Hypertension treatment preferences in long-term dialysed children in Poland - a survey of pediatric nephrologists

Wstęp Przewlekła choroba nerek prowadzi do rozwoju nadciśnienia tętniczego u większości chorych. Leczenie nadciśnienia towarzyszącego niewydolności nerek jest utrudnione przez ograniczenia w stosowaniu wielu preparatów i brak wystarczających doświadczeń klinicznych, a ponadto istniejące obecnie rekomendacje nie obejmują w ogóle chorych ze schyłkową niewydolnością nerek. Wybór terapii hipotensyjnej ogranicza też młody wiek chorych, gdyż wielu leków nie można stosować u dzieci. Celem badania była analiza jakości leczenia przeciwnadciśnieniowego u dzieci ze schyłkową niewydolnością nerek poddawanych przewlekłej dializoterapii. Materiał i metody Analizą objęto wszystkie dzieci dializowane w Polsce w dniu 30 listopada 2004 roku (n = 134). Uzyskano informacje dotyczące grup stosowanych leków oraz dawek preparatów, a także opinie lekarzy na temat doboru leków stosowanych przy nagłym wzroście ciśnienia tętniczego oraz tych, których dzieciom dializowanym nie powinno się podawać. Wyniki Nadciśnienie tętnicze stwierdzono u 74 (55%) dzieci (47 chłopców, 27 dziewczynek). Najczęstszą przyczyną niewydolności nerek w grupie dzieci z nadciśnieniem było kłębuszkowe zapalenie nerek (27/74). W badanej grupie 65% dzieci leczono za pomocą kilku leków hipotensyjnych, 32% za pomocą jednego leku, a 3% jedynie metodami niefarmakologicznymi. Mimo aktywnego leczenia, zaledwie u 58% dializowanych dzieci prowadziło ono do obniżenia wartości ciśnienia tętniczego poniżej 95 percentyla dla wzrostu i wieku. Najmniejszą skuteczność kontroli ciśnienia tętniczego obserwowano w przypadku leczenia skojarzonego, zwłaszcza wielolekowego. Najczęściej stosowanymi lekami byli antagoniści wapnia, które podawano u ogółem 73% dzieci, w tym u 43/48 w politerapii, a 11/24 w monoterapii. Inhibitory konwertazy angiotensyny były najczęściej stosowane w monoterapii (50%). Mimo znanych kontrowersji, przy nagłym wzroście ciśnienia tętniczego stosowano najczęściej nifedipinę. Wnioski Badanie wykazało, że w Polsce odsetek dializowanych dzieci wymagających leczenia nadciśnieniowego sięga 55%, w tym większość z nich wymaga podawania kilku leków. Pomimo że zasady leczenia są podobne we wszystkich ośrodkach, skuteczność leczenia pozostaje niezadowalająca (58%).Background Chronic kidney disease is associated with the development of arterial hypertension in a vast majority of patients. The treatment of hypertension in these subjects is difficult and challenging due to a limited clinical experience with most drugs and no widely recognised recommendations for patients with end-stage renal disease. A choice of antihypertensive drugs is further narrowed by the young age of the patients since almost all drugs are not recommended in children with renal failure. The aim of this nationwide retrospective analysis was to assess the hypertension treatment patterns in the population of children with chronic kidney diseases (CKD) undergoing hemodialysis or peritoneal dialysis in Poland. Material and methods Among all 134 children dialysed on 30th November 2004 in 13 pediatric dialysis centres in Poland seventy four (55%; 47M, 27F) children were hypertensive. For each patients the treating physicians filled a questionnaire that allowed to collect the following data: the primary kidney disease, chronic dialysis treatment, diagnostic criteria of hypertension and present antihypertensive medication if any. Additionally we asked of the doctors’ preference for a therapy for the acute rise in blood pressure and suggestions which drugs, in their opinion, should not be used in dialysed children. Results In the hypertensive dialysed patients the most frequent causes of chronic kidney disease were chronic glomerulopathies (27/74). Thirty two percent of children were on monotherapy whereas 65% required combined treatment. The therapy was adequate only in 58% of subjects. The lowest rate of efficacy was detected in patients requiring a combined antihypertensive therapy. Among antihypertensive drug classes calcium channel blockers were administered most frequently (in 73% of children, in 11/24 cases in monotherapy and in 43/48 patients in combination). Angiotensin converting enzyme inhibitors were most frequently administered in monotheraphy (50%). Nifedipine was preferred in acute blood pressure rise in children. Conclusion We conclude that incidence of hypertension in dialysed children in Poland is relatively high. The pattern of the treatment was quite uniform, although the efficacy was relatively low (58%)

Stress Analysis of Steel Beams Made of Sigma Cross-Section

This paper presents a stress analysis of elements made of a steel cold-formed sigma cross-section, uniformly loaded in a plane parallel to the web and not passing through the shear centre. Such an application of a load very often occurs in engineering practice and corresponds to the application of a load to the upper flange of the cross-section. It usually result in an additional torsional moment. In this paper, special attention is paid to normal stresses from the bi-moment, and shear stresses from restrained and free torsion. The contribution of these stresses to the section utilization was evaluated on the example of a sigma cross-section with different thicknesses of the wall. Furthermore, the paper also included the stresses analysis concerning different load locations at the upper flange. All numerical calculations were made using analytical approach based on Vlasov beam theory

Expression of RUNX2 and its signaling partners TCF7, FGFR1/2 in cleidocranial dysplasia

RUNX2 is a member of the PEBP2/CBF transcription factors family controlling the expression of genes whose products are essential for bone formation. Mutations in the RUNX2 gene may be associated with cleidocranial dysplasia (CCD), a rare skeletal disease characterized by stature aberrations, delayed closure of the cranial sutures, hypoplastic or aplastic clavicles, and multiple dental abnormalities. As RUNX2 is involved in many signaling pathways, we hypothesize that CCD may be associated with their changes. We determined the expression of RUNX2 and its signaling partners TCF7, involved in canonical Wnt signaling, and fibroblast growth factor receptors, FGFR1 and FGFR2 in periodontum of CCD patients and control individuals. We did not observe any differences between the level of RUNX2, TCF7 and FGFR1/2 mRNA, determined by real-time PCR, in CDD patients and controls. Therefore, RUNX2 signaling pathways with their partners TCF7 and FGFR1/2 may not be involved in CCD pathogenesis

Unveiling the Factors of Green Human Resources in Manufacturing Industries

The severe consequences of climate change have left many unanswered questions about the environmental performance of businesses. Appropriate measures must be taken to tackle the problems conquered due to climate change. This study supports exploring the factors needed to get the Employees Environmental Performance (EEP). It includes Green Human Resources (GHR), Green Creativity (GC) and Proactive Environmental Management (PEM). The relationship among the variables was explored in the existing literature. This study aims to test the relationship between GHR and GC. Further, it also examined the mediating role of GC and moderating role of PEM. For this purpose, data were collected from employees of manufacturing companies (automobiles, food processing, chemicals, textiles, machinery and equipment) in India. More specifically, ISO 14001-certified companies were selected. Among the different institutions, 35 are manufacturing in India. Out of 35, 24 companies agreed to conduct a survey in their company. Totally 5376 employees were considered as a population for the study. With 95% confidence interval, 400 samples were selected, and a questionnaire was distributed among them using simple random sampling. 305 (76.25%) cases finalized for further analysis. The collected data analyzed using PLS-SEM with R software. The results highlighted the essential role of GHR practices in the manufacturing industry to enhance EEP since GHR positively influences EEP. Moreover, it was found that GC partially mediates the relationship between GHR and EEP. It indicates the importance of GC’s existence in increasing EEP through GHR. Finally, it was also found that PEM moderates the relationship between GHR and EEP. It suggested the role of pro-environmental management and their active pace in improving EEP. Managerial implications and future scope were discussed in this study

Optimal designs under a multivariate linear model with additional nuisance parameters

Multivariate model, Estimable function, Kiefer optimality, Information matrix, Precision matrix, 62K05, 62K10,

Funnel metadynamics and behavioral studies reveal complex effect of D2AAK1 ligand on anxiety-like processes

Anxiety is a troublesome symptom for many patients, especially those suffering from schizophrenia. Its regulation involves serotonin receptors, targeted e.g. by antipsychotics or psychedelics such as LSD. 5-HT(2A) receptors are known for an extremely long LSD residence time, enabling minute doses to exert a long-lasting effect. In this work, we explore the changes in anxiety-like processes induced by the previously reported antipsychotic, D2AAK1. In vivo studies revealed that the effect of D2AAK1 on the anxiety is mediated through serotonin 5-HT(1A) and 5-HT(2A) receptors, and that it is time-dependent (anxiogenic after 30 min, anxiolytic after 60 min) and dose-dependent. The funnel metadynamics simulations suggest complicated ligand-5HT(2A)R interactions, involving an allosteric site located under the third extracellular loop, which is a possible explanation of the time-dependency. The binding of D2AAK1 at the allosteric site results in a broader opening of the extracellular receptor entry, possibly altering the binding kinetics of orthosteric ligands