目的探讨血液透析治疗患者按照0-1-2月免疫程序接种乙型肝炎(乙肝)疫苗(Hepatitis B vaccine,HepB)的依从性和免疫原性。方法采用两种乙肝免疫程序完成率和免疫原性比较的随机对照临床试验,在北京市朝阳区8家医疗机构招募接受血液透析...目的探讨血液透析治疗患者按照0-1-2月免疫程序接种乙型肝炎(乙肝)疫苗(Hepatitis B vaccine,HepB)的依从性和免疫原性。方法采用两种乙肝免疫程序完成率和免疫原性比较的随机对照临床试验,在北京市朝阳区8家医疗机构招募接受血液透析治疗且乙肝表面抗原、乙肝表面抗体(Hepatitis B surface antibody,HBsAb)和乙肝核心抗体均阴性的18-70岁患者,随机分为试验组和对照组,分别按照0-1-2月和0-1-6月免疫程序接种20μg HepB,检测免疫前和免疫后1个月血清HBsAb,比较两组HepB全程接种完成率、HBsAb阳转率和几何平均浓度(GMC)。结果试验组、对照组受试者HepB全程接种完成率分别为94.39%(101/107)、90.83%(99/109)(χ^(2)=1.00,P=0.316);两组全程免疫后HBsAb阳转率分别为70.10%(68/97)、87.76%(86/98)(率差=-17.66%,95%CI下限:-28.84%);GMC分别为60.81mIU/mL、247.08mIU/mL(t=-3.68,P=0.000)。结论血液透析治疗患者HepB 0-1-2月免疫程序的依从性较好,但免疫原性弱于0-1-6月免疫程序。展开更多
Long-term exposure to bioincompatible peritoneal dialysis(PD) solutions frequently results in peritoneal fibrosis and ultrafiltration failure,which limits the life-long use of and leads to the cessation of PD therapy....Long-term exposure to bioincompatible peritoneal dialysis(PD) solutions frequently results in peritoneal fibrosis and ultrafiltration failure,which limits the life-long use of and leads to the cessation of PD therapy.Therefore,it is important to elucidate the pathogenesis of peritoneal fibrosis in order to design therapeutic strategies to prevent its occurrence.Peritoneal fibrosis is associated with a chronic inflammatory status as well as an elevated oxidative stress(OS) status.Beyond uremia per se,OS also results from chronic exposure to high glucose load,glucose degradation products,advanced glycation end products,and hypertonic stress.Therapy targeting the cannabinoid(CB) signaling pathway has been reported in several chronic inflammatory diseases with elevated OS.We recently reported that the intra-peritoneal administration of CB receptor ligands,including CB_1 receptor antagonistsand CB_2 receptor agonists,ameliorated dialysis-related peritoneal fibrosis.As targeting the CB signaling pathway has been reported to be beneficial in attenuating the processes of several chronic inflammatory diseases,we reviewed the interaction among the cannabinoid system,inflammation,and OS,through which clinicians ultimately aim to prolong the peritoneal survival of PD patients.展开更多
Investigation of depression prevalence in end stage renal disease （ESRD） patients treated with two different methods, hemodialysis （HD） and continuous ambulatory peritoneal dialysis （CAPD） is conducted. We inves...Investigation of depression prevalence in end stage renal disease （ESRD） patients treated with two different methods, hemodialysis （HD） and continuous ambulatory peritoneal dialysis （CAPD） is conducted. We investigated whether the dialysis adequacy （Kt/v） and serum hemoglobin level had any correlation with depression severity. Psychiatric interview was performed on 30 HD and 30 CAPD patients. Hamilton depression rating scale （HAMD） was used to evaluate depression symptoms. Kt/v and serum hemoglobin level were detected. Half of HD patients were depressive, while depression wasn＇t found in any CAPD patient. Hemoglobin was in positive correlation with the HAMD, while Kt/v was in negative correlation with the HAMD. Patients on CAPD had less depressive symptoms. Good dialysis adequacy diminish depressive symptoms.展开更多
Epiploic appendagitis(EA)is rare cause of acute or subacute abdominal pain in patients on peritoneal dialysis(PD),where the diagnosis can be challenging as the clinical features,laboratory markers and imaging characte...Epiploic appendagitis(EA)is rare cause of acute or subacute abdominal pain in patients on peritoneal dialysis(PD),where the diagnosis can be challenging as the clinical features,laboratory markers and imaging characteristics have not been described previously in this group of patients.Here,we present the management of a case of EA in a patient on PD and review published literature pertinent to the subject.The importance of establishing the diagnosis early by laparoscopy is emphasised.展开更多
AIM To investigate awareness and attitudes about preventive dental visits among dialysis patients; to clarify thebarriers to visiting the dentist. METHODS Subjects included 141 dentate outpatients receiving hemodialys...AIM To investigate awareness and attitudes about preventive dental visits among dialysis patients; to clarify thebarriers to visiting the dentist. METHODS Subjects included 141 dentate outpatients receiving hemodialysis treatment at two facilities, one with a dental department and the other without a dental department. We used a structured questionnaire to interview participants about their awareness of oral health management issues for dialysis patients, perceived oral symptoms and attitudes about dental visits. Bivariate analysis using the χ2 test was conducted to determine associations between study variables and regular dental check-ups. Binominal logistic regression analysis was used to determine factors associated with regular dental checkups.RESULTS There were no significant differences in patient demographics between the two participating facilities, including attitudes about dental visits. Therefore, we included all patients in the following analyses. Few patients(4.3%) had been referred to a dentist by a medical doctor or nurse. Although 80.9% of subjects had a primary dentist, only 34.0% of subjects received regular dental check-ups. The most common reasons cited for not seeking dental care were that visits are burdensome and a lack of perceived need. Patients with gum swelling or bleeding were much more likely to be in the group of those not receiving routine dental check-ups(χ2 test, P < 0.01). Logistic regression analysis demonstrated that receiving dental check-ups was associated with awareness that oral health management is more important for dialysis patients than for others and with having a primary dentist(P < 0.05). CONCLUSION Dialysis patients should be educated about the importance of preventive dental care. Medical providers are expected to participate in promoting dental visits among dialysis patients.展开更多
The large prevalence of respiratory acid-base disordersoverlapping metabolic acidosis in hemodialysis popu-lation should prompt nephrologists to deal with the partial pressure of carbon dioxide （pCO2） complying with...The large prevalence of respiratory acid-base disordersoverlapping metabolic acidosis in hemodialysis popu-lation should prompt nephrologists to deal with the partial pressure of carbon dioxide （pCO2） complying with the reduced bicarbonate concentration. What the most suitable formula to compute pCO2 is reviewed. Then, the neglected issue of CO2 content in the dialysis fluid is under the spotlight. In fact, a considerable amount of CO2 comes to patients’ bloodstream every hemodialysis treatment and “acidosis by dialysate” may occur if lungs do not properly clear away this burden of CO2. Moreover, vascular access recirculation may be easy diagnosed by detecting CO2 in the arterial line of extracorporeal circuit if CO2-enriched blood from the flter reenters arterial needle.展开更多
文摘目的探讨血液透析治疗患者按照0-1-2月免疫程序接种乙型肝炎(乙肝)疫苗(Hepatitis B vaccine,HepB)的依从性和免疫原性。方法采用两种乙肝免疫程序完成率和免疫原性比较的随机对照临床试验,在北京市朝阳区8家医疗机构招募接受血液透析治疗且乙肝表面抗原、乙肝表面抗体(Hepatitis B surface antibody,HBsAb)和乙肝核心抗体均阴性的18-70岁患者,随机分为试验组和对照组,分别按照0-1-2月和0-1-6月免疫程序接种20μg HepB,检测免疫前和免疫后1个月血清HBsAb,比较两组HepB全程接种完成率、HBsAb阳转率和几何平均浓度(GMC)。结果试验组、对照组受试者HepB全程接种完成率分别为94.39%(101/107)、90.83%(99/109)(χ^(2)=1.00,P=0.316);两组全程免疫后HBsAb阳转率分别为70.10%(68/97)、87.76%(86/98)(率差=-17.66%,95%CI下限:-28.84%);GMC分别为60.81mIU/mL、247.08mIU/mL(t=-3.68,P=0.000)。结论血液透析治疗患者HepB 0-1-2月免疫程序的依从性较好,但免疫原性弱于0-1-6月免疫程序。
基金Supported by The Ministry Of Science and Technology,Taiwan,Nos.NSC 96-2628-B-075-003-MY3,MOST 104-2314-B-075-031,and MOST 105-2628-B-075-008-MY3Taipei Veterans General Hospital,Taipei,Taiwan,No.V106D25-003-MY3-1Taipei Veterans General Hospital,National Yang-Ming University Excellent Physician Scientists Cultivation Program,No.103-V-B-024
文摘Long-term exposure to bioincompatible peritoneal dialysis(PD) solutions frequently results in peritoneal fibrosis and ultrafiltration failure,which limits the life-long use of and leads to the cessation of PD therapy.Therefore,it is important to elucidate the pathogenesis of peritoneal fibrosis in order to design therapeutic strategies to prevent its occurrence.Peritoneal fibrosis is associated with a chronic inflammatory status as well as an elevated oxidative stress(OS) status.Beyond uremia per se,OS also results from chronic exposure to high glucose load,glucose degradation products,advanced glycation end products,and hypertonic stress.Therapy targeting the cannabinoid(CB) signaling pathway has been reported in several chronic inflammatory diseases with elevated OS.We recently reported that the intra-peritoneal administration of CB receptor ligands,including CB_1 receptor antagonistsand CB_2 receptor agonists,ameliorated dialysis-related peritoneal fibrosis.As targeting the CB signaling pathway has been reported to be beneficial in attenuating the processes of several chronic inflammatory diseases,we reviewed the interaction among the cannabinoid system,inflammation,and OS,through which clinicians ultimately aim to prolong the peritoneal survival of PD patients.
文摘Investigation of depression prevalence in end stage renal disease （ESRD） patients treated with two different methods, hemodialysis （HD） and continuous ambulatory peritoneal dialysis （CAPD） is conducted. We investigated whether the dialysis adequacy （Kt/v） and serum hemoglobin level had any correlation with depression severity. Psychiatric interview was performed on 30 HD and 30 CAPD patients. Hamilton depression rating scale （HAMD） was used to evaluate depression symptoms. Kt/v and serum hemoglobin level were detected. Half of HD patients were depressive, while depression wasn＇t found in any CAPD patient. Hemoglobin was in positive correlation with the HAMD, while Kt/v was in negative correlation with the HAMD. Patients on CAPD had less depressive symptoms. Good dialysis adequacy diminish depressive symptoms.
文摘Epiploic appendagitis(EA)is rare cause of acute or subacute abdominal pain in patients on peritoneal dialysis(PD),where the diagnosis can be challenging as the clinical features,laboratory markers and imaging characteristics have not been described previously in this group of patients.Here,we present the management of a case of EA in a patient on PD and review published literature pertinent to the subject.The importance of establishing the diagnosis early by laparoscopy is emphasised.
基金Supported by A Grant-in-Aid for Scientific Research(25463246)from the Japan Society for the Promotion of Science
文摘AIM To investigate awareness and attitudes about preventive dental visits among dialysis patients; to clarify thebarriers to visiting the dentist. METHODS Subjects included 141 dentate outpatients receiving hemodialysis treatment at two facilities, one with a dental department and the other without a dental department. We used a structured questionnaire to interview participants about their awareness of oral health management issues for dialysis patients, perceived oral symptoms and attitudes about dental visits. Bivariate analysis using the χ2 test was conducted to determine associations between study variables and regular dental check-ups. Binominal logistic regression analysis was used to determine factors associated with regular dental checkups.RESULTS There were no significant differences in patient demographics between the two participating facilities, including attitudes about dental visits. Therefore, we included all patients in the following analyses. Few patients(4.3%) had been referred to a dentist by a medical doctor or nurse. Although 80.9% of subjects had a primary dentist, only 34.0% of subjects received regular dental check-ups. The most common reasons cited for not seeking dental care were that visits are burdensome and a lack of perceived need. Patients with gum swelling or bleeding were much more likely to be in the group of those not receiving routine dental check-ups(χ2 test, P < 0.01). Logistic regression analysis demonstrated that receiving dental check-ups was associated with awareness that oral health management is more important for dialysis patients than for others and with having a primary dentist(P < 0.05). CONCLUSION Dialysis patients should be educated about the importance of preventive dental care. Medical providers are expected to participate in promoting dental visits among dialysis patients.
文摘The large prevalence of respiratory acid-base disordersoverlapping metabolic acidosis in hemodialysis popu-lation should prompt nephrologists to deal with the partial pressure of carbon dioxide （pCO2） complying with the reduced bicarbonate concentration. What the most suitable formula to compute pCO2 is reviewed. Then, the neglected issue of CO2 content in the dialysis fluid is under the spotlight. In fact, a considerable amount of CO2 comes to patients’ bloodstream every hemodialysis treatment and “acidosis by dialysate” may occur if lungs do not properly clear away this burden of CO2. Moreover, vascular access recirculation may be easy diagnosed by detecting CO2 in the arterial line of extracorporeal circuit if CO2-enriched blood from the flter reenters arterial needle.
