Function In Clinical Practice Research Articles

β-Hydroxy-β-methylbutyrate and its impact on skeletal muscle mass and physical function in clinical practice: a systematic review and meta-analysis

Loss of skeletal muscle mass and muscle weakness are common in a variety of clinical conditions with both wasting and weakness associated with an impairment of physical function. β-Hydroxy-β-methylbutyrate (HMB) is a nutrition supplement that has been shown to favorably influence muscle protein turnover and thus potentially plays a role in ameliorating skeletal muscle wasting and weakness. The aim of this study was to investigate the efficacy of HMB alone, or supplements containing HMB, on skeletal muscle mass and physical function in a variety of clinical conditions characterized by loss of skeletal muscle mass and weakness. A systematic review and meta-analysis of randomized controlled trials reporting outcomes of muscle mass, strength, and physical function was performed. Two reviewers independently performed screening, data extraction, and risk-of-bias assessment. Outcome data were synthesized through meta-analysis with the use of a random-effects model and data presented as standardized mean differences (SMDs). Fifteen randomized controlled trials were included, involving 2137 patients. Meta-analysis revealed some evidence to support the effect of HMB alone, or supplements containing HMB, on increasing skeletal muscle mass (SMD=0.25; 95% CI: -0.00, 0.50; z=1.93; P=0.05; I2=58%) and strong evidence to support improving muscle strength (SMD=0.31; 95% CI: 0.12, 0.50; z=3.25; P=0.001; I2=0%). Effect sizes were small. No effect on bodyweight (SMD=0.16; 95% CI:-0.08, 0.41; z=1.34; P=0.18; I2=67%) or any other outcome was found. No study was considered to have low risk of bias in all categories. HMB, and supplements containing HMB, increased muscle mass and strength in a variety of clinical conditions, although the effect size was small. Given the bias associated with many of the included studies, further high-quality studies should be undertaken to enable interpretation and translation into clinical practice. The trial was registered on PROSPERO as CRD42017058517.

Non-invasive assessment of placental perfusion in vivo using arterial spin labeling (ASL) MRI: A preclinical study in rats

IntroductionNon-invasive assessment of placental perfusion is of great interest to characterize placental function in clinical practice. This article proposes a strictly non-invasive MRI technique using ASL to quantify placental blood flow in vivo. The aim of this study was to develop a fMRI tool to quantify placental blood flow (PBF) in rat, by using arterial spin labeling (ASL) MRI at 4.7 T. Materials and methodsMRI was performed with a dedicated magnet for small animals, in pregnant rats on day 20 of the 22-day gestation period. A Look-Locker flow-sensitive alternating inversion recovery gradient echo sequence was developed as ASL technique (TE: 1.55 ms; TR: 3.5 ms, TI: 56 ms, deltaTI: 56 ms, FA: 20°, Matrix: 128 × 128, 8 segments, 4 Nex). Labeling was performed with global and slice-selective inversions, and T1 map was obtained for each mode of inversion. PBF was then derived from a compartmental model of the variation of T1 between global and slice-selective inversions. ResultsThe full protocol was completed and ASL image post-processing was successful in 18 rats. Forty-seven placentas were analyzed, with a mean PBF of 147 ± 70 ml/min/100 g of placenta, consistent with published values of placental perfusion using invasive techniques. ConclusionASL MRI is feasible for the quantification of PBF in rats at 4.7 T. This technique, which requires no administration of contrast media, could have implications for non-invasive longitudinal and in vivo animal studies and may be useful for the management of human pregnancies.

Cystatin C serum levels in healthy children are related to age, gender, and pubertal stage

BackgroundThis study aims to establish age- and gender-specific cystatin C (CysC) reference values for healthy infants, children, and adolescents and to relate them to pubertal stage, height, weight, and body mass index (BMI).MethodsSerum CysC and creatinine levels of 6217 fasting, morning venous blood samples from 2803 healthy participants of the LIFE Child study (age 3 months to 18 years) were analyzed by an immunoassay. Recruitment started in 2011; 1636 participants provided at least one follow-up measurement. Percentiles for CysC were calculated. Age- and gender-related effects of height, weight, BMI, and puberty status were assessed through linear regression models.ResultsOver the first 2 years of life, median CysC levels decrease depending on height (ß = − 0.010 mg/l/cm, p < 0.001) and weight (ß = − 0.033 mg/l/kg, p < 0.001) from 1.06 to 0.88 mg/l for males and from 1.04 to 0.87 mg/l for females. Following the second year of age, the levels remain stable for eight years. From 11 to 14 years of age, there is an increase of median CysC levels in males to 0.98 mg/l and a decrease in females to 0.86 mg/l. The change is associated with puberty (ß = 0.105 mg/l/Tanner stage, p < 0.001 in males and ß = − 0.093 mg/l/Tanner stage, p < 0.01 in females) and in males with height (ß = 0.003 mg/l/cm, p < 0.001).ConclusionsCysC levels depend on age, gender, and height, especially during infancy and puberty. We recommend the use of age- and gender-specific reference values for CysC serum levels for estimating kidney function in clinical practice.

Microbiome, gut dysbiosis and inflammatory bowel disease: That moment when the function is more important than taxonomy

The altered gut microbiome (dysbiosis) is involved in the pathogenesis of most non-infectious gastrointestinal diseases, such as inflammatory bowel disease (IBD), irritable bowel syndrome, colorectal cancer, celiac disease, hepatic encephalopathy, non-alcoholic fatty liver disease, alcoholic liver disease, cholelithiasis and others. The molecular aspects of the interaction between dysbiotic microbiota and host immune system are considered in the context of IBD pathogenesis. The authors do provide original interpretations of the concepts of taxonomic (microbiological) and metabolic (functional) dysbiosis. Special attention is paid to the hypothesis that gut dysbiosis is caused not so much by structural changes in the microbiome as by alterations in microbial metabolism. Thus, the metabolome is a greater predictor of dysbiosis, than the taxonomic composition of the microbiome. It is important to consider dysbiotic changes in the gut microbiota in patients with ulcerative colitis and Crohn's disease, since they may significantly affect the course and prognosis of IBD. Factors hampering the microbiota assessment in clinical practice are discussed in detail, and advanced dysbiosis tests, including the GA-map Dysbiosis Test (GA-test) and the Colonoflor-16 Test, are described. By means of clinical studies it is demonstrated that a reduction in the genetic capacity of the microbiome for butyrate synthesis, together with an increase in pathobionts and a decrease in microbial diversity, is an important and necessary feature of dysbiosis in IBD patients. Thus, the butyryl-CoA:acetate CoA-transferase (BCoAT) gene level can be considered as a valuable biomarker to assess gut microbiota function in clinical practice. In conclusion, approaches to correct gut dysbiosis using probiotics, prebiotics, metabiotics and fecal microbiota transplantation as an addition to conventional treatment in IBD are critically discussed.

The reliability and validity of the 15‐item Systemic Clinical Outcome and Routine Evaluation (SCORE‐15) Thai version

The 15‐item Systemic Clinical Outcome and Routine Evaluation (SCORE‐15) Thai version was developed. This study aims to assess the test‐retest reliability and the criterion validity of the SCORE‐15 Thai version. The assessment of the test‐retest reliability was performed on twenty‐four non‐clinical participants who gave two ratings two to four weeks apart. Furthermore, sixty‐two clinical and seventy‐three non‐clinical subjects were included for the assessment of the criterion validity. The SCORE‐15 Thai version exhibited excellent test‐retest reliability with an intraclass correlation coefficient of 0.94. The validity study revealed that the effect sizes of score differences between clinical and non‐clinical groups were large (0.90–1.85). In conclusion, the SCORE‐15 Thai version can be a choice for routine clinical practice to determine family functioning in systemic family therapy.Practitioner points Assessment of family functioning is an essential process for both initial evaluations and monitoring the progress of family interventions The SCORE‐15 Thai version exhibited excellent test‐retest reliability and criterion validity The SCORE‐15 Thai version can be used as an instrument to determine family functioning in clinical practice and research

Assessment of The Reliability of Cognitive (Attention and Memory) Tests

Research background and hypothesis. Special neuropsychological tests, which are used to assess cognitive functions in clinical practice, are often complicated, time-consuming, demanding special knowledge and expensive; therefore, cognitive functions frequently remain insufficiently assessed. For this reason, our selected and validated tests intended for the assessment of short-term memory and attention could be successfully applied in sports and clinical rehabilitation. Research aim. The aim of this study was to assess the reliability of the tests of cognitive functions (memory and attention). Research methods. The reliability of the tests was assessed using the intraclass correlation coefficient (ICC) and variation coefficient (VC). Young and healthy students (n = 41), aged from 18 to 30 (24.6 ± 2.3), participated in the research. The participants accomplished the tests 4 times, i. e. 2 times (with a one-hour break) on the first day (teaching) and 2 times (with a one-hour break) on the second day (reliability testing). Research results. The results of testing the volume of spatial memory and even number recognition ranged from high to very high reliability of the tests. The results of ICC single of testing memory for figure recognition demonstrated low reliability, whereas ICC average proved average reliability. The results of complex reaction assessment, search for image samples and attention transfer ranged from high to a very high reliability of the tests. Discussion and conclusions. The reliability of the tests of memory and attention assessment is high (with the exception of figure recognition tests, the reliability of which is average/low); therefore, the tests are suitable to be used in sport and clinical rehabilitation practice, aiming at determining the changes in cognitive functions under the influence of external factors, e. g. cold, heat, etc.Keywords: brain functions, validity, stability, testing.

Echocardiographic assessment of right ventricular function: current clinical practice

Echocardiographic evaluation of right ventricular (RV) function is a challenge due to the complex anatomy of the RV. Several transthoracic echocardiographic methods have been suggested for the quantification of RV function. However, many of the parameters are time consuming and need dedicated hardware and software. We suspected that the majority of the established markers are not used on a wide basis. In a multinational online survey, we evaluated the use of current clinical standards for the quantification of RV function in clinical practice. Through the network of an Ultrasound Online Teaching Platform, echocardiographers were invited to participate in an open online survey. The participants were asked about the parameters (eyeballing, TAPSE, S′, fractional area change, RIMP, 3D-EF, dp/dt, longitudinal strain) they used in clinical practice. A total of 1150 participants from 109 countries completed the survey. Only eyeballing (72%), TAPSE (69%), and S′ (31%) were commonly used in clinical routine. These methods were applied significantly less common in low-income economies when compared to high-income economies. Twenty-three percent of all participants stated to rely on eyeballing only, when evaluating RV function in clinical routine. New technologies, such as global longitudinal strain (3%) and 3D echocardiography (1%) were rarely applied independent of region and economic strength. Eyeballing and TAPSE are the most widely used methods in echocardiography for the assessment of RV function. Although advanced parameters such as longitudinal strain and 3D echocardiography were shown to be highly accurate, they are rarely used in clinical routine.

μVEMP: A Portable Interface to Record Vestibular Evoked Myogenic Potentials (VEMPs) With a Smart Phone or Tablet.

Background: Cervical VEMPs and ocular VEMPs are tests for evaluating otolith function in clinical practice. We developed a simple, portable and affordable device to record VEMP responses on patients, named μVEMP. Our aim was to validate and field test the new μVEMP device.Methods: We recorded cervical VEMPs and ocular VEMPs in response to bone conducted vibration using taps tendon hammer to the forehead (Fz) and to air conducted sounds using clicks. We simultaneously recorded VEMP responses (same subject, same electrode, same stimuli) in three healthy volunteers (2 females, age range: 29–57 years) with the μVEMP device and with a standard research grade commercial (CED) system used in clinics. We also used the μVEMP device to record VEMP responses from six patients (6 females, age mean±SD: 50.3 ± 20.8 years) with classical peripheral audio-vestibular diseases (unilateral vestibular neuritis, unilateral neurectomy, bilateral vestibular loss, unilateral superior canal dehiscence, unilateral otosclerosis).Results: The first part of this paper compared the devices using simultaneous recordings. The average of the concordance correlation coefficient was rc = 0.997 ± 0.003 showing a strong similarity between the measures. VEMP responses recorded with the μVEMP device on patients with audio-vestibular diseases were similar to those typically found in the literature.Conclusions: We developed, validated and field tested a new device to record ocular and cervical VEMPs in response to sound and vibration.This new device is portable (powered by a phone or tablet) with pocket-size dimensions (105 × 66 × 27 mm) and light weight (150 g). Although further studies and normative data are required, our μVEMP device is simpler (easier to use) and potentially more accessible than standard, commercially available equipment.

Curriculum Development in Midwife Education: A Systematic Review

Background: One of the most important managerial resources in the health system is the existence of efficient, competent and strong human resources in an organization. In this regard, it is essential to strengthen and educate the human resources and develop a curriculum that meets the needs of society. This study aimed to determine the educational needs of midwifery students. Materials and Methods: This study reviewed the national and international databases including MEDLINE, Scopus, ProQuest and Ovid and the Cochrane Central Register of Controlled Trials. In addition, SID, Iran Medex, Magiran, Medlib, Iran doc, and Google Scholar were searched from inception 1950 to 2018 to find equivalent keywords in Persian, using keywords such as: Educational Needs, Midwifery, Needs Assessment, and Curriculum. Results: Eight studies were included in this systematic review. According to the findings, education needs to develop midwifery curriculum can be divided into three categories: clinical education, public course and specific course. In term of public course, English classes, Information technology lasses and research methodology; regarding specific course, non-pharmacological treatment for menopause complaints, abnormal uterine bleeding, hypertensive disorders, common gynecological infections, common neonatal diseases and infant mortality in crisis situations; in term of clinical education, revising training program in clinical, improving instructor function in clinical practice (skills), the empowerment instructor in appropriate monitoring and evaluating of students, and including of puberty counseling education as component of the maternal and child health internship in the field of midwifery students, should be considered. Conclusion Midwifery curriculum should be developed to be in according to midwifery’s educational needs to achieve a successful program for educate and strength efficient, competent and strong human resource.

Renal Functional Reserve Revisited.

Kidney function, like the function of other organs, is dynamic and continuously adjusts to changes in the internal environment to maintain homeostasis. The glomerular filtration rate, which serves as the primary index of kidney function in clinical practice, increases in response to various physiological and pathological stressors including oral protein intake. The difference between the glomerular filtration rate in the resting state and at maximum capacity has been termed renal functional reserve (RFR). RFR could provide additional information on kidney health and renal function prognosis. Despite longstanding interest in RFR as a biomarker in nephrology, its underlying mechanisms remain inadequately understood. Moreover, no consensus has been reached on how it should be quantified. Previous studies on RFR have used various measurement methods and yielded heterogeneous results. A standardized and clinically feasible approach to quantifying RFR would allow for more rigorous appraisal of its value as a biomarker and could pave the way for adoption of "renal stress tests" into clinical practice.

Variability in Non–Vitamin K Antagonist Oral Anticoagulants Dose Adjustment in Atrial Fibrillation Patients With Renal Dysfunction: The Influence of Renal Function Estimation Formulae

BackgroundNon–vitamin K antagonist oral anticoagulants (NOACs) require renal dose adjustment. The most common estimates of renal function in clinical practice are derived from estimated glomerular filtration rate (eGFR; Modified Diet in Renal Disease [MDRD] or the Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]). However, the landmark stroke prevention trials and product monographs recommend the use of the Cockcroft-Gault creatinine clearance equation (eCrCl) for drug eligibility and dose adjustment. We sought to evaluate the agreement in NOAC dosing between these 3 equations in a large population of patients with atrial fibrillation and moderate chronic kidney disease. MethodsWe identified 831 patients with non–dialysis-dependent chronic kidney disease and atrial fibrillation (CHA2DS2-VASc 3.9). For each patient, eCrCl, MDRD eGFR, and CKD-EPI eGFR were prospectively calculated. Eligibility criteria for NOAC medications were evaluated by comparing the eGFR as estimated by MDRD or CKD-EPI equation with the eCrCl as estimated by Cockcroft-Gault, with the latter regarded as the "gold standard." ResultsThe use of eGFR resulted in significant misclassification with respect to NOAC dosing. Compared with eCrCl, the MDRD eGFR and CKD-EPI eGFR misclassified 36.2% and 35.8% of patients, respectively. The misclassification resulted in undertreatment (eg, inappropriate dose reduction; 26.9% MDRD, 28.8% CKD-EPI), and to a lesser extent overtreatment (eg, inappropriate use of standard dose; 9.3% MDRD, 7.0% CKD-EPI). ConclusionsMDRD and CKD-EPI eGFR fail to correctly identify a significant proportion of patients who require NOAC dose adjustment, limiting their clinical utility. Cockcroft-Gault eCrCl should be calculated for all patients in whom a NOAC is being prescribed.

Circadian health differs between boys and girls as assessed by non-invasive tools in school-aged children

Assessment of circadian health is confined to adults. However, understanding circadian status of school-aged children is necessary due to its health implications. The aim was to develop 1) a protocol to assess circadian function in school-aged children by combining the best non-invasive tools previously validated in adults; 2) a score to capture circadian function in children including food timing. This protocol will allow to explore gender differences and to compare the circadian function of school-aged children with adults from the same Mediterranean area. Healthy children (8-12y) from 3 schools in a Mediterranean area of Spain were recruited (n=248; 125 males and 123 females). Several non-invasive tools were used: a) 7-day-diaries of food timing and food intake, physical-activity and sleep, b) Munich-chronotype-self-reported-questionnaire; c) cortisol and melatonin saliva determinations; d) 7-day-rhythms of wrist temperature (T), activity (A), position (P) and the integrative variable TAP e) 7-day-light exposure. We have constructed the first school-aged children population for the assessment of circadian function (ONTIME-Jr) and a new circadian score has been developed. Among circadian-related measures, TAP was the most suitable and reliable to determine circadian system characteristics. Circadian function was better in girls than in boys [circadian score (AU) Mean±SD (girls, 1216±153 vs. 1159±173 boys, P=0.012)], and also in school-aged children than in adults from the same Mediterranean area (Circadian-Function-Index: children 0.47±0.06 vs. adults 0.45±0.06P=0.001). A new protocol, including TAP and food timing, demonstrated to be reliable in assessing circadian function in children. These non-invasive techniques provide the wherewithal for paediatricians to assess circadian function in clinical practice. Chronobiology and childhood obesity (ONTIME-Jr: Obesity, Nutrigenetics, Timing and Mediterranean, Junior). ClinicalTrials.gov ID: NCT02895282, October 2014.

The association between elevated serum uric acid levels and islet β-cell function indexes in newly diagnosed type 2 diabetes mellitus: a cross-sectional study.

BackgroundSerum uric acid (UA) has been reported as a risk factor for type 2 diabetes mellitus (T2DM). However, whether serum UA is associated with insulin resistance and insulin secretion, and the effect of gender on it in the case of the existed association, both remain undefined.MethodsA cross-sectional study was designed and performed, which enrolled a total of 403 newly diagnosed T2DM patients (mean age, 50.21 ± 13.34 years (62.5% males)). Clinical characteristics and islet function indexes of all participants were analyzed based on gender-specific tertiles of serum UA levels. In addition, multiple linear regression analysis was conducted to investigate covariates associated with islet function indexes.ResultsThe mean levels of serum UA were 331.05 μmol/L (interquartile range (IQR): 60.6, 400.9 μmol/L) and 267.9 μmol/L (IQR: 204.7, 331.9 μmol/L) in men and women, respectively. The values of insulin secretion indexes involving AUCins30/glu30, AUCins120/glu120 and total insulin disposition index (DI120) in females were significantly higher than those in males. Apart from the homeostasis model assessment insulin resistance of men, serum UA was positively associated with insulin secretion and insulin resistance indexes both in men and women. Multivariable linear regression analysis showed serum UA exerted an independent impact on insulin secretion in females, but not on insulin resistance. In males, islet function was simultaneously affected by serum UA age, body mass index (BMI), and serum lipids.ConclusionSerum UA harbored a positive correlation with insulin secretion and insulin resistance indexes in newly diagnosed T2DM patients, which was influenced by gender, BMI, serum lipids. Hence, serum UA may be considered as a predictor for islet function in clinical practice.

Adapting a memory fMRI research protocol in clinical routine: Feasibility and results

ObjectiveThe objective of this study was to test the reliability of functional magnetic resonance imaging (fMRI) evaluation of memory function in clinical practice to predict postoperative memory decline in patients with refractory medial temporal lobe epilepsy (MTLE) candidate to surgery. MethodsTwenty-six consecutive patients with MTLE who underwent a complete presurgical evaluation were included. All patients underwent fMRI memory study and complete neuropsychological assessment. Lesions consisted in hippocampal sclerosis in 18 patients (12 right and 6 left), dysembryoplastic neuroepithelial tumor (DNET) in 5 cases (4 right, 1 left), epidermoid cyst in one patient (right). Two patients had no lesion (2 left). ResultsNineteen patients (73%) underwent surgery. The other seven patients (27%) declined surgery, mainly because of the risk of memory deficit. The fMRI procedure correctly predicted both verbal and nonverbal memory postoperative outcome in 13 of the patients (72%), failed to predict a postoperative memory worsening in only two patients (12%), and predicted worsening in three patients (17%) that remained stable (versus 44%, 39%, and 17% with the sole neuropsychological testing). The reliability of the fMRI procedure was not influenced by the type of lesion, the side of the epileptic focus, or the type of preoperative memory profile (typical or atypical). SignificanceAppearing as a valuable clinical tool to predict postoperative memory outcome, fMRI may add information over and above other available tests.

Endothelial function in rheumatoid arthritis.

Rheumatoid arthritis (RA) patients are at higher risk of accelerated atherosclerosis. To assess endothelial dysfunction in RA to find a possible mechanistic pathway that will explain the clinical phenomenon. A prospective study recruited 44 RA patients with an active long standing (>12 months) disease. All underwent a detailed assessment of disease activity. To estimate the endothelial function the brachial artery method was performed, measuring flow mediated diameter percent (FMD%) change. Clustering analyses (hierarchical and k-means) were performed. Patients were compared to healthy subjects. Forty four RA patients (54.42 ± 11.14 years, females (72.7%)) with co-morbidities (70.5%), not taking tumor necrosis factor-blockers or disease modifying anti rheumatic drugs (63.6%). Only 6 (13.6%) had a normal endothelial function. Hierarchical and k-means clustering techniques showed statistically significant differences among the three clusters concerning disease activity score-28 (DAS-28)- erythrocyte sedimentation rate (ESR) (P = 0.000), DAS-28- C-reactive protein (CRP; P = 0.001), clinical disease activity index (P = 0.002), simplified disease activity index (P = 0.001), ESR (P = 0.000), (CRP) (P = 0.003) and FMD% (P = 0.009). The group with the highest FMD% values exhibited the lowest clinical scores and laboratory parameters. Patients with the lowest FMD% values co-clustered with subjects with positive but low FMD% changes and elevated clinical and laboratory parameters. Our study confirmed the feasibility of exploiting endothelial function in clinical practice as an early predictor of atherosclerosis in RA patients.

Cognitive dysfunction in patients with systemic lupus erythematosus: The challenge in diagnosis and management

Cognitive dysfunction is one of the five psychiatric syndromes recognised by the American College of Rheumatologists neuropsychiatric lupus nomenclature committee. Cognitive dysfunction affects 20%–80% of systemic lupus erythematosus patients with and without overt central nervous system involvement. Specific cognitive dysfunction associated with systemic lupus erythematosus includes impairment in attention, memory and visuospatial process. Besides disease activity and vascular risk factors, the neuropathology behind cognitive dysfunction in systemic lupus erythematosus is a result of dysfunction involving the immune cells, cytokines, chemokines and autoantibodies (Abs), as well as volume reduction in the white matter and grey matter. In this review, we will discuss the challenges of using traditional neuropsychological assessment to assess cognitive function in clinical practice, the limitations of conventional neuroimaging methods, the controversies of using corticosteroids, other pharmacological treatments and non-pharmacological interventions to treat cognitive dysfunction associated with systemic lupus erythematosus.

THE MOVEMENT SYSTEM IN EDUCATION

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Evaluation of various equations for estimating renal function in elderly Chinese patients with type 2 diabetes mellitus.

BackgroundThe clinical assessment of kidney function based on the estimated glomerular filtration rate (GFR) in older patients remains controversial. This study evaluated the concordance and feasibility of using various creatinine-based equations for estimating GFR in elderly Chinese patients with type 2 diabetes mellitus (T2DM).MethodsA cross-sectional analytical study was conducted in 21,723 older diabetic patients (≥60 years) based on electronic health records (EHR) for Minhang District, Shanghai, China. The concordance of chronic kidney disease (CKD) classification among different creatinine-based equations was assessed based on Kappa values, intraclass correlation coefficient (ICC) statistics, and the eGFR agreement between the equations was tested using Bland–Altman plots. The GFR was estimated using the Cockcroft–Gault (CG), Berlin Initiative Study 1 (BIS1), simplified Modification of Diet in Renal Disease (MDRD), MDRD modified for Chinese populations (mMDRD), chronic kidney disease epidemiology collaboration (CKD-EPI), CKD-EPI in Asians (CKD-EPI-Asia), and Ruijin equations.ResultsOverall, the proportion of CKD stages 3–5 (eGFR <60 mL/min/1.73 m2) was calculated as 28.9%, 39.1%, 11.8%, 8.4%, 14.3%, 11.5%, and 12.7% by the eGFRCG, eGFRBIS1, eGFRMDRD, eGFRmMDRD, eGFRCKD-EPI, eGFRCKD-EPI-Asia, and eGFRRuijin equations, respectively. The concordance of albuminuria and decreased eGFR based on the different equations was poor by both the Kappa (<0.2) and ICC (<0.4) statistics. The CKD-EPI-Asia equation resulted in excellent concordance with the CKD-EPI (ICC =0.931), MDRD (ICC =0.963), mMDRD (ICC =0.892), and Ruijin (ICC =0.956) equations for the classification of CKD stages, whereas the BIS1 equation exhibited good concordance with the CG equation (ICC =0.809). In addition, significant differences were observed for CKD stage 1 among all these equations.ConclusionAccurate GFR values are difficult to estimate using creatinine-based equations in older diabetic patients. Kidney function is complex, and the staff need to be aware of the individualized consideration of other risk factors or markers of reduced renal function in clinical practice.

Synchrotron Phase Tomography: An Emerging Imaging Method for Microvessel Detection in Engineered Bone of Craniofacial Districts.

The engineering of large 3D constructs, such as certain craniofacial bone districts, is nowadays a critical challenge. Indeed, the amount of oxygen needed for cell survival is able to reach a maximum diffusion distance of ~150–200 μm from the original vascularization vector, often hampering the long-term survival of the regenerated tissues. Thus, the rapid growth of new blood vessels, delivering oxygen and nutrients also to the inner cells of the bone grafts, is mandatory for their long-term function in clinical practice. Unfortunately, significant progress in this direction is currently hindered by a lack of methods with which to visualize these processes in 3D and reliably quantify them. In this regard, a challenging method for simultaneous 3D imaging and analysis of microvascularization and bone microstructure has emerged in recent years: it is based on the use of synchrotron phase tomography. This technique is able to simultaneously identify multiple tissue features in a craniofacial bone site (e.g., the microvascular and the calcified tissue structure). Moreover, it overcomes the intrinsic limitations of both histology, achieving only a 2D characterization, and conventional tomographic approaches, poorly resolving the vascularization net in the case of an incomplete filling of the newly formed microvessels by contrast agents. Indeed, phase tomography, being based on phase differences among the scattered X-ray waves, is capable of discriminating tissues with similar absorption coefficients (like vessels and woven bone) in defined experimental conditions. The approach reviewed here is based on the most recent experiences applied to bone regeneration in the craniofacial region.

Platelet function investigation by flow cytometry: Sample volume, needle size, and reference intervals

Flow cytometry is an increasingly used method for platelet function analysis because it has some important advantages compared with other platelet function tests. Flow cytometric platelet function analyses only require a small sample volume (3.5 mL); however, to expand the field of applications, e.g., for platelet function analysis in children, even smaller volumes are needed. Platelets are easily activated, and the size of the needle for blood sampling might be of importance for the pre-activation of the platelets. Moreover, to use flow cytometry for investigation of platelet function in clinical practice, a reference interval is warranted.The aims of this work were 1) to determine if small volumes of whole blood can be used without influencing the results, 2) to examine the pre-activation of platelets with respect to needle size, and 3) to establish reference intervals for flow cytometric platelet function assays.To examine the influence of sample volume, blood was collected from 20 healthy individuals in 1.0 mL, 1.8 mL, and 3.5 mL tubes. To examine the influence of the needle size on pre-activation, blood was drawn from another 13 healthy individuals with both a 19- and 21-gauge needle. For the reference interval study, 78 healthy adults were included. The flow cytometric analyses were performed on a NAVIOS flow cytometer (Beckman Coulter, Miami, Florida) investigating the following activation-dependent markers on the platelet surface; bound-fibrinogen, CD63, and P-selectin (CD62p) after activation with arachidonic acid, ristocetin, adenosine diphosphate, thrombin-receptor-activating-peptide, and collagen.The study showed that a blood volume as low as 1.0 mL can be used for platelet function analysis by flow cytometry and that both a 19- and 21-gauge needle can be used for blood sampling. In addition, reference intervals for platelet function analyses by flow cytometry were established.