A pilot study of a crossover trial with randomized use of ankle-foot orthoses for people with Charcot-Marie-tooth disease.

Objectives: This was a pilot and feasibility study of a crossover trial with randomized use of ankle-foot orthoses by people with Charcot-Marie-tooth (CMT) disease, investigating the effects of these on gait parameters, practical aspects of use and achievement of goals.

Design: A randomized crossover trial.

Setting: The community and ambulatory care.

Haemodialysis-induced myocardial stunning in chronic kidney disease - a new aspect of cardiovascular disease.

Chronic haemodialysis (HD) patients are already primed by a large number of structural and functional peripheral vascular and cardiac abnormalities to experience demand myocardial ischaemia. Transient myocardial ischaemia may lead to left ventricular (LV) dysfunction that can persist after the return of normal perfusion. This prolonged dysfunction is known as myocardial stunning.

Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function.

Background And Objectives: Hemodialysis (HD)-induced regional wall motion abnormalities (RWMAs) are common in HD patients and driven by ischemia. In nondialysis patients, repeated ischemia leads to chronic reduction in left ventricular (LV) function. HD-induced myocardial ischemia may initiate the same process.

Mammalian target of rapamycin: a new target in prostate cancer.

Molecular targets in prostate cancer are continually being explored, especially in the poor-prognosis androgen-independent phase of the disease, for which there are currently few therapeutic options. One such target is the mammalian target of rapamycin (mTOR) protein. Activation of mTOR results in sequential activation of downstream molecules, which ultimately results in cell division.

Effects of hemodialysis on cardiac function.

Hemodialysis (HD) patients are subject to an enormous excess of cardiovascular morbidity and mortality. This appears to be largely driven by factors that are different from those at play in the general population. Chronic HD patients are already primed by a large number of structural and functional peripheral vascular and cardiac abnormalities to experience demand myocardial ischemia.

An exploratory study of physical activity and perceived barriers to exercise in ambulant people with neuromuscular disease compared with unaffected controls.

Objective: To determine activity patterns and perceived barriers to exercise in ambulant people with neuromuscular disease compared with ambulatory controls.

Design: Prospective controlled parallel group design.

Setting: Outpatient clinic and community.

Hemodialysis-induced cardiac injury: determinants and associated outcomes.

Background And Objectives: Hemodialysis (HD)-induced myocardial stunning driven by ischemia is a recognized complication of HD, which can be ameliorated by HD techniques that improve hemodynamics. In nondialysis patients, repeated ischemia leads to chronic reduction in left ventricular (LV) function. HD may initiate and drive the same process.

Case mix, outcome and activity for patients with severe acute kidney injury during the first 24 hours after admission to an adult, general critical care unit: application of predictive models from a secondary analysis of the ICNARC Case Mix Programme database.

Introduction: This study pools data from the UK Intensive Care National Audit and Research Center (ICNARC) Case Mix Programme (CMP) to evaluate the case mix, outcome and activity for 17,326 patients with severe acute kidney injury (AKI) occurring during the first 24 hours of admission to intensive care units (ICU).

Methods: Severe AKI admissions (defined as serum creatinine >/=300 mumol/l and/or urea >/=40 mmol/l during the first 24 hours) were extracted from the ICNARC CMP database of 276,326 admissions to UK ICUs from 1995 to 2004. Subgroups of oliguric and nonoliguric AKI were identified by daily urine output.

Calcium antagonists for Duchenne muscular dystrophy.

Background: Duchenne muscular dystrophy (DMD) is a progressive muscle condition starting in childhood, leading to severe disability and a shortened life span. It is due to severe deficiency of the protein dystrophin which performs both structural and signalling roles within skeletal and cardiac myocytes. Calcium accumulates in dystrophic muscle cells and plays a role in cell damage.

A meta-analysis of hemodialysis catheter locking solutions in the prevention of catheter-related infection.

Background: Catheter-related infection (CRI) is associated with increased all-cause mortality and morbidity in hemodialysis patients and may be reduced by using antimicrobial lock solutions (ALSs).

Study Design: We performed a meta-analysis of studies identified from a search conducted in February 2007 of the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, databases of ongoing trials, major renal journals, and reference lists of relevant reports.

Setting & Population: Patients receiving acute or long-term hemodialysis through a tunneled or nontunneled central venous catheter.

Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow.

Background And Objectives: Hemodialysis is associated with hemodynamic instability, acute cardiac ischemia, and the development of regional wall motion abnormalities (RWMAs). This study used serial intradialytic H(2)(15)O positron emission tomography scanning to confirm that the development of dialysis-induced RWMAs was associated with reduction in myocardial blood flow (MBF).

Design, Setting, Participants, & Measurements: Four prevalent hemodialysis patients without angiographically significant coronary artery disease had measurements of MBF during standard hemodialysis and biofeedback dialysis.

Dialysis-induced regional left ventricular dysfunction is ameliorated by cooling the dialysate.

Dialysis patients who develop cardiac failure have a poor prognosis. Recurrent subclinical myocardial ischemia is important in the genesis of heart failure in nondialysis patients. It has previously been demonstrated that subclinical ischemia occurs during hemodialysis; therefore, this study examined whether the improved stability of cool-temperature dialysis lessens this phenomenon.

The UK Vascular Access Survey--follow-up data and repeat survey (chapter 5).

In the 2006 Vascular Access Survey, 51% of all patients commenced renal replacement therapy (RRT) using definitive access. Of patients commencing on haemodialysis HD, 37% commenced with definitive access (31% in the 2005 survey). Of those known to the renal units for a year or more, only half started HD with definitive access.

The acute cardiac effects of dialysis.

It is well recognized that the procedure of hemodialysis is associated with significant changes in blood pressure and systemic hemodynamics; 20-30% of treatments are complicated by intradialytic hypotension (IDH). There are now an increasing number of studies using electrocardiographic, isotopic and echocardiographic techniques that show that subclinical myocardial ischemia occurs during dialysis. This concept is supported by some studies showing that dialysis can induce acute rises in troponins and creatinine kinase MB, although this has not been found by all authors.

Comparison of progressive conductivity reduction with diacontrol and standard dialysis.

We examined whether progressive reduction of dialysate sodium with Diacontrol (DC, plasma conductivity targeted feedback system) confers any clinical benefit over a similar strategy using dialysis with fixed dialysate conductivity (HD). Ten stable patients entered a randomized crossover study conducted over 360 dialysis sessions. Sodium balance, blood pressure (BP), intradialytic hypotension rates (IDH), thirst score, and extracellular water (ECW) were recorded.

The haemodynamic and metabolic effects of hypertonic-glucose and amino-acid-based peritoneal dialysis fluids.

Background: Continuous ambulatory peritoneal dialysis (CAPD) may exert significant effects on systemic haemodynamics. We have previously demonstrated that hypertonic glucose solutions are associated with higher blood pressure (BP) due to a rise in stroke volume (SV) and cardiac output (CO). However, the mechanisms underlying these changes have not been established.

An evidence-based treatment algorithm for anal fissure.

Guidelines for the treatment of anal fissure have been published in the USA and UK but differ. Many centers follow guidelines based on local experience. In December 2005, we met with the aim of developing an evidence-based treatment algorithm for anal fissure, applicable to both primary and secondary care.

Automated peritoneal dialysis has significant effects on systemic hemodynamics.

Objectives: Maintenance of residual renal function (RRF) is an important determinant of outcome in peritoneal dialysis patients. It remains contentious as to whether automated peritoneal dialysis (APD) leads to an increased rate of decline of RRF compared with continuous ambulatory peritoneal dialysis (CAPD). We studied whether APD was associated with significant systemic hemodynamic changes that may play a role in the accelerated loss of RRF.

Occurrence of regional left ventricular dysfunction in patients undergoing standard and biofeedback dialysis.

Background: Cardiac failure and cardiovascular death are extremely prevalent in dialysis patients. Recurrent subclinical myocardial ischemia is important in the genesis of heart failure in nondialysis patients. We examined whether this phenomenon occurs in response to the stress of hemodialysis (HD).

A systematic review of the clinical effects of reducing dialysate fluid temperature.

Background: Intradialytic hypotension (IDH) is a frequent complication of haemodialysis. Reducing the temperature of the dialysis fluid is a simple therapeutic strategy but is relatively underused. This may be due to concerns regarding its effects on symptoms and dialysis adequacy.