Las alteraciones de la concentración plasmática de sodio (Nap, expresado en mEq/l) son frecuentes en los pacientes en hemodiálisis (HD). Los monitores de HD tienen la capacidad de estimar la Nap ...mediante un algoritmo interno a partir de las medidas de la dialisancia iónica. En el presente trabajo se estudia la correlación entre la Nap estimada por el monitor de diálisis y la medida en el laboratorio de bioquímica de nuestro centro.
Estudio observacional prospectivo y unicéntrico en los pacientes en programa crónico de HD con el monitor 6008 CAREsystem y prescripción estándar de sodio (138mEq/l) y bicarbonato (32mmol/l). De cada paciente se extrajeron muestras de sangre venosa antes y después de la sesión para asegurar validez inter e intraindividual. Se analizó la Nap en el laboratorio mediante potenciometría indirecta y simultáneamente se registraba la estimada por el monitor de HD al inicio y al terminar la sesión. Para el análisis estadístico se realizó un diagrama de dispersión y se calculó el cociente de correlación de Spearman. Además, se representaron las diferencias entre métodos mediante diagramas de Bland-Altman.
La Nap prediálisis medida en el laboratorio fue de 137,49±3,3, y la del monitor 137,96±2,91, con una correlación con valor de R2 de 0,683 (p<0,001). La Nap posdiálisis medida en el laboratorio fue de 137,08±2,23 y la del monitor de 138,87±1,88, con una R2 de 0,442 (p<0,001). En los diagramas de Bland-Altman, la Nap prediálisis obtuvo un error sistemático de 0,49mEq/l a favor de la Nap estimada por el monitor, con un intervalo de confianza (IC) al 95% de: −3,24-4,22. En cuanto a la Nap posdiálisis, se obtuvo un error sistemático de 1,79mEq/l con un IC al 95% de: −1,64-5,22.
La correlación entre la Nap estimada por el monitor de HD 6008 CAREsystem de Fresenius y la medida por el laboratorio es buena, siendo mejor en las mediciones prediálisis. Nuevos estudios deberán comprobar la validez externa de estos resultados.
Changes in plasma sodium concentration (pNa, expressed in mEq/l) are common in hemodialysis (HD) patients. Hemodialysis monitors can estimate pNa by using an internal algorithm based on ionic dialysance measurements. The present study studies the accuracy of the correlation between the pNa estimated by the dialysis monitor and that measured by the biochemistry laboratory at our center.
A single-centre prospective observational study in patients on a chronic HD program with the 6008 CAREsystem monitor and standard sodium (138mEq/l) and bicarbonate (32mmol/l) prescriptions. Venous blood samples were drawn from each patient before and after each HD session to ensure inter- and intra-individual validity. The pNa was measured in the biochemistry laboratory using indirect potentiometry and simultaneously the estimated pNa by the HD monitor was recorded at the beginning and at the end of the HD session. For statistical analysis, a scatter plot was made, and Spearman's correlation quotient was calculated. In addition, the differences between both methods were represented as Bland-Altman diagrams.
The pre-dialysis pNa measured in the laboratory was 137.49±3.3, and that of the monitor, 137.96±2.91, with a correlation with R2 value of 0.683 (P<.001). The post-dialysis pNa measured in the laboratory was 137.08±2.23, and that of the monitor was 138.87±1.88, with an R2 of 0.442 (P<.001). On the Bland-Altman plots, the pre-dialysis pNa has a systematic error of 0.49, in favor of the monitor-estimated pNa, with a 95% confidence interval (CI) of (−3.24 to a 4.22). In the post-dialysis pNa, a systematic error of 1.79 with a 95% CI of (−1.64 to 5.22) was obtained.
The correlation between the pNa estimated by Fresnius 6008 CAREsystem HD monitor and that measured by the laboratory is good, especially pre-dialysis measurements. Further studies should verify the external validity of these results.
Abstract Background The sympathetic nervous system has an important role in generating pain. Various pathomechanisms are involved that respond well to the application of local anesthetics (LA), for ...example to the stellate ganglion block (SGB). Objectives We wanted to know more about the effects of SGB on cardiovascular parameters. Methods We included 15 healthy volunteers; another 15 healthy volunteers as a control group (sham injection of LA). In order to produce a more precise SGB, we employed only a small volume of LA (3 mL), a LA with a lower permeability (procaine 1%), and a modified injection technique. Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and echocardiographic parameters were recorded before and after SGB. We also investigated whether there are side differences (left and right SBG). Results At baseline all parameters were within the normal range. After performing right and left SGB DBP significantly increased (on the right side from 68.73 ± 8.61 to 73.53 ± 11.10, p = 0.015; on the left side from 70.66 ± 13.01 to 77.93 ± 10.40, p = 0.003). In the control group no increase in DBP was observed. No side-specific differences were found, except a significant reduction in the maximum velocity of myocardial contraction during the systole with left-sided SGB. Conclusions Even with our methods we could not prevent the simultaneous occurrence of a partial parasympatholytic effect. For this reason, the SGB has only minor hemodynamic effects, which is desirable as it enhances the safety of the SGB.
Wnts are secreted glycoproteins involved in a broad range of essential cell functions, including proliferation, migration and cell-fate determination. Recent years have seen substantial research ...effort invested in elucidating the role of the Wnt signaling pathway in planarians, flatworms with incredible regenerative capacities. In this review, we summarize current knowledge on the role of canonical (β-catenin-dependent) and non-canonical (β-catenin-independent) Wnt signaling in planarians, not only during regeneration, but also during normal homeostasis. We also describe some of the preliminary data that has been obtained regarding the role of these pathways during embryogenesis. Models are proposed to integrate the different results which have been obtained to date and highlight those questions that still remain to be answered.
Efficacy and safety of the Clearum dialyzer Maduell, Francisco; Broseta, José Jesús; Rodríguez‐Espinosa, Diana ...
Artificial organs,
October 2021, 2021-Oct, 2021-10-00, 20211001, Letnik:
45, Številka:
10
Journal Article
Recenzirano
Odprti dostop
The Clearum dialyzer, built by Medtronic, became commercially available in several European countries in 2020, but there are still no reports of in vivo data. The aim of this study was to evaluate ...the efficacy and risk of hypoalbuminemia of this dialyzer compared with previously evaluated hemodialysis (HD), expanded hemodialysis (HDx), and postdilution hemodiafiltration (HDF) treatments. A prospective study was carried out in 15 patients. Each patient underwent seven dialysis sessions: FX80 Cordiax in HD, Clearum HS17 in HD, Phylther 17‐SD in HDx, Theranova 400 in HDx, Phylther 17‐G in postdilution HDF, Clearum HS17 in postdilution HDF, and FX80 Cordiax in postdilution HDF. The reduction ratios of urea, creatinine, ß2‐microglobulin, myoglobin, prolactin, α1‐microglobulin, α1‐acid glycoprotein, and albumin were compared intraindividually. Dialysate albumin loss was also measured. Comparison of dialysis techniques revealed no differences between small molecules, but HDx and HDF were significantly higher than HD with medium and large molecular weights. The Clearum dialyzer in HDF obtained similar results to FX80 Cordiax in HDF, was slightly superior to Phylther 17‐G in HDF, and was statistically superior to both dialyzers in HDx. Albumin losses with the Clearum dialyzer were among the lowest, both in HD and HDF treatments. The highest global removal score (GRS) values were obtained with the helixone and Clearum dialyzers in HDF, with similar results both in HD and HDF. In addition, the GRS values with HDx treatments were statistically significantly higher than those with HD. The new Clearum dialyzer has excellent behavior and tolerance in HD and HDF. Its adequate permeability has been proven with its maximal performance in HDF, which could represent an upgrade versus its predecessor polyphenylene dialyzers.
The new Clearum dialyzer has excellent behavior and tolerance in HD and HDF. Its adequate permeability has been proven with its maximal performance in HDF, which could represent an upgrade versus its predecessor polyphenylene dialyzers.
Objective
To evaluate the role of N‐terminal pro‐brain‐type natriuretic peptide (NT‐proBNP) and a cardiovascular (CV) risk score named FRESCO for predicting anthracycline‐induced cardiotoxicity (AIC) ...in diffuse large B‐cell lymphoma (DLBCL).
Methods
A total of 130 consecutive DLBCL patients treated in first‐line with anthracycline‐containing immunochemotherapy. Competitive risk between NT‐proBNP, FRESCO, and time to AIC was considered.
Results
Cumulative incidence of AIC was 12.2% and 17.5% at 1 and 5 years, respectively. Median time to development cardiotoxicity was 6.4 months, with half of the cases showing heart failure and the other half silent AIC. Both NT‐proBNP levels and FRESCO score were independently associated with higher risk of AIC (P = 0.001 and P = 0.03, respectively). Patients with NT‐proBNP ≥600 pg/mL or those with FRESCO ≥4.5% had 3.97 or 2.54 times higher risk of AIC than those with lower values (P = 0.001 and P = 0.048, respectively). According to the previous cutoffs, three groups of patients with a significantly different risk of AIC could be identified (P < 0.0001).
Conclusions
Doxorubicin‐containing chemotherapy is associated with increased risk of silent and overt AIC. Baseline NT‐proBNP levels and FRESCO CV risk score are accurate predictors of AIC and can identify groups of patients at different risk, in which personalized cardiologic evaluation should be offered.
1) To analyse concordance between the level of risk classification using the Adjusted Groups Morbidity (GMA) tool and the assigned level of intervention by general practitioners (GP). 2) To study the ...usefulness of the GMA tool as an aid in electronic medical records (EMR) for decision making.
Cross-sectional observational study of concordance.
Primary Care. Madrid Health Service.
Twenty eight GPs. A sample of 840 patients assigned to participating GPs was selected by disproportionate stratified random sampling (0.65 kappa, 0.125 precision, 5% positive rate, 95% confidence level).
Weighted Cohen Kappa index for the degree of concordance between the GMA tool and the GPs. The usefulness of the tool was assessed using an ad hoc developed questionnaire.
Kappa weighted index obtained was 0.60 (95%CI: 0.55-0.65). In 3% of cases the disagreement was maximum. The GPs found that the grouping tool had been useful in 76% of cases.
Moderate strength/good concordance; incorporating a grouping tool in the EMR helps as a reminder for taking more proactive/integrated decisions based on social and health needs of people with chronic diseases.
The objective of the study is to investigate the impact of anemia (defined as hemoglobin concentration of <12 g/dl in women and 13 g/dl in men) on prognosis and to study the effect of recovery from ...anemia on echocardiographic and clinical parameters in patients with aortic stenosis (AS). This was a prospective study in 315 patients with moderate or severe AS. Patients with anemia received oral iron (ferrous sulfate with mucoproteose, 160 mg iron/day) and erythropoietin, if needed, or intravenous iron, if necessary. The following tests were performed before and after normalization of hemoglobin values: echocardiogram, 6-minute walk test, N-terminal B-type natriuretic peptide, and measures of depression, cognitive impairment, and dependence. Patient mean age was 74 years (SD 9). Mean follow-up was 25 months (SD 8). Anemia prevalence in the overall group was 22% (n = 70). Patients who are anemic had a higher rate of complications at follow-up (mortality, hospital admission, or need for valve procedure; 80% vs 62%, p = 0.009). In total, 89% of patients recovered from anemia, with a mean time to recovery of 4.6 weeks (SD 1.4). Improvements were observed on echocardiographic parameters of peak velocity (4.1 to 3.7 m/s, p = 0.02) and mean gradient (44 to 35 mm Hg, p = 0.02). Performance on the 6-minute walk test improved from 235 to 303 m (p <0.001). Median N-terminal B-type natriuretic peptide value decreased from 612 to 189 pg/dl (p <0.001). In conclusion, patients with AS and anemia have a worse prognosis than those without anemia. Resolution of anemia is associated with improvements in echocardiographic parameters and functional status, suggesting that treatment of iron deficiency is a relevant option in the management of patients with AS, particularly in nonoperable cases.
Recently, a new class of dialyzers, medium cut-off membranes (MCO), designed to improve the permeability, which could provide an efficacy similar to hemodiafiltration, have been incorporated into our ...therapeutic possibilities. To increase the knowledge about its use, the objective of the study was to evaluate the effect of the surface and blood flow (Qb) on the depurative efficacy in the MCO membranes.
We included 19 patients in the hemodialysis. Each patient received 6 sessions, in which the membrane surface was varied, 1.7 or 2.0 m2, and/or the Qb (300, 350, 400 or 450 mL/min). In each session, different solutes were determined at the beginning and end of dialysis.
The surface change of the dialyzer did not show significant differences in the removal of small or large molecules, without changes in albumin loss. The increase in Qb was accompanied by an increase in clearance of small molecules, without showing differences in the percentage reduction of β2-microglobulin, myoglobin, prolactin, α1-microglobulin and α1-acid glycoprotein, except for some comparison with Qb 450 mL/min. There were also no differences in the loss of albumin in the dialysis fluid, less than 2.5 grams in all situations.
The increase of the surface area of 1.7–2.0 m2 in the MCO dialyzer has not meant a greater depurative effectiveness. In these dialyzers the increase of Qb does not seem to be as determinant as in hemodiafiltration except for the clearance of small molecules.
Recientemente, se han incorporado en nuestras posibilidades terapéuticas, una nueva clase de dializadores, membranas de medio cut-off (MCO), diseñados para mejorar la permeabilidad y podrían alcanzar una eficacia similar a la hemodiafiltración. Para aumentar el conocimiento sobre su utilización, el objetivo del estudio fue valorar en las membranas de MCO el efecto de la superficie y del flujo sanguíneo (Qb) sobre la eficacia depurativa.
Se incluyeron 19 pacientes en programa de hemodiálisis. Cada paciente recibió 6 sesiones, en las que se varió la superficie de membrana, 1.7 o 2.0 m2, y el Qb (300, 350, 400 o 450 mL/min). En cada sesión se determinaron diferentes solutos al inicio y al final de diálisis.
El cambio de superficie del dializador no mostró diferencias significativas en la depuración de pequeñas o grandes moléculas, sin cambios en la pérdida de albúmina. El aumento del Qb se acompaño de un aumento de depuración de pequeñas moléculas, sin mostrar diferencias en el porcentaje de reducción de β2-microglobulina, mioglobina, prolactina, α1-microglobulina y α1-glicoproteína ácida, a excepción de alguna comparación con Qb 450 mL/min. Tampoco se observaron diferencias en la pérdida de albúmina en el líquido de diálisis, inferior a 2.5 gramos en todas las situaciones.
El incremento de la superficie de 1.7 a 2.0 m2 en el dializador de MCO no ha significado una mayor eficacia depurativa. En estos dializadores el aumento del Qb no parece ser tan determinante como en la hemodiafiltración a excepción de la depuración de pequeñas moléculas.
Recientemente, se ha incorporado a nuestras posibilidades terapéuticas una nueva clase de dializadores, las membranas de medio cut-off (MCO), diseñadas para mejorar la permeabilidad y que podrían ...alcanzar una eficacia similar a la hemodiafiltración. Para aumentar el conocimiento sobre su uso, el objetivo del estudio fue valorar en las membranas de MCO el efecto de la superficie y del flujo sanguíneo (Qb) sobre la eficacia depurativa.
Se incluyó a 19 pacientes en programa de hemodiálisis. Cada paciente recibió 6 sesiones, en las que se varió la superficie de membrana, de 1,7 o 2,0 m2, y el Qb (300, 350, 400 o 450mL/min). En cada sesión se determinaron diferentes solutos al inicio y al final de la diálisis.
El cambio de superficie del dializador no mostró diferencias significativas en la depuración de pequeñas o grandes moléculas, sin cambios en la pérdida de albúmina. El aumento del Qb se acompañó de un aumento de depuración de pequeñas moléculas, sin mostrar diferencias en el porcentaje de reducción de β2-microglobulina, mioglobina, prolactina, α1-microglobulina y α1-glicoproteína ácida, a excepción de alguna comparación con Qb 450mL/min. Tampoco se observaron diferencias en la pérdida de albúmina en el líquido de diálisis, inferior a 2,5 g en todas las situaciones.
El incremento de la superficie de 1,7 a 2,0 m2 en el dializador de MCO no ha significado una mayor eficacia depurativa. En estos dializadores el aumento del Qb no parece ser tan determinante como en la hemodiafiltración, a excepción de la depuración de pequeñas moléculas.
Recently, a new class of dialyzers, medium cut-off membranes (MCO), designed to improve the permeability, which could provide an efficacy similar to hemodiafiltration, have been incorporated into our therapeutic possibilities. To increase the knowledge about its use, the objective of the study was to evaluate the effect of the surface and blood flow (Qb) on the depurative efficacy in the MCO membranes.
We included 19 patients in the hemodialysis. Each patient received 6 sessions, in which the membrane surface was varied, from 1.7 to 2.0 m2, and/or the Qb (300, 350, 400 or 450mL/min). In each session, different solutes were determined at the beginning and end of dialysis.
The surface change of the dialyzer did not show significant differences in the removal of small or large molecules, without changes in albumin loss. The increase in Qb was accompanied by an increase in clearance of small molecules, without showing differences in the percentage reduction of β2-microglobulin, myoglobin, prolactin, α1-microglobulin and α1-acid glycoprotein, except for some comparison with Qb 450mL/min. There were also no differences in the loss of albumin in the dialysis fluid, less than 2.5 g in all situations.
The increase of the surface area from 1.7 to 2.0 m2 in the MCO dialyzer has not meant a greater depurative effectiveness. In these dialyzers the increase of Qb does not seem to be as determinant as in hemodiafiltration except for the clearance of small molecules.
Participatory action research and participatory evaluation are two approaches used to involve people in public affairs, fostering the shared construction of knowledge. Recent decades have seen an ...increase in the involvement of agents in public activity, a trend that is also evident among young people. Experiences based on youth participatory action research and participatory youth evaluation are discussed in the literature. The main aim of this article is to define these two methodological approaches, and discuss: the role played by agents, the functions implemented, and the main stages. To this end, we have used a systematic documentary analysis of databases and specialist journals between 2010-2021. The results produce a map of internationally published articles regarding participatory action research and participatory youth evaluation. Secondly, a check-list is provided of the two methodological approaches to youth participation; this compiles the functions of the agents involved and the stages involved in both approaches. The article aims to be of use to public administrations and social entities with decision-making powers over actions that favour the involvement of young people in public affairs.
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