An extended kinetic model-based correction factor equation to account hemodialysis post-treatment hemoconcentration

The hemoconcentration effect for middle weight solutes in hemodialysis is corrected by oversimplified methods based on hematocrit changes or distribution volume variations. Here we implemented a variable volume dual pool kinetic model targeted at obtaining a precise correction factor equation for extracellularly distributed solutes based on relevant kinetic parameters such as the ultrafiltration to dry weight ratio UF/DW, the dialyzer clearance, Kd, the intercompartment mass-transfer coefficient, Kc, and the central compartment to extracellular volume ratio, α. More than 300,000 solutions of the model were computed, performing a sweep among physiological values of the proposed kinetic parameters, resulting in a linear regression denoted by the expression fcorr = 1.0707 - 5.2246 (UF/DW) - 0.0005 Kd - 0.0004 Kc - 0.0007 α, with an excellent coefficient of determination R2 = 0.983. The presented fcorr provides a substantial extension of the currently implemented methods to estimate the hemoconcentration factor for middle and high molecular weight extracellular distributed solutes in hemodialysis

Detoxification of azo dyes by a novel pH-versatile, salt-resistant laccase from Streptomyces ipomoea

A newly identified extracellular laccase produced by Streptomyces ipomoea CECT 3341 (SilA) was cloned and overexpressed, and its physicochemical characteristics assessed together with its capability to decolorize and detoxify an azotype dye. Molecular analysis of the deduced sequence revealed that SilA contains a TAT-type signal peptide at the N-terminus and only two cupredoxine domains; this is consistent with reports describing two other Streptomyces laccases but contrasts with most laccases, which contain three cupredoxine domains. The heterologous expression and purification of SilA revealed that the homodimer is the only active form of the enzyme. Its stability at high pH and temperature, together with its resistance to high concentrations of NaCl and to typical laccase inhibitors such as sodium azide confirmed the unique properties of this novel laccase. The range of substrates that SilA is able to oxidize was found to be pH-dependent; at alkaline pH, SilA oxidized a wide range of phenolic compounds, including the syringyl and guayacil moieties derived from lignin. The oxidative potential of this enzyme to use phenolic compounds as natural redox mediators was shown through the coordinated action of SilA and acetosyringone (as mediator), which resulted in the complete detoxification of the azo-type dye Orange II.This work was financially supported by the Spanish Ministry of Science (CICYT Project CTQ2004-0344/PPQ to MEA and BFU 2006-00972/BMC to JMD). We thank the Autonomous Government of Madrid and the University of Alcalá for the fellowship awarded to R.M

Results of salt intake restriction monitored with the new sodium control biosensor

Adherence to a low sodium (Na) diet is crucial in patients under hemodialysis, as it improves cardiovascular outcomes and reduces thirst and interdialytic weight gain. Recommended salt intake is lower than 5 g/day. The new 6008 CareSystem monitors incorporate a Na module that offers the advantage of estimating patients' salt intake. The objective of this study was to evaluate the effect of dietary Na restriction for 1 week, monitored with the Na biosensor.A prospective study was conducted in 48 patients who maintained their usual dialysis parameters and were dialyzed with a 6008 CareSystem monitor with activation of the Na module. Total Na balance, pre/postdialysis weight, serum Na (sNa), changes in pre- to post-dialysis sNa (ΔsNa), diffusive balance, and systolic and diastolic blood pressure were compared twice, once after 1 week of patients' usual Na diet and again after another week with more restricted Na intake.Restricted Na intake increased the percentage of patients on a low-sodium diet (<85 Na mmol/day) from 8% to 44%. Average daily Na intake decreased from 149 ± 54 to 95 ± 49 mmol and interdialytic weight gain was reduced by 460 ± 484 g per session. More restricted Na intake also decreased pre-dialysis sNa and increased both intradialytic diffusive balance and ΔsNa. In hypertensive patients, reducing daily sodium by more than 3 g Na/day lowered their systolic blood pressure.The new Na module allowed objective monitoring of Na intake, which in turn could permit more precise personalized dietary recommendations in patients under hemodialysis.S. Karger AG, Basel

Assessment of Body Composition as an Indicator of Early Peripheral Parenteral Nutrition Therapy in Patients Undergoing Colorectal Cancer Surgery in an Enhanced Recovery Program

Background: A poor body composition (BC) has been identified as a risk factor for patients with colorectal cancer (CRC). This study was performed to assess the effect of early peripheral parenteral nutrition (PPN) on BC in patients undergoing CCR surgery within an enhanced recovery program. Methods: Patients with normal nutritional status were prospectively included between October 2016 and September 2019, randomized into two groups (PPN with periOlimel N4-E versus conventional fluid therapy) and subsequently classified according to their preoperative CT scan into high- or low-risk BC groups. Postoperative complications and length of hospital stay (LOS) were assessed. Results: Of the 156 patients analyzed, 88 patients (56.4%) were classified as having high-risk BC according to CT measurements. PPN led to a 15.4% reduction in postoperative complications in high-risk vs. 1.7% in low-risk BC patients. In the multivariate analysis, high-risk BC was related to an OR (95% CI) of 2 (p = 0.044) of presenting complications and of 1.9 (p = 0.066) for major complications, and was associated with an increase in LOS of 3.6 days (p = 0.039). Conclusions: The measurement of patients’ BC can allow for the identification of target patients where PPN has been proven to be an effective tool to improve postoperative outcomes

A Comparative Study of the Efficacy of an Intervention with a Nutritional Supplement for Patients with Chronic Kidney Disease: A Randomized Trial.

Chronic kidney disease (CKD) involves heterogeneous diseases that affect the renal structure and function. Malnutrition plays a crucial role during patients with CKD on hemodialysis (HD) treatment and is associated with an increased rate and duration of hospitalizations. The aim of this randomized, parallel, intervention-controlled trial was to assess whether the use of daily supplementation with a new nutritional product developed by the Grand Fontaine Laboratories improves the nutritional status and anthropometric parameters of stage 5 CKD patients, compared with standard renal dietary advice, after three months of follow-up. Dietary intake, anthropometric measurements, physical activity, and blood samples were collected at baseline and after three months of intervention. Significant improvements were observed within the intervention group in body weight (1.5 kg [95% CI: 0.9 to 2.12 kg]) and BMI (0.54 kg/m2 [95% CI: 0.31 to 0.77]; p-value between groups, 0.002 and 0.006, respectively). In the control group, significant decreases were observed in transferrin saturation (−5.04% [95% CI: −8.88 to −1.21]) and alpha-tocopherol levels (−3.31 umol/L [95% CI: −6.30 to −0.32]). We concluded that daily dietary intake of a specific renal nutritional complement in CKD patients with or at risk of malnutrition may prevent deterioration in nutritional parameters

Detection of latent tuberculosis infection in peritoneal dialysis patients: new methods

Introducción: El riesgo de tuberculosis (TB) está aumentadoen pacientes con insuficiencia renal crónica y en diálisis. Laprueba de la tuberculina (PT) es el test de cribado clásico enestos pacientes, a pesar de su baja sensibilidad. En los últi-mos años se han desarrollado nuevos métodos diagnósticosque se basan en la producción de interferón gamma tras laestimulación con antígenos de M. tuberculosis. El objetivo deeste estudio fue evaluar si el Quantiferon®TB-gold In Tube(QFT-GIT) puede contribuir en el diagnóstico de la infeccióntuberculosa en pacientes en diálisis peritoneal (DP). Pacien-tes y métodos:Se incluyeron 54 pacientes en DP. Se valoróla posibilidad de infección tuberculosa latente mediante elQFT-GIT, la PT y la valoración clinicorradiológica por parte deun neumólogo experto. Se estudiaron las concordancias en-tre los tests. Resultados: La prevalencia de un resultado posi-tivo para el test de la tuberculina fue del 29,6% para el pri-mer test y del 31,5% para el segundo (valorando el efectobooster). Una radiografía de tórax positiva aumentaba la de-tección de infección tuberculosa latente hasta un 42,6% y ladel neumólogo hasta un 44,4%. El nivel de correlación entreel QFT-GIT y la PT fue moderado (kappa = 0,36; p = 0,006), aligual que entre la PT y la valoración del neumólogo (kappa= 0,257, p = 0,06). Conclusiones: El QFT-GIT aporta algunasventajas en el diagnóstico de la infección tuberculosa en pa-cientes con insuficiencia renal crónica en DP, y puede com-plementar a la prueba de la tuberculina.Objective: The risk for tuberculosis (TB) is increased in patients with chronic renal failure and dialysis. Tuberculin skin test (TST) is the classical diagnostic method for screening despite its low sensitivity. New methods based on interferon-gamma have been developed. The aim of this study was to evaluate if Quantiferon® TB-gold In Tube (QFTGIT) could be useful in the diagnosis of TB infection in patients on peritoneal dialysis (PD). Patients and methods: Fifty-four patients on PD were included in the study. They were evaluated for latent tuberculosis with QFT-GIT, TST and an assessment by an expert pulmonologist using patients medical history and x-rays. Agreement between test results was determined. Results:The prevalence of a positive TST was 29.6% for the first test and 31.5% for the second (booster effect). A positive chest x-ray increased the rate of detection of patients with latent TB infection up to 42.6% and the expert physician?s evaluation to 44.4%. The correlation between QFT-GIT and TST was fair ( =0.36; P=.006), as it was between TST and expert physician?s evaluation ( =0.257; P=.06). Conclusions: According to our experience QFT-GIT represents an important advantage in the diagnosis of latent TB infection in chronic renal failure patients on PD. It may complement but not replace TST

Electronic structure analysis of the quasi-one-dimensional oxide Sr6Co5O15 within the LDA+U method

The quasi-one-dimensional cobalt oxide Sr6Co5O15 is studied using first-principles electronic-structure calculations and Boltzmann transport theory. We have been able to describe the electronic structure, characterized by the structural one-dimensionality and a particular type of charge ordering, with unexpected electronic structure of the different Co atoms. The origin of the large unquenched misaligned orbital angular momenta comes out naturally from a correct description of the different crystal-field environments. The evolution with the on-site Coulomb repulsion (U) of the electronic structure and the transport properties is discussed, with a best agreement with experiment found for the smallest value of U that allows to converge the correct in-chain ferrimagnetic ground stateThe authors thank the CESGA for the computing facilities, the Ministerio de Educación y Ciencia (MEC) for the financial support through the project MAT2009-08165, the Ministerio de Ciencia e Innovación (MICINN) for the project MAT2007-60536 and the Xunta de Galicia for the project INCITE08PXIB236052PR. A.S.B. thanks MEC for a FPU grant. M.P. and J.B. thank Isabel Barreto program and Deputación da Coruña, respectively, for financial supportS

Are Type, Frequency, and Daily Time Equally Valid Estimators of Support Needs in Children With Intellectual Disability? A Multitrait?Multimethod Analysis of the Supports Intensity Scale for Children (SIS-C)

ABSTRACT: Support needs represent the intensity of support required by a person with a disability in order to take part in the activities related to normative human functioning. The Supports Intensity Scale for Children (SIS-C) is possibly the most promising tool for assessing and designing individualized support programs in children with intellectual disability. The SIS-C measures support needs across 61 activities, each one assessed along three methods: type of support, frequency, and daily time during which support is to be given. We investigated the impact of method effects in the SIS-C through a bifactor approach to the analysis of multitrait?multimethod matrices. The results suggest that neither intensity nor frequency scales produced method effects that significantly distorted the measurement of support needs. However, the daily support time method had substantial undesirable effects on five of the seven subscales of support needs. Considerations about support needs assessment and future modifications of the scale are discussed.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Work on this research was funded by the Spanish Ministry of the Economy and Competitiveness (R&D Projects, PSI2012- 36278), and the Autonomous Community of Castile and Leon (R&D Projects, SA120U13)

Repercusión de la actualización del software del monitor 5008 en el volumen convectivo total

Introducción: La hemodiafiltración on-line (HDF-OL) se basa en la administración controlada de grandes volúmenes de sustitución de líquido de diálisis ultrapuro al circuito sanguíneo extracorpóreo de diálisis. Actualmente es la técnica más efectiva para la eliminación de toxinas urémicas de pequeño y gran tamaño. Recientes estudios han observado una asociación en el descenso de la mortalidad en relación directa con el volumen convectivo recibido. La última actualización del software del monitor Fresenius 5008 (5008 CorDiax) permite la automatización del volumen de sustitución sin precisar la introducción de los valores de proteínas totales y hematocrito, con el objetivo optimizar al máximo la convección. Objetivo: El objetivo del estudio fue valorar la reciente versión del software del monitor 5008 comparada con la versión anterior sobre la repercusión en el volumen convectivo total. Material y métodos: Se incluyeron 63 pacientes, 44 varones y 19 mujeres, con una edad media de 65,2 ± 15 años, que se encontraban en programa de HDF-OL. Cada paciente fue analizado en 6 sesiones, 3 con el monitor 5008 y 3 con el monitor 5008 CorDiax. En cada sesión se feterminaron el volumen de sustitución, el volumen convectivo total y los parámetros de diálisis. Resultados: No se observaron diferencias significativas en las presiones arterial, venosa o transmembrana ni aumento en el número de alarmas o coagulación de líneas o dializadores. Se observó un aumento significativo del volumen de sustitución con el uso del software CorDiax al pasar de 27,2 a 31,2 l/sesión. El volumen convectivo total se incrementó de 29,5 a 33,3 l/sesión, representando un aumento del volumen convectivo efectivo del 26 % al 29,6 % de la sangre total depurada. Conclusión: El cambio de software en el monitor de diálisis 5008 ha significado un aumento del volumen convectivo total del 13 %, representando un incremento del 3,5 % de la sangre total depurada

Recent trend reversal for declining European seagrass meadows

Seagrass meadows, key ecosystems supporting fisheries, carbon sequestration and coastal protection, are globally threatened. In Europe, loss and recovery of seagrasses are reported, but the changes in extent and density at the continental scale remain unclear. Here we collate assessments of changes from 1869 to 2016 and show that 1/3 of European seagrass area was lost due to disease, deteriorated water quality, and coastal development, with losses peaking in the 1970s and 1980s. Since then, loss rates slowed down for most of the species and fastgrowing species recovered in some locations, making the net rate of change in seagrass area experience a reversal in the 2000s, while density metrics improved or remained stable in most sites. Our results demonstrate that decline is not the generalised state among seagrasses nowadays in Europe, in contrast with global assessments, and that deceleration and reversal of declining trends is possible, expectingly bringing back the services they provide