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Advanced wasting in peritoneal dialysis patients

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World Journal of Nephrology 2017年第3期6卷 143-149页

作者： Zhi Xu Glen H Murata Robert H Glew Yijuan Sun Darlene Vigil Karen S Servilla antonios H Tzamaloukas Nephrology Division Department of MedicineUniversity of New Mexico School of Medicine Research Service Raymond G.Murphy Veterans Affairs Medical Center Department of Surgery University of New Mexico School of Medicine Renal Section Medicine ServiceRaymond G.Murphy VA Medical Center Department of Medicine University of New Mexico School of Medicine Research Service and Renal Section Raymond G.Murphy VA Medical Center

AIM To identify patients with end-stage renal disease treated by peritoneal dialysis(PD) who had zero body fat(BF) as determined by analysis of body composition using anthropometric formulas estimating body water(V) and to compare nutritional parameters between these patients and PD patients whose BF was above *** Body weight(W) consists of fat-free mass(FFM) *** formulas for calculating V allow the calculation of FFM as V/0.73,where 0.73 is the water fraction of FFM at normal *** from loss of BF has adverse survival outcomes in *** wasting was defined as zero BF when V/0.73 is equal to or exceeds *** study,which analyzed 439 PD patients at their first clearance study,used the Watson formulas estimating V to identify patients with V_(Watson)/0.73 ≥ W and compared their nutritional indices with those of PD patients with V_(Watson)/0.73 < *** The study identified at the first clearance study two male patients with V_(Watson)/0.73 ≥ W among 439 patients on *** to 260 other male patients on PD,the two subjects with advanced wasting had exceptionally low body mass index and serum albumin *** first of the two subjects also had very low values for serum creatinine concentration and total(in urine and spent peritoneal dialysate) creatinine excretion rate while the second subject had an elevated serum creatinine concentration and high creatinine excretion rate due,most probably,to non-compliance with the PD *** Advanced wasting(zero BF) in PD patients,identified by the anthropometric formulas that estimate V,while rare,is associated with indices of poor somatic and visceral nutrition.

关键词：肾病体重指数治疗方法临床分析

Hematogenous Osteomyelitis by Acinetobacter Baumannii: Case Report and Literature Review

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World Journal of AIDS 2011年第2期1卷 23-27页

作者： Rajendrakumar Chimanlal Patel Sumir Prakash Sahgal Shervin Mortazavi Yagnang Kaushikkumar Vyas Richard Joseph Adam Vera Salim antonios Essen Medical Associates New York USA

Skeletal infection with Acinetobacter baumanii is a rare condition and found mainly among soldiers injured in war. Multidrug resistant (MDR) Acinetobacter baumanii (A. baumanii) osteomyelitis is difficult to treat and requires long course of intravenous antibiotics. Most of reported cases in the literature are the consequences of direct inoculation of the pathogen. Here in, we report the first case of A. Baumannii osteomyelitis disseminated through hematogenous route and the therapeutic approach for this rare infection. Clinical Presentation: A 46 year old African-American male patient with human immunodeficiency virus (HIV) and end- stage renal disease on hemodialysis, who developed persistent MDR A. baumanii bacteremia in the hospital, thought to be secondary to the hemodialysis catheter, necessitating replacement of the catheter. Three months after his discharge to a skilled nursing facility (SNF), he developed left leg swelling without noticeable pain or fever. MRI revealed findings consistent with chronic osteomyelitis of left tibia and intra operative bone culture grew MDR A. baumannii. The patient had good outcome after three surgical debridements and prolonged period (7 Months) of dual antimicrobial therapy. Discussion: While in most documented cases of A. baumannii osteomyelitis, entry appears to require direct inoculation;our case suggests that this pathogen can seed into bone hematogenously in the setting of immunosuppression, persistent bacteremia and possibly in the presence of underlying bone infarcts. Clinicians need to be aware of this rare possible consequence of A. baumannii bacteremia. In conclusion, combination of multiple surgical debridements and dual antimicrobial therapy for a long period may result in a good outcome.

关键词： Osteomyelitis Hematogenous Acinetobacter Baumannii Risk factors Bacteremia

Peritoneal Colorectal Carcinomatosis Treated with Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy

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Surgical Science 2012年第2期3卷 72-77页

作者： antonios-Apostolos K. Tentes Odysseas Korakianitis Nikolaos Pallas Christos Mavroudis Panagiotis Sarlis Anastasios Liberis Athanasios Pagalos Stephanos Popidis Department of Anesthesiology Didimotichon General Hospital Didimotichon Greece Surgical Department Didimotichon General Hospital Didimotichon Greece

Background-Aims: Peritoneal colorectal carcinomatosis is a potentially curative disease. The purpose of the study is the retrospective analysis of survival of the patients with peritoneal colorectal carcinomatosis that underwent cytoreductive surgery and perioperative intraperitoneal chemotherapy and the identification of prognostic variables of the disease. Patients-Methods: Patients with primary or recurrent colorectal cancer and peritoneal carcinomatosis were included in the study. Clinical variables were correlated to survival, recurrence, hospital mortality, and morbidity. Results: From 2000-2010, 28 patients underwent 33 cytoreductive operations. The hospital mortality and morbidity rate was 9.1% and 45.5% respectively. The overall 5-year and median survival time was 29.2% and 19 months respectively. The extent of peritoneal carcinomatosis (p = 0.0003) and the completeness of cytoreduction (p = 0.0002) were related to survival. The completeness of cytoreduction (p = 0.003) was the single prognostic variable of survival. The recurrence rate was 42.4% and the use of systemic chemotherapy was identified as the single prognostic variable of recurrence (p = 0.047). Conclusions: Patients with limited extent of peritoneal colorectal carcinomatosis who undergo complete cytoreduction may be offered long-term survival.

关键词： Colorectal Cancer Peritoneal Carcinomatosis Cytoreductive Surgery Intraperitoneal Chemotherapy

Reproducibility of serial creatinine excretion measurements in peritoneal dialysis

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World Journal of Nephrology 2017年第4期6卷 201-208页

作者： ZhiXu Glen H Murata Yijuan Sun Robert H Glew Clifford Qualls Darlene Vigil Karen SServilla Thomas A Golper antonios H Tzamaloukas Nephrology Division Department of MedicineUni-versity of New Mexico School of MedicineAlbuquerqueNM 87131United States Research Service Raymond G Murphy Veterans Affairs Medical CenterAlbuquerqueNM 87108United States Renal Section Medicine ServiceRaymond G Murphy VA Medical Center and Department of MedicineUniversity of New Mexico School of MedicineAlbuquerqueNM 87108United States Department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87131United States Division of Nephrology and Hypertension Vanderbilt UniversityNashvilleTN 37212United States Renal Section and Research Service Raymond G Murphy VA Medical Center and Department of MedicineUniversity of New Mexico School of MedicineAlbu-querqueNM 87108United States

AIM To test whether muscle mass evaluated by creatinine excretion(EXCr) is maintained in patients with end-stage kidney disease(ESKD) treated by peritoneal dialysis(PD),we evaluated repeated measurements of EXCr in a PD *** One hundred and sixty-six PD patients(94 male,72 female) receiving the same PD dose for the duration of the study(up to approximately 2.5 years) had repeated determinations of total(in urine plus spent dialysate) 24-h EXCr(EXCr T) to assess the adequacy of PD by creatinine *** 166 patients had two EXCr T determinations,84 of the 166 patients had three EXCr T determinations and 44 of the 166 patients had four EXCr T *** T values were compared using the paired t test in the patients who had two studies and by repeated measures ANOVA in those who were studied three or four *** In patients who were studied twice,with the first and second EXCr T measurements performed at 9.2 ± 15.2 mo and 17.4 ± 15.8 mo after onset of PD,respectively,EXCr T did not differ between the first and second *** patients studied three times and whose final assessment occurred 24.7 ± 16.3 mo after initiating PD,EXCr T did not differ between the first and second study,but was significantly lower in the third study compared to the first *** patients who were studied four times and whose fourth measurement was taken 31.9 ± 16.8 mo after onset of PD,EXCr T did not differ between any of the *** average EXCr T value did not change significantly,with the exception of the third study in the patients studied ***,repeated determinations of EXCr T in individuals showed substantial variability,with approximately 50% of the repeated determinations being higher or lower than the first determination by 15% or *** The average value of EXCr T remains relatively constant for up to 2.5 years of follow-up in PD patients who adhere to the same PD ***,repeated individual EXCr T values vary conside

关键词：肾病患者肌肉临床分析

Antiretroviral naive and treated patients: Discrepancies of B cell subsets during the natural course of human immunodeficiency virus type 1 infection

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World Journal of Virology 2016年第4期5卷 155-160页

作者： Olga Tsachouridou Lemonia Skoura Pantelis Zebekakis Apostolia Margariti Adamantini Georgiou Dimitrios Bougiouklis Dimitrios Pilalas antonios Galanos Michael Daniilidis Symeon Metallidis 1~(st) Internal Medicine Department Infectious Diseases Division Medical School Aristotle University of Thessaloniki National AIDS Reference Centre of Northern Greece Medical School Aristotle University of Thessaloniki

AIM To evaluate alterations of memory B cell subpopulations during a 48-wk period in human immunodeficiency virus type 1(HIV-1) patients. METHODS Forty-one antiretroviral na?ve and 41 treated HIV-1 patients matched for age and duration of HIV infection were recruited. All clinical, epidemiological and laboratory data were recorded or measured. The different B cell subsets were characterized according to their surface markers: Total B cells(CD19^+), memory B cells(CD19^+CD27^+, BMCs), resting BMCs(CD19^+CD27^+CD21^(high), RM), exhausted BMCs(CD19^+CD21^(low)CD27-, EM), IgM memory B(CD19^+CD27^+IgM^(high)), isotype-switched BMCs(CD19^+CD27^+IgM-, ITS) and activated BMCs(CD19^+CD21^(low+)CD27^+, AM) at baseline on week 4 and week *** Mean counts of BMCs were higher in treated patients. There was a marginal upward trend of IgM memory B cell proportions which differed significantly in the treated group(overall trend, P = 0.004). ITS BMC increased over time significantly in all patients. Naive patients had of ^(low)er levels of EM B cells compared to treated, with a downward trend, irrespectively of ^(high)ly active antiretroviral therapy(HAART) intake. Severe impairment of EM B cells was recorded to both treated(P = 0.024) and naive(P = 0.023) and patients. Higher proportions of RM cells were noted in HAART group, which differed significantly on week 4^(th)(P = 0.017) and 48th(P = 0.03). Higher levels of AM were preserved in HAART naive group during the whole study period(week 4: P = 0.018 and 48: P = 0.035). HIV-RNA viremia strongly correlated with AM B cells(r = 0.54, P = 0.01) and moderately with RM cells(r =-0.45, P = 0.026) at *** HIV disrupts memory B cell subpopulations leading to impaired immunologic memory over time. BMC, RM, EM and ITS BMC were higher in patients under HAART. Activated BMCs(AM) were higher in patients without HAART. Viremia correlated with AM and RM. Significant depletion was recorded in EM B cells irrespectively of HAART

关键词： B cell subpopulations Time-trend Memory cells Human immunodeficiency virus infection Highly active antiretroviral therapy

Risk assessment instruments for screening bone mineral density in a Mediterranean population

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World Journal of Orthopedics 2016年第9期7卷 577-583页

作者： Sotirios Christodoulou Georgios I Drosos Athanasios Ververidis antonios Galanos George Anastassopoulos Konstantinos Kazakos Department of Orthopaedic Surgery Democritus University of Thrace University General Hospital of Alexandroupolis Laboratory for Research of the Musculoskeletal System University of Athens KAT Hospital Medical Informatics Laboratory Medical School Democritus University of Thrace

AIM To evaluate the power of six osteoporosis-screening instruments in women in a Mediterranean *** Data concerning several osteoporosis risk factors were prospectively collected from 1000 postmenopausal women aged 42-87 years who underwent dual-energy X-ray absorptiometry(DEXA) screening. Six osteoporosis risk factor screening tools were applied to this sample to evaluate their performance and choose the most appropriate tool for the study *** The most important screening tool for osteoporosis status was the Simple Calculated Osteoporosis Risk Estimation, which had an area under the curve(AUC)of 0.678, a sensitivity of 72%, and a specificity of 72%, with a cut-off point of 20.75. The most important screening tool for osteoporosis risk was the Osteoporosis Self-assessment Tool, which had an AUC of 0.643, a sensitivity of 77%, and a specificity of 46%,with a cut-off point *** Some commonly used clinical risk instruments demonstrate high sensitivity for distinguishing individuals with DEXA-ascertained osteoporosis or reduced bone mineral density.

关键词： Osteoporosis Bone mineral density Risk assessment Dual X-ray absorptiometry Osteopenia

BK nephropathy in the native kidneys of patients with organ transplants: Clinical spectrum of BK infection

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World Journal of Transplantation 2016年第3期6卷 472-504页

作者： Darlene Vigil Nikifor K Konstantinov Marc Barry Antonia M Harford Karen S Servilla Young Ho Kim Yijuan Sun Kavitha Ganta antonios H Tzamaloukas Nephrology Section Medicine Service Raymond G. Murphy VA Medical Center and Department of Medicine University of New Mexico School of Medicine Department of Medicine University of Minnesota School of Medicine Department of Pathology University of New Mexico School of Medicine Division of Nephrology Department of Medicine University of New Mexico School of Medicine Division of Nephrology University of North Carolina School of Medicine

Nephropathy secondary to BK virus, a member of the Papoviridae family of viruses, has been recognized for some time as an important cause of allograft dysfunction in renal transplant recipients. In recent times, BK nephropathy(BKN) of the native kidneys has being increasingly recognized as a cause of chronic kidney disease in patients with solid organ transplants, bone marrow transplants and in patients with other clinical entities associated with immunosuppression. In such patients renal dysfunction is often attributed to other factors including nephrotoxicity of medications used to prevent rejection of the transplanted organs. Renal biopsy is required for the diagnosis of BKN. Quantitation of the BK viral load in blood and urine are surrogate diagnostic methods. The treatment of BKN is based on reduction of the immunosuppressive medications. Several compounds have shown antiviral activity, but have not consistently shown to have beneficial effects in BKN. In addition to BKN, BK viral infection can cause severe urinary bladder cystitis, ureteritis and urinary tract obstruction as well as manifestations in other organ systems including the central nervous system, the respiratory system, the gastrointestinal system and the hematopoietic system. BK viral infection has also been implicated in tumorigenesis. The spectrum of clinical manifestations from BK infection and infection from other members of the Papoviridae family is widening. Prevention and treatment of BK infection and infections from other Papovaviruses are subjects of intense research.

关键词： BK viral infection BK nephropathy Cardiac transplant Bone marrow transplant Liver transplant Pancreatic transplant Lung transplant

Establishing the presence or absence of chronic kidney disease:Uses and limitations of formulas estimating the glomerular filtration rate

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World Journal of Methodology 2017年第3期7卷 73-92页

作者： Ahmed Alaini Deepak Malhotra Helbert Rondon-Berrios Christos P Argyropoulos Zeid J Khitan Dominic SC Raj Mark Rohrscheib Joseph I Shapiro antonios H Tzamaloukas Division of Nephrology Department of MedicineUniversity of New Mexico School of Medicine Division of Nephrology Department of MedicineUniversity of Toledo School of Medicine Renal and Electrolyte Division Department of MedicineUniversity of Pittsburgh School of Medicine Division of Nephrology Department of MedicineJoan C. Edwards School of Medicine Division of Nephrology Department of MedicineGeorge Washington University Marshall University Joan C. Edwards School of Medicine Nephrology Section Medicine ServiceRaymond G. Murphy VA Medical Center Department of Medicine University of New Mexico School of Medicine

The development of formulas estimating glomerular filtration rate(eG FR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity, gender and age, has led to the current scheme of diagnosing and staging chronic kidney disease(CKD),which is based on e GFR values and *** scheme has been applied extensively in various populations and has led to the current estimates of prevalence of CKD. In addition, this scheme is applied in clinical studies evaluating the risks of CKD and the efficacy of various interventions directed towards improving its course. Disagreements between creatinine-based and cystatin-based e GFR values and between e GFR values and measured GFR have been reported in various cohorts. These disagreements are the consequence of variations in the rate of production and in factors, other than GFR, affecting the rate of removal of creatinine and cystatin C. The disagreements create limitations for all e GFR formulas developed so far. The main limitations are low sensitivity in detecting early CKD in several subjects, e.g., those with hyperfiltration, and poor prediction of the course of CKD. Research efforts in CKD are currently directed towards identification of biomarkers that are better indices of GFR than the current biomarkers and,particularly, biomarkers of early renal tissue injury.

关键词： Chronic kidney disease Serum creatinine Creatinine clearance Creatinine excretion Estimated glomerular filtration rate Cystatin C Renal imaging Hyperfiltration Biomarkers of chronic kidney disease

Circadian variation in expression of G_1 phase cyclins D_1 and E and cyclin-dependent kinase inhibitors p16 and p21 in human bowel mucosa

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World Journal of Gastroenterology 2006年第13期12卷 2109-2114页

作者： John Griniatsos Othon P Michail Stamatios Theocharis antonios Arvelakis Ioannis Papaconstantinou Evangelos Felekouras Emmanouel Pikoulis Ioannis Karavokyros Chris Bakoyiannis George Marinos John Bramis Panayiotis O Michail 1st Department of Surgery Medical School University of AthensGreece Department of Forensic Medicine and Toxicology Medical School University of AthensGreece

瞄准：评估在大肠上皮细胞的细胞的增长率是否被生理节奏的节奏描绘。方法：在 2003 年 1 月和 2004 年 12 月之间，作为受不了被诊断的二十个病人主要，将切除更低的直肠的有能力的、非变形的腺癌，渗入括约肌机制，经历了腹会阴切除... 详细信息

瞄准：评估在大肠上皮细胞的细胞的增长率是否被生理节奏的节奏描绘。方法：在 2003 年 1 月和 2004 年 12 月之间，作为受不了被诊断的二十个病人主要，将切除更低的直肠的有能力的、非变形的腺癌，渗入括约肌机制，经历了腹会阴切除术，全部的中央直肠的切除和永久左肠骨的结肠开口术。在每六个小时( 00:00 ， 06:00 ， 12:00 ， 18:00 和 24:00 )从结肠开口术粘膜获得的修理福尔马林、嵌入石蜡的活体检视标本，我们象 G ( 1 )阶段的表示一样学习了 G ( 1 )阶段 cyclins ( D ( 1 )和 E )的表示房间的指示物骑车的cyclin依赖的激酶( CDK )禁止者 p16 和 p21 在用免疫的结肠的上皮细胞的前进组织化学的方法。结果：两 cyclins 的表示显示出在 00:00 和 18:00 获得他们的最低、最高的价值的类似的生理节奏的时尚，分别地(P<0.001 ) 。在 CDK 禁止者蛋白质 p16 和 p21 的表示的生理节奏的节奏也被观察，与分别地在 12:00 和 18:00 (P<0.001 ) 获得的底层。当建筑群 cyclins D (1 )-p21 和 E-p21 被检验时， cyclins 的表示不利地在整个日子被相关到 p21 表示。什么时候建筑群 cyclins D (1 )-p16 和 E-p16 被检验， p16 表示的高水平在 00:00， 06:00 和 24:00 被相关到 cyclin 表示的底层。同时，两 cyclins 的最高的表示层次在 18:00 被相关到 p16 表示的高水平。结论：结肠的上皮细胞似乎在下午期间进入房间周期的 G (1 ) 阶段(在 12:00 和 18:00 之间) 与在 18:00 获得的最高的率。从一个临床的观点，当最小化毒性时，现在的结果建议在下午力量的 G (1 ) 阶段 specific 反癌症治疗最大化他们的反肿瘤效果。

关键词：生理节奏 G1位相周期蛋白肠黏膜抑制剂