Conventional HD Research Articles

Exploring Design Tradeoffs and Rate Gain Regions in Full-Duplex Wireless Communications

Conventional HD wireless networks operated by using distinct time slots or frequency (freq.) sub-bands for transmission and reception within the same family. Therefore, the wireless research community aims to develop FD operation to enable simultaneous transmission along with reception inside a single time/ freq. channel. This research aims to conduct an analytical investigation of the conditions under which real FD systems may attain higher data rates compared to analogous HD systems. The primary obstacle in real FD systems is to the uncancelled self-interference (SI) signal, which arises due to a confluence of hardware along with implementation defects. First, provide a signal model that encompasses the impact of notable impairments, including oscillator phase noise (PN), along with low-noise amplifier (LNA) noise figure, along with mixer noise, along with analog-to-digital converter quantization noise. The rate gain area (RGA) is examined in this research using the comprehensive signal model. A~1.2x to ~1.4x that of HD systems for short-range applications like class-3 Bluetooth. To get the same rate gain with Class-1 Bluetooth, −70dB in-band PN must be paired with 50dB passive SI suppression.

Use of a Novel Artificial Intelligence System Leads to the Detection of Significantly Higher Number of Adenomas During Screening and Surveillance Colonoscopy: Results From a Large, Prospective, US Multicenter, Randomized Clinical Trial.

Adenoma per colonoscopy (APC) has recently been proposed as a quality measure for colonoscopy. We evaluated the impact of a novel artificial intelligence (AI) system, compared with standard high-definition colonoscopy, for APC measurement. This was a US-based, multicenter, prospective randomized trial examining a novel AI detection system (EW10-EC02) that enables a real-time colorectal polyp detection enabled with the colonoscope (CAD-EYE). Eligible average-risk subjects (45 years or older) undergoing screening or surveillance colonoscopy were randomized to undergo either CAD-EYE-assisted colonoscopy (CAC) or conventional colonoscopy (CC). Modified intention-to-treat analysis was performed for all patients who completed colonoscopy with the primary outcome of APC. Secondary outcomes included positive predictive value (total number of adenomas divided by total polyps removed) and adenoma detection rate. In modified intention-to-treat analysis, of 1,031 subjects (age: 59.1 ± 9.8 years; 49.9% male), 510 underwent CAC vs 523 underwent CC with no significant differences in age, gender, ethnicity, or colonoscopy indication between the 2 groups. CAC led to a significantly higher APC compared with CC: 0.99 ± 1.6 vs 0.85 ± 1.5, P = 0.02, incidence rate ratio 1.17 (1.03-1.33, P = 0.02) with no significant difference in the withdrawal time: 11.28 ± 4.59 minutes vs 10.8 ± 4.81 minutes; P = 0.11 between the 2 groups. Difference in positive predictive value of a polyp being an adenoma among CAC and CC was less than 10% threshold established: 48.6% vs 54%, 95% CI -9.56% to -1.48%. There were no significant differences in adenoma detection rate (46.9% vs 42.8%), advanced adenoma (6.5% vs 6.3%), sessile serrated lesion detection rate (12.9% vs 10.1%), and polyp detection rate (63.9% vs 59.3%) between the 2 groups. There was a higher polyp per colonoscopy with CAC compared with CC: 1.68 ± 2.1 vs 1.33 ± 1.8 (incidence rate ratio 1.27; 1.15-1.4; P < 0.01). Use of a novel AI detection system showed to a significantly higher number of adenomas per colonoscopy compared with conventional high-definition colonoscopy without any increase in colonoscopy withdrawal time, thus supporting the use of AI-assisted colonoscopy to improve colonoscopy quality ( ClinicalTrials.gov NCT04979962).

High-density open window mapping vs conventional mapping in accessory pathways ablation

Abstract Background and purpose High density (HD) mapping is associated with a reduction in fluoroscopy time compared to conventional mapping in accessory pathway (AP) ablation. The Open Window (OW) technique (CARTO 3, Biosense Webster) is a new tool that automatically uses conventional electrophysiology criteria for AP location, as shorter local EGM AV interval (extended early meets late tool), earliest local activation time (LAT) and annotation at unipolar signal (wavefront annotation). However, no studies comparing its feasibility to conventional mapping have been conducted. Therefore, the aim of the present study was to assess the feasibility and the clinical implications of high-density OW mapping when compared to conventional HD mapping. Methods A prospective, unicentric cohort study was conducted that included consecutive patients which were referred to our institution for AP ablation with OW mapping technique and compared to a recent retrospective cohort of patients who underwent conventional HD mapping. Total fluoroscopy time, total mapping time and the rate of recurrence of the AP were compared between groups. A schematic step by step graphic of the workflow procedure is represented in figure 1. Results A total of 33 consecutive patients (32.28 ± 18 years, 58% males) were included in the OW group and compared with a cohort of 29 patients (29.6 ± 18 years, 52% males) who underwent conventional HD mapping. An example of Right Superior AP ablation is showed in figure 2. No differences in the location of the AP were observed (p=NS). OW mapping was associated to a lower mapping time (29.3 vs 37.8 min; p=0.04), lower fluoroscopy time (14.3 vs 21.3 min; p= 0.04) and lower radiofrequency time (p=0.007). After a median follow up of6 months, there were no differences in the rate of recurrence of the AP conduction between groups (p=NS). Conclusions In our experience, OW mapping was a feasible tool for AP location associated to a lower mapping time, lower radiofrequency time and lower X-ray exposure time with no differences in recurrence rate when compared to conventional HD mapping. However, more studies should be performed to corroborate these conclusions.Step by Step WorkflowRight Superior AP ablation

Essential oil obtained from Chrysanthemum indicum var. aromaticum leaf using solvent-less microwave irradiation-induced hydrodistillation and extraction in situ

Chrysanthemum indicum var. aromaticum is a new variety in the family Compositae and is an aromatic plant resource with high economic value that was first discovered in Shennongjia, Hubei, China. In this work, an improved technique for collecting essential oil from leaves using solvent-less microwave irradiation-induced hydrodistillation and extraction in situ was developed. We extensively investigated a few of the variables that could impact essential oil yield using Pareto analysis and Box‒Behnken design response surface analysis. The highest yield of the essential oil under optimal circumstances was 7.22 ± 0.31 mL/kg DW. The results of GC‒MS analysis showed that C. indicum var. aromaticum leaf essential oil mainly contained terpenes, and the main abundant components were myrtene acetate (21.72%) and cis-sabinol (19.23%). And the first-order kinetic model demonstrated a better fit for the SLMHD. SLMHD (microwave irradiation power 540 W) for 30 min gives a higher yield of essential oil than conventional HD (heating power 450 W) for 180 min, i.e., the emission of CO2, the main greenhouse gas, is reduced from 1080 g for 180 min in conventional HD (heating power 450 W) to 216 g in SLMHD. It can be shown that for the same power consumption, SLMHD can indeed obtain more essential oil. The operator's working hours can be significantly reduced because of the quicker response time, which can help cut labor expenses. Taking all these points into account, further development of the approach could yield good economic benefits.

A cutting‐edge assessment of recent advancements in essential oils extraction technologies for energy and ecological sustainability: A comprehensive review

AbstractHydrodistillation (HD) systems have been popular for essential oils extraction from medicinal and aromatic plants for several decades. Nevertheless, they substantially consume thermal or electrical energy and have a visible carbon footprint on the environment. This article describes a state‐of‐the‐art review of the HD systems used for essential oil extraction to examine their effectiveness. From this study, it has been found that, for a microwave‐assisted system, the yield of an essential oil varies from 0.079% to 8.62%. The microwave‐assisted hydrodistillation (MAHD) system yields 32% more than a conventional HD system. The average extraction time saved using the MAHD system is 67.17% compared with the traditional one. Ohmic‐assisted HD system is better than the microwave‐assisted and conventional HD system, with an 18.04% enhancement in the yield. During this study, it is also investigated that for the distillation system operating at atmospheric pressure, the extraction temperature ranges from 80°C to 120°C. This temperature can easily be attained in a solar hydrodistillation system. Several investigators have demonstrated the use of solar energy for essential oil extraction. However, these systems mostly use a concentrating collector, henceforth found bulky and expensive.

High-density open window mapping vs conventional mapping in accessory pathways ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background and purpose High density (HD) mapping is associated with a reduction in fluoroscopy time compared to conventional mapping in accessory pathway (AP) ablation. The Open Window (OW) technique (CARTO 3, Biosense Webster) is a new tool that automatically uses conventional electrophysiology criteria for AP location, as shorter local EGM AV interval (extended early meets late tool), earliest local activation time (LAT) and annotation at unipolar signal (wavefront annotation). However, no studies comparing its feasibility to conventional mapping have been conducted. Therefore, the aim of the present study was to assess the feasibility and the clinical implications of high-density OW mapping when compared to conventional HD mapping. Methods A prospective, unicentric cohort study was conducted. Consecutive patients which were referred to our institution for AP ablation with OW mapping technique were included and compared to a recent retrospective cohort of patients who underwent conventional HD mapping. Total fluoroscopy time, total mapping time and the rate of recurrence of the AP were compared between groups. Results A total of 29 consecutive patients (32.28 ± 18 years, 58% males) were included in the OW group and compared with a cohort of 29 patients (29.6 ± 18 years, 52% males) who underwent conventional HD mapping. An example of Right Superior AP ablation is showed in figure 1. No differences in the location of the AP were observed (p=NS). OW mapping was associated to a lower mapping time (29.3 vs 37.8 min; p=0.04), lower fluoroscopy time (14.3 vs 21.3 min; p= 0.04) and lower radiofrequency time (p=0.007). After a median follow up of 6 months, there were no differences in the rate of recurrence of the AP conduction between groups (p=NS). A schematic step by step graphic of the workflow procedure is represented in figure 2. Conclusions In our experience, OW mapping was a feasible tool for AP location associated to a lower mapping time, lower radiofrequency time and lower X-ray exposure time with no differences in recurrence rate when compared to conventional HD mapping. However, more studies should be performed to corroborate these conclusions.

Design and Performance Analysis of an In-Band Full-Duplex MAC Protocol for Ad Hoc Networks

This paper proposes a MAC protocol for ad hoc networks using In-band Full-duplex (IBFD) wireless communications, which are named as AdHoc-FDMAC. To utilize IBFD communications in ad hoc networks, this protocol modifies a number of control frames in the IEEE 802.11 Distributed Coordination Function (DCF) MAC standard. Here, the detailed time sequences for all types of IBFD communications are shown for the data transmission and routing. In this paper, the probability and throughput equations for IBFD communications in different situations have been derived. The performance of the proposed AdHoc-FDMAC has been analysed in terms of probability, throughput, and routing time. The Maximum throughput of AdHoc-FDMAC has been found to be 48.34 Mbps, and it is compared with a recently published ad hoc MAC as well as with the conventional HD MAC. The AdHoc-FDMAC outperforms the recently published ad hoc MAC and conventional HD MAC by 16.80% and 66.50% throughput gain, respectively. AdHoc-FDMAC incorporates the existing Ad hoc On-demand Distance Vector (AODV) routing protocol, but this AODV routing is utilized here using IBFD communications. This paper also compares the routing time of the IBFD-based AODV with the conventional AODV. The result shows that the IBFD-based AODV requires 33.33% less routing time than that of the conventional AODV for 3-hop distance between the transmitter and receiver. This paper suggests that the AdHoc-FDMAC protocol provides much more throughput in ad hoc networks by utilizing IBFD communications.

Acetabular Coverage Area Occupied by the Femoral Head as an Indicator of Hip Congruency.

Simple SummaryRadiographic diagnosis is essential for the genetic control of canine hip dysplasia (HD). The Fédération Cynologique Internationale (FCI) scoring HD scheme is based on objective and qualitative radiographic criteria. Subjective interpretations can lead to errors in diagnosis and, consequently, to incorrect selective breeding, which in turn impacts the gene pool of dog breeds. The aim of this study was to use a computer method to calculate the Hip Congruency Index (HCI) to objectively estimate radiographic hip congruency for future application in the development of computer vision models capable of classifying canine HD. The HCI measures the percentage of acetabular coverage that is occupied by the femoral head. Normal hips are associated with an even, parallel joint surface that translates into reduced acetabular free space, which increases with hip subluxation and becomes maximal in hip dislocation. We found statistically significant differences in mean HCI values among all five FCI categories. These results demonstrate that the HCI reliably reflects the different degrees of congruency associated with HD. Therefore, it is expected that when used in conjunction with other HD evaluation parameters, such as Norberg angle and assessment of osteoarthritic signs, it can improve the diagnosis by making it more accurate and unequivocal.Accurate radiographic screening evaluation is essential in the genetic control of canine HD, however, the qualitative assessment of hip congruency introduces some subjectivity, leading to excessive variability in scoring. The main objective of this work was to validate a method-Hip Congruency Index (HCI)-capable of objectively measuring the relationship between the acetabulum and the femoral head and associating it with the level of congruency proposed by the Fédération Cynologique Internationale (FCI), with the aim of incorporating it into a computer vision model that classifies HD autonomously. A total of 200 dogs (400 hips) were randomly selected for the study. All radiographs were scored in five categories by an experienced examiner according to FCI criteria. Two examiners performed HCI measurements on 25 hip radiographs to study intra- and inter-examiner reliability and agreement. Additionally, each examiner measured HCI on their half of the study sample (100 dogs), and the results were compared between FCI categories. The paired t-test and the intraclass correlation coefficient (ICC) showed no evidence of a systematic bias, and there was excellent reliability between the measurements of the two examiners and examiners’ sessions. Hips that were assigned an FCI grade of A (n = 120), B (n = 157), C (n = 68), D (n = 38) and E (n = 17) had a mean HCI of 0.739 ± 0.044, 0.666 ± 0.052, 0.605 ± 0.055, 0.494 ± 0.070 and 0.374 ± 0.122, respectively (ANOVA, p < 0.01). Therefore, these results show that HCI is a parameter capable of estimating hip congruency and has the potential to enrich conventional HD scoring criteria if incorporated into an artificial intelligence algorithm competent in diagnosing HD.

Outcomes of incident patients treated with incremental haemodialysis as compared with standard haemodialysis and peritoneal dialysis.

Residual kidney function is considered better preserved with incremental haemodialysis (I-HD) or peritoneal dialysis (PD) as compared with conventional thrice-weekly HD (TW-HD) and is associated with improved survival. We aimed to describe outcomes of patients initiating dialysis with I-HD, TW-HD or PD. We conducted a retrospective analysis of a prospectively assembled cohort in a single university centre including all adults initiating dialysis from January 2013 to December 2020. Primary and secondary endpoints were overall survival and hospitalization days at 1 year, respectively. We included 313 patients with 234 starting on HD (166 TW-HD and 68 I-HD) and 79 on PD. At the end of the study, 10 were still on I-HD while 45 transitioned to TW-HD after a mean duration of 9.8±9.1 months. Patients who stayed on I-HD were less frequently diabetics (P=.007). Mean follow-up was 33.1±30.8 months during which 124 (39.6%) patients died. Compared with patients on TW-HD, those on I-HD had improved survival (hazard ratio 0.49, 95% confidence interval 0.26-0.93, P=.029), while those on PD had similar survival. Initial kidney replacement therapy modality was not significantly associated with hospitalization days at 1 year. I-HD is suitable for selected patients starting dialysis and can be maintained for a significant amount of time before transition to TW-HD, with diabetes being a risk factor. Although hospitalization days at 1 year are similar, initiation with I-HD is associated with improved survival as compared with TW-HD or PD. Results of randomized controlled trials are awaited prior to large-scale implementation of I-HD programmes.

The rationale and clinical potential of on-line hemodiafiltration as renal replacement therapy.

On-line hemodiafiltration (ol-HDF) was developed in the 1980s in response to the unmet medical needs observed with conventional low- and high-flux hemodialysis. Firstly, the limited overall efficacy of conventional HD treatment programs as compared to native kidney function has been consistently documented over the broad MW spectrum of uremic toxins as well as fluid volume and hemodynamic control. Secondly, the unphysiological profile of intermittent treatment leading to repetitive dialysis-induced hemodynamic stress is now a well-recognized component of cardiovascular disease and end organ damage. Thirdly, the bioincompatibility of patient-dialysis system leading to dialysis-induced biological reactions also identified as contributing to dialytic morbidity and mortality. To overcome these limitations and pitfalls, alternative convective-based therapies (hemofiltration and hemodiafiltration), using higher hemoincompatible membranes and ultrapure dialysis fluid, were proposed as a solution to enhance and enlarge MW spectrum of uremic compounds cleared and to reduce dialysis-patient biological interactions. In this context, online HDF appeared soon as the best viable and efficient renal replacement modality to cover these needs. Clinical development and implementation of ol-HDF showed also that dialytic convective dose matters with a threshold point (23 L/1.73 m2 in postdilution mode) to observe clinical benefits and outcomes improvements.

The Effect of Hemodiafiltration on Inflammatory Biomarkers in Comparison to High Flux Dialyzers in Prevalent Hemodialysis Patients

Abstract Introduction Inflammation in patients with ESRD undergoing HD is an increasing concern for physicians and has been related to increase the rates of morbidity and mortality. Interestingly, patients with ESRD in conventional HD have frequent infections and a suboptimal response to vaccines; this is probably related to an immune inflammatory disorder associated either with uremia and/or nutritional status. In addition to CRP, which seems to be the most important marker for the identification and control of inflammation in clinical practice, many other markers are also available for the evaluation of inflammatory state. Decreased renal clearance clearly accounts for higher levels of circulating cytokines, although increased production has also been described. Hemodiafiltration has been shown to improve cardio-protection and the immunologic system and reduces infection and mortality compared with conventional HD. A recent study showed that hemodiafiltration compared with conventional HD reduced the risk of mortality in ESRD patients. Analysis of pooled individual participant data from randomized controlled trials has shown survival benefits of high volume-HDF on all-cause mortality and especially cardiovascular mortality rate. The mechanisms that lead to improved outcomes are not clear, but it is thought that HDF may reduce the production of inflammatory mediators through the use of biocompatible dialysers and ultrapure dialysate and also improve clearance of larger molecular weight substances, many of which are associated with oxidative stress, inflammation and endothelial dysfunction. Objective The aim of this study is to detect, prospectively, the effect of 3 months dialysis with Hemodiafiltration on inflammatory and nutritional biomarkers in comparison to conventional dialysis with high flux dialyzer in stable HD patients. Patients and methods 30 adults aged 20-75 years who were selected from Dialysis Unit, Kobary El-Kobba Military Hospital. 30 male patients known to have chronic kidney disease and are on dialysis with high flux dialyzer more than 3 months were divided into 2 groups:15 Patients are shifted to be on dialysis with HDF and 15 Patients are continued to be on Regular Hemodialysis with high flux dialyzer. Full medical history and clinical examination. Anthropometric measurements and Laboratory investigations including Complete Blood Picture (WBCs, platelets, Hb), Coagulation profile PT, PTT&amp;INR, Liver function tests (ALT, AST, T. Bilirubin and S. Albumin), Lipid profile (Triglycerides, total cholesterol, VLDL), S. creatinine, BUN, Na, K, Uric acid, Total Proteins, Serum Calcium, Serum Phosphorus, PTH, Serum ferritin, High sensitivity CRP (Enzyme- Linked Immunosorbent Assay (ELISA)) and IL6 (ELISA). Results The current study was conducted on 30 patients with chronic kidney disease on regular dialysis. The patients were divided into two groups A representing patients on hemodiafiltration (n = 15) and group B representing patients on dialysis with high flux dialyzer (n = 15). A high statistical significant difference (P &amp;lt; 0.01) was found regarding K 4.3±0.6 meq/l in group A while it is 5.2±0.5 meq/l in group B, a high statistical significant difference (P &amp;lt; 0.01) was found regarding phosphorus 4.6±1.0 mg/dl in group A while it is 6.1±0.9 mg/dl in group B and no statistical significant difference (P &amp;gt; 0.05) was found as regard the uric acid. A statistical significant difference (P &amp;lt; 0.05) was found regarding CRP 63.5±40.9 mg/dl in group A while it is 73.4±33.2 mg/dl in group B, a statistical significant difference (P &amp;lt; 0.01) was found regarding IL6 85.3±37.6 mg/dl in group A while it is 156.7±151.9 mg/dl in group B after 3 months and no statistical significant difference (P &amp;gt; 0.05) was found as regard those inflammatory markers before 3 months. A statistical significant difference (P &amp;lt; 0.05) was found regarding CRP. A statistical significant difference (P &amp;lt; 0.05) was found regarding IL6. Conclusion The present study revealed that there was no significant change in CRP and IL6 in patients on HDF compared to patients undergoing hemodialysis with high flux dialyzer before 3 months but there was a significant decrease in CRP and IL6 in patients on HDF compared to patients undergoing hemodialysis with high flux dialyzer after 3 months.

Analysis Of The Achieved Quality Of Life In Patients With End-Stage Ckd Undergoing Online Hemodiafiltration

Online hemodiafiltration (OL-HDF), as a renal replacement therapy, has gained significant momentum in recent years due to the added benefit of increased clearance of middle molecules responsible for organ damage and the development of complications in patients with end-stage CKD (ESRD). The beneficial effect of OL-HDF on mortality from a variety of causes, as well as cardiovascular mortality and morbidity, has been reported by some clinical trials. Health-related quality of life (HRQOL) is an important component of care for hemodialysis patients and is of interest to both healthcare providers and patients. Improved quality of life in hemodialysis patients has been associated with a reduced rate of hospitalizations, morbidity and mortality, as well as higher self-esteem, well-being, and psychological comfort. Data on HRQOL in ESRD patients under OL-HDF are scarce and of negligible quality. In the Clinic of Nephrology and Dialysis at the St. Marina University Hospital, Varna, we performed a comparative analysis on 41 patients with HD with an average age of 58.6 ± 12 years (36–70), divided into two groups: Group 1—undergoing conventional HD, and Group 2—undergoing online HDF for a period of 6 months. The main research method is based on a standardized questionnaire on quality of life in kidney disease (KDQOL-SF36), containing 36 elements for assessing eight health concepts of HRQOL, as well as statistics on hospitalizations, morbidity and mortality in patients. The study shows that the use of OL-HDF is associated with a better quality of life related to health in both dimensions: the scale of the physical component and the scale of mental components. There is a reduction in the number of annual hospitalizations, a lower incidence of cardiovascular events, improvement in hypertension, chronic joint pain and stiffness, itching, and improved nutritional status and response to erythropoietin therapy.

Role of adjunct plasma exchange or high cut-off hemodialysis in the management of myeloma cast nephropathy: A systematic review.

e20032 Background: Renal impairment by cast nephropathy is a common complication in multiple myeloma. Tubulointerstitial injury results from precipitation of filtered free light chains (FLC) with Uromodulin in the distal convoluted tubules. Rapid reduction in serum FLC levels has shown to improve renal function in modeling studies. Extracorporeal light chain removal techniques such as plasma exchange (PEX) and high cut-off hemodialysis (HCO-HD) have been explored as potential adjunct treatment options for cast nephropathy in various clinical trials. Methods: PubMed, Cochrane library, and Clinicaltrials.gov were searched systematically for the use of plasma exchange and/or hemodialysis with chemotherapy in the treatment of myeloma cast nephropathy using their MeSH words and keywords. PRISMA guidelines were followed for screening and 5 out of 866 studies were finalized (N = 342). Results: Zucchelli et al. 1988 (n = 29) reported a dramatic reduction in Bence Jones protein (BJP) levels of 0.81 ± 0.46 g/day (P value &lt; 0.01) and 1-year survival rate of 66% in the PEX group and decrease in BJP of 3.25 +/- 0.21 g/day (P-value &lt; 0.05) with a survival rate of 28% in the control group. Clark et al. 2005 (n = 104) reported a primary composite response (patient alive at 6 months + dialysis independence + serum creatinine improvement of 50% at 6 months) in 57.9% of patients in the PEX group and 69.2% in the control group [95% CI, -8.3% to 29.1%]; P = 0.36. Johnson et al. 1990 (n = 21) reported a mean change of 880 μmol /L ± 260(SD) in serum creatinine in the PEX group and 570 μmol /L +/-240 in the control group. HD independence at 3 months was reported as 41.3% (n = 19) in the HCO-HD group and 33.3% (n = 16) in the conventional HD group (95% CI -12%–27.9%; P = 0.42) in the MYRE trial 2017 (n = 98). The EuLITE trial 2019 (n = 90) compared the efficacy of the high cut-off vs high flux hemodialysis (HF-HD) technique and concluded that there was no clinical benefit of one over the other. Independence from HD was achieved in 56% (n = 24) in the HCO-HD cohort vs 51% (n = 24) in HF-HD cohort (relative risk [RR] 1.09, 95% CI 0.74–1.61; P = 0.81). Conclusions: The use of high cut-off hemodialysis and plasma exchange as adjunct therapy did not show any significant survival benefit or improvement in clinical outcome. The role of routine use of PEX/HCO-HD in the management of cast nephropathy is still unclear and the decision to use these modalities should be made on an individual basis.

POS-112 HEMODIALYSIS EMERGENCIES : A MONOCLONAL EXPERIENCE

Hemodialysis emergencies in nephrology are frequent. Prompt diagnosis and management are needed to save life and enhance prognosis. The aim of this work was to determine the hemodialysis’ prevalence in emergency situations, its indications, the clinical, paraclinical and evolutionary profiles and to describe the parameters of the session as well as the per-dialytic incidents and their impacts on patient mortality. It is a retrospective monocentric descriptive study during 3 months (July, August, and September 2020) carried out in the nephrology department of the University teaching hospital of Sousse. We collect patients who underwent at least one session of HD. We included 61 patients who underwent emergency hemodialysis. The average age of our patients was 58±17 years (17- 95) and the sex ratio was 1,5. Our patients have hypertension and diabetes in respectively 56,1% and 34,4% of cases. 42,6% of patients were admitted from the emergency department, 27,9% of patients from the surgical and urology department, 18% of patients from nephrology departments and 11,5% of patients from other departments. Our population consists in chronic HD patients in 34,5%. Chronic renal failure was noted in 43,6% with diabetic nephropathy as the most primary cause (44,1%). Acute renal failure was found in 18.2% with Obstructive nephropathy (66,1%) as the main etiology.two patients were transplanted (3,3%). HD indications were hyperkalemia in 30%, acute pulmonary edema in 25% and metabolic acidosis in 23,3% of cases. Conventional HD was performed with mean session duration of 3,4 hours. Ultrafiltration was required in 73,8% with an average of 1800ml (range: 500-4000).The most frequently used approach was the femoral route in 54,1% followed by arterioveinous fistula in 24,6%. Transfusion was required in 26,2% of cases. Perdialytic complications were observed in 29,5% of cases. Hypotension was the most common complication present in 13,1% of case ; which leads to the interruption of the session in 4.9% of cases ; followed by agitation in 4,9% of case. The renal evolution of our population was hemodialysis dependence in 35,6%, back to basic level in13,3%chronic kidney disease in4,4% and recovery in 2,2%. Death occurred in 5 cases including 3 patients outside dialysis and 2 patients on dialysis. Infection by SARS covid 19 was the cause of death in 1 patient. Extra-renal purification (REE) is sometimes essential in an emergency situation in the management of severe ARI or terminal CKD. Early diagnosis and relevant treatment will enhance the prognosis of patients in the short and medium term.

Expanded Hemodialysis: Promising Prospects

End stage kidney disease (ESKD) causes accumulation of uremic toxins which cover a wide range of molecules classified according to molecular weight into small molecules (&lt;500 Da), medium-sized molecules (500 Da – 60 kDa) and protein-bound toxins.Hemodialysis (HD) remains the main modality of renal replacement therapy in ESKD. Preferably used low-flow dialyzers provided removal of small soluble substances by diffusion, but not clearance of medium-sized molecules.The situation has changed somewhat with the advent of high-flow membranes (HF) and, later, online hemodiafiltration (ol-HDF) which significantly increased the clearance of small and medium-sized molecules due to a combination of diffusion and convection.There is some evidence confirming the hypothesis of insufficient clearance of uremic toxins with higher molecular weight by conventional HD which is the cause of high rates of comorbidity and mortality in patients with ESKD.Specific complications of HD are associated with the accumulation of medium-sized molecules, including myoglobin, leptin, prolactin, fibroblast growth factor (FGF) 23, free light chains kappa and lambda (FLC). Moreover, molecules bound to the proteins like homocysteine, oxidative stress mediators and inflammatory cytokines accelerate the development of atherosclerosis and, as a result, increase cardiovascular mortality.The introduction of MCO membranes into clinical practice has made it possible to develop a new concept of HD therapy called “expanded hemodialysis” (HDx).Thus, new technological solutions concerning the composition of the MCO dialysis membrane enabled to change the dialysis therapeutic targets and combine the capabilities of diffusion and convective transport processes to affect them. Preliminary results demonstrate positive effect of HDx on the triggers of a range of mechanisms of dialysis-associated comorbidity and mortality which can potentially significantly reduce their frequency and/or rate of progression.

Acompanhamento de três anos de restaurações do tipo bulk-fill flow em dentes posteriores: ensaio clínico controlado randomizado duplo-cego

Objective: This randomized clinical trial evaluated the behavior of restorations with flowable bulk-fill resin composite in posterior teeth three years after the restorative treatment. Methods: Seventeen patients (12 women, 5 men, age 23-59) were selected to have at least two failing amalgam or resin restorations replaced and/or to have a carious lesion restored. The cavities were randomly allocated to receive either the flowable bulk-fill composite Surefil SDR Flow occlusally covered with the conventional nano-hybrid composite Esthet-X HD (bulk and body technique) or filled exclusively with Esthet-X HD placed in 2 mm increments (incremental technique). A two-step etch-and-rinse adhesive was applied in all cavities. Thirty-four Class I or II restorations were performed in posterior teeth (n=17) during baseline. After 03 years, modified USPHS and FDI criteria were used to evaluate the restorations. Data were subjected to Mann-Whitney statistical analysis (p0.05). No restoration failures were observed over time. Conclusion: After 03 years of clinical service, all restorations using a flowable bulk-fill composite in posterior teeth showed an acceptable performance. Clinical Significance: The overall quality of posterior restorations made with the bulk and body technique was similar to that of restorations made with a nano-hybrid composite incrementally placed.

Effect of high cut-off dialysis for acute kidney injury secondary to cast nephropathy in patients with multiple myeloma: a systematic review and meta-analysis.

ABSTRACTBackgroundAcute kidney injury (AKI) caused by cast nephropathy is associated with increased morbidity and mortality among patients with multiple myeloma (MM). High cut-off haemodialysis (HCO-HD) has proven to be effective in the removal of serum light chains but the effect on clinical outcomes, especially renal recovery, remains uncertain. MethodsA systematic review and meta-analysis were performed examining all randomized controlled trials (RCTs) and observational studies (OBSs) assessing the effect of HCO-HD on clinical outcomes of patients with MM complicated by cast nephropathy–induced severe AKI. The primary outcome was all-cause mortality at the end of the study. The secondary outcomes included all-cause mortality at 12 months, HD independence and serum kappa and lambda light chain reduction. Pooled analysis was performed using random effects models.ResultsWe identified five studies, comprising two RCTs and three retrospective cohort studies, including 276 patients with a mean follow-up of 18.7 months. The majority of the studies were of suboptimal quality and underpowered. Compared with patients treated with conventional HD, HCO-HD was not associated with a survival benefit at 12 months {five studies, 276 patients, relative risk [RR] 1.02 [95% confidence interval (CI) 0.76–1.35], I2 = 33.9%} or at the end of the studies at an average of 34 months [five studies, 276 patients, RR 1.32 (95% CI 0.71–2.45), I2 = 62.0%]. There was no difference in HD independence at 90 days [two trials, 78 patients, RR 2.23 (95% CI 1.09–4.55)], 6 months [two studies, 188 patients, RR 1.19 (95% CI 0.68–2.06)] or 12 months [two studies, 188 patients, RR 1.14 (95% CI 0.58–2.26)]. Patients receiving HCO dialysis, however, had a greater reduction in serum kappa [two studies, 188 patients, weighted mean difference (WMD) 46.7 (95% CI 38.6–54.7), I2 = 52.0%] and lambda [two studies, 188 patients, WMD 50.3 (95% CI 21.4–79.3), I2 = 95.1%] light chain levels.ConclusionCurrent evidence from RCTs and OBSs suggests HCO dialysis is able to reduce serum free light chains but makes no significant improvement in all-cause mortality and renal outcomes compared with conventional HD for patients with myeloma cast nephropathy. However, there is a trend towards better renal outcomes with the use of HCO dialysis. The lack of long-term data and the small sample sizes of the included studies limit this analysis. Therefore further large-scale RCTs with longer follow-up are needed to assess the effect of HCO dialysis on clinical outcomes in patients with myeloma cast nephropathy.

Improved adenoma detection with linked color imaging technology compared to white-light colonoscopy

ObjectivesLinked color imaging (LCI) is a new endoscopic technology that may increase colorectal adenoma detection rate (ADR) and polyp detection rate (PDR) by virtual chromoendoscopy. Aim of the present study was to evaluate the effectiveness of LCI in ADR and PDR compared to the HD white-light colonoscopy (WLC) technique.Materials and methodsBetween October 2016 and June 2018, we enrolled consecutive outpatients prospectively. Eligible patients allocated randomly to undergo HD WLC or LCI colonoscopy technique during instrument withdrawal. Each colonoscopy was performed in a single center by the same three expert endoscopists (with expertise more than 5000 colonoscopies).ResultsA total of 1278 patients underwent colonoscopy in the study period. ADR and PDR were significantly higher in the LCI group compared to the WLC group (34.4% vs. 26.8%; p = .007; and 53.3% vs 46.4%; p = .023, respectively). Similarly, the mean number of adenomas per patient (MAP) was significantly higher with the LCI than WLC (0.64 vs 0.44, respectively; p = .002). The mean age of patients at the time of colonoscopy was 51.95 years (SD = 13.861) in the LCI group and 51.96 years (SD = 14.028) in the WLC group. No significant differences observed in patient demographic characteristics (there was no difference in gender and age distribution, p = .986), quality of colonoscopy preparation and withdrawal times (WT) between the two groups (WLC and the LCI groups, 493.9 (SD: 143.5) and 514.0 (SD: 139.5) sec, respectively).ConclusionsAccording to our results, LCI virtual chromoendoscopic technology was superior compared to conventional HD WLC in detecting colorectal polyps and adenomas.

Comparison of chemical composition, antioxidant and antibacterial activity of Callistemon citrinus skeels (bottlebrush) essential oil obtained by conventional and microwave-assisted hydrodistillation

Microwave-assisted hydrodistillation and conventional hydrodistillation (MAHD and HD) were used for a comparative study of extraction Callistemon citrinus Skeels leaf essential oils. The time required for a MAHD method is 75 minutes that for HD method is 3.5 hours, so MAHD requires lesser time. The increases in yield of extracted oil by MAHD (0.84%) is found compared oil extracted by HD (0.6%). Essential oils were examined by GC–MS. MAHD extracted essential oils were wealthier in oxygenated molecules. The main constituent was 1, 8-cineole, followed by α-pinene in the case of MAHD. Percentage of the major component increases from 80% to 90% as compared to HD. Their antibacterial activity was examined on ‘Gram-negative’ and ‘Gram-positive bacteria’. In the case of both bacteria, MAHD extracted oil shows better activity than HD extracted one. Antioxidant action was studied by using 2, 2-diphenyl-1-picrylhydrazyl (DPPH•) radical scavenging and β-carotene/linoleic acid assay it is shown that MAHD extract has better activity than HD extract. Surface morphology of Callistemon leaves was studied with scanning electronic microscopy (SEM) which reveals that the MAHD leaves surface undergo major damage to the conventional HD.

P1110IN VITRO CYTOKINE REMOVAL - COMPARISM OF CONVENTIONAL HDF AND HDX (MIDDLE-CUT-OFF-DIALYZER, BAXTER THERANOVA)

Abstract Background and Aims The removal of inflammatory mediators and cytokines is of great importance in the treatment of patients with acute or chronic renal failure. In patients with acute renal failure and sepsis, an attempt is made to achieve removal through the use of high-volume treatments or adsorbers in order to achieve better circulatory stability. In chronic dialysis patients, this has so far not been sufficiently addressed, but is important for mortality and cardiovascular events (MIA syndrome). Some studies show a superiority of HDF over conventional HD. By using new MCO filters in HD mode such as the Baxter Theranova (HDx), an improvement of cytokine status seems to be possible in both areas (chronic and acute). The effectiveness of MCO filters (HDx) compared to high flux hemodiafiltration in the removal of interleukins (interleukin 6, interleukin 10 and TNF (tumor necrosis factor) alpha will be assessed. Method The efficacy of HDx was compared with that of conventional high-flux dialysis filters (Fresenius FX80, HDF) in HDF mode. Based on real world conditions the ultrafiltration/substitution rate was set to 50 ml/min. (blood flow 200 ml/min., dialysate flow 500 ml/min.) No effective ultrafiltration was used. The measurements were performed in vitro in a 3l pool of fresh frozen plasma (citrate anticoagulated, with additional heparin during dialysis treatment). IL6 (24.5 kDa) IL10 (18.6 kDa, dimer)) and TNFalpha (17.4 kDa, trimer) were added to the plasma pool in concentrations of 1.5 μg/l each. This results in very high cytokine levels, as for example in severe sepsis. Samples were taken before and after the dialyzer for 180 minutes (after 5, 15, 30, 60, 120 and 180 minutes).For HDF the measured cytokine concentration was corrected for ultrafiltration rates. In addition to cytokines, albumin and total protein concentration were measured (ELISA Kit LEGEND MAX Human IL-6 / IL-10 / TNF-α; Biolegend and Cobas Mira Plus; Roche Kit LT-AB 0103 and LT-TP 0253). Every test was repeat 5 times. Results Theranova HDx showed higher removal rates of all tested cytokines over a period of 180 minutes. A comparison of the concentrations at the beginning and end of the measurements showed: IL-6 reduction - HDx about 77% / HDF about 63%. IL-10 reduction - HDx about 53% and HDF about 22%. TNF-α Reduction - HDx about 26%; HDF about 18% The concentration of albumin and total serum protein was not significant different during the treatments in both groups. Conclusion Hemodialysis therapy with Theranova HDx appears to be a superior or equal therapy option for the removal of cytokines. This opens up new treatment options for both acute renal failure and chronic dialysis patients, especially if citrate anticoagulation is necessary. The ultrafiltration rate in HDF was lower than recommended for high volume diafiltration,but as high as in our real world experience. Therefore the effect of HDF could be underestimated. Clinical studies with clinically relevant blood flow and ultrafiltration rates are still necessary.