Risk factors for peritoneal dialysis catheter failure in children

Background Peritoneal dialysis catheter (PDC) failure still remains a common clinical problem in pediatric patients despite advancements in catheter placement and dialysis techniques. Our aim was to determine the risk factors that may lead to PDC failure, especially those factors that could be potentially modified to minimize PDC failures.Patients and methods This study was designed as a retrospective chart review of 31 patients less than 12 years of age who had end-stage renal disease (ESRD) on whom a total of 54 operative PDC placements were carried out at the tertiary Children’s Hospital, King Fahad Medical City, Riyadh, Saudi Arabia, from January 2007 to December 2010. The data included patient demographics and perioperative and operative variables.Results Fifty-four PDCs were inserted in 31 pediatric patients with ESRD, of whom 17 (55%) were boys and 14 (45%) were girls. Young age showed a statistically significant effect on PDC failure [1.8 (± 5) vs. 5 (± 7.8), P = 0.007], whereas weight did not (P = 0.085). Five types of PDCs were used, which showed significant association with PDC failure (P =0.009). Supraumbilical paramedian abdominal entry incisions were used in 49 (90.7%) patients without peritoneal leakage in any case. Nonsimultaneous omentectomy and upward PDC exit site orientation showed significant association with PDC failure (Pr0.001). The causes of PDC failure included idiopathic peritonitis in 13 (56.5%), PDC occlusion by omentum in five (21.7%), PDC malposition in four (17.4%) patients, and PDC leakage in one (4.4%) patient. Peritonitis showed a high statistical significance in PDC failure with P value of less than 0.001. The serum albumin level at the time of PDC insertion was not statistically significant in terms of PDC failure (P = 0.40) but had a high association with idiopathic peritonitis.Conclusion Our study provides some recommendations to minimize PDC failures that include improvement of patients’ nutritional status, use of a swan-neck double-cuffed catheter, paramedian abdominal entry incision, simultaneous omentectomy, downward orientation of exit site, and use of an up-to-date technique by a dedicated team for proper use of PDC. However, prospective studies possibly on a multicentric basis are necessary to standardize the best PDC insertion and maintenance techniques to minimize PDC failures and improve the quality of life for children with ESRD. Keywords: end-stage renal disease, pediatric patients, peritoneal dialysis, tenckhoff cathete

Porto-systemic shunt using adrenal vein as a conduit; an alternative procedure for spleno – renal shunt

PubMed ID: 17555599Background. Currently, portal hypertension is still big problem for the patients with serious liver diseases. Variceal bleeding is one of the most important complications of portal hypertension. In case of failure of endoscopic and combined medical treatments, surgical decompressive shunts are required. We emphasized an alternative splenorenal shunt procedure using adrenal vein as a conduit. Case presentation. A 26-year-old male suffered from recurrent variceal bleeding was considered for surgical therapy. Although we planned to perform a distal splenorenal shunt procedure, it was observed to be difficult. Therefore left adrenal vein was used as a conduit between left renal vein and splenic vein after splenic artery was ligated. He did well and was discharged from the hospital on the postoperative day 6. In the follow up period for nine months, endoscopic and ultrasonographic examinations were normal. Conclusion. We concluded that, in case of failure to perform distal splenorenal shunt due to technical problems, alternative porto-systemic shunt procedure using the adrenal vein as a vascular conduit can be safely employed. © 2007 Aydin et al; licensee BioMed Central Ltd

Performance analysis of a solar pond

In this contribution, we develop a theoretical solar pond in different geometries for the Adiyaman region in Turkey and analyze its performance assessment through energy efficiency. Some key parameters such as surface area, depth, densities of the layers, the thicknesses of the inner zones and the insulations of the walls to assess the solar pond are considered. In the parametric studies, the dimensions of the zones (e.g., upper convective zone, non-convective zone, and lowconvective zone) are varied to investigate their effects. Although the density and temperature gradient of the inner zones are considered similar to each other, the energy efficiencies of the storage zones become different due to varying dimensions of the pond. The shading area decreases by increasing the surface area of the inner zones. The amount of incoming solar energy to the upper surface is increased with the size of the solar pond. The energy efficiency of the solar pond is determined to be maximum (31.76 %) for case4a, and to be minimum (16.80 %) for case1b in August. As a result, through careful determination of the dimensions and insulation parameters, incoming solar radiation reaching the storage zone increases the energy efficiency of the solar pond. © Springer International Publishing Switzerland 2014

Synergistic Effect of Sophora japonica and Glycyrrhiza glabra Flavonoid-Rich Fractions on Wound Healing: In Vivo and Molecular Docking Studies.

Peer reviewed: TrueGlycyrrhiza glabra and Sophora japonica (Fabaceae) are well-known medicinal plants with valuable secondary metabolites and pharmacological properties. The flavonoid-rich fractions of G. glabra roots and S. japonica leaves were prepared using Diaion column chromatography, and the confirmation of flavonoid richness was confirmed using UPLC-ESI-MS profiling and total phenolics and flavonoids assays. UPLC-ESI-MS profiling of the flavonoid-rich fraction of G. glabra roots and S. japonica leaves resulted in the tentative identification of 32 and 23 compounds, respectively. Additionally, the wound healing potential of topical preparations of each fraction, individually and in combination (1:1) ointment and gel preparations, were investigated in vivo, supported by histopathological examinations and biomarker evaluations, as well as molecular docking studies for the major constituents. The topical application of G. glabra ointment and gel, S. japonica ointment and gel and combination preparations significantly increase the wound healing rate and the reduction of oxidative stress in the wound area via MDA reduction and the elevation of reduced GSH and SOD levels as compared to the wound and Nolaver®-treated groups. The molecular docking study revealed that that major compounds in G. glabra and S. japonica can efficiently bind to the active sites of three proteins related to wound healing: glycogen synthase kinase 3-β (GSK3-β), matrix metalloproteinases-8 (MMP-8) and nitric oxide synthase (iNOS). Consequently, G. glabra roots and S. japonica leaves may be a rich source of bioactive metabolites with antioxidant, anti-inflammatory and wound healing properties