[Usefulness of the Biofeedback Diacontrol module in the automatic programming of plasmatic conductivity and ionic mass transfer]. / Utilidad del módulo de "Biofeedback" Diacontrol en la programación automática de la conductividad plasmática y la transferencia de masa iónica.

Programmed variable sodium in the dialysate can improve hypotension during hemodialysis but may also alter sodium balance and thus resulting in a increase of water intake and weight gain between dialysis sessions. The aim of this study was to evaluate the changes on plasma volume (PV), Ionic Mass Transfer (IMT) and plasma conductivity (PC) with two different hemodialysis techniques. We studied 10 patients during a four-period protocol (one week each: PF1-DC1-DC2PF2): 120 dialysis sessions. During periods PF1 and PF2, the dialysis procedure was as usual, with exponential decrease of dialysate conductivity (DC) profile (15.7 mS/cm at start, 14.4 mS/cm at middle and 13.8 mS/cm at the end of the session) and UF profile (1.7 1/h at start and 0.1 1/h at the end). During periods DC1 and DC2, DC was automatically determined by a biofeedback modulae (Diacontrol) in order to reach a plasma water conductivity fixed at 14 mS/cm. All hemodialysis parameters were the same for the four periods: duration, blood and dialysate flow rates, dialysis membrane. A lower reduction of PV was evident on PF1 and PF2 (104 +/- 3.26% and -4.36 +/- 2.7%) compared with DC 1 and DC2 (-6.53 +/- 3.31% and -6.67 +/- 3.12%) (p < 0.001). No significant differences were seen in systolic, mean and diastolic blood pressure pre-HD or post-HD, UF, and weight gain, between the four periods. Hypotensive episodes were seen in 33.3% of PF1, 20% of DC1, 23.3% of DC2 and 26.6% of PF2 sessions (NS). PF1 and PF2 periods resulted in a significantly higher 30', mid and post-dialysis PC as compared to DC1 and DC2 periods (p < 0.001). The mean difference between the actual value and the prescribed value of PC at the end of the session was -0.01 +/- 0.07 mS/cm (n: 60). There was a negative correlation between the mean DC during session and the PC at 30' of session. IMT was 420.73 +/- 126.9 mEq in PF1, 311.96 +/- 161.75 in DC1, 278.34 +/- 153.14 in DC2 and 417.66 +/- 152.17 in PF2 (p > 0.001 PF1 and PF2 vs. DC1 and DC2). Diacontrol determines automatically an individualized DC profile for each patient, and accurately reaches the prescribed PC target. By reaching both the dry weight and PC settings, the water and sodium pool is maintained lower in the hemodialysis session using a biofeedback module. Clinical tolerance was similar in the two different dialysis procedures.

Utilidad del módulo de «Biofeedback» DiacontrolTM en la programación automática de la conductividad plasmática y la transferencia de masa iónica / Biofeedback diacontrolTM module in the automatic programation of plasmatic conductivity ad ionic mass transfer

La utilización de perfiles descendentes de conductividad en el dializado (CD) ha disminuido el número de complicaciones intradiálisis. No obstante, la presencia de una mayor concentración de sodio puede originar un balance positivo de este catión y favorecer los episodios de sed y el desarrollo de hipertensión arterial. El objetivo de este estudio fue comparar la tolerancia, así como la evolución de la Conductividad Plasmática (CP) y la Transferencia de Masa lónica (TMI), al pasar de un tipo se sesión con alto contenido en Na (perfiles de CI) y UF) a otro tipo de sesión que emplea un sistema de «biofeedback» (DiacontroITM ) y repetir el proceso inverso. Se han estudiado 120 sesiones de diálisis en 10 pacientes durante cuatro periodos de tratamiento (PF1-DC1-DC2-PF2). Durante los períodos PF1 y PF2 los pacientes se dializaban con perfiles logarítmicos descendentes de conductividad (C1) al inicio de la sesión 15,7 mS/cm, a la mitad 14,4 mS/cm y 13,8 mS/cm al final) y UF (1,7 I/h al inicio y 0,1 I/h al final) y en los períodos DC1 y DC2 se realizaron con el sistema DiacontroITM, fijando la CP final en 14 mS/cm. No se detectaron diferencias significativas en la TAS, TAM y TAD pre o postsesión entre los cuatro períodos. El porcentaje de sesiones con al menos un episodio de hipotensión fue del 33,3% en PF1, 20% en DC1, 23,3% en DC2 y 26.6% en PF2 (ns). El descenso del VP fue de -4,04 +- 3,26% en PF1, -6,53 +- 3,31% en DC1, -6,67 +- 3,12% en DC2 y 4,36 +- 2,7% en PF2 (p < 0,00l PF1 y PF2 vs DC1 y DC2). La CP fue significativamente superior tanto a los 30’, mitad de sesión, post-HD, así como a lo largo de toda la sesión, en los períodos PF1 y PF2 vs DC1 y DC2 (p < 0,001). En las sesiones con Diacontrol, la diferencia media entre la CP final conseguida y programada fue de 0,01 +- 0,07 mS/cm (intervalo de confianza al 95% -0,03-0,008). Asimismo se apreció una correlación inversa entre los valores de CD media y los de la CP prediálisis (r: -0,42, p < 0,05 en DC1 y r: - 0,65, p < 0,001 en DC2). La TMI fue de 420,73 +- 126,9 mEq en PF1, 311,96 +- 161,75 en DCI, 278,34 +- 153,14 en DC2 y 417,66 +- 152,17 en PF2 (p < 0,001 PF1 y PF2 vs DCI yDC2). Podemos concluir que el sistema «biofeedback» Diacontrol permite programar un valor de conductividad plasmática al final de la sesión de hemodiálisis, en lugar de programar los valores de conductividad en el dializado. Por tanto, permite mantener una CP plasmática y una TMI inferior a aquellas logradas en las sesiones con perfiles descendentes de conductividad en el líquido de diálisis, manteniendo una estabilidad hemodinámica similar

Programmed variable sodium in the dialysate can improve hypotension during hemodialysis but may also alter sodium balance and thus resulting in a increase of water intake and weight gain between dialysis sessions. The aim of this study was to evaluate the changes on plasma volume (PV), Ionic Mass Transfer (IMT) and plasma conductivity (PC) with two different hemodialysis techniques. We studied 10 patients during a four-period protocol (one week each: PF1-DC1 -DC2PF2): 120 dialysis sessions. During periods PF1 and PF2, the dialysis procedure was as usual, with exponential decrease of dialysate conductivity (DC) profile (15.7 mS/cm at start, 14.4 mS/cm at middle and 13.8 mS/cm at the end of the session) and UF profile (1.7 1/h at start and 0.1 1/h at the end). During periods DC1 and DC2, DC was automatically determined by a biofeedback module (DiacontroITM) in order to reach a plasma water conductivity fixed at 14 mS/cm. All hemodialysis parameters were the same for the four periods: duration, blood and dialysate flow rates, dialysis membrane. A lower reduction of PV was evident on PF1 and PF2 (104 +- 3.26% and -4.36 +- 2.7%) compared with DC 1 and DC2 (-6.53 +- 3.31% and -6.67 +- 3.12%) (p 0.001 PF1 and PF2 vs. DC1 and DC2). DiacontrolTM determines automatically an individualized DC profile for each patient, and accurately reaches the prescribed PC target. By reaching both the dry weight and PC settings, the water and sodium pool is mantained lower in the hemodialysis session using a biofeedback module. Clinical tolerance was similar in the two different dialysis procedures

DNA interstrand cross-linking efficiency and cytotoxic activity of novel cadmium(II)-thiocarbodiazone complexes.

We have prepared mono- and binuclear complexes of Zn(II) and Cd(II) with bis(2-pyridyl aldehyde) thiocarbodiazone (H(2)L(1)) and bis(methyl 3-pyridyl ketone) thiocarbodiazone (H(2)L(2)). Cytotoxicity data against the ovarian tumor cell line A2780cisR (acquired resistance to cisplatin) indicate that the mononuclear complex Cd/H(2)L(2) (1) and the binuclear complex Cd(2)/H(2)L(1) (4) are able to circumvent cisplatin resistance and that their cytotoxic activity does not substantially vary after depletion of intracellular levels of glutathione. Moreover, DNA binding studies show that complexes 1 and 4 have higher efficiency than cisplatin at forming DNA interstrand cross-links in both naked pBR322 plasmid and A2780cisR cellular DNA. Interestingly, the thiocarbodiazone ligands alone do not show the biological properties of complexes 1 and 4. Altogether these results suggest that DNA interstrand cross-link formation by compounds 1 and 4 might be related with their cytotoxic activity in cisplatin-resistant cells. We think that compounds 1 and 4 may represent a novel structural lead for the development of cadmium cytotoxic agents capable of improving antitumor activity in cisplatin-resistant tumors.

[Approximation to cost analysis of various types of hemodialysis using relative value units]. / Aproximación al análisis de costes de diferentes tipos de hemodiálisis mediante unidades relativas de valor (URV).

Hemodialysis sessions performed in Hospital Units have a different degree of complexity depending on the kind of patients who is receiving this treatment. This paper's aim is to apply certain weighting factors, which measure the complexity of each type of session performed, and so allow a more realistic comparison with hemodialysis sessions performed in dialysis Units. The various costs of the Castellón General Hospital Dialysis Unit were calculated. Five types of Hospital-performed sessions were defined, to which were applied concrete weighting factors called Relative Value Units (RVU). These took account of health professionals' time, disposable material and drug expenses. The cost of single hemodialysis session, before the RVU calculation was added, was 28,549 pesetas (171.58 Eu.). Thirty-two per cent of the cost was from disposable material, 29.38% for cost of health professionals time, 18.54% for structural costs, 13.4% for drug expenses, and 5.73% for the nephrologists' time. When RVU were applied, the Type I session cost (chronic renal failure patients on regular hemodialysis), was 28,882 pesetas (149.54 Eu.). As the complexity of the procedure increased, up to the Type V session (acute renal failure patients in intensive Care Units), the costs also rose to 68,448 pesetas (411.38 Eu.). We conclude that weighing the different types of hemodialysis sessions by means of RVU, allows a better measurement of the costs and achieves a more accurate comparison with others hemodialysis units.

Aproximación al análisis de costes de diferentes tipos de hemodiálisis mediante unidades relativas de valor (URV) / Hemodialysis costs analysis calculated by relative value units

Las sesiones de hemodiálisis realizadas en las unidades hospitalarias presentan un distinto grado de complejidad en función del tipo de paciente que reciba este tratamiento. El objetivo de este estudio es aplicar unos factores de ponderación que sean capaces de discriminar la distinta complejidad de cada tipo de sesión realizada, y así lograr una aproximación más real con las sesiones realizadas entre las distintas unidades. Se han analizado los distintos costes de la unidad de hemodiálisis del Hospital General de Castellón y se han definido 5 tipos de sesiones realizadas en el hospital, a las que se aplicaron unos factores de ponderación denominados Unidades Relativas de Valor (URV), en función de los tiempos de dedicación del personal sanitario, el gasto en material fungible y en farmacia. Los costes por sesión de hemodiálisis antes de la aplicación de las URV fue de 28.549 ptas. El 32` por ciento correspondió a material fungible, el 29,38 por ciento a personal sanitario, el 18,54 por ciento a costes estructurales, el 13,4 por ciento a gastos de farmacia y el 5,73 por ciento a personal facultativo. Al aplicar las URV, los costes de la sesión tipo 1 (crónicos en programa) fue de 24.882 ptas. Los costes se incrementan progresivamente a medida que aumenta la complejidad de las sesiones hasta las sesiones tipo V (pacientes agudos en U.C.I.) cuyo coste fine de 68.448 ptas. Concluimos que la ponderación de los distintos tipos de sesiones mediante URV permite una mejor valoración de los costes y logra una mejor comparación de los distintos tipos de sesiones realizadas en las unidades de hemodiálisis hospitalarias (AU)