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Variabilidade da freqüência cardíaca e seu valor prognóstico imediato em nefropatas crônicos submetidos à hemodiálise.Gatti, Márcio 17 November 2015 (has links)
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Previous issue date: 2015-11-17 / Introduction: Chronic Renal Failure (CRF) is a metabolic syndrome
resulting in progressive loss of ability to renal excretion. In advanced stages
dialysis is necessary. The introduction of new technological advances in
hemodialysis made this procedure safe and able to maintain patients' lives for
long periods. However, in 30% of the hemodialysis, may occur some kind of
complication. The heart rate variability (HRV) reveals information on the
functional state of the autonomic nervous system and reflects the balance
between the sympathetic and parasympathetic branches of the same. HRV
analysis have been proposed as a component of the clinical evaluation for risk
stratification of patients. HRV can be studied by linear methods, time domain
and frequency and nonlinear methods in the field of chaos. Objective: Assess
whether or not there is an association between lower HRV immediately
preceding the hemodialysis and the occurrence of complications during or after
the same period. Casuistic and Method: 44 unselected patients were included
in the study, regardless of sex and age being 15 (34.1%) were female and 29
patients (65.9%) males, with 61.7 ± 14.5 years. Inclusion criteria were
considered just the fact of having IRC, be in regular program of performing
hemodialysis in the dialysis unit at Hospital de Base (HB) of São José do Rio
Preto. The methodology consisted of the assessment of HRV in the time,
frequency and chaos, using registration electrocardiographic time series with
the aid of equipment Polar RS800CX for 20 minutes moments before initiating
hemodialysis session. The 44 patients were followed throughout the dialysis period by verifying the occurrence of complications. Results: 35 patients (NC)
had no complications during hemodialysis, while 9 patients (C) had
complications, such as hypotension, hypoglycemia, and cramps. The results
showed no association between lower HRV with the occurrence of
complications during or after hemodialysis. But it was evident that the diabetic
patients had a higher probability of complications, because it was the only
variable that showed a statistically significant difference. Comparing the results
of HRV in diabetic patients with nondiabetic patients, we found lower values for
the variables that represent the sympathetic autonomic activity, such as SDNN,
LF, SD2 and alpha 1. Conclusions: HRV in the time, frequency and chaos was
not characterized as a predictor of the occurrence of complications during or
after hemodialysis. However, in diabetic patients there is a significant reduction
in the sympathetic component associated with the occurrence of complications,
highlighting the possibility of using a simple, noninvasive method for
determining prognosis by studying HRV. / Introdução: Insuficiência Renal Crônica (IRC) é uma síndrome
metabólica decorrente de perda progressiva da capacidade de excreção renal.
Em fases avançadas é necessário o tratamento dialítico. A introdução de novos
avanços tecnológicos no tratamento hemodialítico tornou esse procedimento
seguro e capaz de manter a vida dos pacientes por longos períodos.
Entretanto, em 30% das sessões de hemodiálise, pode ocorrer algum tipo de
complicação. A variabilidade da freqüência cardíaca (VFC) revela informações
do estado funcional do sistema nervoso autônomo e reflete o balanço entre os
ramos parassimpático e simpático do mesmo. Análises da VFC têm sido
propostas como um componente da avaliação clínica para a estratificação do
risco dos pacientes. A VFC pode ser estudada por meio de métodos lineares,
no domínio do tempo e da frequência e métodos não lineares, no domínio do
caos. Objetivo: Avaliar se há ou não associação entre menor VFC no período
imediatamente precedente à realização de hemodiálise e a ocorrência de
complicações durante ou logo após a mesma. Casuística e Método: Foram
incluídos no estudo 44 pacientes não selecionados, independente do sexo e
idade sendo 15 (34,1%) do sexo feminino e 29 (65,9%) do sexo masculino,
com 61,7±14,5 anos. Os critérios de inclusão foram considerados apenas o fato
de ser portador de IRC, estar em programa regular de realização de
hemodiálise na Unidade de Terapia Dialítica do HB de São José do Rio Preto.
A metodologia consistiu na avaliação da VFC nos domínios do tempo,
frequência e caos, utilizando-se de registro de series temporais
eletrocardiográficas com auxilio do equipamento Polar RS800CX, por 20 minutos instantes antes de iniciarem a sessão de hemodiálise. Os 44 pacientes
foram acompanhados durante todo o período dialítico com a verificação da
ocorrência de complicações. Resultados: 35 pacientes (NC) não tiveram
complicações durante a hemodiálise, enquanto que 9 pacientes (C)
apresentaram complicações, como hipotensão, hipoglicemia e câimbras. Os
resultados obtidos mostraram que não houve associação entre uma menor
VFC com a ocorrência de complicações durante ou logo após a hemodiálise.
Porém foi evidente que os pacientes diabéticos apresentaram maior
probabilidade de complicações, pois foi a única variável que apresentou
diferença estatisticamente significativa. Comparando os resultados da VFC nos
pacientes diabéticos com os não diabéticos, encontramos menores valores
para as variáveis que representam a atividade autonômica simpática, como
SDNN, LF, SD2 e alfa 1. Conclusões: A VFC nos domínios do tempo,
freqüência e caos não se caracterizou como preditivo da ocorrência de
complicações durante ou logo após a hemodiálise. Entretanto, em pacientes
diabéticos há uma redução significante do componente simpático associado à
ocorrência de complicações, ressaltando-se a possibilidade de utilização de um
método simples e não invasivo para determinação de prognóstico por meio do
estudo da VFC.
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Efeitos da suplementação com probióticos sobre o perfil da microbiota intestinal e inflamação de pacientes renais crônicos em hemodiáliseBorges, Natália Alvarenga January 2016 (has links)
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Previous issue date: 2016 / Universidade Federal Fluminense. Hospital Universitário Antonio Pedro / O uso de probióticos tem sido apontado como estratégia terapêutica promissora na disbiose intestinal presente nos pacientes com doença renal crônica (DRC). Os probióticos emergiram em um contexto no qual a microbiota intestinal se tornou fator importante envolvido na progressão e nas complicações da DRC. Assim, o objetivo deste estudo foi avaliar os efeitos da suplementação com probióticos sobre o perfil da microbiota intestinal e inflamação em pacientes renais crônicos em hemodiálise (HD). Neste estudo radomizado, duplo cego, placebo controlado, 46 pacientes foram recrutados na clínica Renal Vida/RJ para receberem probiótico (n=23; Streptococcus thermophilus, Lactobacillus acidophilus e Bifidobacteria longum - 90 bilhões de Unidades Formadoras de Colônias (UFC) por dia, ou placebo (n=23). Amostras de sangue e fezes foram coletadas no momento inicial e após 3 meses de intervenção. Marcadores inflamatórios plasmáticos como Proteína C-Reativa (PCR) e Interleucina-6 (IL-6),bem como os níveis plasmáticos de lipopolissacarídeos (LPS) foram analisados por ensaio imunoenzimático (ELISA). Os níveis plasmáticos das toxinas urêmicas indoxil sulfato (IS), p-cresil sulfato (p-CS), ácido indol-3-acético (AIA) e trimetilamina n-oxidase (TMAO), além dos compostos colina e betaína, foram obtidos por Cromatografia Líquida de Fase Reversa (RP-HPLC) e o perfil da comunidade microbiana das amostras fecais foi determinado através da Reação em Cadeia da Polimerase (PCR) e Eletroforese em Gel com Gradiente Desnaturante (DGGE). Foi realizada avaliação antropométrica e análise da ingestão alimentar através do recordatório de 24h de 3 dias. A análise estatística foi realizada através do programa SPSS 19.0. Permaneceram no estudo até o momento final da intervenção, 16 pacientes do grupo probiótico [11 homens, 53,6 ±11,0 anos, 25,3± 4,6 kg/m2, tempo em HD de 75,1± 53,9 meses] e 17 do grupo placebo [10 homens, 50,3 ±8,5 anos, 25,2 ±5,7 kg/m2, tempo em HD de 52,0 ± 44,7 meses]. Após a intervenção, o número médio de bandas avaliado pelo DGGE não se modificou (de 21,2 ± 4,9 para 22,4 ± 6,7, p=0,62). Observou-se aumento significativo, após suplementação com probiótico, nos níveis plasmáticos de ureia pré-diálise [de 149,6 ±34,2 mg/dL para 172,6 ±45,0 mg/dL (p=0,02)], potássio [de 4,4 ± 0,41 mg/dL para 4,8 ± 0,47 mg/dL (p=0,02)] e IS [de 31,2 ± 15,9mg/dL para 36,5 ± 15,0mg/dL (p=0,02)] e redução significativa do pH fecal [de 7,2 ± 0,8 para 6,5 ± 0,5 (p=0,01)]. Não houve alteração significativa dos níveis de PCR e IL-6.O número médio de bandas apresentou associação negativa com o pH fecal (r= -0,504; p= 0,02). Os níveis de ureia foram preditores independente do número médio de bandas (β= -0,25; p= 0,02). A toxina AIA correlacionou-se negativamente com hematócrito (r= - 0,416; p= 0,043) e foi preditora independente para os níveis de hemoglobina (β= -0,49; p= 0,05). Em conclusão, não se observou mudança no perfil micobiano intestinal e nos níveis de marcadores inflamatórios tradicionais com o uso de probióticos, no entanto, alterações observadas em parâmetros bioquímicos como ureia e IS sugerem que essa terapia pode ser contra-indicada em pacientes com DRC em HD. Além disso, as correlações encontradas reforçam o link entre microbiota intestinal e DRC / Probiotics have been suggested as a promising alternativetherapeutic in treatment of Chronic Kidney Disease (CKD) due to their various health-promoting effects. They emerged in a context in which the intestinal microbiota has become an important factor involved in the progression and complications of CKD. Thus, the aim of this study was to evaluate the effects of oral probiotic supplementation onintestinal microbiota profile and inflammation in CKD patients on hemodialysis (HD). In this randomized, double-blind, placebo-controlled study, 46 patients were recruited from Renal Vida/RJ clinic, to receive probiotic (n= 23; Streptococcus thermophilus, Lactobacillus acidophilus e Bifidobacteria longum- 90 billion CFU per day or placebo (n = 23). Blood and feces were collected at baseline and after 3 months. The inflammatory markers C - reactive protein (CRP)and interleukin-6 (IL-6), and plasma levels of lipopolysaccharides (LPS) were analyzed by Immunoenzymatic Assay (ELISA). Plasma levels of uremic toxins indoxyl sulfate (IS), p-cresil sulfate (p-CS), indole-3-acetic acid (IAA) and trimethylamine n-oxidase (TMAO), and choline and betaine compounds, were obtained by Reverse Phase High Performance Liquid Chromatography (RP-HPLC) and, the profile of the microbial community of fecal samples was determined by Polymerase Chain Reaction (PCR) and Denaturing Gradient Gel Electrophoresis (DGGE). The feces pH was measured by colorimetric method. Anthropometric assessment was carried out, analysis of food intake was assessment by 24-hour recall for 3 days. Statistical analysis was performed using the SPSS 19.0 program.Until the end of the intervention, 16 patients remained in probiotic group [11 men, 53.6 ± 11.0 years, 25.3 ± 4.6 kg/m2, HD times of 75.1± 53.9 months] and 17 in placebo group [10 men, 50.3 ± 8.5 years, 25.2 ± 5.7 kg/m2, HD time of 52.0 ± 44.7 months]. The number of bands was not different after intervention (21.2 ± 4.9 to 22.4 ± 6.7, p=0.62).After probiotic supplementation there was a significant increase on urea plasma levels (from 149.6 ± 34.2 mg/dL to 172.6 ± 45.0 mg/dL, p = 0.02), potassium (from 4.4 ± 0.41 mg/dL to 4.8 ± 0.47 mg/dL, p = 0.02) and IS (from 31.2 ± 15.9 to 36.5 ± 15.0 mg/dL, p = 0.02). Thefecal pH was reduced from 7.2 ± 0.8 to 6.5 ± 0.5 (p = 0.01).There was no significant change in CRP and IL-6 levels. Predialysis urea was an independent predictor of the average number of bands (β = -0.25; p = 0.02). The average number of bands was negatively associated with fecal pH (r = -0.504; p = 0.02). IAA levels were negatively correlated with hematocrit (r = - 0.416, p = 0.043) and were an independent predictor for hemoglobin (β = -0.49; p = 0.05). In conclusion, there was no observed change the intestinal microbial profile and levels of traditional inflammatory markers after probiotics supplementation, however, changes were observed in biochemical parameters and IS plasma lvels, suggesting that this therapy may be contraindicated in CKD patients on HD. In addition, this study showed that there is a strong correlation between gut microbiota and CKD
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Punção de fístula arteriovenosa de pacientes em hemodiálise: evidências para a enfermagem / Arteriovenous fistula cannulation in hemodialysis patients: evidences for nursingRodrigues, Jéssica Guimarães 16 March 2018 (has links)
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Previous issue date: 2018-03-16 / Hemodialysis is the most common category of kidney replacement therapy set for
chronical kidney disease. In order to perform this treatment it’s needed a vascular access (VA) that
offers an adequate flow rate, a long use-life and a low rate of complications. The Arteriovenous
Fistula (AVF) is the closest access to meet these requirements. It can, however, present
complications and, during the cannulation that usually happens three times per week, adverse
events (AE) can occur to the patient. The arteriovenous fistula cannulation must happen with safety
in order to prevent future patency problems. There are three methods of cannulation: area, rope
ladder and buttonhole. In the area method, the insertion points of the needles are in the same area;
in the rope ladder method there’s the varying of the place of the puncture, at a distance defined by
the previous puncture, all along the VA; and in the buttonhole method, the needle’s insertion
happen in the same place, angle and deepness, forming a subcutaneous tunnel that will be
cannulated with the blunt needle. Each one of these methods has its own particularity and can
influence in the need to repair the fistula. This is a prospective cohort study, during the course of
six months, from April to September of 2017, conducted with the participation of 347 patients
using the vascular access by autologous arteriovenous fistula, within three hemodialysis clinics in
the city of Goiânia - GO. The data collection happened by weekly interview to the patients, using a
structured instrument online. The research was approved by the Ethics Committee and the
participation conditioned to signing of the consent form by the patient. The general objective was
to analyze the factors that can influence in the necessity to repair the arteriovenous fistula of
patients in hemodialytic treatment cannulated by different cannulation methods. The specific
objective was to relate the adverse events and complications in the different arteriovenous fistula
cannulation methods. We’ve found that in the buttonhole method, the most frequent AE was
dermatitis and misscannulation, and in the area/rope-ladder methods, the most frequent AE were
haematoma and peri-punction bleeding. The patients in the buttonhole method group received the
hemodialytic treatment with a higher blood flow compared the other group. We’ve observed that
the dual lumen catheter (DLC) is a predictor to the need of AVF repairments, due to enhancing in
28% the risk of need for AFV repair. The “arterial” retrograde cannulation has presented itself as a
protection factor, diminishing the need to AVF repairments in 1%. In conclusion, the buttonhole
method is recommended, since there is an intermittent surveillance of the arteriovenous fistula by
the nurse in the touching exam. The area method is not recommended, and the rope ladder method
should be individually evaluated in future studies. The nurse must act by monitoring the AFV,
surveillance of the patency parameters and health education to the patients for the AVF self-care,
as well as continued education to the nursing team in order to promote safe and scientifically based
practices. / A hemodiálise é a modalidade de terapia renal substitutiva mais comumente instituída
para a doença renal crônica. Para esse tratamento é necessário um acesso vascular que ofereça
fluxo sanguíneo adequado à necessidade dialítica, meia vida longa e baixo índice de complicações.
A fístula arteriovenosa é o acesso que mais se aproxima desses requisitos. Porém, não obstante,
pode apresentar complicações, e durante as punções, que comumente se repetem três vezes por
semana, pode haver eventos adversos (EA) ao paciente. A punção da fístula arteriovenosa deve ser
realizada com segurança a fim de prevenir futuros problemas de perviedade. Há três métodos de
punção: regional, escada de corda, e buttonhole. No método regional, os pontos de inserção das
agulhas são na mesma região; no método escada de corda, há rotação do sítio de punção, a uma
distância definida a partir da anterior ao longo de todo o AV; e no buttonhole, a inserção da agulha
é no mesmo local, ângulo e profundidade, formando de um túnel subcutâneo que será puncionado
com agulha romba. Cada um desses métodos tem sua particularidade e podem influenciar na
necessidade para reparos na fístula. Este é um estudo longitudinal de coorte prospectiva, no
período de seis meses, abril a setembro de 2017, realizado com 347 pacientes em hemodiálise
usando acesso vascular por fístula arteriovenosa autóloga, em três clínicas satélites do município
de Goiânia - GO. A coleta de dados foi por entrevista semanal aos pacientes, por meio de
instrumento estruturado online. A pesquisa foi aprovada por comitê de ética, e a participação
condicionada à assinatura do Termo de Consentimento Livre e Esclarecido do paciente. O objetivo
geral foi analisar fatores que influenciam na necessidade de reparo à fístula arteriovenosa de
pacientes em hemodiálise puncionados por distintos métodos de punção. E os objetivos específicos
foram identificar e relacionar os eventos adversos e complicações em distintos métodos de punção
da fístula arteriovenosa, e caracterizar os preditores de complicações da fístula arteriovenosa.
Encontramos como resultados que no método de punção de fístula arteriovenosa buttonhole o EA
mais frequente foi dermatite e reinserção de agulhas de punção, e nos métodos escada/regional
foram hematoma e sangramento peripunção. Os pacientes no grupo puncionado pelo método
buttonhole receberam hemodiálise sob fluxos de sangue mais altos comparado ao outro grupo.
Observamos que o uso do cateter venoso central de duplo lúmen (CDL) caracteriza-se um preditor
de necessidade de reparo da fístula arteriovenosa, pois aumenta em 28% o risco dessa necessidade.
A punção “arterial” retrógrada apresentou-se como fator de proteção, diminuindo em 1% a
necessidade de reparos. Concluímos que o método de punção buttonhole é recomendado desde que
haja a monitoração intermitente da fístula arteriovenosa pelo enfermeiro durante exame físico. O
método regional é desestimulado. E o método escada de corda deve ser avaliado individualmente
em estudos futuros. O enfermeiro deve estabelecer a vigilância dos parâmetros de perviedade,
educação em saúde para autocuidado da fístula arteriovenosa, bem como educação continuada para
a equipe de enfermagem a fim de promover práticas seguras e cientificamente embasadas.
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Avaliação da infusão de vesículas extracelulares e células tronco mesenquimais derivadas de tecido adiposo em modelo experimental de fibrose peritoneal / Evaluation of the infusion of extracellular vesicles and mesenchymal stem cells derived from adipose tissue in an experimental model of peritoneal fibrosisPriscila Queiroz Gouveia 24 July 2018 (has links)
Em pacientes submetidos à diálise peritoneal (DP), alterações morfofuncionais da membrana peritoneal (MP) ocorrem de forma progressiva ao longo dos anos. Estas alterações caracterizam-se, morfologicamente, por perda da camada mesotelial, inflamação, neoangiogênese e fibrose peritoneal (FP) e, funcionalmente, pela queda na ultrafiltração. Tais alterações implicam diretamente em perda da eficiência dessa terapia renal substitutiva. Até o momento, não existe tratamento específico capaz de prevenir ou reverter esta situação. As células tronco mesenquimais (CTm) têm mostrado efeitos terapêuticos benéficos em doenças associadas à fibrose. A participação das CTm no reparo tecidual está principalmente relacionada à sua atividade parácrina, através da liberação de fatores solúveis e vesículas extracelulares (VE). As VE liberadas são importantes na intercomunicação célula-célula e possivelmente contribuem para o efeito terapêutico das CTm ao entregar seu conteúdo (mRNAs, miRNAs, proteínas) para as células alvo. Assim, o objetivo central do presente estudo foi comparar o possível efeito terapêutico das CTm de tecido adiposo (CTmTA) e de VE derivadas de CTmTA na prevenção da FP experimental em ratos. A FP foi induzida em ratos Wistar machos através de injeções intraperitoneais (IP) de gluconato de clorexidina (GC) a 0,1%, em dias alternados, por um período de 30 dias. As CTmTA utilizadas foram obtidas de tecido adiposo gonadal de rato Wistar, cultivadas e expandidas até a 4ª passagem e caracterizadas de acordo com a sua capacidade de aderência ao plástico, presença de marcadores de superfície e pela diferenciação celular in vitro. As VE derivadas de CTmTA foram isoladas por ultracentrifugação. Os protocolos de isolamento por ultracentrifugação e caracterização por microscopia eletrônica, rastreamento de nanopartículas e quantificação das proteínas totais das VE foram padronizados e estabelecidos no laboratório. Os tratamentos com 2x106 CTmTA ou com 30 ug VE foram administrados por injeções de IP. Os animais do estudo foram divididos em 4 grupos: Grupo Controle (n = 8), animais que receberam apenas injeções IP de solução fisiológica; Grupo FP (n = 9), animais que receberam injeções IP de GC para indução da FP e foram tratados com solução fisiológica; Grupo FP + CTmTA (n = 8), animais que receberam injeções IP de GC para indução da PF e foram tratados com 2x106 CTmTA, no 3º e 10º dias, via IP, e Grupo FP + VE (n = 8), animais que receberam injeções IP de GC para indução da FP e foram tratados com 30 ug de VE, IP no 3º e 10º dias, via IP. Após 30 dias da indução de FP, os animais foram submetidos ao teste de função peritoneal e, em seguida, à eutanásia para coleta de amostras de tecido do peritôneo. As amostras do peritôneo parietal foram direcionadas para análises histológicas, imunohistoquímicas, de imunofluorescência e biologia molecular. No Grupo FP, como esperado, houve um aumento significativo da espessura da MP. Os tratamentos com CTmTA e VE preveniram o espessamento da MP, mantendo a espessura similar à do Grupo Controle. Os tratamentos com CTmTA e VE bloquearam o aumento do número de miofibroblastos, da expressão de fibronectina e de fatores envolvidos na FP (TGF-beta e FSP-1), observados nos animais do Grupo FP. Além disso, a expressão gênica de Smad3, que está associada à ativação de genes pró-fibróticos, estava aumentada no Grupo FP e foi reduzida nos grupos tratados. Por outro lado, a expressão gênica de Smad7, um gene associado à contrarregulação do TGF-beta, estava reduzida no Grupo FP e foi aumentada nos grupos que receberam tratamento. Os tratamentos com CTmTA e VE também apresentaram efeitos anti-inflamatórios, reduzindo o número de macrófagos e de linfócitos na MP e diminuindo a expressão do TNF-alfa, uma citocina pró-inflamatória, quando comparados ao Grupo FP. Com relação a análise funcional, o grupo tratado com VE apresentou melhora na capacidade de ultrafiltração. No entanto, os tratamentos com CTmTA e VE não alteraram o transporte de glicose pela MP em relação ao Grupo FP. Outro aspecto dos efeitos dos tratamentos CTmTA e VE diz respeito à neoangiogênese na MP, importante fator relacionado a capacidade de ultrafiltração. Apesar dos grupos tratados com CTmTA e VE apresentarem diminuição significativa da expressão de VEGF na MP, não foi constatada diferença na densidade capilar na MP destes grupos, em relação ao Grupo FP. Em conclusão, no modelo experimental de FP, os tratamentos com CTmTA e VE apresentaram efeito anti-inflamatório e foram igualmente eficientes no bloqueio do processo de FP. O tratamento com VE mostrou melhor capacidade de preservação da função peritoneal, com aumento da capacidade de ultrafiltração. Portanto, os tratamentos com CTmTA ou com VE derivadas de CTmTA apresentam potencial terapêutico e constituem uma nova abordagem, ainda pouco explorada, na prevenção do desenvolvimento da FP associada à DP / In patients undergoing peritoneal dialysis (PD), morphofunctional changes of the peritoneal membrane (PM) occur progressively over the years. These modifications are morphologically characterized by loss of the mesothelial layer, inflammation, neoangiogenesis and peritoneal fibrosis (PF), and functionally, by the reduction in ultrafiltration (UF). Moreover, these changes directly imply in failure of treatment. Currently, there is no clinical alternative to prevent or reverse this situation. In this context, mesenchymal stem cells (MSC) have shown beneficial therapeutic effects in diseases associated with fibrosis. The participation of MSC in tissue repair is related to their paracrine activity, through the release of soluble factors and extracellular vesicles (EV). The EV released are important to cell-to-cell communication and the possibility to contribute to the therapeutic effect of MSC, by delivering their content (mRNAs, miRNAs, proteins) to the target cells. Therefore, the aim of this study was to compare the possible therapeutic effect of MSC versus EV derived from MSC for prevention of experimental PF fibrosis in rats. PF was induced in male Wistar rats by intraperitoneal (IP) injections of 0.1% chlorhexidine gluconate (CG) on alternate days, for a period of 30 days. The MSC used were obtained from Wistar rats gonadal adipose tissue (ASC), cultured and expanded to the 4th passage and characterized according to their ability to adhere to plastic, presence of membranes markers and by cell differentiation in vitro. EV derived from ASC were isolated by ultracentrifugation. The protocols of ultracentrifugation and characterization by electron microscopy, nanoparticle tracking and quantification of total proteins from EV were standardized and established in the laboratory. Both treatments using ASC (2x106 cells) or EV (30 ug) were administered via IP injections. The animals were divided into four groups: Control group (n = 8), animals that received only IP injections of physiological solution; PF group (n = 9), animals that received IP injections of CG to induce PF and were treated with physiological solution; PF+ASC group (n = 8), animals that received IP injections of CG for induction of PF and were treated with 2x106 ASC, at the 3rd and 10th day, by IP delivery; PF+EV group (n = 8), animals that received IP injections of CG for induction of PF and were treated with 30 ug of EV at the 3rd and 10th day, by IP delivery. After 30 days of PF induction, the animals were submitted to the peritoneal function test and then, to euthanasia to collect tissue samples from the peritoneum. The samples were analyzed by histology immunohistochemistry, immunofluorescence, and also by molecular biology. In the FP group, there was a significant increase in the thickness of the PM. Both treatments with ASC or EV prevented increase in PM thickness. Importantly, ASC and EV treatments blocked the increased number of myofibroblast, fibronectin expression and the factors involved in PF (TGF-beta and FSP-1) observed in the PF group. In addition, the Smad3 gene expression, which is associated with activation of pro-fibrotic genes, was increased in the PF group and decreased in the treatments groups. Conversely, the gene expression of Smad7, a gene associated with TGF-beta against regulation, was decreased in the PF group and increased in the animals that received the treatment. ASC and EV injections also showed anti-inflammatory effects, reducing the infiltration of macrophages and lymphocytes into the PM and decreasing the expression of TNF-alpha, a proinflammatory cytokine. The treatments with ASC and EV did not alter the glucose transport by the PM in relation to the PF group, but promoting an increase of the UF capacity. Only the EV treated group showed an increase in UF capacity. Another aspect of the effects of ASC and EV treatments concerns to neoangiogenesis in the PM, an important factor related to the UF capacity. Although the treated groups showed a significant decrease of the VEGF expression in the PM, no difference in the capillary density was observed in relation of PF group. In conclusion, in the experimental model of FP, treatement with ASC or EV showed anti- inflammatory effects and were equally efficient in blocking the PF process. However, the treatment with EV showed a better capacity of preservation of the peritoneal function, with increased capacity of UF. Therefore, the use of ASC and EV potentially represents a new therapeutic approach in preventing the development of PF associated with PD
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Chronic Kidney Disease Awareness and Quality of Care in Abuja NigeriaEze, Patience 01 January 2017 (has links)
Chronic kidney disease (CKD) is a non-communicable progressive disease that can lead to kidney failure or end-stage renal disease. In Nigeria, many people do not have access to health care due to extreme poverty, which means that those suffering from diabetes or high blood pressure, or both diseases, which have been identified as the 2 main risk factors, may not know their health status. The purpose of this phenomenological study was to explore the level of CKD awareness among Nigerians and if cultural beliefs affect individuals' health seeking behaviors because of the diverse nature of the Nigerian population. The protection motivation theory provided the framework for the study. Data were collected through semi-structured interviews with 14 participants, and data analysis included traditional coding. Findings indicated that CKD awareness in Nigeria is low. The social change implication is that the findings may be used to increase awareness of the CKD mortality and morbidity rate in Nigeria to facilitate the development and implementation of health policies that could lower the morbidity and mortality rate of CKD.
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Factors Associated with Hospital Readmissions Among United States Dialysis FacilitiesPaulus, Amber B 01 January 2019 (has links)
Hospital readmissions are a major burden for patients with end stage renal disease (ESRD). On average, one in three hospital discharges among patients with ESRD are followed by a readmission within 30 days. Currently, dialysis facilities are held accountable for readmissions via the ESRD Quality Incentive Program standardized readmission ratio (SRR) clinical measure. However, little is known about facility-level factors associated with readmission. Additionally, unlike other standardized measures of quality in the dialysis setting, incident patients within their first 90-days of dialysis are included in the performance calculation. This study analyzed CMS Dialysis Facility Report data from 2013 to 2016 to examine dialysis facility and incident patient factors associated with SRR using multivariate mixed models. Among 5,419 dialysis facilities treating 104,768 incident patients, the mean SRR remained stable across all four study years at 0.99. Factors significantly associated with a lower SRR (p<0.0001) included Western geographic region and higher patient care technician ratios. Several incident patient pre-dialysis nephrology care characteristics were associated with lower SRRs including higher percentages of patients with a fistula present at first dialysis treatment, higher percentages of patients receiving 6-12 months or greater than 12 months of nephrology care prior to dialysis and higher facility average hemoglobin. Factors significantly associated with a higher SRR (p<0.0001) included Northeastern geographic region, higher registered nurse ratios, higher percentage of incident patients, and higher facility average GFR. Understanding facility-level and patient-level factors associated with higher SRRs may inform interventions to reduce 30-day hospital readmission among patients receiving dialysis.
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Occupational performance of Mexican Americans with end-stage-renal-disease living on dialysis in the lower Rio Grande Valley.Wells, Shirley A. Barroso, Cristina Sofia, January 2009 (has links)
Source: Dissertation Abstracts International, Volume: 70-03, Section: B, page: 1628. Advisers: Belinda M. Reininger; Henry S. Brown. Includes bibliographical references.
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Assembly of colloidal nanocrystals into phospholipid structures and photothermal materialsRasch, Michael 12 November 2013 (has links)
There has been growing interest in developing colloidal metal and semiconductor nanocrystals as biomedical imaging contrast agents and therapeutics, since light excitation can cause the nanocrystals to fluoresce or heat up. Recent advances in synthetic chemistry produced fluorescent 2-4 nm diameter silicon and 1-2 nm diaemeter CuInSSe nanocrystals, as well as 16 nm diameter copper selenide (Cu₂₋[subscript x]Se) nanocrystals exhibiting strong absorbance of near infrared light suitable for biomedical applications. However, the syntheses yield nanocrystals that are stabilized by an adsorbed layer of hydrocarbons, making the nanocrystals hydrophobic and non-dispersible in aqueous solution. Encapsulating these nanocrystals in amphiphilic polymer micelles enables the nanocrystals to disperse in water. Subsequently, the Si nanocrystals were injected into tissue to demonstrate fluorescence imaging, the photothermal transduction efficiency of copper selenide nanocrystals was characterized in water, and the copper selenide nanocrystals were used enhance the photothermal destruction of cancer cells in vitro. The polymer-encapsulated copper selenide nanocrystals were found to have higher photothermal transduction efficiency than 140 nm diameter Au nanoshells, which have been widely investigated for photothermal therapy. Combining the optical properties of metal and semiconductor nanocrystals with the drug-carrying capability of lipid vesicles has received attention lately since it may create a nanomaterial capable of performing simultaneous drug delivery, optical contrast enhancement, and photo-induced therapy. Hydrophobic, dodecanethiol-coated Au nanocrystals were dispersed in water with phosphatidylcholine lipids and characterized using cryo transmission electron microscopy. 1.8 nm diameter Au nanocrystals completely load the bilayer of unsaturated lipid vesicles when the vesicles contain residual chloroform, and without chloroform the nanocrystals do not incorporate into the vesicle bilayer. 1.8 nm Au nanocrystals dispersed in water with saturated lipids to form lipid-coated nanocrystal agglomerates, which sometimes adhered to vesicles, and the shape of the agglomerates varied from linear nanocrystal chains, to flat sheets, to spherical clusters as the lipid fatty acid length was increased from 12 to 18 carbons. Including squalene formed lipid-stabilized emulsion droplets which were fully loaded with the Au nanocrystals. Results with 4.1 nm Au and 2-3 nm diameter Si nanocrystals were similar, but these nanocrystals could not completely load the bilayers of unsaturated lipids. / text
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High-resolution characterization of structural changes involved in prion diseases and dialysis-related amyloidosis / High-resolution characterization of structural changes involved in prion diseases and dialysis-related amyloidosisSkora, Lukasz Stanislaw 07 August 2009 (has links)
No description available.
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Restless-Legs-Syndrom bei dialysepflichtiger Niereninsuffizienz: Untersuchungen zur Pathophysiologie und Schlafqualität – spielt Homocystein eine Rolle? / Restless-Legs-Syndrome in patients with renal insufficiency on hemodialysis: examining pathophysiology and sleep quality- does homocystein play a role?Gade, Katrin 09 July 2012 (has links)
No description available.
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