Randomized controlled pilot study of 2 weeks' treatment with high cutoff membrane for hemodialysis patients with elevated C-reactive protein.

Chronic inflammation in hemodialysis (HD) patients is associated with cardiovascular complications and mortality. Circulating immune active proteins in the molecular range 15-45 kD that cannot be efficiently cleared by high-flux (HF) dialysis may be causally involved. We intended to test the feasibility of using a high cutoff (HCO) dialyzer in chronic HD patients and its influence on inflammation and monocyte activation. The Gambro HCO1100 dialyzer was compared to a conventional HF membrane in a randomized double-blind crossover trial in 19 chronic HD patients selected for the presence of elevated serum C-reactive protein levels. Patients were treated for six consecutive dialysis sessions (2 weeks) with each membrane. Safety analysis recorded adverse events and albumin losses through the protein-leaking membranes. Efficacy analysis observed reductions in the number of proinflammatory (CD14+CD16+) monocyte subpopulations in circulating blood. Treatment with the HCO membrane was well tolerated, although the number of adverse events was slightly higher. Despite significant serum albumin loss (from 34.1 ± 2.7 to 29.6 ± 3.0 g/L; P < 0.01), there was no need to supplement albumin, and rising activity of cholinesterase during HCO treatment indicated compensation by enhanced hepatic synthesis. The HCO membrane cleared high amounts of proinflammatory cytokines, but did not reduce predialysis inflammatory monocytes and markers. Although the time of HD session was extended, the study was hampered by a lower Kt/V in the HCO compared to the HF period. Treatment of chronic HD patients with this HCO dialyzer for 2 weeks is tolerable in terms of albumin loss and able to clear proinflammatory cytokines; however, this was not sufficient to decrease monocyte activation. Therefore, a more selective, less albumin-leaking membrane is desirable to allow prolonged high-efficient dialysis with more effective cytokine clearance.

Application testing of a new three-dimensional acceleration measuring system with wireless data transfer (WAS) for behavior analysis.

A wireless acceleration measurement system was applied to free-moving cows and horses. Sensors were available as a collar and a flat box for measuring leg or trunk movements. Results were transmitted simultaneously by radio or stored in an 8-MB internal memory. As analytical procedures, frequency distributions with standard deviations, spectral analyses, and fractal analyses were applied. Bymeans of the collar sensor, basic behavior patterns (standing, grazing, walking, ruminating, drinking, and hay uptake) could be identified in cows. Lameness could be detected in cows and horses by means of the leg sensor. The portion of basic and harmonic spectral components was reduced; the fractal dimension was reduced. The system can be used for the detection and analysis of even small movements of free-moving humans or animals over several hours. It is convenient for the analysis of basic behaviors, emotional reactions, or events causing flight or fright or for comparing different housing elements, such as floors or fences.

Model-based clustering of binary longitudinal atopic dermatitis disease histories by latent class mixture models.

Atopic dermatitis is a skin disease which affects mainly children, has a very strong genetical component, and manifests itself clinically as flexural excema in connection with torturing itching. The course of disease is notoriously changeable and runs in phases, therefore it is difficult to predict the future course of disease. To improve prediction it would be interesting to identify clusters of children with different disease histories because this would shed light on common genetic and environmental risk factors. We use, relying on previous work of Nagin, a Latent class mixture model to estimate, in a data-dependent and model-based fashion, a clustering of typical binary atopic dermatitis disease histories in children. The data were collected from 1990 to 1997 in the so called MAS-study, a prospective cohort study of 1314 children in five German cities. The original method of Nagin is extended in two different aspects, first we use bootstrap confidence intervals to account for uncertainty in curve fitting, and second, we propose to model covariates for cluster membership by Anderson's Stereotype regression model. We feel that the Latent class mixture model is a valuable tool for assessing the course of atopic dermatitis, yielding a wealth of communicable and graphically displayable results.