Effect of a Management Algorithm for Wet Contamination of Peritoneal Dialysis System on the Prevention of Peritonitis: A Prospective Observational Study

Introduction: Wet contamination was a common problem of peritoneal dialysis (PD) system. We developed a management algorithm for wet contamination of PD system (wet contamination) on the basis of the related research literature and clinical practice experience. The purpose of this study was to observe clinical effect of the management algorithm on the prevention of peritonitis. Methods: Patients treated wet contamination in a single PD center between October 2017 and September 2022 were included. A management algorithm was established to treat wet contamination. It comprised identification of the contamination type, addressing contaminated or aging catheters, prophylactic antibiotics, and retraining. Demographic data and clinical data about wet contamination were collected and compared. Results: One hundred and forty-one cases of wet contamination were included in this study. The mean age was 51.7 ± 14.1 years, and 49.6% were female. The proportion of diabetic nephropathy was 9.9%. The median PD duration was 27.0 (1.7–79.7) months. Eighteen episodes (12.8%) of wet contamination-associated peritonitis developed after wet contamination. The main pathogenic bacteria of peritonitis were Gram-positive bacteria (33.3%) and Gram-negative bacteria (27.8%). The incidence of wet contamination-associated peritonitis in the compliance with the management algorithm group was significantly lower than that in the non-compliance with the management algorithm group (0.9 vs. 48.6%; p < 0.001). Non-compliance with management algorithm (OR = 185.861, p < 0.001) together with advance age (OR = 1.116, p < 0.001) and longer distance from home to hospital (OR = 1.007, p < 0.001) were independent risk factors for wet contamination-associated peritonitis. Conclusion: The management algorithm for wet contamination of PD system could reduce the risk of peritonitis

Association of Lean Body Mass Index and Peritoneal Protein Clearance in Peritoneal Dialysis Patients

Background/Aims: The relationship between peritoneal protein clearance (PPCl) and nutritional status in peritoneal dialysis (PD) population have not been clarified. This study aims to investigate the relationship between PPCl and nutritional status in PD population. Methods: Prevalent PD patients were enrolled in the cross-sectional survey in a single center from April to November 2013. The total amount of protein loss in the dialysate was calculated. PPCl reflects the individual differences of peritoneal protein loss, and is calculated by the formula, that PPCl (ml/day)=24-h dialysate protein loss / (albumin/0.4783). Nutritional status measured by lean body mass index (LBMI) was assessed by multi-frequency bioelectrical impedance analysis (BIA). Results: Totally 351 PD patients (55% male, 17.1% with diabetes, mean age 47.7±14.3 years) were included. The median PPC l was 58 ml/day. Patients were divided into four groups for comparison according to the PPC quartiles. Compared with lower PPCl quartiles, patients with higher PPCl had higher body mass index (BMI) (P< 0.001), body surface area (BSA) (P < 0 .001), LBMI (P<0.001), 4-hour D/P creatinine ratio (P< 0.001), and lower residual renal CCl (P<0.001). Compared with conventional body index (BMI and BSA) in ROC analysis, LBMI (area under curve: 0.71, 95% confidence interval [CI]: 0.66-0.77) had better performance in predicting higher PPCl. After adjustment in logistic regression models, each 1 kg/m2 increase of LBMI (odd ratio[OR] =1.37; 95% CI: 1.17-1.60), each 0.1 increase of 4-hour D/P creatinine ratio (OR =1.47; 95% CI: 1.11-1.93), and every 1 L/week/1.73m2 decrease of residual renal CCl (OR =0.98; 95% CI: 0.96-0.99) were independently associated with higher PPCl (> 58 ml/day). Conclusion: Higher LBMI was independently associated with higher , indicating that better nutritional status dominates peritoneal protein metabolism in PD patients

Association of diet and outdoor time with inflammatory bowel disease: a multicenter case-control study using propensity matching analysis in China

ObjectiveTo investigate the association between dietary and some other environmental factors and the risk of inflammatory bowel diseases (IBD) in Chinese population.Materials and methodsA multicenter case-control study was conducted involving 11 hospitals across China. A total of 1,230 subjects were enrolled consecutively, and diet and environmental factor questionnaires were collected. IBD patients were matched with healthy controls (HC) using propensity-score matching (PSM) at a 1:1 ratio with a caliper value of 0.02. Multivariate conditional logistic regression analyses were performed to evaluate the associations between diet, environmental factors, and IBD.ResultsModerate alcohol and milk consumption, as well as daily intake of fresh fruit, were protective factors for both Crohn's disease (CD) and ulcerative colitis (UC). Conversely, the consumption of eggs and chocolate increased the risk of IBD. Outdoor time for more than 25% of the day was a protective factor only for CD. In eastern regions of China, CD patients had higher egg consumption and less outdoor time, while UC patients consumed more chocolate. IBD patients from urban areas or with higher per capita monthly income consumed more fruit, eggs, and chocolate.ConclusionsThis study reveals an association between specific foods, outdoor time, and the emergence of IBD in the Chinese population. The findings emphasize the importance of a balanced diet, sufficient outdoor time and activities, and tailored prevention strategies considering regional variations

Triadin/Junctin Double Null Mouse Reveals a Differential Role for Triadin and Junctin in Anchoring CASQ to the jSR and Regulating Ca2+ Homeostasis

Triadin (Tdn) and Junctin (Jct) are structurally related transmembrane proteins thought to be key mediators of structural and functional interactions between calsequestrin (CASQ) and ryanodine receptor (RyRs) at the junctional sarcoplasmic reticulum (jSR). However, the specific contribution of each protein to the jSR architecture and to excitation-contraction (e-c) coupling has not been fully established. Here, using mouse models lacking either Tdn (Tdn-null), Jct (Jct-null) or both (Tdn/Jct-null), we identify Tdn as the main component of periodically located anchors connecting CASQ to the RyR-bearing jSR membrane. Both proteins proved to be important for the structural organization of jSR cisternae and retention of CASQ within them, but with different degrees of impact. Our results also suggest that the presence of CASQ is responsible for the wide lumen of the jSR cisternae. Using Ca2+ imaging and Ca2+ selective microelectrodes we found that changes in e-c coupling, SR Ca2+content and resting [Ca2+] in Jct, Tdn and Tdn/Jct-null muscles are directly correlated to the effect of each deletion on CASQ content and its organization within the jSR. These data suggest that in skeletal muscle the disruption of Tdn/CASQ link has a more profound effect on jSR architecture and myoplasmic Ca2+ regulation than Jct/CASQ association

Comparison of PBL and CBL with LBL

Traditional lecture-based teaching method is the most commonly used approach in the medical curriculum in China. Problem-based Learning (PBL) and case-based learning (CBL) have been widely researched and utilized in the world. This study aims to evaluate the effectiveness and acceptability of the combined PBL and CBL method in the second-year undergraduate students in their Nephrology experiment module of Medical Diagnostics course.</p

SURVIVAL AND RISK FACTORS ASSOCIATED WITH MORTALITY IN DIABETIC PATIENTS ON CONTINUOUS AMBULATORY PERITONEAL DIALYSIS IN SOUTHERN CHINA

This study aimed to analyze the survival and the risk factors associated with mortality in diabetic CAPD patients in Southern China. This single-center prospective cohort study enrolled all incident CAPD patients from Jan 2006 to Dec 2009 and followed-up until Dec 2011.Survival in diabetic and non-diabetic CAPD patients and the risk factors on mortality in the diabetic CAPD subjects were evaluated. Among 841 incident CAPD subjects in this study, 193 patients (22.9%) were diabetes. The mean vintage of CAPD was 29.4±15.5 months. Shorter patient survival time was found in diabetic patients compared to that of non-diabetic ones (p<0.01). The 1-, 3- and 5-year patient survival rates were 90%, 64% and 40% in diabetes and 95%, 88% and 75% in non-diabetes, respectively (p<0.01). There was no significant difference in the death-censored technique survival time between diabetic and non-diabetic patients. The 1-, 3- and 5-year technique survival rates were 96%, 88% and 86% in diabetic, while 99%, 93% and 87% in non-diabetic patients, respectively. Diabetic CAPD patients that died during the follow-up period had older age(63.4±10.5 vs.58.6±10.4 yrs, p<0.01), higher proportion of cardiovascular diseases (CVD)(64.9% vs. 47.1%, p<0.05), higher level of hsCRP [5.1(1.5∼11.7) vs. 1.8 (0.8∼7.2)] mg/L, p<0.01), but lower levels of haemoglobin (95.5±20.2 vs. 103.4±19.2g/L, p<0.01), serum albumin (33.7±4.0 vs.35.3±4.9g/L, p<0.05) and 24h urine output [600(300∼813) vs. 800(500∼1100]ml/d, p<0.01) compared to the survivors. The presence of CVD, advanced age, higher glycosylated haemoglobin, lower hemoglobin and serum albumin at the initiation of PD were independent predictors of death in diabetic patients.It was concluded that survival of diabetic CAPD patients is not as good as that of non-diabetic patients in Southern Chinese patients, but better than those reported by other previous studies. Better management of modifiable risk factors such as hyperglycaemia, anemia and hypoalbuminemia may improve outcomes of diabetic PD patients