Survival advantage of initiating dialysis in elderly and non-elderly incident end-stage kidney disease patients.

AIM: Many patients, especially the elderly, who require renal replacement therapies (RRT) have delayed or rejected dialysis for various reasons. Current dialysis guidelines may not be relevant for the elderly or frail patients. We aim to determine survival advantage of initiating dialysis in patients deemed to require RRT. METHODS: This was an observational cohort on incident end-stage kidney disease (ESKD) patients from January 1, 2007 to December 31, 2008. The primary outcome was all-cause mortality. Patients contributed person-time from the date of ESKD diagnosis until death, transplant or end of study on December 31, 2014, whichever occurred first. An extended Cox regression model with time-varying exposure to dialysis was used to account for immortal time bias. RESULTS: Of 3990 incident ESKD patients included, 70.2% patients initiated dialysis; 78.8% with haemodialysis (HD) while the remaining 21.2% with peritoneal dialysis (PD). Dialysis reduced hazard of death in both elderly and non-elderly patients even after controlling for comorbidities (hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.50, 0.68 and HR 0.76, 95% CI 0.69, 0.85, respectively). HD was protective in both the elderly and non-elderly (HR 0.53, 95% CI 0.45, 0.63 and HR 0.71, 95% CI 0.64, 0.80, respectively). PD significantly reduced risk of death compared to no dialysis in the elderly but not in the non-elderly. CONCLUSION: Dialysis improved survival in all incident ESKD patients. The findings suggested a larger protection offered by HD. Although improvement in survival from initiating dialysis was large, its true benefit should take overall quality of life into account. SUMMARY AT A GLANCE This observational study showed that initiation of dialysis improves the survival of end-stage kidney disease (ESKD) patients of all age groups, but the quality of life is an important aspect that has not been explored.

Insights into the Survival Capabilities of Cryomyces antarcticus Hydrated Colonies after Exposure to Fe Particle Radiation.

The modern concept of the evolution of Mars assumes that life could potentially have originated on the planet Mars, possibly during the end of the late heavy bombardment, and could then be transferred to other planets. Since then, physical and chemical conditions on Mars changed and now strongly limit the presence of terrestrial-like life forms. These adverse conditions include scarcity of liquid water (although brine solutions may exist), low temperature and atmospheric pressure, and cosmic radiation. Ionizing radiation is very important among these life-constraining factors because it damages DNA and other cellular components, particularly in liquid conditions where radiation-induced reactive oxidants diffuse freely. Here, we investigated the impact of high doses (up to 2 kGy) of densely-ionizing (197.6 keV/µm), space-relevant iron ions (corresponding on the irradiation that reach the uppermost layer of the Mars subsurface) on the survival of an extremophilic terrestrial organism-Cryomyces antarcticus-in liquid medium and under atmospheric conditions, through different techniques. Results showed that it survived in a metabolically active state when subjected to high doses of Fe ions and was able to repair eventual DNA damages. It implies that some terrestrial life forms can withstand prolonged exposure to space-relevant ion radiation.

Glycinergic and GABAergic synaptic activity differentially regulate motoneuron survival and skeletal muscle innervation.

GABAergic and glycinergic synaptic transmission is proposed to promote the maturation and refinement of the developing CNS. Here we provide morphological and functional evidence that glycinergic and GABAergic synapses control motoneuron development in a region-specific manner during programmed cell death. In gephyrin-deficient mice that lack all postsynaptic glycine receptor and some GABA(A) receptor clusters, there was increased spontaneous respiratory motor activity, reduced respiratory motoneuron survival, and decreased innervation of the diaphragm. In contrast, limb-innervating motoneurons showed decreased spontaneous activity, increased survival, and increased innervation of their target muscles. Both GABA and glycine increased limb-innervating motoneuron activity and decreased respiratory motoneuron activity in wild-type mice, but only glycine responses were abolished in gephyrin-deficient mice. Our results provide genetic evidence that the development of glycinergic and GABAergic synaptic inputs onto motoneurons plays an important role in the survival, axonal branching, and spontaneous activity of motoneurons in developing mammalian embryos.

Stability of Tylosin A in manure containing test systems determined by high performance liquid chromatography.

Tylosin is a widely used antibiotic for the treatment of infections in swine. Tylosin consists of a mixture of Tylosin A, Tylosin B, Tylosin C and Tylosin D. All components contribute to the potency of tylosin but Tylosin A is by far the major component (usually about 90% and not less than 80%). A fast, robust and easily performed HPLC method has been developed for determination of Tylosin A in the presence of tylosin residues; Tylosin B, Tylosin C and Tylosin D in manure containing incubation media. The separation was performed using a YMC-Pack ODS-AQ column (250 x 4.6 mm i.d., 5 microns particle size) operated at 35 degrees C. The mobile phase consisted of 2.25% (w/v) sodium perchlorate pH 2.5-acetonitrile (60:40 v/v). Detection was performed by measuring the UV absorption at a wavelength of 290 nm. Calibration curves of tylosin made in the incubation medium containing 6.4% manure were linear in the range from 0.375 to 128.0 mg/l (R2 = 0.999). The limit of quantitation (at the RSD 20% level) for Tylosin A was found to be 0.4 mg/l in incubation media containing 6.4% manure. The recovery of Tylosin A was in the range from 100% to 108% depending on the concentration of manure. The reproducibility was good as the relative standard deviation (n = 4) in each matrix tested was in the range from 0.7 to 1.9 at the 25 mg/l level. The stability of Tylosin A was studied under methanogenic conditions and the half-life was found to be less than two days. Studies under aerobic conditions showed that the degradation rate was found to increase with increasing concentrations of manure particles in the incubation medium. It is, however, not clear whether the decrease in the concentration of Tylosin A is caused by sorption, abiotic or biotic chemical degradation. The major degradation product of Tylosin A in methanogenic as well as aerobic incubation media has a UV-spectrum and a retention time corresponding to Tylosin B. Furthermore, Tylosin D is believed to be a minor degradation product.

Primary biodegradation of veterinary antibiotics in aerobic and anaerobic surface water simulation systems.

The primary aerobic and anaerobic biodegradability at intermediate concentrations (50-5000 microg/l) of the antibiotics olaquindox (OLA), metronidazole (MET), tylosin (TYL) and oxytetracycline (OTC) was studied in a simple shake flask system simulating the conditions in surface waters. The purpose of the study was to provide rate data for primary biodegradation in the scenario where antibiotics pollute surface waters as a result of run-off from arable land. The source of antibiotics may be application of manure as fertilizer or excreta of grazing animals. Assuming first-order degradation kinetics, ranges of half-lives for aerobic degradation of the four antibiotics studied were 4-8 days (OLA), 9.5-40 days (TYL), 14-104 days (MET) and 42-46 days (OTC). OLA and OTC were degraded with no initial lag phase whereas lag phases from 2 to 34 days (MET) and 31 to 40 days (TYL) were observed for other substances. The biodegradation behaviour was influenced by neither the concentrations of antibiotics nor the time of the year and location for sampling of surface water. Addition of 1 g/l of sediment or 3 mg/l of activated sludge from wastewater treatment increased the biodegradation potential which is believed to be the result of increased bacterial concentration in the test solution. Biodegradation was significantly slower in tests conducted in absence of oxygen. Assessments of the toxic properties of antibiotics by studying the influence on the biodegradation rates of 14C-aniline at different concentrations of antibiotics showed that no tests were conducted at toxic concentrations.

New concepts in lower limb orthotics.

Lower limb orthotics is in the process of a default transformation because of its association with lower limb prosthetics, a mechanical discipline that has translated component and material innovations into balance and velocity function gains to achieve a level of ambulation not possible a generation ago. This article discusses the fundamental mechanical similarities and differences of lower limb orthotics to prosthetics and their application to orthoses designed to improve the gait outcome of patients requiring orthotic intervention.

Noninvasive monitoring of DNAPL migration through a saturated porous medium using electrical impedance tomography.

Electrical impedance tomography (EIT) was used to monitor the movement of a fluorinated hydrocarbon dense nonaqueous phase liquid (DNAPL) through a saturated porous medium within a laboratory column. Impedance measurements were made using a horizontal plane of 12 electrodes positioned at regular intervals around the centre of the column. A 2D inversion algorithm, which incorporated the cylindrical geometry of the column, was used to reconstruct resistivity and phase images from the measured data. Differential time-lapse images of DNAPL movement past the plane of electrodes were generated by the cell-by-cell subtraction of resistivity and phase baseline models from those associated with the DNAPL release stage of the experiment. The DNAPL pulse was clearly delineated as resistive anomalies in the differential time-lapse resistivity images. The spatial extent of the resistive anomalies indicated that in addition to vertical migration, some lateral spreading of the DNAPL had occurred. Residual contamination could be detected after quasi-static conditions were reestablished. Residual DNAPL saturation was estimated from the resistivity model data by applying Archie's second equation.Despite significant measured phase changes due to DNAPL contamination, the differential phase images revealed only weak anomalies associated with DNAPL flow; these anomalies could be seen only in the initial stages of the experiment during peak flow through the plane of electrodes.

[When is surgical correction of the terminal ileum during appendectomy indicated?]. / Mikor válik szükségessé appendectomia során a terminalis vékonybélmegtöretés felszabadítása?

During 1416 appendectomy operations we examined the ileum and found 42 cases of terminal ileum infraction (ileum terminale duplex) caused by the cicatrisation of the mesenterium. Nine of the forty-two had characteristic symptoms of terminal ileum infraction syndrome (stomachodynia and pain in the right lower part of the abdomen 4 or 5 hours after meals, distensions). Deliberation was performed in this cases at the time of the appendectomy operations. Following the operations they had no symptoms. When the infraction is severe or the patient has typical complaints of terminal ileum infraction syndrome necessitates the deliberation of the terminal ileum in our opinion.

[The place of micro- and modern mini-laparotomy in the management of biliary calculi]. / Micro- és modern mini-laparotomia helye az epekövesség mütéti kezelésében.

The authors treated 537 patients biliary stone disease between 1-st january 1991. and 1-st june 1994. With the conventional method of 20 cm of the subcostal incision, they operated 250 patients, among them 17 (6.8%) also had the common bile duct stone. There was no case of mortality and common bile duct injury. The postoperative morbidity was 12.8%. The average days of treatment was 9. With micro- and modern mini-laparotomy 287 cases were operated, 16 (5.5%) of them had common bile duct stones which were extracted during the process of cholecystectomy. In one case transduodenal sphincterectomy was performed. There was no case of mortality and injury of common bile duct. The postoperative morbidity was 10.4%. There was 6 cases of conversion (2.09%). The average period of treatment was 5 days. The treatment of biliary stone disease by micro- or modern minilaparotomy does not cause more danger to the patients than the conventional subcostal method. This approach is suitable for the surgical treatment of all kinds of biliary stone disease. This method is also suitable to extract a stone (stones) from the common bile duct discovered during cholecystectomy. This method has a pleasant cosmetical results.

[Correlation of the length of the preoperative period and the severity of appendicitis]. / A praeoperativ idöszak hossza és az appendicitis súlyossága közötti összefüggésröl.

1364 appendectomy were performed by the authors in two hospitals (1976 to 1982 in City Hospital Nagyatád and 1983 to 1988 in Hungarian State Railways Hospital Szolnok). Patients were divided into groups according to degree of inflammation of appendix. Length of the elapsed time from the appearance of first symptoms to operation and degree of inflammation of the appendix were fixed. It is found that time-factor did not appear to be the most important determinant of degree of inflammation in a certain part of cases.

Hydrogeophysical imaging of deposit heterogeneity and groundwater chemistry changes during DNAPL source zone bioremediation.

Robust characterization and monitoring of dense nonaqueous phase liquid (DNAPL) source zones is essential for designing effective remediation strategies, and for assessing the efficacy of treatment. In this study high-resolution cross-hole electrical resistivity tomography (ERT) was evaluated as a means of monitoring a field-scale in-situ bioremediation experiment, in which emulsified vegetable oil (EVO) electron donor was injected into a trichloroethene source zone. Baseline ERT scans delineated the geometry of the interface between the contaminated alluvial aquifer and the underlying mudstone bedrock, and also the extent of drilling-induced physical heterogeneity. Time-lapse ERT images revealed major preferential flow pathways in the source and plume zones, which were corroborated by multiple lines of evidence, including geochemical monitoring and hydraulic testing using high density multilevel sampler arrays within the geophysical imaging planes. These pathways were shown to control the spatial distribution of the injected EVO, and a bicarbonate buffer introduced into the cell for pH control. Resistivity signatures were observed within the preferential flow pathways that were consistent with elevated chloride levels, providing tentative evidence from ERT of the biodegradation of chlorinated solvents.

The Lichtenstein open tension-free hernioplasty.

In the department of general surgery, in Szolnok MAV General Hospital the authors performed 51 open tension-free herniorrhaphies by Lichtenstein method between 1st July 1995 and 31st December 1996. According to this method the rings are closed anteriorly with Dacron mesh. The method is simple and rapid, less painful than any other technique. Apart from two minor complications, our patients recovered without any problem. The method helps to reduce the period of hospital treatment as well as that of sick-leave.