Current clinical practice in adapted automated peritoneal dialysis (aAPD)-A prospective, non-interventional study.

Adapted automated peritoneal dialysis (aAPD), comprising a sequence of dwells with different durations and fill volumes, has been shown to enhance both ultrafiltration and solute clearance compared to standard peritoneal dialysis with constant time and volume dwells. The aim of this non-interventional study was to describe the different prescription patterns used in aAPD in clinical practice and to observe outcomes characterizing volume status, dialysis efficiency, and residual renal function over 1 year. Prevalent and incident, adult aAPD patients were recruited during routine clinic visits, and aAPD prescription, volume status, residual renal function and laboratory data were documented at baseline and every quarter thereafter for 1 year. Treatments were prescribed according to the nephrologist's medical judgement in accordance with each center's clinical routine. Of 180 recruited patients, 160 were analyzed. 27 different aAPD prescription patterns were identified. 79 patients (49.4%) received 2 small, short dwells followed by 3 long, large dwells. During follow-up, volume status changed only marginally, with visit mean values ranging between 1.59 (95% confidence interval: 1.19; 1.99) and 1.97 (1.33; 2.61) L. Urine output and creatinine clearance decreased significantly, accompanied by reductions in ultrafiltration and Kt/V. 25 patients (15.6%) received a renal transplant and 15 (9.4%) were changed to hemodialysis. Options for individualization offered by aAPD are actually used in practice for optimized treatment. Changes observed in renal function and dialysis efficiency measures reflect the natural course of chronic kidney disease. No safety events were observed during the study period.

Suitable conditions for sealing of open dentinal tubules using a pulsed Nd:YAG laser.

UNLABELLED: BACKGROUND DATA AND OBJECTIVES: Nd:YAG laser radiation has been applied in treatment of dentine hypersensitivity; dentine melt created after irradiation on a tooth surface can occlude open dentinal tubules. Different conditions (energy of pulses, number of successive irradiations, and type of dye agent) have been reported in the literature. In our study, different conditions are compared and the most suitable ones are suggested. METHODS: One hundred nine dentine samples prepared from extracted human third molars in the form of 2- or 3-mm thick discs and facets from an outer convex surface of a root were irradiated by pulses with duration 0.3 ms and beam diameter 0.3 or 0.6 mm. The laser repetition rate was 15 Hz. Energies per pulse have been changed from 20 mJ to 250 mJ (the corresponding energy densities rho are 22 and 275 J/cm(2) for the beam diameter of 0.3 mm). Dyes including tartrazine, carmine indigo, erythrosin, and methylene blue have been used to cover dentine surfaces and to increase absorption of laser radiation. Irradiated dentine surfaces have been investigated using scanning electron microscopy. RESULTS: Sealing of open dentinal tubules can be accomplished even without dyes, provided that a sufficiently intense laser radiation level is used. To avoid damage to the dentine's surface the use of dyes is necessary. Erythrosin has been found to be the best agent, and closing of dentinal tubules occurred after four doses of irradiation with 30-mJ pulses with a beam diameter of 0.6 mm (energy density rho = 8.25 J/cm(2), total energy density rho(T) = 33 J/cm(2)). The upper limit has been reached using four doses of irradiation by 90-mJ pulses with a beam diameter of 0.3 mm (rho = 99 J/cm(2), rho(T) = 396 J/cm(2)). CONCLUSIONS: Occluding dentinal tubules can safely and effectively be accomplished using pulsed Nd:YAG laser radiation provided that the dentine surface is covered with erythrosin solution.

Sealing of open dentinal tubules by laser irradiation: AFM and SEM observations of dentine surfaces.

Dentin of human teeth is a vital hydrated tissue. It is strongly sensitive to dehydration and drying that are commonly used in preparation of samples for scanning electron microscopy. Experience in examination of dentine surfaces of extracted human third molars using contact mode atomic force microscopy under moist conditions is described. The examined dentine surfaces are modified by laser radiation produced by a pulsed Nd:YAG laser that leads to sealing of open dentinal tubules under suitable conditions that are reached after covering dentine surfaces with dye agents. Out of four investigated dye agents erythrosin solution in water has been found the most suitable and the lower and upper limits of pulse energies for sealing of dentinal tubules have been set.

Ghrelin variants influence development of body mass index and plasma levels of total cholesterol in dialyzed patients.

BACKGROUND: Ghrelin is an endogenous hormone expressed predominantly in the stomach. Ghrelin controls growth hormone secretion and also affects the body's energy balance. We analyzed the association of ghrelin variants with body mass index (BMI), albumin as a marker of malnutrition and plasma lipids as risk factors for atherosclerosis in hemodialyzed patients, in whom malnutrition and accelerated atherosclerosis are common complications. METHODS: Ghrelin variants Arg51>Gln and Leu72> Met were analyzed by PCR-RFLP in 210 hemodialyzed patients, prospectively followed up for 15 months. Changes in body mass index, triglycerides, total cholesterol and albumin over time (after 3, 6, 9, 12 and 15 months of dialysis) were analyzed in subgroups divided according to ghrelin genotypes. RESULTS: Carriers of at least one of the Gln51 and Met72 alleles lost body weight more quickly than Arg51Arg/Leu72Leu homozygotes (p<0.01). Carriers of the Gln51 allele were at higher risk of developing high cholesterol levels (p<0.01). CONCLUSIONS: Common ghrelin variants may have an effect on changes in biochemical and anthropometric parameters in hemodialyzed patients over time and could be used in the future to plan individualized therapy.