Pretransplant dialysis modality and long-term patient and kidney allograft outcome: a 15-year retrospective single-centre cohort study.

Among factors determining long-term kidney allograft outcome, pretransplant renal replacement therapy (RRT) is the most easily modifiable. Previous studies analysing RRT modality impact on patient and graft survival are conflicting. Studies on allograft function are scarce, lack sufficient size and follow-up. We retrospectively studied patient and allograft survival together with allograft function and its decline in 2277 allograft recipients during 2000-2014. Pretransplant RRT modality ≥60 days as grouped into "no RRT" (n = 136), "haemodialysis (HD)" (n = 1847), "peritoneal dialysis (PD)" (n = 159), and "HD + PD" (n = 135) was evaluated. Kaplan-Meier analysis demonstrated superior 5-/10-/15-year patient (93.0/81.8/73.1% vs. 86.2/71.6/49.8%), death-censored graft (90.8/85.4/71.5% vs. 84.4/75.2/63.2%), and 1-year rejection-free graft survival (73.8% vs. 63.8%) in PD versus HD patients. Adjusted Cox regression revealed 34.5% [1.5-56.5%] lower hazards of death, whereas death-censored graft loss was similar [HR = 0.707 (0.469-1.064)], and rejection was less frequent [HR = 0.700 (0.508-0.965)]. Allografts showed higher 1-/3-/5-year estimated glomerular filtration rate (eGFR) in "PD" versus "HD" groups. Living donation benefit for allograft function was most pronounced in groups "no RRT" and "PD". Functional allograft decline (eGFR slope) was lowest for "PD". Allograft recipients on pretransplant PD versus HD demonstrated superior all-cause patient and rejection-free graft survival along with better allograft function (eGFR).

Friction characteristics of polymeric nanofiber arrays against substrates with tailored geometry.

We present a study on macroscale friction of polyethylene nanofibrillar arrays against patterned rough surfaces with various asperity heights, spacings, and area fractions. These surfaces are prepared by utilizing colloidal lithography and silica evaporation, which allows the independent control of geometric parameters. While the nanofiber arrays exhibit high friction on a smooth surface, much lower friction is observed when the asperity height becomes larger than can be compensated by fiber compliance, or when the asperity spacing becomes small enough to prevent fiber penetration for contact. The observed behavior is discussed with simple mechanical models and summarized to provide some criteria to maintain high friction against rough surfaces.

Soluble neprilysin, NT-proBNP, and growth differentiation factor-15 as biomarkers for heart failure in dialysis patients (SONGBIRD).

BACKGROUND: Dialysis patients are at increased risk of HF. However, diagnostic utility of NT-proBNP as a biomarker is decreased in patients on dialysis. GDF-15 and cNEP are biomarkers of distinct mechanisms that may contribute to HF pathophysiology in such cohorts. The aim of this study was to determine whether growth differentiation factor-15 (GDF-15) and circulating neprilysin (cNEP) improve the diagnosis of congestive heart failure (HF) in patients on dialysis. METHODS AND RESULTS: We compared circulating concentrations of NT-proBNP, GDF-15, and cNEP along with cNEP activity in patients on chronic dialysis without (n = 80) and with HF (n = 73), as diagnosed by clinical parameters and post-dialysis echocardiography. We used correlation, linear and logistic regression as well as receiver operating characteristic (ROC) analyses. Compared to controls, patients with HF had higher median values of NT-proBNP (16,216 [interquartile range, IQR = 27739] vs. 2883 [5866] pg/mL, p < 0.001), GDF-15 (7512 [7084] vs. 6005 [4892] pg/mL, p = 0.014), but not cNEP (315 [107] vs. 318 [124] pg/mL, p = 0.818). Median cNEP activity was significantly lower in HF vs. controls (0.189 [0.223] vs. 0.257 [0.166] nmol/mL/min, p < 0.001). In ROC analyses, a multi-marker model combining clinical covariates, NT-proBNP, GDF-15, and cNEP activity demonstrated best discrimination of HF from controls (AUC = 0.902, 95% CI 0.857-0.947, p < 0.001 vs. base model AUC = 0.785). CONCLUSION: We present novel comparative data on physiologically distinct circulating biomarkers for HF in patients on dialysis. cNEP activity but not concentration and GDF-15 provided incremental diagnostic information over clinical covariates and NT-proBNP and may aid in diagnosing HF in dialysis patients.

Fibrillar Collagen Quantification With Curvelet Transform Based Computational Methods.

Quantification of fibrillar collagen organization has given new insight into the possible role of collagen topology in many diseases and has also identified candidate image-based bio-markers in breast cancer and pancreatic cancer. We have been developing collagen quantification tools based on the curvelet transform (CT) algorithm and have demonstrated this to be a powerful multiscale image representation method due to its unique features in collagen image denoising and fiber edge enhancement. In this paper, we present our CT-based collagen quantification software platform with a focus on new features and also giving a detailed description of curvelet-based fiber representation. These new features include C++-based code optimization for fast individual fiber tracking, Java-based synthetic fiber generator module for method validation, automatic tumor boundary generation for fiber relative quantification, parallel computing for large-scale batch mode processing, region-of-interest analysis for user-specified quantification, and pre- and post-processing modules for individual fiber visualization. We present a validation of the tracking of individual fibers and fiber orientations by using synthesized fibers generated by the synthetic fiber generator. In addition, we provide a comparison of the fiber orientation calculation on pancreatic tissue images between our tool and three other quantitative approaches. Lastly, we demonstrate the use of our software tool for the automatic tumor boundary creation and the relative alignment quantification of collagen fibers in human breast cancer pathology images, as well as the alignment quantification of in vivo mouse xenograft breast cancer images.

Are ISPD Guidelines on Peritonitis Diagnosis Too Narrow? A 15-Year Retrospective Single-Center Cohort Study on PD-Associated Peritonitis Accounting for Untrained Patients.

Background:Peritoneal dialysis (PD)-associated peritonitis remains by far the most important complication requiring patients to transfer to hemodialysis and has a major impact on patient morbidity and mortality. Current International Society for Peritoneal Dialysis (ISPD) guidelines on peritonitis recommend analysis of peritonitis episodes only in trained patients. In a large tertiary care center, we analyzed peritonitis episodes accounting for different groups of untrained patients and compared these with episodes in the trained patient population.Methods:We analyzed data collected prospectively over a 15-year time span regarding differences between peritonitis episodes in trained patients and episodes in untrained patients post-catheter insertion but prior to training completion as well as on in-center intermittent PD with respect to incidence rates, pathogenic organisms, outcome, and peritonitis predictors.Results:In 275 patients, a total of 160 peritonitis episodes in trained patients were counted. A total of 27 additional episodes in untrained patients were recorded. When accounting for these episodes, the peritonitis incidence significantly increased and the percentage of peritonitis-free patients decreased. Peritonitis episodes in untrained patients were most often culture-negative and the pathogen spectrum differed significantly compared with episodes counted as per ISPD recommendations, while outcome of peritonitis episodes did not differ. Predictors of peritonitis after multivariate logistic regression analysis included glomerulonephritis as primary kidney disease, being on home PD rather than being on in-center intermittent PD, and higher dialysis vintage.Conclusions:Depending on local practice patterns, we argue that centers should additionally monitor peritonitis episodes in untrained patients because computation of statistics as per ISPD recommendations could underestimate peritonitis incidence and may depict a distorted pathogen spectrum.

Clínica Integrada Odontológica: perfil e expectativas dos usuários e alunos / Dental Integrated Clinic: profile and expectance of users and students

O objetivo desta pesquisa é revelar diferentes dimensões da relação acadêmico-paciente na Clínica Integrada, descrevendo: perfil sócio-econômico-cultural dos acadêmicos e dos usuários; noções de responsabilidade e ética dos acadêmicos; satisfação dos usuários com o atendimento e as expectativas dos sujeitos. A abordagem foi qualitativa, com técnica de entrevista não-diretiva entre usuários (n=57) e alunos matriculados na clínica integrada da 8ª e 9ª fases(n=39). Para a análise dos dados quantitativos, referentes ao perfil dos acadêmicos e usuários, utilizou-se a comparação entre as freqüências relativas encontradas nos dois grupos. A análise qualitativa foi desenvolvida a partir da criação de categorias (resolutividade técnica; humanização do atendimento; satisfação) baseadas nos relatos. Resultados: 1)Perfil dos acadêmicos: 87 porcento de 21 e 25 anos; 61,5 porcento mulheres;77 porcento renda superior a 11 SM; 54 porcento cursaram outro idioma;escolaridade dos pais 51 porcento superior; profissão dos pais 59 porcento profissional liberal/empresário. Perfil dos usuários: 49 porcento entre31 e 50 anos; 65 porcento mulheres; 80 porcento renda até 4 SM; 3,5 porcento nível superior; 17,5 porcento cursaram outro idioma; 42 porcento profissão doméstica remunerada ou não; 2) Expectativa dos acadêmicos: aprendizado técnico, humanização da relação paciente/profissional, resolução do problema e satisfação do paciente; 3) Expectativa do usuário: conclusão e resolutividade do problema; ser bem atendido; 4) noções de responsabilidade ética como regras e normas profissionais; 5) satisfação dos usuários: 98 porcento. Há uma diferença sócio-econômico-cultural significativa entre os acadêmicos e os usuários. Natureza da relação prioritariamente técnica, porém incorporando valores éticos e humanísticos. Forte reconhecimento da atuação dos acadêmicos, com elevada satisfação manifestada pelos usuários

Exostose sub-ungueal: estudo de oito casos / Subungheal exostosis: study of 8 cases

Os autores descrevem oito casos de exostose sub-ungueal dos quais sete localizados no hálux e um no terceiro artelho. Em sete pacientes a lesäo apresentava-se ulcerada. Em todos, a lesäo foi diagnosticada tardiamente. A cura foi obtida com a ressecçäo do tumor, preservando-se a matriz ungueal. Após revisäo da literatura, säo analisados os aspectos clínicos e etiopatogênicos