Relationship between gut microbiota and vascular calcification in hemodialysis patients.

INTRODUCTION: Vascular calcification (VC) is an independent risk factor for cardiovascular mortality in end-stage renal disease (ESRD) patients. The pathogenesis of VC is complicated and unclear. Uremic toxins produced by gut microbiota can promote VC. This study aims to identify the differences in gut microbiota between the different VC groups and the main bacteria associated with VC in hemodialysis (HD) patients in an attempt to open up new preventive and therapeutic approaches and define the probable mechanism for VC in HD patients in the future. METHODS: A total of 73 maintenance HD patients were enrolled in this cross-sectional study. According to the abdominal aortic calcification (AAC) scores, the participants were divided into the high AAC score group and the low AAC score group. High-throughput sequencing of the gut microbiota was performed and the results were evaluated by alpha diversity, beta diversity, species correlation, and model predictive analyses. RESULTS: The prevalence of VC was 54.79% (40/73) in the study. The majority of phyla in the two groups were the same, including Firmicutes, Actinobacteriota, Proteobacteria, and Bacteroidota. The microbial diversity in the high AAC score group had a decreasing trend (p = 0.050), and the species abundance was significantly lower (p = 0.044) than that in the low AAC score group. The HD patients with high AAC scores showed an increased abundance of Proteobacteria and decreased abundances of Bacteroidota and Synergistota at the phylum level; increased abundances of Escherichia-Shigella, Ruminococcus_gnavus_group, and Lactobacillus; and decreased abundances of Ruminococcus and Lachnospiraceae_NK4A136_group at the genus level (p<0.05). Escherichia-Shigella and Ruminococcus_gnavus_group were positively correlated with VC, and Ruminococcus, Adlercreutzia, Alistipes, and norank_f__Ruminococcaceae were negatively correlated with VC. Escherichia-Shigella had the greatest influence on VC in HD patients, followed by Ruminococcus and Butyricimonas. CONCLUSIONS: Our results provide clinical evidence that there was a difference in gut microbiota between the different VC groups in HD patients. Escherichia-Shigella, a lipopolysaccharide (LPS)-producing bacterium, was positively correlated with VC and had the greatest influence on VC. Ruminococcus, a short-chain fatty acid (SCFA)-producing bacterium, was negatively correlated with VC and had the second strongest influence on VC in HD patients. The underlying mechanism is worth studying. These findings hint at a new therapeutic target.

Peritoneal dialysis can maintain nitrogen balance with low Kt/V in anuric patients.

BACKGROUND: A big concern for continuous ambulatory peritoneal dialysis (CAPD) is dialysis adequacy in anuric patients. Some studies have even suggested that CAPD patients should be transferred to hemodialysis when they become anuric in order to achieve adequate dialysis. In the present study, we tried to find out whether anuric patients can maintain nitrogen balance with standard or even lower dialysis dose. MATERIALS AND METHODS: This was a cross-sectional single-center study. Fifteen anuric CAPD patients were selected. Their 3-day dietary records were reviewed by a dedicated dietitian to calculate their energy, protein, and nitrogen intake (NI). Nitrogen removal (NR) from urine and dialysate was measured by Kjeldahl technique. Fluid status was evaluated by bioimpedance analysis. Subjective global nutritional assessment was used to evaluate nutritional status. RESULTS: Among the 15 patients, 9 males and 6 females, mean age was 63.80 (31 - 77) years, dialysis duration 39.76 (6 - 127) months, body weight 58.70 ± 9.86 kg, and height 160.20 ± 7.93 cm. The mean dietary protein intake was 43.28 ± 7.57 g/day (0.80 ± 0.15 g/kg/d), total Kt/V was 1.59 ± 0.32 with dialysis dose of 7,904.00 ± 1,481.79 mL. However, they achieved neutral nitrogen balance (NI 6.92 ± 1.21 g/d vs. NR 6.83 ± 1.36 g/d, N balance 0.09 ± 1.00 g/d). All of them maintained good nutritional status (SGA "A", serum albumin 39.67 ± 3.58 g/L), and no symptom of nitrogen retention (serum urea 20.49 ± 3.06 mmol/L). Meanwhile, they achieved good volume control with a slightly low total fluid removal (704.00 ± 293.21 mL/d). CONCLUSION: Our study suggested that anuric patients (even with low Kt/V) can achieve nitrogen balance and stay well-nourished with appropriate dietary protein intake.

Use of low-protein staple foods in the dietary management of patients with stage 3-4 chronic kidney disease: a prospective case-crossover study.

OBJECTIVE: Maintaining a low-protein diet (LPD) is important for patients with chronic kidney disease (CKD) to delay renal degradation and alleviate clinical symptoms. For most patients with CKD, it is difficult to maintain the necessary low level of dietary protein intake (DPI). To improve the current dietary management of CKD, we conducted an intervention study by administering low-protein staple foods (LPSF). DESIGN AND METHODS: We conducted a prospective case-crossover study among 25 patients with stage 3-4 CKD. During the initial 12 weeks of the study, we instructed the patients regarding a standard LPD according to the recommendations of a renal dietitian. In the second stage of the study, we requested the patients taking low-protein rice or low-protein flour (250 g/d) as an LPSF diet instead of regular staple food daily, and followed these patients up for 12 weeks. We compared the DPI, dietary energy intake (DEI), normalized protein equivalent of total nitrogen appearance (nPNA), serum creatinine levels, and nutritional index between baseline and the end of the study. RESULTS: We found no change in dietary variables among the patients during the first 12 weeks of the LPD. After subjecting them to an LPSF diet, the corresponding variables showed a pronounced change. The patients' DPI decreased from 0.88 ± 0.20 to 0.68 ± 0.14 g/kg/d (P < 0.01) and the nPNA value decreased from 0.99 ± 0.18 to 0.87 ± 0.19 g/kg/d (P < 0.01). The high biological value protein intake proportion increased from 42% (baseline) to 57% (P < 0.01) during the 24 weeks. No variation was found in the measured DEI (28.0 ± 5.8 vs 28.6 ± 5.4 kcal/kg/d), nutrition assessment, or renal function and serum creatinine levels. CONCLUSION: Our prospective case-crossover study demonstrated that an LPSF diet can help patients with stage 3-4 CKD reduce DPI and nPNA values, improve the proportion of highly bioavailable proteins, ensure adequate calorie intake, and avoid malnutrition. An LPSF diet is an effective and simple therapy for patients with stage 3-4 CKD.

The estimation of protein equivalents of total nitrogen in Chinese CAPD patients: an explanatory study.

OBJECTIVE: The protein equivalent of total nitrogen appearance (PNA) formula, based on the urea nitrogen appearance (UNA), is popularly used by stable continuous ambulatory peritoneal dialysis (CAPD) patients to estimate dietary daily protein intake (DPI). However, we found that the estimated DPI was higher than that directly evaluated from the dietary records of most of our CAPD patients. Therefore, in the present study, we tried to determine possible bias in PNA estimation by UNA with a nitrogen balance study of our CAPD patients. METHODS: Thirty-one CAPD patients with stable clinical conditions were included. Their 3-day dietary records were reviewed by a dedicated dietitian to calculate their energy, protein, and nitrogen intake (NI). The nitrogen removal (NR) from urine and dialysate was measured by the Kjeldahl technique. Then, we calculated the proportion of urea nitrogen appearance (UNA) in total nitrogen appearance (TNA) and analyzed the possible factors that could affect this proportion. RESULTS: Among these patients, 17 males and 14 females, the mean age was 64.19 ± 12.42, and the dialysate drainage volume was 6700 (2540) ml/day. The percentage of UNA in TNA was 63.22 ± 6.66%. Compared with the other classic nitrogen balance studies in the CAPD population, the protein nitrogen and other nonurea nitrogen losses in this study were all lower. Based on these 31 nitrogen balance studies, we proposed a pair of new equations to estimate PNA by UNA. (1) PNA = 9.3 + 7.73 UNA; (2) PNA = PNPNA + TPL = 6.7 + 7.28 UNA + TPL. CONCLUSION: Our study suggested that the PNA formula generated from previous European studies overestimated DPI in our CAPD patients.

Correction to: Urine Sediment Recognition Method Based on Multi-View Deep Residual Learning in Microscopic Image.

In the original version of this article, the authors' units in the affiliation section are, unfortunately, incorrect. Jining No.1 people's hospital and Affiliated Hospital of Jining Medical University are two independent units and should not have been combined into one affiliation.

Urine Sediment Recognition Method Based on Multi-View Deep Residual Learning in Microscopic Image.

Urine sediment recognition is attracting growing interest in the field of computer vision. A multi-view urine cell recognition method based on multi-view deep residual learning is proposed to solve some existing problems, such as multi-view cell gray change and cell information loss in the natural state. Firstly, the convolutional network is designed to extract the urine sediment features from different perspectives based on the residual network, and the depth-wise separable convolution is introduced to reduce the network parameters. Secondly, Squeeze-and-Excitation block is embedded to learn feature weights, using feature re-calibration to improve network representation, and the robustness of the network is enhanced by adding spatial pyramid pooling. Finally, for further optimizing the recognition results, the Adam with weight decay optimization method is used to accelerate the convergence of the network model. Experiments on self-built urine microscopic image data-set show that our proposed method has state-of-the-art classification accuracy and reduces network computing time.

Low-dose dialysis combined with low protein intake can maintain nitrogen balance in peritoneal dialysis patients in poor economies
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OBJECTIVE: Due to limited economic conditions, we tried to provide "fitted" dialysis doses instead of the doses recommended by the international guidelines to the individual patients. In the present cross-sectional study, we studied the dialysis adequacy and nutritional status of 5 peritoneal dialysis patients who had a low dialysis dose (2 bags, 4,000 mL/day). METHODS: The 3-day dietary records were reviewed to calculate patients' energy, protein, and nitrogen intake (NI). The nitrogen removal (NR) from urine and dialysate was measured by Kjeldahl technique. Fecal nitrogen was estimated as 0.0155 g/kg/day. Subjective global nutritional assessment was used to evaluate the nutritional status. RESULTS: Among the 5 patients, 1 male and 4 female, mean age was 59 (42 - 81) years, dialysis duration 43 (33 - 74) months, body weight 51.05 ± 2.53 kg. The mean dietary protein intake was 0.66 g/kg/day, total weekly Kt/v was 1.25 (residual kidney Kt/v was 0.09), and total daily fluid removal was 699 mL. However, they achieved lower-level neutral nitrogen balance (NI 5.26 ± 0.93 g/day vs. NR 5.33 ± 0.81 g/day, N balance -0.07 ± 0.60 g/day). All of them maintained good nutritional status (SGA "A") without symptoms of nitrogen retention (serum urea 22 ± 4.18 mmol/L). CONCLUSIONS: Lower dialysis dose with lower daily protein intake can achieve a lower-level nitrogen balance and does not lead to malnutrition. It may be an effective approach to solve the dialysis problem for the economically week population in China, especially for people with a smaller body size with lower transport membrane.
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Phospholipids profiling and outcome of peritoneal dialysis patients.

OBJECTIVES: To investigate phospholipids (PLs) biomarkers in predicting outcome of patients undergoing peritoneal dialysis (PD). MATERIALS AND METHODS: Twenty PD patients were followed using baseline plasma PLs with an improved online two-dimensional liquid chromatography-quadrupole time-of-flight mass spectrometry system. RESULTS: Significant differences were observed in eight PL species with sphingomyelin (SM) and glycerophosphocholine between technical survival (n=15) and failure patients (n = 5). Cox regression showed SM 21:0 (adjusted HR 13.7, 95% CI 2.42-77.88, p = 0.003) was independently associated with patients technical failure. CONCLUSIONS: PD failure patients had different plasma PLs profiling as compared with survival patients. Elevated plasma SM 21:0 level may potentially serve as a biomarker of PD patients at risk for adverse outcomes.

Potassium metabolism in continuous ambulatory peritoneal dialysis patients.

BACKGROUND: Hypokalemia is common and may have contributed to the poor clinical outcome in peritoneal dialysis (PD) patients. In this study, we made a detailed investigation on the potassium metabolism in continuous ambulatory peritoneal dialysis (CAPD) patients and tried to find out the possible factors associated with the high prevalence of hypokalemia in PD patients. METHODS: A cross-sectional survey in 243 clinically stable CAPD patients was made in our PD center in 2010. Patients were divided into four groups according to whether they were anuric or not and different dialysis regimens. Patients' demographic data and data on potassium metabolism including dietary potassium intakes, residual renal potassium, and peritoneal dialysis potassium removal were collected. RESULTS: The average potassium intake in our 243 PD patients was 32.1 ± 11.1 mmol/day. The total potassium removal was significantly higher in non-anuric patients as compared to anuric patients (33.2 ± 9.1 vs. 23.0 ± 4.7 mmol/day for 3 exchanges per day and 35.2 ± 8.9 vs. 28.6 ± 6.3 mmol/day for 4 exchanges per day, respectively, p < 0.01) and in anuric patients dialyzed with 4 exchanges per day as compared to anuric patients dialyzed with 3 exchanges per day (28.6 ± 6.3 vs. 23.0 ± 4.7 mmol/L, p < 0.05). Compared to non-anuric patients dialyzed with 3 exchanges per day, serum potassium level was significantly lower (4.1 ± 0.7 vs. 4.5 ± 0.7 mmol/L, p < 0.05) while the prevalence of hypokalemia was significantly higher (22.2% vs. 9.3%, p < 0.05) in non-anuric patients that dialyzed with 4 exchanges per day. There was a strong correlation between renal potassium removal and renal urea Kt/V (R(2) linear = 0.645, p < 0.05). In a linear multiregression analysis, dietary potassium intake, intracellular water (ICW) significantly positively predicted serum potassium level while dialysis exchanges, residual renal function (RRF), D/P potassium all significantly negatively predicted serum potassium levels. CONCLUSIONS: Our study suggested that if potassium intake was limited in PD patients, we should be aware of the risk of hypokalemia with high doses of PD when patients have good RRF. Our study also suggested that potassium removal in PD patients may not necessarily reflect potassium intake even if serum potassium is normal, the effect of ICW should be considered when evaluating potassium homeostasis.

Comprehensive analysis of the immune implication of EPHX4 gene in laryngeal squamous cell carcinoma.

OBJECTIVES: The role of Epoxide Hydrolase-4 (EPHX4), a member of epoxide hydrolase family, has not been investigated in cancer. The purpose of this article is to explore the application value of EPHX4 in laryngeal cancer and its relationship with immune infiltration. METHODS: We observed that EPHX4 expression and its survival assays in laryngeal cancer specimens based on The Cancer Genome Atlas (TCGA) cohorts. We also analyzed the correlation between immune cell infiltration levels and EPHX4 gene copy number in laryngeal cancer. Finally, we conducted in vitro assay to evaluate the functions of EPHX4 in laryngeal cancer cell line. RESULTS: EPHX4 is highly expressed in laryngeal cancer specimens and has a poor prognosis. EPHX4 related immune cell analysis showed that it participated in NK Natural killer cell mediated cytotoxicity. Finally, Cell experiments indicate that EPHX4 could promote laryngeal cancer cell line proliferation, colony formation and invasion. CONCLUSIONS: Our research results suggest that EPHX4 may be a potential immunotherapy target for laryngeal cancer. The nominated immune signature is a helpful and promising prognostic indicator in laryngeal cancer. LEVELS OF EVIDENCE: Level 3.

Characterizing the role of iodine doping in improving photovoltaic performance of dye-sensitized hierarchically structured ZnO solar cells.

We report two novel types of hierarchically structured iodine-doped ZnO (I-ZnO)-based dye-sensitized solar cells (DSCs) using indoline D205 and the ruthenium complex N719 as sensitizers. It was found that iodine doping boosts the efficiencies of D205 I-ZnO and N719 I-ZnO DSCs with an enhancement of 20.3 and 17.9 %, respectively, compared to the undoped versions. Transient absorption spectra demonstrated that iodine doping impels an increase in the decay time of I-ZnO, favoring enhanced exciton life. Mott-Schottky analysis results indicated a negative shift of the flat-band potential (V(fb)) of ZnO, caused by iodine doping, and this shift correlated with the enhancement of the open circuit voltage (V(oc)). To reveal the effect of iodine doping on the effective separation of e(-)-h(+) pairs which is responsible for cell efficiency, direct visualization of light-induced changes in the surface potential between I-ZnO particles and dye molecules were traced by Kelvin probe force microscopy. We found that potential changes of iodine-doped ZnO films by irradiation were above one hundred millivolts and thus significantly greater. In order to correlate enhanced cell performance with iodine doping, electrochemical impedance spectroscopy, incident-photon-current efficiency, and cyclic voltammetry investigations on I-ZnO cells were carried out. The results revealed several favorable features of I-ZnO cells, that is, longer electron lifetime, lower charge-transfer resistance, stronger peak current, and extended visible light harvest, all of which serve to promote cell performance.

Study on the formation pathways of characteristic volatiles in preserved egg yolk caused by lipid species during pickling.

The formation of volatiles in high-fat foods is strongly influenced by the composition and structure of lipids. The relationship between key variable lipid species and characteristic volatiles were performed by lipidomics and flavoromics to resolve the pathways of volatiles in preserved egg yolk (PEY) during pickling. The results showed that the formation of nonanal and benzaldehyde at early stage possibly derived from oleic acid sited at Sn-1 in TG(18:1_18:2_20:4), Sn-2 in PE(22:6_18:1), and linoleic acid bonded at Sn-2 in TG(18:1_18:2_20:4), respectively. 1-octen-3-ol may be formed from linoleic acid located at Sn-2 in TG(18:1_18:2_20:4) and arachidonic acid sited at Sn-3 in TG(18:1_18:2_20:4). Indole was formed through TGs(16:0_16:1_20:1;16:1_18:1_22:1;23:0_18:1_18:1) at the later stage, and acetophenone through TGs(14:0_20:0_20:4;14:0_15:0_18:1; 16:0_16:0_22:6), PCs(24:0_18:1;O-18:1_18:2), PEs(P-18:1_20:4;P-18:1_22:6) and SPH(d18:0) during whole process of pickling. Our study provides a deep and precise insight for the formation pathways of characteristic volatiles in PEY through lipids degradation during pickling at the molecular level.

Gastrointestinal symptoms predict peritonitis rates in CAPD patients.

OBJECTIVE: Peritonitis is still one of the major causes of peritoneal dialysis (PD) patients' dropout. In the present study, we analyzed the relationship between gastrointestinal (GI) problems and peritonitis in our CAPD patients. METHODS: It is a prospective observational study. In December, 2008, 158 patients on continuous ambulatory peritoneal dialysis (CAPD) for more than 3 months from our PD unit were included in this study. A questionnaire was used to evaluate their GI symptoms score (GISS). All patients were followed up for 24 months or until they dropped out from our PD program. All peritonitis events were recorded. RESULTS: The patients' PD duration was 22 (4 - 132) months before the study. During the 24 months follow-up, 37 patients dropped out. And 37 patients had 46 episodes of peritonitis (peritonitis group) whereas the other 121 patients did not have peritonitis (peritonitisfree group). The overall peritonitis rate was one episode per 75.87 patient months. The peritonitis free group had lower GISS (1.35 ± 1.94 vs. 2.95 ± 3.19, p = 0.006), higher albumin level and longer dialysis duration at baseline as compared to the peritonitis group. Multivariate Cox-regression analysis showed that only GISS (OR 1.206, 95% CI 1.093 - 1.330) and dialysis duration (OR 1.018, 95% CI 1.006 - 1.031) were the risk factors for the time to first peritonitis episodes during the follow-up. Further analysis identified 2 GISS components, belching and constipation, as the strongest predictors of peritonitis during the follow-up period (p < 0.005). CONCLUSION: Our study showed that GI symptoms could predict peritonitis in CAPD patients. Prevention and treatment for GI problems may thus be helpful to decrease peritonitis rate.

Volume control in peritoneal dialysis patients guided by bioimpedance spectroscopy assessment.

BACKGROUND: Volume overload is a common problem in peritoneal dialysis patients and may contribute to the high cardiac mortality in this patient population. Controlling volume status is difficult due to the lack of appropriate and accurate assessment of dry weight. This randomized, controlled study was conducted to test if the recent use of overhydration value (OH) provided by bioimpedance spectroscopy and patients' education would help to control overhydration. METHODS: 160 continuous ambulatory peritoneal patients were included in this study. All the patients were randomly allocated to 2 groups: in Group 1 the patients and their primary nurses were informed of the OH values provided by bioimpedance spectroscopy whereas in Group 2 the values were not revealed and patients' volume was measured by the standard methods. Fluid status was evaluated by means of repeated bioimpedance analysis and clinical assessment. Urine volume, blood pressure and use of antihypertensive medications were recorded. RESULTS: There were no differences in gender, age, diabetes, height, weight and clinical hydration status between the 2 groups at the baseline. In Group 1, OH (p < 0.05), extracellular volume and the extracellular volume to intracellular volume ratio decreased steadily during the 3-month follow-up. On the contrary, all 3 parameters increased significantly in Group 2. SBP decreased significantly in Group 1 but increased significantly in Group 2. CONCLUSION: Our study shows that the use of OH as determined by bioimpedance spectroscopy may facilitate volume control in peritoneal dialysis patients.

Prevalence and risk factors for peripheral artery disease among patients on maintenance peritoneal dialysis.

BACKGROUND: Cardiovascular disease is common in end-stage renal disease patients and accounts for more than half of the mortalities. Peripheral artery disease (PAD) is frequently found in this population and is an independent predictor of cardiovascular mortality. However, there have been limited studies reporting the prevalence and risk factors for PAD among patients on maintenance continuous ambulatory peritoneal dialysis (CAPD) therapy. METHODS: 343 CAPD patients from our clinic were recruited, and PAD was diagnosed using a value of ankle-brachial index <0.9. Both traditional and dialysis-related factors were evaluated. RESULTS: The prevalence of PAD was 27.4% in all patients, which increased to 45% in patients aged >70 years. In age- and gender-adjusted logistic regression, diabetes mellitus (OR 2.354, 95% CI 1.288-4.3), diastolic blood pressure (OR 0.964, 95% CI 0.939-0.989), extracellular/intracellular water ratio (OR 2.504, 95% CI 1.067-5.804), and lnCRP (OR 1.251, 95% CI 1.031-1.518) were independently associated with PAD. CONCLUSION: Our study suggested that PAD is a common problem in patients on maintenance peritoneal dialysis, especially in elderly dialysis subjects. Diabetes mellitus, elevated hsCRP level, and extracellular/intracellular water ratio are all independent risk factors for PAD. It also suggested that aggressive risk factor management for PAD should be undertaken in CAPD patients.

Effect of nutrition on arterial stiffness in peritoneal dialysis patients.

BACKGROUND: A poor nutritional state is associated with an increased risk of cardiovascular events in end-stage renal disease. It is unclear whether malnutrition itself can induce cardiovascular disease (CVD). We examined the impact of nutritional status on patients' arterial stiffness in peritoneal dialysis (PD) patients. METHODS: We prospectively enrolled 121 stable PD patients and evaluated them at baseline and 1 year later. According to patients' Subjective Global Assessment (SGA) changes from baseline to the end, patients were divided into four groups: group 1, SGA from A to B; group 2, SGA remained A, group 3, SGA changed from B to A, and group 4, SGA remained B. Arterial stiffness was assessed by pulse-wave velocity (PWV). RESULTS: At baseline, PWV in well-nourished patients were lower than malnourished patients (p < 0.05). One year later, in group 1, as compared with baseline, PWV increased significantly (p < 0.001) whereas handgrip strength (HGS), daily dietary protein intake and dietary energy intake decreased significantly. In group 3, PWV decreased significantly (p < 0.05) whereas HGS and ALB increased significantly. In groups 1 and 3, lgCRP level remained unchanged. CONCLUSION: There was a closely longitudinal association between nutritional status and arterial stiffness in PD patients, suggesting a possible impact of nutritional status on arterial function.

Implementing continuous quality improvement process in potassium management in peritoneal dialysis patients.

BACKGROUND: Abnormal plasma potassium levels are not uncommon in peritoneal dialysis (PD) patients. Here, we implemented a continuous quality improvement (CQI) approach that mainly focused on dietary management to improve potassium control in PD patients. METHODS: All clinically stable patients who visited the PD clinic monthly were included in this study. A CQI team that included nephrologists, primary nurses, dietician, patients, and their family members was organized, and it monitored patients for 6 months. Patients were asked to provide their dialysis records and 3-day dietary records at each visit. Dialysis adequacy, including potassium and phosphorus removals, was checked before and after the implementation of CQI. Changes in dietary prescription, without altering dialysis prescriptions and potassium supplementation, were made monthly, according to patients' dietary information and blood potassium levels. RESULTS: In total, 84 patients (28 male and 56 female) were included in this study. At baseline, the prevalence of hyperkalemia and hypokalemia was 14.3% each. After the intervention, the prevalence of hyperkalemia dropped to 10.7% and 6% at 3 months and 6 months, respectively. The prevalence of hypokalemia dropped to 8.3% and 7.1% at 3 months and 6 months, respectively. CONCLUSIONS: Our data suggest that implementing CQI, with a focus on dietary intervention, could significantly reduce the prevalence of potassium abnormality in PD patients.

Promoting self-management improves the health status of patients having peritoneal dialysis.

AIM: This paper is a report of a study conducted to explore the effects of promoting self-management on the well-being of patients having peritoneal dialysis. BACKGROUND: Peritoneal dialysis is a home-based treatment for end-stage renal disease. Promoting self-management has been shown to improve the health status of people with diabetes mellitus and other chronic diseases. However, little is known about the effects of self-management support for patients having peritoneal dialysis. METHOD: Thirty patients who had received peritoneal dialysis for at least 6 months and were clinically stable were enrolled in the study in 2006. A multidisciplinary team was built to support the patients' self-management. Various forms of education such as group discussion and individual consultation were used to improve patients' self-efficacy and all were followed up for 6 months. We compared the volume status, adequacy of dialysis, nutritional status, quality of life, rehabilitation status, self-management capacity and self-efficacy levels at baseline, 3 and 6 months after enrolment. RESULTS: During follow-up, patients' urine volume and residual renal function decreased, while the adequacy of dialysis (Kt/v and Ccr) did not change. Volume status, quality of life and rehabilitation status all improved, whereas nutritional status did not deteriorate. Both self-management capacity and self-efficacy level increased statistically significantly. CONCLUSION: A team approach needs to be taken to achieve successful self-management in patients having peritoneal dialysis, as with other chronic disease treatments. Nurses should use multiple strategies based on self-efficacy theory to improve patients' self-efficacy levels and self-management capacities.

Direct detection of Staphylococcus aureus in positive blood cultures through molecular beacon-based fluorescence in situ hybridization.

OBJECTIVE: Clinical diagnosis of bloodstream infection diseases depends on the blood culture results. Bacterial identification by traditional methods is time-consuming. This study aimed to utilize molecular beacon-based fluorescence in situ hybridization (MB-FISH) for rapid and direct detection of Staphylococcus aureus in positive blood cultures. METHODS: Three molecular beacon probes (MB1, MB2 and MB3) were designed and synthesized to target the 16S rRNA gene fragment of S. aureus. The MB-FISH system was optimized, and the specificity of this method in detecting S. aureus was evaluated. This approach was used to test 41 g-positive clinical specimens with positive blood cultures. In addition, the consistency of this method with traditional methods was evaluated. RESULTS: Signal-to-noise ratio (S/N) of the molecular beacon MB1 was significantly higher than that of MB2 and MB3 (P < .001). The S/N ratios of MB1 probe at different concentrations were all >20. Thermal denaturation curve of the probe suggested that its hairpin structure can be opened and closed. Conditions such as deionized formamide concentration, ionic strength and temperature were optimized by monitoring the fluorescence intensity of MB1 in the presence or absence of its target sequence B1. The optimized hybridization system produced fluorescence only in S. aureus. The specificity and sensitivity of MB1 probe for detecting S. aureus in 41 specimens were 100% and 93.75%, respectively. Although sample size was small, MB-FISH appeared to be consistent with traditional culture methods (Kappa value = 0.948). CONCLUSION: MB-FISH demonstrates strong specificity and high sensitivity, and can be used for direct detection of S. aureus in positive blood cultures.

Establishing a renal management clinic in China: initiative, challenges, and opportunities.

BACKGROUND: Chronic kidney disease (CKD) has been identified as a growing global burden and traditional health care systems are inadequate for the management of CKD patients. This paper describes an initiative to establish a renal management clinic (RMC) in China and discusses the challenges and opportunities in the management of CKD patients. SUBJECTS AND METHODS: We collected and analyzed the data for the first 1,000 CKD patients treated since the establishment of the RMC (from April 2006 to April 2007). They had CKD stages 1-4 and stage 5 (before dialysis), as described by the Kidney Outcome Quality Initiatives (KDOQI). They were managed at the RMC established at the Peking University Third Hospital, by a multidisciplinary team (nephrologists, nurses, and dietitians) who developed care plans, clinical pathways, and a multidimensional patient-education program. RESULTS: The most frequent causes of CKD among these 1,000 patient were glomerulonephritis (35%), hypertensive nephrosclerosis (19%), chronic interstitial nephritis (13%), and diabetic nephropathy (11%). Six percent of the patients had stage 1 CKD, 27% stage 2, 33% stage 3, 20% stage 4, and 13% had stage 5. Five hundred and fifty-four were male and 446 were female; mean age was 55 +/- 18.9 years (range 18-92 years). Seven hundred and seventy patients (77%) had hypertension; 400 patients (40%) had body mass index (BMI) equal to or higher than 25 kg/m(2); 180 (18%) had overt cardiovascular disease; 726 (72.6%) had low-density lipoprotein (LDL)-cholesterol higher than 2.6 mmol/l; 440 patients (44%) had hyperuriemia; and 274 patients (27.4%) had anemia (hemoglobin <110 g/l). Although the team is multidisciplinary, management of the patients in the RMC is undertaken mainly by nephrologists, whereas nurses and dietitians still do not play an important role. There are no family doctors in China and nephrologists are responsible for management of these patients' kidney disease and related complications. CONCLUSIONS: Our findings show that the prevalence of hypertension, diabetes mellitus, overweight. and hyperuricemia is high among Chinese CKD population. Nurses and dietitians do not yet play an important role in the present pattern of RMC. We believe that the present medical care model should be revised because it does not address the concerns of CKD patients and their need for lifestyle changes that would help them to cope with their chronic condition.