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1.
Medicine (Baltimore) ; 99(31): e21460, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756167

RESUMO

Volume status is a key parameter for cardiovascular-related mortality in dialysis patients. Although N-terminal pro-B-type natriuretic peptide (NT-proBNP), myeloperoxidase, copeptin, and pro-adrenomedullin have been reported as volume markers, the relationship between body fluid status and volume markers in dialysis patients is uncertain. Therefore, we investigated the utility of volume status biomarkers based on body composition monitor (BCM) analyses.We enrolled pre-dialysis, hemodialysis (HD), and peritoneal dialysis (PD) patients and age- and gender-matched healthy Korean individuals (N = 80). BCM and transthoracic echocardiography were performed and NT-proBNP, myeloperoxidase, copeptin, and pro-adrenomedullin concentrations were measured. Relative hydration status (ΔHS, %) was defined in terms of the hydration status-to-extracellular water ratio with a cutoff of 15%, and hyperhydrated status was defined as ΔHS > 15%.Although there were no significant differences in total body water, extracellular water, or intracellular water among groups, mean amount of volume overload and hyperhydrated status were significantly higher in HD and PD patients compared with control and pre-dialysis patients. Mean amount of volume overload and hyperhydrated status were also significantly associated with higher NT-proBNP and pro-adrenomedullin levels in HD and PD patients, although not with myeloperoxidase or copeptin levels. Furthermore, they were significantly associated with cardiac markers (left ventricular mass index, ejection fraction, and left atrial diameter) in HD and PD patients compared with those in the control and pre-dialysis groups.On the basis of increased plasma NT-proBNP and pro-adrenomedullin concentrations, we might be able to make predictions regarding the volume overload status of dialysis patients, and thereby reduce cardiovascular-related mortality through appropriate early volume control.


Assuntos
Biomarcadores/sangue , Líquidos Corporais/metabolismo , Doenças Cardiovasculares/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia , Adrenomedulina/sangue , Adulto , Composição Corporal/fisiologia , Doenças Cardiovasculares/diagnóstico por imagem , Estudos de Casos e Controles , Diálise/métodos , Diálise/tendências , Ecocardiografia/métodos , Feminino , Glicopeptídeos/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Diálise Peritoneal/estatística & dados numéricos , Peroxidase/sangue , Precursores de Proteínas/sangue , Diálise Renal/estatística & dados numéricos , República da Coreia/epidemiologia , Volume Sistólico , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem
3.
Chemosphere ; 248: 126027, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32032875

RESUMO

In this study, an activation treatment for recycled anion exchange membranes is proposed. Following the circular economy approach, these membranes were prepared by using end-of-life reverse osmosis membranes as mechanical support. The end-of-life membrane was previously used and discarded by desalination plants after overcoming its lifespan. The activation treatment was based on the subsequent immersion of the membranes in diluted acid and alkali solutions. This treatment promoted the complete dissociation of the functional groups in the membrane, making them more reactive to the counter ions. The effects of acid and alkali concentrations and exposition times on the electrochemical properties were studied and the best combination was selected. In such a way, a decrease of 37% in membrane electrical resistance was achieved. The performance of activated and non-activated membranes in brackish water desalination by electrodialysis was compared. The results showed that the proposed activation treatment increased the flux of fresh water more than four-fold (from 1.2 to 4.9 L h-1·m-2), with a considerable reduction of energy consumption (from 5.2 to 3.0 kWh·m-3) and a great improvement in current efficiency (from 38% to 71%). In conclusion, this work shows a simple and low cost methodology for the improvement of the electrochemical properties of recycled electromembranes and thus, their performance in electrodialysis.


Assuntos
Diálise/métodos , Purificação da Água/instrumentação , Diálise/instrumentação , Filtração/instrumentação , Água Doce , Concentração de Íons de Hidrogênio , Membranas Artificiais , Reciclagem , Purificação da Água/métodos
4.
J Sci Food Agric ; 100(1): 168-176, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31471909

RESUMO

BACKGROUND: Removing excessive naturally occurring fluoride from tea and/or infusions is difficult because the process has low efficiency and causes secondary pollution. In this study, a novel electrodialysis (ED) technology was developed. We examined the effect of crucial parameters (electrolyte concentration, operation voltage, ED duration and initial concentration of the tea infusion) on defluoridation performance using a highly efficient ion-exchange membrane with five-compartment cells. RESULTS: The most effective ED system results were obtained at an electrolyte concentration of 10 g kg-1 and operating voltage of 20 V. Moreover, the fluoride removal capacity (10.70-66.93%) was highly dependent on the ED duration (1-15 min) and initial concentration of the tea infusion (0.5-10 g kg-1 ). The longer the ED duration and the lower the initial concentration, the higher was the defluoridation performance. During ED, limited loss of the main inclusions (total polyphenols, catechins, caffeine and selected ions) was observed. Furthermore, the D201 anion resin-filled ED stack (0.5-5 g) and improvement of concentrate compartment electrolyte (≥5 times the dilute compartment electrolyte) in the ED system enhanced the defluoridation rate significantly. CONCLUSION: ED is a potentially effective method that can be used for defluoridation in the deep processing of tea products. © 2019 Society of Chemical Industry.


Assuntos
Diálise/métodos , Fluoretos/química , Manipulação de Alimentos/métodos , Chá/química , Diálise/instrumentação , Fluoretos/isolamento & purificação , Manipulação de Alimentos/instrumentação
5.
Crit Care ; 23(1): 389, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791373

RESUMO

BACKGROUND: Intradialytic hypotension, a complication of intermittent hemodialysis, decreases the efficacy of dialysis and increases long-term mortality. This study was aimed to determine whether different predialysis ultrasound cardiopulmonary profiles could predict intradialytic hypotension. METHODS: This prospective observational single-center study was performed in 248 critically ill patients with acute kidney injury undergoing intermittent hemodialysis. Immediately before hemodialysis, vena cava collapsibility was measured by vena cava ultrasound and pulmonary congestion by lung ultrasound. Factors predicting intradialytic hypotension were identified by multiple logistic regression analysis. RESULTS: Intradialytic hypotension was observed in 31.9% (n = 79) of the patients, interruption of dialysis because of intradialytic hypotension occurred in 6.8% (n = 31) of the sessions, and overall 28-day mortality was 20.1% (n = 50). Patients were classified in four ultrasound profiles: (A) 108 with B lines > 14 and vena cava collapsibility > 11.5 mm m-2, (B) 38 with B lines < 14 and vena cava collapsibility ≤ 11.5 mm m-2, (C) 36 with B lines > 14 and vena cava collapsibility Di ≤ 11.5 mm m-2, and (D) 66 with B lines < 14 and vena cava collapsibility > 11.5 mm m-2. There was an increased risk of intradialytic hypotension in patients receiving norepinephrine (odds ratios = 15, p = 0.001) and with profiles B (odds ratios = 12, p = 0.001) and C (odds ratios = 17, p = 0.001). CONCLUSION: In critically ill patients on intermittent hemodialysis, the absence of hypervolemia as assessed by lung and vena cava ultrasound predisposes to intradialytic hypotension and suggests alternative techniques of hemodialysis to provide better hemodynamic stability.


Assuntos
Diálise/efeitos adversos , Hipotensão/etiologia , Ultrassonografia/classificação , APACHE , Lesão Renal Aguda/terapia , Idoso , Diálise/métodos , Feminino , Humanos , Hipotensão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Estudos Prospectivos , Estatísticas não Paramétricas , Ultrassonografia/métodos
6.
Pak J Pharm Sci ; 32(4): 1563-1570, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31608875

RESUMO

Herbal remedies like the Thymus serpyllum L. is useful in traditional medicine for the treatment of many diseases especially congestion, and bronchitis. The purpose of this study was to formulate a micro-emulsion, a gel and an ointment containing the plant hydro distilled thymus oil extracted from Thymus serpyllum L. collected from Ziarat, Balochistan. The prepared formulations were subjected to in-vitro and ex vivo study release, High performance Liquid Chromatography (HPLC), Thin Layer Chromatography (TLC), to justify their suitability for topical use. The in-vitro and ex-Vivo release was studied using Franz Cells and using two different kinds of membrane synthetic dialysis cellulose membrane and natural rabbit skin and the amount of drug released was determined by HPLC at λ 274nm. The three formulations result obtained through dialysis cellulose membrane showed the faster release than the natural rabbit skin. However, the micro-emulsion, gel formulation showed the same release except ointment. The release from the above mentioned formulation can be arranged in the following descending order. micro-emulsion > Gel > Ointment. The best fit of release kinetics was achieved by Krosmeyer- Peppas, the TLC and HPLC identifies the Thymol, isolation and quantification of the marker. This study demonstrates that it is necessary to assess the impact of release and permeability pattern of different formulations. In vitro and ex-vivo diffusion cell experiments can be utilized to develop formulations of traditional medicines identifies.


Assuntos
Óleos Vegetais/administração & dosagem , Óleos Vegetais/farmacologia , Pele/efeitos dos fármacos , Thymus (Planta)/química , Administração Tópica , Animais , Celulose , Fracionamento Químico , Cromatografia Líquida de Alta Pressão , Cromatografia em Camada Delgada , Diálise/instrumentação , Diálise/métodos , Avaliação Pré-Clínica de Medicamentos/métodos , Liberação Controlada de Fármacos , Emulsões/química , Emulsões/farmacocinética , Géis/química , Géis/farmacocinética , Masculino , Membranas Artificiais , Permeabilidade , Óleos Vegetais/química , Óleos Vegetais/isolamento & purificação , Coelhos , Timol/análise , Timol/farmacocinética
7.
Nat Protoc ; 14(10): 2931-2953, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31534230

RESUMO

Carbon-based dots (CDs) and their functionalized (nano)composites have recently attracted attention due to their seemingly easy preparation and numerous potential applications, ranging from those in the biomedical field (i.e., imaging and drug delivery) to those in (opto)electronics (i.e., solar cells and LEDs). This protocol details step-by-step procedures for synthesis, purification, functionalization and characterization of nitrogen-doped carbon nanodots (NCNDs), which we have been preparing for the past few years. First, we describe the bottom-up synthesis of NCNDs, starting with the use of molecular precursors (arginine (Arg) and ethylenediamine (EDA)) and making use of microwave-assisted hydrothermal heating. We also provide guidelines for the purification of these materials, through either dialysis or low-pressure size-exclusion chromatography (SEC). Second, we outline post-functionalization procedures for the surface modification of NCNDs, such as alkylation and amidation reactions. Third, we provide instructions for the preparation of NCNDs with different properties, such as color emission, electrochemistry and chirality. Given the fast evolution of preparations and applications of CDs, issues that might arise from artifacts, errors and impurities should be avoided. In this context, the present protocol aims to provide details and guidelines for the synthesis of high-quality nanomaterials with high reproducibility, for various applications. Furthermore, specific needs might require the CDs to be prepared by different synthetic procedures and/or from different molecular precursors, but such CDs can still benefit from the purification and characterization procedures outlined in this protocol. The sample preparation takes various time frames, ranging from 4 to 18 d, depending on the adopted synthesis and purification steps.


Assuntos
Carbono/química , Nanotecnologia/métodos , Pontos Quânticos/química , Arginina/química , Diálise/métodos , Micro-Ondas , Nitrogênio/química , Controle de Qualidade
8.
Emerg Med J ; 36(11): 684-685, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31530584

RESUMO

OBJECTIVE: The purpose of this case series is to describe the application of a vascular closure button (VCB) for the repair of haemodialysis access bleeding. The VCB's main function is not to assist in bleeding control, but instead to provide easy access for removal of tightly placed sutures in the repair. METHODS: A retrospective review of patients undergoing ED repair of persistent bleeding from puncture sites in haemodialysis access conduits (HACs) using a VCB was conducted. Study patients were collected from ED visits to Our Lady of Lourdes Medical Center in Camden, New Jersey, USA, between May 2013 and August 2017. Patients were followed until the time of definitive repair of the underlying pathology or until the end of the study period. RESULTS: Seventeen VCBs were used to control persistent bleeding from HACs in the ED. Sixteen bleeds were the result of recent haemodialysis punctures, while one was from a bleeding site ulcer. All repairs were successful at controlling the bleeding with preserved HAC function in the ED and no delayed thrombosis. Follow-up time ranged from 1 day to 778 days. CONCLUSION: Vascular control buttons provide an effective means to control HAC postdialysis bleeding and allow for ease of suture removal without disruption of a repair with no long-term complications.


Assuntos
Diálise/efeitos adversos , Hemorragia/terapia , Dispositivos de Oclusão Vascular/normas , Idoso , Diálise/métodos , Desenho de Equipamento/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Jersey , Estudos Retrospectivos , Técnicas de Sutura , Resultado do Tratamento , Dispositivos de Oclusão Vascular/estatística & dados numéricos
9.
Int J Mol Sci ; 20(14)2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31340475

RESUMO

Electrodialysis (ED) with ion-exchange membranes is a promising method for the extraction of phosphates from municipal and other wastewater in order to obtain cheap mineral fertilizers. Phosphorus is transported through an anion-exchange membrane (AEM) by anions of phosphoric acid. However, which phosphoric acid anions carry the phosphorus in the membrane and the boundary solution, that is, the mechanism of phosphorus transport, is not yet clear. Some authors report an unexpectedly low current efficiency of this process and high energy consumption. In this paper, we report the partial currents of H2PO4-, HPO42-, and PO43- through Neosepta AMX and Fujifilm AEM Type X membranes, as well as the partial currents of H2PO4- and H+ ions through a depleted diffusion layer of a 0.02 M NaH2PO4 feed solution measured as functions of the applied potential difference across the membrane under study. It was shown that the fraction of the current transported by anions through AEMs depend on the total current density/potential difference. This was due to the fact that the pH of the internal solution in the membrane increases with the growing current due to the increasing concentration polarization (a lower electrolyte concentration at the membrane surface leads to higher pH shift in the membrane). The HPO42- ions contributed to the charge transfer even when a low current passed through the membrane; with an increasing current, the contribution of the HPO42- ions grew, and when the current was about 2.5 ilimLev (ilimLev was the theoretical limiting current density), the PO43- ions started to carry the charge through the membrane. However, in the feed solution, the pH was 4.6 and only H2PO4- ions were present. When H2PO4- ions entered the membrane, a part of them transformed into doubly and triply charged anions; the H+ ions were released in this transformation and returned to the depleted diffusion layer. Thus, the phosphorus total flux, jP (equal to the sum of the fluxes of all phosphorus-bearing species) was limited by the H2PO4- transport from the bulk of feed solution to the membrane surface. The value of jP was close to ilimLev/F (F is the Faraday constant). A slight excess of jP over ilimLev/F was observed, which is due to the electroconvection and exaltation effects. The visualization showed that electroconvection in the studied systems was essentially weaker than in systems with strong electrolytes, such as NaCl.


Assuntos
Técnicas Eletroquímicas , Ácidos Fosfóricos/isolamento & purificação , Águas Residuárias/química , Ânions , Diálise/métodos , Difusão , Humanos , Concentração de Íons de Hidrogênio , Troca Iônica , Cinética , Membranas Artificiais , Eletricidade Estática
10.
Medicina (Kaunas) ; 55(5)2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31137563

RESUMO

Background and Objectives: Anxiety-depression of patients undergoing hemodialysis has a strong relation with the levels of anxiety-depression of their caregivers. The aim of this study was to evaluate anxiety-depression of dialysis patients and their caregivers. Materials and Methods: In this cross-sectional study, 414 pairs of patients and caregivers from 24 hemodialysis centers of Greece completed the Hospital Anxiety and Depression Scale (HADS). The statistical analysis of the data was performed through the Statistical Program SPSS version 20.0. The statistical significance level was set up at 5%. Results: The mean age of patients was 64 (54.06-72.41) years old and the mean duration of hemodialysis was 36 (16-72) months. The mean age of caregivers was 54 (44-66) years old. Of the total sample, 17.1% (n = 71) of patients had high levels of anxiety and 12.3% (n = 51) had high levels of depression. Additionally, 27.8% (n = 115) of caregivers had high levels of anxiety and 11.4% (n = 47) had high levels of depression. Caregivers had higher levels of anxiety when their patients had high levels of anxiety as well (42.3%). Additionally, they had higher levels of depression when their patients had high levels of depression as well (17.6%). Conclusions: The results of this study showed a significant association between the levels of anxiety and depression among patients and caregivers. There is a necessity for individualized assessment of dialysis patients and their caregivers and the implementation of specific interventions for reducing the levels of anxiety and depression among them.


Assuntos
Ansiedade/diagnóstico , Cuidadores/psicologia , Depressão/diagnóstico , Idoso , Ansiedade/epidemiologia , Cuidadores/estatística & dados numéricos , Estudos Transversais , Depressão/epidemiologia , Diálise/métodos , Diálise/estatística & dados numéricos , Feminino , Grécia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Inquéritos e Questionários
11.
Crit Care Clin ; 35(3): 519-533, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076051

RESUMO

As more specialized care gets centralized in centers of excellence, patients admitted to rural hospitals may be at a disadvantage at the time of accessing expertise or receiving advanced care. In this setting, telemedicine models provide a justification to equalize care across different levels. The diversity in telemedicine services is vast and is expanding. Even with all the subsets of telemedicine, including telepharmacy, telestroke, teledialysis, and tele-emergency medicine, the reasons for providing services and associated limitations are similar. However, there is a lack of empirical research including best practices and resultant outcomes for these subsets of telemedicine models.


Assuntos
Diálise/métodos , Serviço Hospitalar de Emergência , Serviço de Farmácia Hospitalar , Acidente Vascular Cerebral/terapia , Telemedicina , Humanos , Serviço de Farmácia Hospitalar/métodos , Serviço de Farmácia Hospitalar/organização & administração , Telemedicina/métodos , Telemedicina/organização & administração
12.
Acta Biochim Pol ; 66(2): 167-172, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30986279

RESUMO

The present clinical trial investigates the sustaining anesthetic effect of Ropivacaine when administered as epidural injection followed by transdermal patch with and without Reverse electrodialysis (RED) system in order to maintain anesthesia in children. It also focuses on rate of release of drug in-vitro when administered with RED system. The transdermal patch of Ropivacaine was prepared using evaporation technique enclosing 25 mg of Local anesthetic Ropivacaine. Thus prepared patches were evaluated for physical parameters like folding endurance, tensile strength, in vitro drug release etc. The thicknesses of the patches were in the range of 0.02 ±0.006 to 0.04 ± 0.007 mm with 95.79 ±1.85 to 97.45±0.07 % drug content. The average weight and tensile strength was found to be 0.15±0.2 to 0.17±0.18 gm and 0.42±0.006 to 0.58±0.002 kg/cm2. The folding endurance of the patches was in range of 155.21 ±0.2 to 167± 0.29 and content of moisture was 1.43±0.23 % to 2.97±0.23 %. The formulation shows In - vitro release in Phosphate buffer pH 7.4 as 55.56 % to 89.23 ± 0.24 % in 24 hr with reverse electrodialysis system attached and 43.76 % to 81.23 ± 0.14 % in 24 hr without reverse electrodialysis system. The children of different age groups, different body weight with no premedication of anesthetic of analgesic were selected as subjects with written informed consent and divided into two groups depending upon RED system to be attached or not. The patches with and without RED system were attached to forearm of subjects and trial is run. The results obtained showed that patch when attached with reverse electrodialysis system showed greater potential for thermal threshold, lowering of cool sensation and depth of pain. Keywords: Child Anesthesia, Iontophoresis, Reverse Electrodialysis ,Ropivacaine, Transdermal Patch.


Assuntos
Anestésicos Locais/uso terapêutico , Sistemas de Liberação de Medicamentos/métodos , Iontoforese/métodos , Dor/tratamento farmacológico , Ropivacaina/uso terapêutico , Adesivo Transdérmico , Administração Cutânea , Anestésicos Locais/administração & dosagem , Animais , Criança , Pré-Escolar , Diálise/métodos , Composição de Medicamentos , Liberação Controlada de Fármacos , Feminino , Humanos , Masculino , Ropivacaina/administração & dosagem , Pele/efeitos dos fármacos , Suínos , Resultado do Tratamento
13.
J Steroid Biochem Mol Biol ; 190: 207-211, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30970279

RESUMO

Testosterone (T) is strongly bound to sex hormone binding globulin and measurement of free T may be more appropriate than measuring total serum T, according to the free hormone theory. This view remains controversial and it has its detractors who claim that little extra benefit is gained than simply measuring total T, but it is endorsed by recent clinical practice guidelines for investigation of androgen disorders in both men and women. Free T measurement is very challenging. The gold standard equilibrium dialysis methods are too complex for use in routine clinical laboratories, assays are not harmonized and consequently there are no common reference intervals to aid result interpretation. The algorithms derived for calculating free T are inaccurate because they were founded on faulty models of testosterone binding to SHBG, however they can still give clinically useful results. To negate the effects of differences in binding protein constants, some equations for free T have been derived from accurate measurement of testosterone in large population studies, however a criticism is that the equations may not hold true in different patient populations. The free androgen index is not recommended for use in men because of inaccuracy at extremes of SHBG concentration, and in women it can also give inaccurate results when SHBG concentrations are low. If the free hormone hypothesis is to be believed, then calculated free testosterone may offer the best way forward but better equations are needed to improve accuracy and these should be derived from detailed knowledge of testosterone binding to SHBG. There is still much work to be done to improve harmonization of T and SHBG assays between laboratories because these can have a profound effect on the equations used to calculate free testosterone.


Assuntos
Testosterona/análise , Algoritmos , Diálise/métodos , Feminino , Humanos , Masculino , Ligação Proteica , Saliva/química , Saliva/metabolismo , Globulina de Ligação a Hormônio Sexual/metabolismo , Testosterona/sangue , Testosterona/metabolismo
14.
Int J Mol Sci ; 20(8)2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-31003492

RESUMO

Electrodialysis (ED) is frequently used in the desalination of whey. However, the fouling onto the membrane surface decreases the electrodialysis efficiency. Pulsed Electrodialysis Reversal (PER), in which short pulses of reverse polarity are applied, is expected to decrease the fouling onto membrane surface during ED. Three (PER) regimes were applied in the desalination of acid whey (pH ≤ 5) to study their effects on the membrane fouling and the ED efficiency. The PER regimes were compared to the conventional ED as the control. For each regime, two consecutive runs were performed without any cleaning step in-between to intensify the fouling. After the second run, the membranes were subjected to the Scanning electron microscope (SEM) imaging and contact angle measurement to investigate the fouling on the membrane surface in different regimes. The ED parameters in the case of conventional ED were almost the same in the first and the second runs. However, the parameters related to the ED efficiency including ED capacity, ash transfer, and ED time, were deteriorated when the PER regimes were applied. The contact angle values indicated that the fouling on the diluate side of anion exchange membranes was more intensified in conventional ED compared to the PER regimes. The SEM images also showed that the fouling on the diluate side of both cation and anion exchange membranes under PER regimes was reduced in respect to the conventional ED. However, the back transfer to the diluate compartment when the reverse pulse was applied is dominant and lowers the ED efficiency slightly when the PER is applied.


Assuntos
Diálise/métodos , Sais/química , Soro do Leite/química , Soluções para Diálise/química , Eletroquímica , Membranas Artificiais , Microscopia Eletrônica de Varredura , Propriedades de Superfície
15.
Nefrología (Madrid) ; 39(2): 115-123, mar.-abr. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181318

RESUMO

La pica como entidad individual en el paciente con enfermedad renal crónica (ERC) no ha sido ampliamente estudiada, a pesar de que se ha reportado una alta prevalencia en esta población, y de que las complicaciones propias de la pica (anemia, alteración en electrolitos, mala absorción de micro y macronutrientes y desnutrición) podrían verse exacerbadas en la ERC, lo cual limitaría alcanzar una mejor calidad de la terapia de remplazo renal. La ingesta de sustancias no calóricas y no nutricionales podría ser perjudicial por los efectos en la saciedad y en el descontrol metabólico/electrolítico, y por afectar la biocompatibilidad de los micronutrientes, toxinas y patógenos, lo que finalmente puede empeorar el estado de salud. En la práctica diaria es posible que la pica resulte subreportada debido a la vergüenza del paciente a reconocerlo, o el miedo a que dicho comportamiento pueda influir en su tratamiento. Adicionalmente, los clínicos, al no investigar la presencia de pica o sus complicaciones contribuyen a la falta de información acerca de la magnitud y la relevancia de este trastorno de la conducta alimentaria en la ERC


Pica is an individual entity in the patient with chronic kidney disease (CKD), which phenomenon has not been widely studied despite the high reported prevalence. Moreover, pica complications (anemia, altered electrolytes, poor absorption of micro and macronutrients and malnutrition) could be exacerbated in CKD and limit the quality of renal replacement therapy. The intake of non-caloric and non-nutritional substances could be harmful and cause effects on satiety and metabolic / electrolyte imbalance and modify the biocompatibility of micronutrients, toxins and pathogens worsening health status. In daily practice, pica could be under-reported because patient's shame to recognize it, or fear that such behavior influences their treatment. Additionally, clinicians who not investigate the presence of pica or its complications contribute to the lack of information about the magnitude and relevance of this problem in CKD


Assuntos
Humanos , Insuficiência Renal Crônica/dietoterapia , Comportamento Alimentar , Pica/epidemiologia , Nutrição de Grupos de Risco , Nível de Saúde , Diálise/métodos , Pica/diagnóstico , Pica/terapia , Eletrólitos , Micronutrientes
16.
Nat Protoc ; 14(4): 1130-1168, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30903110

RESUMO

Among the different developed solid-state nanopores, nanopores constructed in a monolayer of molybdenum disulfide (MoS2) stand out as powerful devices for single-molecule analysis or osmotic power generation. Because the ionic current through a nanopore is inversely proportional to the thickness of the pore, ultrathin membranes have the advantage of providing relatively high ionic currents at very small pore sizes. This increases the signal generated during translocation of biomolecules and improves the nanopores' efficiency when used for desalination or reverse electrodialysis applications. The atomic thickness of MoS2 nanopores approaches the inter-base distance of DNA, creating a potential candidate for DNA sequencing. In terms of geometry, MoS2 nanopores have a well-defined vertical profile due to their atomic thickness, which eliminates any unwanted effects associated with uneven pore profiles observed in other materials. This protocol details all the necessary procedures for the fabrication of solid-state devices. We discuss different methods for transfer of monolayer MoS2, different approaches for the creation of nanopores, their applicability in detecting DNA translocations and the analysis of translocation data through open-source programming packages. We present anticipated results through the application of our nanopores in DNA translocations and osmotic power generation. The procedure comprises four parts: fabrication of devices (2-3 d), transfer of MoS2 and cleaning procedure (24 h), the creation of nanopores within MoS2 (30 min) and performing DNA translocations (2-3 h). We anticipate that our protocol will enable large-scale manufacturing of single-molecule-analysis devices as well as next-generation DNA sequencing.


Assuntos
Dissulfetos/química , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Microtecnologia/métodos , Molibdênio/química , Nanoporos/ultraestrutura , Nanotecnologia/métodos , DNA/análise , DNA/genética , Diálise/instrumentação , Diálise/métodos , Sequenciamento de Nucleotídeos em Larga Escala/instrumentação , Humanos , Microtecnologia/instrumentação , Nanotecnologia/instrumentação , Imagem Individual de Molécula/instrumentação , Imagem Individual de Molécula/métodos
17.
J Ren Care ; 45(1): 59-67, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30784228

RESUMO

BACKGROUND: Caring for patients with diabetes undergoing dialysis often proves challenging for staff working in haemodialysis units as they are not experts in diabetes and unfamiliar with insulin dosing regimens and the impact dialysis can have on blood sugar levels and lifestyle adjustment. There is a need to improve the knowledge base of renal healthcare professionals to better understand the physiology of diabetes, its relationship with end stage kidney disease, and potential changes that can take place when commencing dialysis. OBJECTIVES: The aim of this paper is to improve the understanding of the epidemiology of diabetes, associated risk factors, and complications associated with combined kidney disease & diabetes. In addition, readers will learn about the impact of dialysis on this complex patient group; adjustments which need to be made to accommodate haemodialysis schedules e.g. timing of meals and insulin requirements; treatment time including travel; the monitoring of blood glucose levels: increased risk of hypoglycaemia; review of oral glycaemic medication and the need to maintain regular health checks and contact with diabetes teams. RECOMMENDATIONS FOR PRACTICE: Specialist evidence based guidelines for the management of patients with diabetes receiving haemodialysis are readily available and can be used to support clinical practice. One of the key components to improving the patient experience is to maintain collaborative working relationship between renal and diabetes teams. LEARNING OUTCOMES: After reading this paper the reader will be able to Understand the risk factors and complications of diabetes and relate to patients in their care Critically review the management of patients undergoing dialysis with diabetes Gain knowledge and understanding of changes in the dosing of insulin needed for patients receiving dialysis Understand how clinical guidelines can be applied in practice.


Assuntos
Complicações do Diabetes/terapia , Diálise/normas , Administração dos Cuidados ao Paciente/métodos , Anemia/etiologia , Anemia/terapia , Glicemia/análise , Diabetes Mellitus/tratamento farmacológico , Diálise/métodos , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/administração & dosagem , Insulina/uso terapêutico , Fatores de Risco
18.
Int J Mol Sci ; 20(4)2019 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-30781748

RESUMO

The drying of acid whey is hindered by its high mineral and organic acid contents, and their removal is performed industrially through expensive and environmentally impacting serial processes. Previous works demonstrated the ability to remove these elements by electrodialysis alone but with a major concern-membrane scaling. In this study, two conditions of pulsed electric field (PEF) were tested and compared to conventional DC current condition to evaluate the potential of PEF to mitigate membrane scaling and to affect lactic acid and salt removals. The application of a PEF 25 s/25 s pulse/pause combination at an initial under-limiting current density allowed for decreasing the amount of scaling, the final system electrical resistance by 32%, and the relative energy consumption up to 33%. The use of pulsed current also enabled better lactic acid removal than the DC condition by 10% and 16% for PEF 50 s/10 s and 25 s/25 s, respectively. These results would be due to two mechanisms: (1) the mitigation of concentration polarization phenomenon and (2) the rinsing of the membranes during the pause periods. To the best of our knowledge, this was the first time that PEF current conditions were used on acid whey to both demineralize and deacidify it.


Assuntos
Diálise/métodos , Eletricidade , Ácido Láctico/isolamento & purificação , Minerais/isolamento & purificação , Soro do Leite/química , Cálcio/análise , Condutividade Elétrica , Concentração de Íons de Hidrogênio , Resinas de Troca Iônica , Proteínas/análise , Soluções , Espectrometria por Raios X , Termodinâmica , Difração de Raios X
19.
PLoS One ; 14(1): e0209578, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30650094

RESUMO

BACKGROUND: Patients with chronic kidney disease (CKD), a precursor of end stage renal disease (ESRD), face an increasing burden of hospitalizations. Although mortality on dialysis is highest during the first year, the impact of pre-dialysis acute hospitalizations on clinical outcomes in dialysis patients remains unknown. METHODS: We evaluated 170,897 adult patients who initiated dialysis between 1/1/2010 and 12/31/2014 with linked Medicare claims from the United States Renal Data System. Using logistic regression models, we examined the association of 2-year pre-dialysis hospitalization on the primary outcome of 1-year all-cause mortality. Secondary outcomes included 90-day mortality, type of initial dialysis modality and type of vascular access at hemodialysis initiation. RESULTS: Mean age was 72.7 ± 11.0 years. In the study sample, 76.0% of patients had at least one pre-dialysis hospitalization. Compared to patients with no pre-dialysis hospitalization, the adjusted 1-year mortality was higher with pre-dialysis cardiovascular related hospitalization (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.57-1.68), infection related hospitalization (OR, 1.51; CI, 1.45-1.57), both cardiovascular and infection hospitalization (OR, 1.91; CI, 1.83-1.99), and neither-cardiovascular nor-infection hospitalization (OR, 1.23; CI, 1.19-1.27). Additionally, the adjusted odds of hemodialysis vs. peritoneal dialysis as the initial dialysis modality were higher, whereas adjusted odds to initiate hemodialysis with an arteriovenous access vs. central venous catheter were lower in patients with any type of hospitalization. CONCLUSION: Pre-dialysis hospitalization is an independent predictor of 1-year mortality in dialysis patients. Reducing the risk of pre-dialysis hospitalization may provide opportunities to improve quality of care in ESRD.


Assuntos
Diálise/métodos , Falência Renal Crônica/terapia , Diálise Renal/métodos , Insuficiência Renal Crônica/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diálise/efeitos adversos , Feminino , Hospitalização , Humanos , Falência Renal Crônica/mortalidade , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Análise de Regressão , Diálise Renal/mortalidade , Insuficiência Renal Crônica/mortalidade , Estudos Retrospectivos , Estados Unidos
20.
J Ren Care ; 45(1): 9-19, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30648345

RESUMO

INTRODUCTION: End-stage kidney disease (ESKD) is characterised by several complications, leading to reduced functional ability and quality of life during transition to dialysis. This study aimed to establish the feasibility and effectiveness of a patient-centred programme of exercise, nutritional intervention and multidisciplinary education for persons approaching dialysis. METHODS: Patients with eGFR <15 ml/min/1.73 m2 and anticipated to start dialysis within 6-12 months were invited to participate. The 10-week pre-dialysis intervention included a weekly 1-hour gym-based exercise circuit and an education programme. Feasibility and acceptability were assessed through recruitment and retention rates, adherence to the intervention, and from patient feedback following the intervention. Physical function, nutritional status, and anxiety and depression, were assessed at baseline, after intervention, and as dialysis commenced. RESULTS: Thirty patients agreed to participate, with 22 completing the pre-dialysis intervention. Thirteen (59%) participants achieved 100% attendance at the exercise and education sessions, with only two participants attending less than 8/10 sessions. The intervention also led to improved physical function, demonstrated by significant increase in both incremental shuttle walk distance (330 vs. 385 m, p = 0.006) and quadriceps one repetition maximum (p = 0.007), and a trend towards increased sit-to-stand repetitions (20-23, p = 0.11). There was a trend for improved patient perception of activity (Duke Activity Status Index score 31.55 vs. 33.75, p = 0.09). Hand grip strength (29.1 vs. 29.8 kg), body mass index (30.4 vs. 30.5 kg/m2 ) and nutritional status assessed by subjective global assessment (73% well-nourished) were maintained. CONCLUSION: This study demonstrated the feasibility and effectiveness of a patient-centred exercise and education programme in those approaching dialysis. Further research is therefore required to evaluate the impact of this programme on clinical outcomes.


Assuntos
Diálise/métodos , Falência Renal Crônica/reabilitação , Adulto , Índice de Massa Corporal , Terapia por Exercício/métodos , Feminino , Força da Mão , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Educação de Pacientes como Assunto/métodos , Qualidade de Vida/psicologia
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