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1.
Kidney Blood Press Res ; 40(2): 130-40, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25831974

RESUMEN

Telemedicine comprises different concepts aiming to close a spatial distance between practitioner, medical staff and patient. It's functionality can include mere data transmission but extend as well to triggering alarms or enable consultation and therapy suggestions. A special form of telemedicinal application is interventional decentralized telemonitoring. Here practitioner-patient communication is characterized by telemedicinial data collection driven therapy-control and -optimization. To identify feasible indications for the employment of telemonitoring a detailed definition of communicated parameters, alarm rules and algorithms of intervention are required as well as a benefit-cost analysis. The quality of the telemedical application is determined by the medical quality of the resulting actions.


Asunto(s)
Equipos y Suministros , Monitoreo Fisiológico/métodos , Pacientes , Médicos , Telemedicina/métodos , Algoritmos , Presión Sanguínea , Peso Corporal , Humanos , Hipertensión/diagnóstico , Hipertensión/terapia , Monitoreo Fisiológico/instrumentación , Telemedicina/instrumentación
2.
Telemed J E Health ; 21(3): 145-50, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25569481

RESUMEN

BACKGROUND AND AIM: We have shown that better blood pressure (BP) control can be achieved by using 3-month telemetric BP measurement (TBPM) in comparison with a standard-care control group (C-G). The present analysis should clarify if this will also lead to a better middle- and long-term BP control. SUBJECTS AND METHODS: Fifty-seven patients finished the main study. After the 3 months no TBPM was performed. For 40 patients, 18 from the TBPM group (TBPM-G) and 22 from the C-G, we obtained ambulant BP measurements (ABPMs) with a mean follow-up of 20 months. Seventeen patients were lost to follow-up. BP target values were defined as ABPM ≤130/80 or ≤125/75 mm Hg with diabetes or renal failure. RESULTS: At the end of the follow-up, the systolic BP was 121.2±11.2 mm Hg in TBPM-G and 130.7±10.4 mm Hg in C-G, and the diastolic BP was 72.8±10.9 versus 77.0±7.1 mm Hg, respectively. Fifty-six percent in TBPM-G versus 40% in C-G (p=0.024) had a controlled BP as defined by ABPM criteria. CONCLUSIONS: TBPM helps achieve BP target values in patients with previously inadequately treated arterial hypertension, and the benefit is sustained. Beyond its immediate application, in comparison with standard treatment, TBPM allows for a better BP adjustment in the long term as well.


Asunto(s)
Antihipertensivos/uso terapéutico , Determinación de la Presión Sanguínea/métodos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Telemetría/métodos , Adulto , Anciano , Femenino , Estudios de Seguimiento , Alemania , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Valores de Referencia , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento
4.
Telemed J E Health ; 19(6): 480-6, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23614336

RESUMEN

Lacking compliance with liquid intake restrictions is one of the major problems in patients on hemodialysis and causes an increased mortality. In 120 patients on hemodialysis with an average interdialytic weight gain (IWG) exceeding 1.5 kg on at least 2 days during the 4 weeks preceding the intervention, the effect of telemetric body weight measurement (TBWM) on IWG, ultrafiltration rate, and blood pressure was evaluated over a period of 3 months. Patients of the telemetric group (TG) were supplied with automatic scales, which transferred the weight via telemetry on a daily basis. In the case of IWG of more than 0.75 kg/24 h, a telephonic contact was made as required, and in the case of an IWG of more than 1.5 kg, telephonic contacting was obligatory along with the advice of a liquid intake restriction to 0.5 L/day until the next dialysis. The patients of the control group (CG) received standard treatment without telemetric monitoring. We examined specific data of the second interdialytic interval (IDI2) and the average within 1 week. The average difference of IWG between TG and CG was not significant before the start of the study but 0.2 kg (p=0.027) (IDI2)/0.27kg (p=0.001) (WP) at the end of the study, respectively. The average difference in the ultrafiltration rate within 1 week was 19.0 mL/h (p=0.282) (IDI2)/8.2 mL/h (p=0.409) before the start of the study but 28.4 mL/h (p=0.122) (IDI2)/30.9 mL/h (p=0.004) at the end of the study, respectively. Thus, TBWM is a feasible method for optimizing the IWG and reducing the ultrafiltration rate.


Asunto(s)
Fallo Renal Crónico/terapia , Diálisis Renal , Telemetría/métodos , Aumento de Peso , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad
5.
Atheroscler Suppl ; 14(1): 29-32, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23357137

RESUMEN

Lipoprotein apheresis is a well-established extracorporeal treatment in modality of severe hyperlipoproteinemia. Besides the reduction of LDL cholesterol and modifications to physiology of lipoprotein and lipid metabolism, Lipoprotein apheresis may have crucial effects on many other atherogenic factors as vascular inflammation, rheology and gene expressions in blood cells. These different effects of lipoprotein apheresis treatments are reviewed with respect to oxidative stress in plasma, red and white blood cells and in consequence to progression of atherosclerosis. However, in consideration of these reviewed aspects as a factor of biocompatibility lipoprotein apheresis remains safe.


Asunto(s)
Eliminación de Componentes Sanguíneos , Colesterol/sangre , Hiperlipoproteinemias/terapia , Lipoproteínas/sangre , Animales , Biomarcadores/sangre , Eliminación de Componentes Sanguíneos/efectos adversos , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Regulación de la Expresión Génica , Humanos , Hiperlipoproteinemias/sangre , Hiperlipoproteinemias/complicaciones , Hiperlipoproteinemias/diagnóstico , Hiperlipoproteinemias/genética , Estrés Oxidativo , Resultado del Tratamiento
6.
Ther Apher Dial ; 15(1): 105-12, 2011 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-21272260

RESUMEN

Lipid apheresis treatment has been suggested to cause oxidative stress. Cells respond to oxidative stress in many ways, including, among others, altered gene expressions. In the present investigation we investigated whether the gene expression of known stress genes was affected in the WBCs of patients undergoing lipid apheresis. For this purpose cellular early-growth-response gene-1 (Egr-1), c-Jun, c-Fos, and heat shock protein 70 (Hsp70) mRNA expression was followed before and immediately after lipid apheresis treatments (N=24). Gene expression was determined by quantitative reverse transcription-polymerase chain reaction. With the exception of c-Fos, the expression of Egr-1, c-Jun, and Hsp70 mRNA was not affected in WBCs by a single lipid apheresis treatment (median [16th percentile; 84 th percentile]): Egr-1, before 0.30 (0.13; 0.53), after 0.31 (0.14; 1.33); c-Jun, before 0.03 (0.03; 0.16), after 0.05 (0.03; 0.18); Hsp70, before 0.49 (0.23; 1.07), after 0.53 (0.20; 1.61)). Expression of c-Fos was significantly decreased (P<0.01) after lipid apheresis treatment (before 2.18 [1.06; 5.27], after 1.65 [0.74; 4.12]). Hsp70 and c-Fos expression in lipid apheresis patients was not different from that in 35 healthy blood donors, whereas Egr-1 and c-Jun were significantly decreased (P<0.05) in lipid apheresis patients when compared to controls (Egr-1 0.96 [0.42; 1.83], c-Jun 0.64 [0.40; 0.98], c-Fos 2.77 [1.32; 4,02], Hsp70 0.43 [0.28; 0.61]). These results show that lipid apheresis procedures do not induce stress gene expression in WBCs. Therefore, all the lipid apheresis systems used seem to be safe with respect to oxidative stress and other injuries induced in WBCs due to contact with extracorporeal tubing and membranes.


Asunto(s)
Eliminación de Componentes Sanguíneos , Proteína 1 de la Respuesta de Crecimiento Precoz/genética , Genes fos/genética , Genes jun/genética , Leucocitos/fisiología , Lípidos , Adulto , Anciano , Femenino , Expresión Génica , Proteínas HSP70 de Choque Térmico/genética , Humanos , Masculino , Persona de Mediana Edad
7.
Artif Organs ; 34(11): 961-8, 2010 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-21092038

RESUMEN

Several genetic polymorphisms have been identified to play a role in the occurrence and progression of renal dysfunction after cardiac surgery with cardiopulmonary bypass (CPB). Recently, it was demonstrated that the T allele of SNP rs1617640 in the promoter of the erythropoetin (EPO) gene is significantly associated with proliferative diabetic retinopathy (PDR) and end-stage renal disease (ESRD) due to increased EPO expression. This disease risk-associated gene and its potential pathway mediating severe microvascular complications in T-allele carriers could also play a role on renal dysfunction in patients who underwent cardiac surgery with CPB. We hypothesized that the patients' ability to produce increased EPO concentrations will affect morbidity and mortality after CPB. We conducted a prospective single center study between April 2006 and May 2007. In 481 patients who underwent cardiac surgery with CPB we prospectively examined the SNP rs1617640 in the promoter of the EPO gene by DNA sequencing. The patients were grouped according to their genotype (GG, GT, and TT). The genotype distribution of SNP rs1617640 in the promoter of the EPO gene was 36% (TT), 49% (TG), and 15% (GG). There was no difference in age, body mass index, gender, CPB time, or length of stay in intensive care unit. The hospitalization was irrespective of the patients' genotypes. The baseline creatinine in the TT group was 0.2 points higher than in the other groups; however this was without statistical significance in the multivariate analysis. No significant difference was shown in Euroscore, the Simplified Acute Physiology Score II, the Acute Physiology and Chronic Health Evaluation Score II, Acute Renal Failure Score, or the Risk, Injury, Failure, Loss of Kidney Function Score. The mortality was equal across the genotypes. However, an association between the TT genotype and acute renal replacement therapy (P=0.03), intra-aortic balloon pump usage (P=0.02), and serum creatine phosphokinase-MB increase (P=0.03) were observed after cardiac surgery. Our analysis suggests that the risk allele (T) of rs1617640 plays a role in the development of renal dysfunction after cardiac surgery with CPB. Patients with the TT risk allele required more frequent acute renal replacement therapy. Since our result is close to the border of significance, this hypothesis should be investigated in larger prospective studies with long-term follow-up to emphasize this polymorphism as a potential risk factor.


Asunto(s)
Lesión Renal Aguda/genética , Lesión Renal Aguda/terapia , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Puente Cardiopulmonar/efectos adversos , Eritropoyetina/genética , Polimorfismo de Nucleótido Simple , Regiones Promotoras Genéticas , Terapia de Reemplazo Renal , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/fisiopatología , Anciano , Biomarcadores/sangre , Procedimientos Quirúrgicos Cardíacos/mortalidad , Puente Cardiopulmonar/mortalidad , Distribución de Chi-Cuadrado , Forma MB de la Creatina-Quinasa/sangre , Creatinina/sangre , Femenino , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Alemania , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Fenotipo , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo
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