english Aims: In order to develop the e-learning teaching material for medical professionals who are not physicians, we compared solution-based interactive and reading-based reproductive learning ...with regard to the increase of knowledge. Furthermore we tried to identify additional factors influencing learning.Methods: We used a quasi-experimental double-stage study design with pre-test (point of time t), intervention and post-test (point of time t). The classification into three comparable groups was carried out according to the pre-test results. The interactive and reproductive group participated in the intervention but not the control group. All three groups consisted of graduates of medical schools (N=150) and more experienced physiotherapists during continuing training (N=66). The increase of knowledge was assessed by the post-test. The analysis of variance was the most important statistical tool.Results: Interactive learning generated a higher increase of knowledge than reproductive learning but was more time consuming. The two groups which participated in the intervention obtained better results than the control group. The level of education and the prior knowledge also influenced the post-test results. Conclusion: We recommend combining interactive and reproductive approaches for designing the e-learning platform.german Zielsetzung: Für die Weiterbildung von Nichtmedizinern im Fach Anatomie entwickelten wir Lehrmaterial für E (elektronisches)-learning. Deshalb interessierte uns die Frage, ob interaktives (selbstständiges Erarbeiten der Lösungen) oder reproduktives („nur Lesen“) Lernen zu einem höheren Wissenszuwachs führen und welche weiteren Faktoren den Lernprozess beeinflussen.Methodik: Wir verwendeten ein quasi-experimentelles zweistufiges Studiendesign mit Vortest (Zeitpunkt t), Intervention und Nachtest (Zeitpunkt t). Die Einteilung in leistungsmäßig etwa gleich starke Gruppen erfolgte anhand der Ergebnisse des Vortests. Die interaktive und reproduktive Gruppe nahmen an der Intervention teil, die Kontrollgruppe nicht. Alle drei Gruppen bestanden aus Absolventen medizinischer Berufsfachschulen (N=150) und bereits länger tätigen Physiotherapeuten in postgradualer Weiterbildung (N=66). Mit Hilfe des Nachtests wurde der Wissenszuwachs dokumentiert. Als wichtigstes statistisches Instrument wurde die Varianzanalyse eingesetzt. Ergebnisse: Interaktives Lernen führt zu einem höheren Wissenszuwachs, braucht aber mehr Zeit. Beide Interventionsgruppen schnitten besser ab als die Kontrollgruppe. Der Ausbildungsstand (in Ausbildung/Ausbildung abgeschlossen) und das Vorwissen hatten einen zusätzlichen Einfluss auf die Ergebnisse im Nachtest.Schlussfolgerung: Für die Gestaltung des E-learning-Moduls „Anatomie für Nichtmediziner“ empfehlen wir eine Kombination aus interaktivem und reproduktivem Lernen.
In order to develop the e-learning teaching material for medical professionals who are not physicians, we compared solution-based interactive and reading-based reproductive learning with regard to ...the increase of knowledge. Furthermore we tried to identify additional factors influencing learning.
We used a quasi-experimental double-stage study design with pre-test (point of time t(1)), intervention and post-test (point of time t(2)). The classification into three comparable groups was carried out according to the pre-test results. The interactive and reproductive group participated in the intervention but not the control group. All three groups consisted of graduates of medical schools (N=150) and more experienced physiotherapists during continuing training (N=66). The increase of knowledge was assessed by the post-test. The analysis of variance was the most important statistical tool.
Interactive learning generated a higher increase of knowledge than reproductive learning but was more time consuming. The two groups which participated in the intervention obtained better results than the control group. The level of education and the prior knowledge also influenced the post-test results.
We recommend combining interactive and reproductive approaches for designing the e-learning platform.
Marked cyclin protein oscillations over the cell cycle ensure tight regulation of all cell cycle transitions. Despite expression patterns closely mirroring those of cyclin A, cyclin F has long been ...regarded as an odd outlier within the cyclin family. Constituting part of an E3 ubiquitin ligase, its main role was seen as highly restricted to timely degradation of very few key substrates to ensure termination of one error‐free round of replication. Now, a recent series of studies suggests that cyclin F has very similar roles as its closest relatives, merely mediated through a very different mechanism.
Several recent studies suggests that the unusual cyclin F may play very similar cell‐cycle regulatory roles as its closest relatives, merely mediated through a very different mechanism.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Objective
To test the association between statin use and prostate volume (PV) change over time using data from the REduction by DUtasteride of prostate Cancer Events (REDUCE) trial, a 4‐year ...randomised controlled trial testing dutasteride for prostate cancer chemoprevention.
Subjects/Patients and Methods
We identified men with a baseline negative prostate biopsy from REDUCE who did not undergo prostate surgery or develop prostate cancer over the trial period. Men reported statin use at baseline. PV was determined from transrectal ultrasonography performed to guide prostate biopsy at baseline, and 2‐ and 4‐years after randomisation. Multivariable generalised estimating equations tested differences in PV change over time by statin use, overall and stratified by treatment arm. We tested for interactions between statins and time in association with PV using the Wald test.
Results
Of 4106 men, 17% used statins at baseline. Baseline PV did not differ by statin use. Relative to non‐users, statin users had decreasing PVs over the trial period (P = 0.027). Similar patterns were seen in the dutasteride and placebo arms, although neither reached statistical significance. The mean estimated PV was modestly but significantly lower in statin users relative to non‐users in the dutasteride arm at 2‐years (4.5%, P = 0.032) and 4‐years (4.0%, P = 0.033), with similar (3–3.3%) but non‐significant effects in the placebo arm.
Conclusion
If confirmed, our present findings support a role for statins in modestly attenuating PV growth, with a magnitude of effect in line with previously reported prostate‐specific antigen‐lowering effects of statins (~4%). Future studies are needed to assess whether this putative role for statins in PV growth could impact lower urinary tract symptom development or progression.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Background
Previous studies investigating hospitalizations in dialysis patients have focused primarily on patient-centered factors. We analyzed the impact of hospital and dialysis unit ...characteristics on pediatric dialysis patients’ hospitalizations for access-related complications (ARCs).
Methods
This cross-sectional study involved 102 hemodialysis (HD) and 163 peritoneal dialysis (PD) patients. Data between July 2017 and July 2018 were analyzed.
Results
Children’s hospitals (CHs) had more pediatric nephrologists and longer PD experience (years) than general hospitals (GHs) (
p
= 0.026 and
p
= 0.023, respectively). A total of 53% of automated PD (APD) and 6% of continuous ambulatory PD (CAPD) patients were in CHs (
p
< 0.001). Ninety-three percent of APD and 69% of CAPD patients were treated in pediatric-specific PD units (
p
= 0.001). CHs had a higher prevalence in providing hemodiafiltration (HDF) than GHs (83% vs. 30%). Ninety-seven percent of HDF vs. 66% for conventional HD (cHD) patients, and 94% of patients with arteriovenous fistula (AVF) vs. 70% of those with central venous catheters (CVC), were dialyzed in pediatric-specific HD units (
p
= 0.001 and
p
= 0.016, respectively). Eighty patients (51 PD and 29 HD) had 135 (84 PD, 51 HD) hospitalizations. CAPD was an independent risk factor for hospitalizations for infectious ARCs (I-ARCs) (
p
= 0.009), and a health center’s PD experience negatively correlated with CAPD patient hospitalizations for I-ARCs (
p
= 0.041). cHD and dialyzing in combined HD units significantly increased hospitalization risk for non-infectious (NI-)ARCs (
p
= 0.044 and
p
= 0.017, respectively).
Conclusions
CHs and pediatric-specific dialysis units have higher prevalence of APD and HDF use. Hospitalizations for I-ARCs in CAPD are lower in centers with longer PD experience, and pediatric HD units are associated with fewer hospitalizations due to NI-ARCs.
Graphical abstract
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Secondary hyperparathyroidism (sHPT) is particularly severe in rapidly growing infants in dialysis. Although cinacalcet is effective and licensed in dialysis in children aged >3 years, its efficacy ...and safety for children aged <3 years is unknown.
We identified 26 children aged <3 years who were on dialysis and treated with cinacalcet between 2009 and 2021 in 8 European pediatric centers.
Median (interquartile range) age at the start of cinacalcet was 18 (interquartile range: 11–27) months, serum parathyroid hormone (PTH) was 792 (411–1397) pg/ml, corresponding to 11.6 (5.9–19.8) times the upper limit of normal (ULN). Serum calcium was 2.56 (2.43–2.75) mmol/l, and serum phosphate 1.47 (1.16–1.71) mmol/l. Serum 25-OH vitamin D (25–OHD) was 70 (60–89) nmol/l, 3 children were vitamin D deficient (<50 nmol/l). The initial cinacalcet dose was 0.4 (0.2–0.8) mg/kg/d and the maximum dose was 1.1 (0.6–1.2) mg/kg/d. The median follow-up under cinacalcet was 1.2 (0.7–2.0) years. PTH decreased to 4.3 (2.2–7.8) times the ULN after 6 months, to 2.0 (1.0–5.3) times ULN after 12 months, and to 1.6 (0.5–3.4) times thereafter (P = 0.017/0.003/<0.0001, log-transformed PTH). Seven of the 26 infants developed 10 hypocalcemic episodes <2.10 mmol/l. Oral calcium intake was 84% (66%–117%) of recommended nutrient intake at start, 100% (64%–142%) at 3 months and declined to 78% (65%–102%) at 12 months of therapy. Three children developed clinical signs of precocious puberty.
Cinacalcet efficiently controlled severe sHPT in children aged <3 years and was associated with hypocalcemic episodes (similar to what is observed in older children) and precious puberty, thereby mandating meticulous control of calcium (considering nutrition, supplementation, and dialysate) and endocrine changes.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
ABSTRACT
Background and hypothesis
Hospital admissions in pediatric dialysis patients need to be better studied, and most existing studies are retrospective and based on registry data. This study ...aimed to analyse and compare hospital admission rates, causes, length of stay (LOS), and outcomes in children treated with peritoneal dialysis (PD) and hemodialysis (HD).
Methods
Data from 236 maintenance PD and 138 HD patients across 16 European dialysis centers were collected between 1 July 2017 and 30 June 2018. A total of 178 hospitalized patients (103 PD, 75 HD) were included for further analyses.
Results
There were 465 hospitalization events (268 PD, 197 HD) with a rate of 0.39 admissions per 100 patient-days at risk (PDAR) and 2.4 hospital days per 100 PDAR. The admission rates were not significantly different between HD and PD patients. The most common causes of hospitalization were access-related infections (ARI) (17%), non-infectious complications of access (NIAC) (14%), and infections unrelated to access (12%). ARI was the leading cause in PD patients (24%), while NIAC was more common in HD patients (19%). PD patients had more ARIs, diagnostic procedures, and treatment adjustments (P < .05), while HD patients had more NIACs, infections unrelated to access, access placement procedures, and interventional/surgical procedures (P < .001). LOS was longer with acute admissions than non-acute admissions (P < .001). Overall LOS and LOS in the intensive care unit were similar between HD and PD patients. High serum uric acid and low albumin levels were significant predictors of longer LOS (P = .022 and P = .045, respectively). Young age, more significant height deficit, and older age at the start of dialysis were predictors of longer cumulative hospital days (P = .002, P = .001, and P = .031, respectively).
Conclusion
Access-related complications are the main drivers of hospitalization in pediatric dialysis patients, and growth and nutrition parameters are significant predictors of more extended hospital stays.
Graphical Abstract
Graphical Abstract
Background
Sodium (Na) balance is unexplored in dialyzed children. We assessed a simplified sodium balance (sNaB) and its correlates in pediatric patients receiving maintenance dialysis.
Methods
...Patients < 18 years old on hemodialysis (HD) or peritoneal dialysis (PD) in six European Pediatric Dialysis Working Group centers were recruited. sNaB was calculated from enteral Na, obtained by a 3-day diet diary, Na intake from medications, and 24-h urinary Na (uNa). Primary outcomes were systolic blood pressure and diastolic blood pressure standard deviation scores (SBP and DBP SDS), obtained by 24-h ambulatory blood pressure monitoring or office BP according to age, and interdialytic weight gain (IDWG).
Results
Forty-one patients (31 HD), with a median age of 13.3 (IQR 5.2) years, were enrolled. Twelve patients (29.3%) received Na-containing drugs, accounting for 0.6 (0.7) mEq/kg/day. Median total Na intake was 1.5 (1.1) mEq/kg/day, corresponding to 60.6% of the maximum recommended daily intake for healthy children. Median uNa and sNaB were 0.6 (1.8) mEq/kg/day and 0.9 (1.7) mEq/kg/day, respectively. The strongest independent predictor of sNaB in the cohort was urine output. In patients receiving HD, sNaB correlated with IDWG, pre-HD DBP, and first-hour refill index, a volume index based on blood volume monitoring. sNaB was the strongest predictor of IDWG in multiple regression analysis (
β
= 0.63;
p
= 0.005). Neither SBP SDS nor DBP SDS correlated with sNaB.
Conclusions
Na intake is higher than uNa in children on dialysis, and medications may be an important source of Na. sNaB is best predicted by urine output in the population, and it is a significant independent predictor of IDWG in children on HD.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Artificial neural stimulation is widely used in clinic, rehabilitation, and research. One of the limitations of electrical stimulation is the current spread in tissue. Recently, pulsed mid-infrared ...laser stimulation of nerves has been investigated as an alternative stimulation method. The likely benefits of infrared neural stimulation (INS) include spatial selectivity of stimulation, noncontact mode of operation, and the lack of stimulation artifact in simultaneous electrical recordings. The hypothesis for this study is that INS of the cochlear spiral ganglion at low pulse energy is as spatially selective as low-level tonal stimulation of the cochlea. Spatial selectivity was measured using a masking method. An optical pulse with fixed optical parameters was delivered through a 200- m diameter optical fiber. An acoustic tone, variable in frequency and level, was presented simultaneously with the optical pulse. Tone-on-light masking in gerbils revealed tuning curves with best frequencies between 5.3 and 11.4 kHz. The width of the tone-on-light tuning curves was similar to the width of tone-on-tone tuning curves. The results indicate that the spatial area of INS in the gerbil cochlea is similar to the cochlear area excited by a low level acoustic tone, showing promising results for future use of INS in implantable cochlear prostheses.
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