Using repeated-prevalence data in multi-state modeling of renal replacement therapy

Multi-state models help predict future numbers of patients requiring specific treatments but these models require exhaustive incidence data. Deriving reliable predictions from repeated-prevalence data would be helpful. A new method to model the number of patients that switch between therapeutic modalities using repeated-prevalence data is presented and illustrated. The parameters and goodness of fit obtained with the new method and repeated-prevalence data were compared to those obtained with the classical method and incidence data. The multi-state model parameters’ confidence intervals obtained with annually collected repeated-prevalence data were wider than those obtained with incidence data and six out of nine pairs of confidence intervals did not overlap. However, most parameters were of the same order of magnitude and the predicted patient distributions among various renal replacement therapies were similar regardless of the type of data used. In the absence of incidence data, a multi-state model can still be successfully built with annually collected repeated-prevalence data to predict the numbers of patients requiring specific treatments. This modeling technique can be extended to other chronic diseases.     

Impact of metabolic syndrome and its components on kidney stone in aging Taiwanese males

Objectives: Metabolic syndrome (MtS) and kidney stone are two common aging diseases with male dominant. This is the first study regarding the potential impact of MtS and its components on kidney stone in aging Chinese population.

Methods: A total of 694 males with a mean age of 55.6 years were enrolled. The definition of MtS was according to the modified criteria developed by the Bureau of Health Promotion in Taiwan. Subjects were classified as having a disease of kidney stones according to diagnosis by a physician with available medical records or evidence from ultrasonography judged by an investigator of urologist.

Results: Using age-adjusted multivariate logistic regression analysis, our results showed that subjects with kidney stone had significantly higher prevalence of MtS (p?=?0.04, OR?=?1.74, 95% CI: 1.0 1–3.00). The presence of MtS had significant correlation with kidney stone (p?=?0.01, OR?=?1.83, 95% CI: 1.1 4–2.93), which were associated with the increment of MtS components (p?p?Conclusions: In aging Taiwanese males, the presence of MtS and its components are strongly associated with kidney stone. Abnormal BP is the most significant risk component of MtS for kidney stone.     

Dual‐Donor Organ Exchange

Owing to the worldwide shortage of deceased‐donor organs for transplantation, living donations have become a significant source of transplant organs. However, not all willing donors can donate to their intended recipients because of medical incompatibilities. These incompatibilities can be overcome by an exchange of donors between patients. For kidneys, such exchanges have become widespread in the last decade with the introduction of optimization and market design techniques to kidney exchange. A small but growing number of liver exchanges have also been conducted. Over the last two decades, a number of transplantation procedures emerged where organs from two living donors are transplanted to a single patient. Prominent examples include dual‐graft liver transplantation, lobar lung transplantation, and simultaneous liver‐kidney transplantation. Exchange, however, has been neither practiced nor introduced in this context. We introduce dual‐donor organ exchange as a novel transplantation modality, and through simulations show that living‐donor transplants can be significantly increased through such exchanges. We also provide a simple theoretical model for dual‐donor organ exchange and introduce optimal exchange mechanisms under various logistical constraints.     

运动与运动性蛋白尿

讨论了运动训练对肾脏功能的影响，即运动性蛋白尿的影响因素及蛋白尿的形成机制；同时，论述了蛋白尿等指标在运动实践中的应用     

益气补肾活血法治疗小儿哮喘的临床研究

探讨益气补肾活血法对支气管哮喘患儿血内皮素-1(ET-1)、一氧化氮(NO)和内皮细胞(CEC)变化的影响.应用放射免疫法、硝酸还原法和Hladovec法对加服中药的100例支气管哮喘患儿于急性期、恢复期等分别检测血ET-1、NO和CEC.与未加服中药的支气管哮喘患儿比较,其恢复期和1年后血ET-1、NO和CEC水平明显下降,发作次数明显减少,有显著性差异.益气补肾活血中药可降低支气管哮喘患儿血ET-1、NO的合成,减轻肺血管内皮细胞的损伤.对防治小儿支气管哮喘有效.     

紫彩血蛤肾脏和围心腔腺的超微结构

用透射电镜观察了紫彩血蛤（Ｎｕｔｔａｌｌｉａ ｏｌｉｖａｃｅａ）的肾脏和围心腔腺的超微结构．在肾脏中观察到４种细胞：具液泡的立方形细胞、具液泡的长柱形细胞、吞噬细胞和肌细胞．在围心腔腺中观察到３种细胞：柱状上皮细胞、实质细胞和吞噬细胞．肾脏中除了肌细胞外的３种细胞及围心腔腺中除了柱状上皮外的２种细胞内均有色素颗粒，它们能将色素颗粒转化降解．     

补肾汤治疗肾阳虚证的临床观察

目的探讨中药治疗肾阳虚证的有效方法.方法将肾阳虚证患者172例,随机分成两组治疗组采用自拟方补肾汤进行治疗,对照组用金匮肾气丸治疗,4周后观察疗效并进行比较.结果治疗组显效率为60.2%,总有效率为97.7%;对照组显效率为34.5%,总有效率为88.1%.两组显效率比较有非常显著性差异(P＜0.01),总有效率比较有显著性差异(P＜0.05).结论认为补肾汤补而不腻,温而不燥,治疗肾阳虚证效果显著.     

大亚湾核电站附近地区与汕尾地区扇贝肝肾组织中SOD、GPT活性的研究

采用邻苯三酚自氧化紫外法和赖氏法测定了大亚湾核电站运转一年后附近地区华贵栉孔扇贝（Chlanys(Mimachlamys)Nabilis)的肝、肾组织澡超氧化物歧化酶（Superoxide dismutase SODEC1.15.1.1)与谷丙转氨酶（Glutamate-pyruvate transaminase GPTEC2.6.1.2)活性与肝肾组织蛋白含量，并与广东汕尾地区的同种贝类进行了比较，发现大亚湾附近地区扇贝肝组织SOD活性高于汕尾地区（P<0.05)而肾组织蛋白含量则低于后（P<0.05)，其他测定结果则未见两地区有显性差异。     

Chronic kidney disease (CKD) in the elderly – a geriatrician's perspective

Chronic kidney disease (CKD) is becoming increasingly prevalent among many different populations all over the world, including the US and Europe. Its multitude of complications with devastating outcomes leads to a significantly higher risk for cardio-vascular and all-cause mortality in an individual. However, it is clear now that early detection of CKD might not only delay some of the complications but also prevent them. Therefore, various important public health organizations all over the world have turned their focus and attention to CKD and its risk factors, early detection and early intervention. Nevertheless, the general goals in preventing the increase in CKD and its complications are far from being completely achieved. Why is this so? What is the magnitude and complexity of the problem? How is it affecting the population – are there differences in its affection by age, gender or frail elderly versus the robust? Are we modifying the risk factors appropriately and aggressively? Are there subtle differences in managing the risk factors in those on dialysis versus the non-dialysis CKD patients? Is it important to treat anaemia of CKD aggressively, will it make a difference in the disease progression, its complications or to quality of life? What do these unfortunate individuals commonly succumb to? What do we advise patients who refuse dialysis or those who desire dialysis or transplant? Are there useful non-dialytic treatment recommendations for those who refuse dialysis? What is the role of the physicians caring for the elderly with CKD? When should the primary care givers refer a CKD patient to a nephrologist? The key to eventually controlling incident and prevalent CKD and improve quality of life of affected individuals, lies in not only knowing these and many other vital aspects, but also in applying such knowledge compulsively in day-to-day practice by each and every one us. As CKD is increasingly a disease of the elderly with men being affected more, this review details fairly comprehensively the vital aspects of CKD, especially from a primary care geriatrician's practical standpoint.