Exploring haemodynamics of haemodialysis using extrema points analysis model

Background: Haemodialysis is a form of renal replacement therapy used to treat patients with end stage renal failure. It is becoming more appreciated that haemodialysis patients exhibit higher rates of multiple end organ damage compared to the general population. There is also a strong emerging evidence that haemodialysis itself causes circulatory stress. We aimed at examining haemodynamic patterns during haemodialysis using a new model and test that model against a normal control. Methods: We hypothesised that blood pressures generated by each heart beat constantly vary between local peaks and troughs (local extrema), the frequency and amplitude of which is regulated to maintain optimal organ perfusion. We also hypothesised that such model could reveal multiple haemodynamic aberrations during HD. Using a non-invasive cardiac output monitoring device (Finometer®) we compared various haemodynamic parameters using the above model between a haemodialysis patient during a dialysis session and an exercised normal control after comparison at rest. Results: Measurements yielded 29,751 data points for each haemodynamic parameter. Extrema points frequency of mean arterial blood pressure was higher in the HD subject compared to the normal control (0.761Hz IQR 0.5-0.818 vs 0.468Hz IQR 0.223-0.872, P < 0.0001). Similarly, extrema points frequency of systolic blood pressure was significantly higher in haemodialysis compared to normal. In contrary, the frequency of extrema points for TPR was higher in the normal control compared to HD (0.947 IQR 0.520-1.512 vs 0.845 IQR 0.730-1.569, P < 0.0001) with significantly higher amplitudes. Conclusion: Haemodialysis patients potentially exhibit an aberrant haemodynamic behaviour characterised by higher extrema frequencies of mean arterial blood pressure and lower extrema frequencies of total peripheral resistance. This, in theory, could lead to higher variation in organ perfusion and may be detrimental to vulnerable vascular beds

Association of claw disorders with claw horn colour in norwegian red cattle - a cross-sectional study of 2607 cows from 112 herds

<p>Abstract</p> <p>Claw disorders cause problems in dairy cattle all over the world. Nutrition, feeding, environment, claw trimming routines, hormonal changes related to calving and genetics are among the factors which influence the pathogenesis. The colour of the claw horn (pigmentation) has been suggested to play a role. The aim of this study was to investigate if there were any associations between the colour of the sole horn and claw disorders detected at claw trimming. Altogether, 2607 cows on 112 farms were claw trimmed once and the colour (dark, mixed or light) of the right lateral hind claw and hind claw disorders were recorded by 13 trained claw trimmers. The data were analysed using logistic regression models with logit link function, binomial distribution and herd and claw trimmer as repeated effects, with herd nested within claw trimmer. Haemorrhages of the sole (HS) and white line (HWL) were more frequently found in light than in dark claws (OR = 2.61 and 2.34, respectively). Both HS (OR = 1.43) and corkscrewed claws (OR = 1.84) were slightly more prevalent among cows which had claws with mixed colour versus dark claws. There were no significant associations of other claw disorders with claw horn colour.</p