Meta-analysis: antibiotics for prophylaxis against hemodialysis catheter-related infections.

Background: Catheter-related infections cause morbidity and mortality in patients undergoing hemodialysis.

Purpose: To examine whether topical or intraluminal antibiotics reduce catheter-related bloodstream infection compared with no antibiotic therapy in adults undergoing hemodialysis.

Data Sources: Electronic databases, trial registries, bibliographies, and conference proceedings up to October 2007, with no language restrictions.

Citrate 4% versus heparin and the reduction of thrombosis study (CHARTS).

Background And Objectives: Citrate 4% has antithrombotic and antibacterial properties, which makes it a potentially superior alternative to heparin as an indwelling intraluminal locking agent.

Design, Setting, Participants, And Measurements: Sixty-one prevalent hemodialysis (HD) patients dialyzing with a tunneled cuffed HD catheter were randomized in a pilot study to receive either heparin 5000 U/ml or citrate 4% as a locking agent after HD. The primary outcomes were the development of catheter dysfunction (defined as a blood pump speed <250 ml/min or the use of tissue plasminogen activator) and catheter-associated bacteremia.

Comorbidities do not influence primary fistula success in incident hemodialysis patients: a prospective study.

Background And Objectives: Concern about primary fistula failure may contribute to the underuse of arteriovenous fistula. The objective of this study was to investigate the baseline clinical parameters associated with primary fistula success.

Design, Setting, Participants, & Measurements: Consecutive incident patients who commenced dialysis during a 28-mo period in a regional renal program were studied.

Surface plasmon resonance imaging for real-time, label-free analysis of protein interactions with carbohydrate microarrays.

Plant lectin recognition of glycans was evaluated by SPR imaging using a model array of N-biotinylated aminoethyl glycosides of beta-D-glucose (negative control), alpha-D: -mannose (conA-responsive), beta-D-galactose (RCA(120)-responsive) and N-acetyl-beta-D-: glucosamine (WGA-responsive) printed onto neutravidin-coated gold chips. Selective recognition of the cognate ligand was observed when RCA(120) was passed over the array surface. Limited or no binding was observed for the non-cognate ligands.

Vascular access and cardiac disease: is there a relationship?

Purpose Of Review: Despite advances in hemodialysis technology, a stable and well functioning vascular access remains the bane of every hemodialysis patient. It is recognized that vascular access contributes to cardiovascular disease mortality through a number of mechanisms. This review describes the relationship between vascular access and cardiovascular disease by reviewing the relationships between infection risk, inflammation and cardiovascular disease, and the cardiovascular changes that occur as a consequence of vascular access.

Surveillance cultures of tunneled cuffed catheter exit sites in chronic hemodialysis patients are of no benefit.

Catheter-related infections are a major cause of morbidity and mortality in hemodialysis (HD) patients. This study evaluated the utility of surveillance swab cultures (Ssc) of tunneled cuffed catheter (TCC) exit sites as a prediction and prevention strategy for infection. A 6-month prospective-controlled trial with 94 chronic HD patients with a TCC who received monthly Ssc and were stratified by dialysis day into topical therapy based on Ssc results (Group A) or no therapy (Group B).

The cardiovascular effects of arteriovenous fistulas in chronic kidney disease: a cause for concern?

Arteriovenous fistulas (AVFs) are the preferred type of vascular access, but relatively little is known regarding their effects on cardiovascular remodeling and cardiac function. The following is a review regarding the immediate and long-term complications associated with AVF creation, including the development of left ventricular hypertrophy, high-output cardiac failure, exacerbation of coronary ischemia, and the possible contribution to the development of central vein stenosis.

Determining lung water volume in stable hemodialysis patients.

Lung water (LW) reflects the water content of the lung interstitium. Because hemodialysis patients have expanded total body water (TBW) they may also have increased LW. Hypertonic saline promotes a flux of water from lung to blood, which is measured by ultrasound flow probes on hemodialysis tubing.

Extravascular lung water and peripheral volume status in hemodialysis patients with and without a history of heart failure.

Determining volume status in hemodialysis patients with a history of congestive heart failure (CHF) is difficult. Extravascular lung water (EVLW) may be derived from blood ultrasound velocity changes following injections of 0.9% and 5% saline.

Patients consulting outside of funded practices within primary health organisations: implications for utilisation reporting.

Aim: To consider two definitions for utilisation reporting in primary care in New Zealand and to assess the affect of two reporting methods on volumes of utilisation in four primary health organisations (PHOs).

Methods: Utilisation data was analysed for a 6-month period from 60 practices across four PHOs. Analysis was based on comparing the expected volumes from two alternative collection and reporting methods, named "matched" and "unmatched" reporting.

The suppression of galactose metabolism in Trypanosoma cruzi epimastigotes causes changes in cell surface molecular architecture and cell morphology.

The cell surface of the epimastigote form of Trypanosoma cruzi is covered by glycoconjugates rich in galactose. The parasite cannot take up galactose through its hexose transporter, suggesting that the epimerisation of UDP-glucose to UDP-galactose may be the parasite's only route to this sugar. The T.

Correlations between arsenic in Maine groundwater and microbial populations as determined by fluorescence in situ hybridization.

Arsenic is known to cause serious health effects when consumed in drinking water. In the state of Maine, approximately half of the population relies on private groundwater wells for their drinking water. Of those wells, as many as 13% may contain arsenic levels above the current EPA maximum contaminant level of 10 microgl(-1).

Live and deceased donor kidney transplantation in patients aged 75 years and older in the United States.

Objective: To examine the outcomes of geriatric ESRD patients selected for kidney transplantation.

Design: Data were extracted from the USRDS Standard Analysis Files (SAF). All persons ages 75 and over who received a kidney transplant from 1994 to 2000 were compared with those remaining on dialysis or on a transplant waiting list.

Structure and metal-dependent mechanism of peptidoglycan deacetylase, a streptococcal virulence factor.

Streptococcus pneumoniae peptidoglycan GlcNAc deacetylase (SpPgdA) protects the Gram-positive bacterial cell wall from host lysozymes by deacetylating peptidoglycan GlcNAc residues. Deletion of the pgda gene has been shown to result in hypersensitivity to lysozyme and reduction of infectivity in a mouse model. SpPgdA is a member of the family 4 carbohydrate esterases, for which little structural information exists, and no catalytic mechanism has yet been defined.

Short and long alteplase dwells in dysfunctional hemodialysis catheters.

Background: Hemodialysis catheter dysfunction (CD) is the inability to attain adequate blood pump speeds (BPS) and is attributed to thrombus or catheter malposition; alteplase (TPA) is often given in a variety of dwell times to treat CD. The purpose of this study was to determine if TPA dwell time affects short- or long-term catheter patency rates.

Methods: Sixty hemodialysis (HD) patients with CD, as defined by BPS of < 250 mL/min, were randomized to receive either 1- or > 48-hr (to subsequent HD run) TPA dwell.

Improved survival in HIV-infected African-Americans with ESRD.

Aims: To determine if there has been improvement in survival of HIV-infected patients with end-stage renal failure subsequent to widespread use of highly active antiretroviral therapy.

Methods: The United States Renal Data System is a national data system funded by the National Institute of Diabetes and Digestive and Kidney Disease with the Centers for Medicare and Medicaid. Using the United States Renal Data System Standard Analysis Files, we analyzed all African-American end-stage renal failure patients in the United States from 1990-2001.

Polybrominated diphenyl ethers in fish and wastewater samples from an area of the Penobscot River in central Maine.

Polybrominated diphenyl ethers (PBDEs) are one class of flame retardants commonly used in textiles, foams and plastics. They are similar in behavior to the well-studied polychlorinated biphenyls and growing evidence suggests they are widespread global environmental pollutants that are capable of bioaccumulation. Fish tissue samples were collected from sites along the Penobscot River in central Maine.

Urea clearance in dysfunctional catheters is improved by reversing the line position despite increased access recirculation.

Background: Problematic or dysfunctional hemodialysis (HD) catheters are routinely reversed to achieve adequate blood flow for dialysis delivery. The purpose of the study is to determine the effect of varying blood pump speed (Qb) on access recirculation (AR), and urea clearance (K) in dysfunctional catheters in the normal and reversed positions.

Methods: Nineteen HD patients with tunneled cuffed catheters (5 functional and 14 dysfunctional catheters) were included; dysfunctional catheters are defined as the inability to attain a Qb of 300 mL/min or greater on 2 consecutive HD runs.

The suppression of galactose metabolism in procylic form Trypanosoma brucei causes cessation of cell growth and alters procyclin glycoprotein structure and copy number.

Galactose metabolism is essential in bloodstream form Trypanosoma brucei and is initiated by the enzyme UDP-Glc 4'-epimerase. Here, we show that the parasite epimerase is a homodimer that can interconvert UDP-Glc and UDP-Gal but not UDP-GlcNAc and UDP-GalNAc. The epimerase was localized to the glycosomes by immunofluorescence microscopy and subcellular fractionation, suggesting a novel compartmentalization of galactose metabolism in this organism.

Central vein stenosis: a common problem in patients on hemodialysis.

Central vein stenosis (CVS) has been associated with subclavian (SCV) catheter insertions. The prevalence of CVS in the current era with minimal use of SCV catheters is unknown. Furthermore, the prevalence of CVS in patients with access problems has not been previously described to our knowledge.

Structural characterization of NETNES, a novel glycoconjugate in Trypanosoma cruzi epimastigotes.

The unicellular stercorarian protozoan parasite Trypanosoma cruzi is the etiological agent of Chagas' disease. The epimastigote form of the parasite is covered in a dense coat of glycoinositol phospholipids and short glycosylphosphatidylinositol (GPI)-anchored mucinlike molecules. Here, we describe the purification and structural characterization of NETNES, a relatively minor but unusually complex glycoprotein that coexists with these major surface components.

A robust and selective method for the quantification of glycosylphosphatidylinositols in biological samples.

We have developed an assay for the quantification of glycosylphosphatidylinositol (GPI)-anchored glycoconjugates. The method is based on nitrous acid deamination and sodium borodeuteride reduction of the glucosamine residue, common to all GPI structures, to yield [1-2H]-2,5-anhydromannitol. Following acid methanolysis and trimethylsilyl derivatization, detection is by selected ion monitoring gas chromatography-mass spectrometry.

Uptake of mercury by thiol-grafted chitosan gel beads.

This study describes the synthesis and characterization of thiol-grafted chitosan beads for use as mercury (Hg) adsorbents. Chitosan flakes were dissolved and formed into spherical beads using a phase inversion technique, then crosslinked to improve their porosity and chemical stability. Cysteine was grafted onto the beads in order to improve the adsorption affinity of Hg to the beads.

High levels of untreated distress and fatigue in cancer patients.

The purpose of the study was to assess a large representative sample of cancer patients on distress levels, common psychosocial problems, and awareness and use of psychosocial support services. A total of 3095 patients were assessed over a 4-week period with the Brief Symptom Inventory-18 (BSI-18), a common problems checklist, and on awareness and use of psychosocial resources. Full data was available on 2776 patients.