0.41 mm, respectively. Mean pre-embolization and postembolization cartilage and synovitis scores were elevated at 35.13 and 73.3 and 5.5 and 9.2, respectively. The K_trans/v_e values of Subjects 4, 5, and 6 were elevated at 0.049/0.38, 0.074/0.53, and 0.065/0.51, respectively. Altered gait of the hind limb was observed in all subjects after induction, with reduced joint mobility. No skin necrosis or osteonecrosis was observed.ConclusionsA nonsurgical ovine animal knee OA model was created, which allowed the collection of angiographic, histopathological, MR imaging, and kinematic data to study the effects of GAE.     

长期应用双膦酸盐类药物对老年性骨质疏松骨折愈合过程的影响

目的探讨长期应用双膦酸盐类药物(阿仑膦酸钠)治疗老年性骨质疏松症所引起的骨质疏松骨折的可行性以及长期应用双膦酸盐类药物在骨质疏松骨折愈合过程中对于骨组织的影响,为临床正确应用抗骨吸收药物治疗原发性骨质疏松症提供科学理论根据。方法选择90只12月龄雌性SD大鼠,常规饲养至15月龄左右。每组于骨折造模前2周以及骨折造模后并开始给药后的2周、4周、8周、12周5个时间点,进行X线、组织形态、骨代谢生化标志物以及micro-CT的检测。结果 X线:实验组A早期有明显的梭形外骨痂,但12周未愈合。组织形态学:实验组A早期见大量软骨细胞,愈合晚期虽有改建后成熟骨小梁和新生血管,但骨折处未愈合。骨代谢生化标志物:BAP:实验组A于12周的成骨活性均低于实验组B和实验组C;CTX-1:实验组A于8周后其水平逐渐增高。Micro-CT:实验组A的骨小梁厚度、骨小梁数量减少;骨小梁分离度增加。(统计数据均利用SPSS16.0进行统计分析,P<0.05)。结论长期应用双膦酸盐药物治疗老年性骨质疏松引起的骨折会导致骨折断端愈合延迟甚至不愈合。     

胺碘酮联合磷酸肌酸钠对窒息兔心肺复苏后心肌形态学及丙二醛、超氧化物歧化酶的影响

目的 探讨胺碘酮联合磷酸肌酸钠对窒息兔心肺复苏( cardiopulmonary resuscitation,CPR)后心肌形态学、丙二醛( malondialdehyde,MDA)含量及超氧化物歧化酶(superoxide dismutase,SOD)活性的影响.方法 采用窒息法制作CPR模型.选取健康日本长耳大白兔40只,完全随机分为A组(假手术组)、B组(生理盐水组)、C组(胺碘酮5 mg/kg组)、D组(磷酸肌酸钠100 mg/kg组)、E组(胺碘酮5 mg/kg联合磷酸肌酸钠100 mg/kg组),每组8只.CPR后6h处死兔,光镜及电镜下观察心肌形态学变化,检测心肌MDA含量、SOD活性.结果 光镜下心肌组织病理改变显示:E组心肌损伤轻于C组和D组,C组和D组又轻于B组.电镜下心肌超微结构显示:A组兔的心肌线粒体完整,肌丝排列整齐,明暗带清晰;B组兔的心肌线粒体部分水肿、空泡化,线粒体嵴断裂,肌丝排列紊乱,明暗带分界不清;C组兔心肌少数线粒体空泡化、嵴断裂,肌丝排列尚整齐,明暗带显示不清;D组兔心肌少数线粒体空泡化、嵴断裂,明暗带清晰;E组兔心肌线粒体完整,个别线粒体水肿、嵴断裂,明暗带清晰可见.B组、C组、D组兔心肌MDA含量(2.45±0.41,1.65±0.18,1.71±0.17)较A组(0.98±0.22)升高,差异有统计学意义(P＜0.05);B组兔心肌MDA含量显著高于C组和D组,C组和D组又高于E组,差异有统计学意义(P＜0.05);E组(1.21±0.55)与A组比较差异无统计学意义.B组、C组、D组和E组兔心肌SOD活性(16.2±0.9,17.9±1.0,18.2±0.6,19.8±1.4)较A组(21.4±2.1)减低,差异有统计学意义(P＜0.05);B组心肌SOD活性低于C组和D组,C组和D组又低于E组,差异有统计学意义(P＜0.05).结论 胺碘酮联合磷酸肌酸钠能减轻CPR后心肌损伤;部分抑制CPR后的过氧化反应,减轻脂质过氧化损伤,可能是胺碘酮联合磷酸肌酸钠心肌保护作用的主要机制之一.     

帕瑞昔布钠预防妇科腹腔镜手术患者瑞芬太尼麻醉后痛觉过敏

目的探讨帕瑞昔布钠预防妇科腹腔镜手术患者瑞芬太尼麻醉后痛觉过敏的效应。方法选择ASAⅠ级妇科腹腔镜手术患者60例,随机均分为两组:帕瑞昔布钠组(P组)和对照组(C组)。观察患者术后拔管即刻(T0)、0.5h(T1)、1h(T2)、3h(T3)、6h(T4)、12h(T5)的MAP、HR、SpO2、RR、镇痛评分(VAS)、镇静评分(RSS),并记录患者的满意度、手术时间、手术结束至拔管的时间及术后不良反应。结果与C组比较,T0～T3时P组MAP显著下降、HR显著减慢(P<0.05)。与C组比较,T0～T4时P组VAS评分显著下降(P<0.01),RSS评分显著上升(P<0.01)。P组满意度显著高于C组(P<0.01)。两组手术时间、手术结束至拔管的时间和术后不良反应差异无统计学意义。结论帕瑞昔布钠能有效预防妇科腹腔镜手术患者瑞芬太尼麻醉后痛觉过敏,不增加不良反应。     

甲状腺功能异常者摄碘率与血液中NIS-Ag甲状腺过氧化物酶的相关性研究*

目的 探讨甲状腺功能减退（甲减）和甲状腺功能亢进（甲亢）患者治疗前后摄碘率（RAIU）与甲状腺钠/碘同向转运体抗原（NIS-Ag）、甲状腺过氧化物酶（TPO）含量变化的相关性。方法 选取2015年2月— 2016年8月濮阳市安阳地区医院36例健康体检人员和108例甲状腺疾病就诊患者做为研究对象。电化学发光法检测血清中游离三碘甲状腺素原氨酸（FT3）、游离甲状腺素原氨酸（FT4）和促甲状腺激素（TSH）含量。用甲状腺摄碘功能仪分别检测各组的3?h RAIU、24?h RAIU,用酶联免疫吸附试验测定血浆中NIS-Ag、TPO含量,比较各组别RAIU、NIS-Ag、TPO含量,并分析患者药物治疗前后RAIU与NIS-Ag、TPO相关性。结果 FT3、FT4、TSH含量,除甲减摄碘率增高组和减低组之间比较无差异外,其余各组含量比较,差异有统计学意义（均P?<0.05）。甲减摄碘率增高组和减低组FT3、FT4含量最低,TSH最高;甲亢组FT3、FT4含量最高,TSH 最低。各组治疗前3?h RAIU、24?h RAIU、NIS-Ag及TPO含量比较,差异有统计学意义（P?<0.05）。24?h RAIU、 3?h RAIU、NIS-Ag及TPO在甲减甲状腺摄碘率减低组中最低,而在甲亢组中最高。各患病组3?h RAIU、24?h RAIU与NIS-Ag、TPO均呈正相关,差异有统计学意义（P?<0.05）,但在正常组该指标间无相关性（P?>0.05）。各组治疗后24?h RAIU、3?h RAIU、NIS-Ag及TPO值均较治疗前降低,差异有统计学意义（P?<0.05）。各患病组治疗后3?h RAIU、24?h RAIU与NIS-Ag、TPO均呈正相关,差异有统计学意义（P?<0.05）。结论 甲减患者和甲亢患者RAIU与NIS-Ag、TPO存在正相关性;药物治疗能降低RAIU、NIS-Ag及TPO。     

左旋甲状腺素钠片治疗妊娠期亚临床甲状腺功能减退症的疗效及对患者血脂水平的影响

目的探讨左旋甲状腺素钠片治疗妊娠期亚临床甲状腺功能减退症的疗效及对患者血脂水平的影响。方法选取2017年1月～2019年1月于我院诊治的妊娠期亚临床甲状腺功能减退症患者60例,采用随机数字表法随机分为观察组和对照组,每组30例,观察组给予左旋甲状腺素钠片治疗,初始剂量为50μg/次,1次/d,早餐前半小时口服;对照组不给予药物进行治疗。比较两组治疗前后TSH、FT4、FT3水平及血脂各项指标变化情况及用药安全性情况。结果两组治疗前TSH、FT4、FT3水平比较,无显著性差异(P0.05),治疗后,两组TSH及FT3水平明显降低,FT4水平明显升高,且观察组治疗后TSH及FT3水平显著低于对照组,FT4水平显著高于对照组,两组比较,差异有统计学意义(P0.05);两组治疗前TC、TG、HDL-C、LDL-C水平比较,均未见明显差异(P0.05),治疗后,两组TC、TG及LDL-C水平显著降低,HDL-C水平显著升高,且观察组治疗后TC、TG及LDL-C水平显著低于对照组,HDL-C水平显著高于对照组,两组比较,差异有统计学意义(P0.05)。两组治疗期间未见明显不良反应,安全性较好。结论左旋甲状腺素钠片治疗妊娠期亚临床甲状腺功能减退症疗效确切,能显著改善患者甲状腺功能,同时可纠正脂质代谢紊乱。