PD Duration Research Articles

#1262 Risk factors of peritoneal dialysis associated peritonitis caused by gram-negative bacteria: a single-center retrospective study over 16 years

Abstract Background and Aims To analyse the clinical characteristics, pathogen distribution, and treatment outcomes of peritoneal dialysis associated peritonitis (PDAP) caused by gram-negative bacteria, and explore the risk factors for the occurrence and treatment failure of gram-negative bacterial peritonitis. Method We performed a single-center retrospective study included 544 PD patients who underwent regular follow-up between January 1, 2007, and December 31, 2022. After excluding culture-negative peritonitis, fungal peritonitis, and tuberculous peritonitis, based on the pathogens, all episodes were divided into the gram-negative peritonitis group (GNP) and the non-gram-negative peritonitis group (non-GNP). Demographic characteristics, laboratory examinations, pathogenic bacteria, and treatment outcomes were collected and compared between the two groups of peritonitis. Results Over the course of 16 years, 297 episodes of peritonitis occurred in 179 patients. Although the overall incidence of peritonitis is showing a year-on-year downward trend, the incidence of GNP has not changed significantly. However, the percentage of GNP cases among all peritonitis cases is on the rise. After excluding episodes of culture-negative peritonitis, fungal peritonitis, and tuberculous peritonitis, a total of 226 cases of peritonitis were included in the study. Among them, females accounted for 50.0%, with an average age of 63.04 ± 11.58 years and a median PD duration of 42 (21, 73) months. Escherichia coli was the main pathogen responsible for gram-negative bacterial peritonitis in our center (37/80, 46.3%), followed by Klebsiella pneumoniae (9/80, 11.3%). The GNP group had significantly higher white blood cell counts in peritoneal effluent on day 0, day 3, and day 5 after peritonitis onset compared to the non-GNP group (p < 0.001 for all). In terms of treatment outcomes, the GNP group had significantly higher rates of developing refractory peritonitis, treatment failure, and peritonitis-associated death compared to the non-GNP group (p < 0.001 for all). Multivariate logistic regression analysis revealed that enteric infection was an independent risk factor for GNP occurrence (OR = 6.315, 95% CI 3.364-11.854, p < 0.001). White blood cell counts on day 3 of peritoneal effluent (OR = 2.666, 95% CI 1.099-6.469, p = 0.030) and post-PDAP blood white blood cell counts (OR = 1.389, 95% CI 1.060-1.820, p = 0.017) were independent risk factors for treatment failure in GNP. Conclusion Over the past 16 years, the incidence rate of GNP in our center has shown no significant decrease, and the proportion of GNP cases has been increasing year by year. Escherichia coli is the main pathogen responsible for GNP in our center. GNP cases are more difficult to treat and have a poorer prognosis compared to non-GNP cases. Therefore, it is important to strengthen preventive measures for peritoneal dialysis patients, reduce the risk of enteric infection, and actively treat patients who have already developed gram-negative bacterial peritonitis to avoid adverse outcomes.

Differential expression and clinical significance of IGF2BP3 in peritoneal dialysate of patients with varying duration of peritoneal dialysis.

This study aims to investigate the differential expression of insulin-like growth factor 2 mRNA-binding protein 3 (IGF2BP3) in the peritoneal dialysate among patients with different durations of peritoneal dialysis and its association with the angiogenic marker vascular* endothelial growth factor (VEGF), the fibronectin (FN), and various clinical indicators. A cohort of 122 peritoneal dialysis patients was categorized into short-term (≤1 year, n = 33), mid-term (>1 and ≤5 years, n = 55), and long-term (>5 years, n = 34) groups based on dialysis duration. We utilized enzyme-linked immunosorbent assay (ELISA) and western blot assays to quantify the levels of IGF2BP3, VEGF, and FN in the dialysate. Our findings showed a progressive increase in IGF2BP3 levels with the duration of PD, with the long-term group exhibiting significantly higher levels than both the short-term and mid-term groups (p < 0.001). A positive correlation between IGF2BP3 and VEGF (r = 0.386, p = 0.013), as well as between IGF2BP3 and FN (r = 0.340, p = 0.030), was observed. IGF2BP3 levels also correlated positively with serum creatinine, calcium, and phosphorus levels. Invitro analysis further confirmed that IGF2BP3 expression is enhanced in human peritoneal mesothelial cells under high-glucose conditions (p < 0.05). The study highlights the potential of IGF2BP3 in PD effluent as a biomarker for monitoring PF progression, with its expression significantly correlated with the duration of PD (Pearson r = 0.897, p < 0.001). In conclusion, our results underscore a correlation between elevated IGF2BP3 levels and PD duration, suggesting the clinical significance of IGF2BP3 as a biomarker for PF progression.

Metformin use is associated with reduced mortality risk in diabetic patients with Parkinson's disease

IntroductionParkinson’s disease (PD) and type-2 diabetes (T2D) arguably share pathophysiologic mechanisms, resulting in a more severe phenotype and progression and diabetes is currently considered a risk factor of PD. Besides, research suggests antidiabetic therapies as potential disease-modifying strategies. The main aim was to assess the impact of a metformin-inclusive antidiabetic treatment on patient all-cause mortality. MethodsA nested case-control prospective study including newly diagnosed PD patients reporting the onset of T2D within ±2 years from the onset of PD (n=159) and matched (1:5; gender, year of PD onset and age at PD onset) non-diabetic cases (n=795) followed until death or censoring. Patients on a metformin-inclusive treatment regimen were compared to those receiving other oral anti-diabetics (OADs). ResultsAmong patients with T2D, 123 were treated with a drug regimen containing metformin (alone [65.0%] or in combination with other drugs [35.0%]) and 36 were prescribed other OADs. During a median PD duration of 96 months [IQR, 60-144], 171 patients died. Diabetes was not associated with reduced survival: fully-adjusted HR=1.19 [95%CI, 0.81-1.76] (P=0.37). After stratifying for T2D treatment, a metformin-inclusive regimen was not associated with increased risk of death (HR=1.06 [95%CI, 0.61-1.84]; P=0.83), while patients receiving other OADs had reduced survival (HR=1.83 [95%CI, 1.01-3.32]; P=0.034). ConclusionsMetformin use was not associated with increased risk of death in diabetic patients with PD reporting concomitant onset of the two diseases. Metformin appears to be a promising disease-modifying therapy given also the preclinical background, low cost and satisfactory safety and tolerability. Further studies are warranted to investigate its impact on disease progression.

Microwave irradiation of guar seed flour: Effect on anti-nutritional factors, phytochemicals, in vitro protein digestibility, thermo-pasting, structural, and functional attributes.

Guar seed flour (GSF) has a high amount of carbohydrates, proteins, phytochemicals, and anti-nutritional factors (ANFs), which limits its use. To address this issue, the current study was undertaken to understand the effect of microwave (MW) irradiation on ANFs, phytochemicals, in vitro protein digestibility (IVPD), and functional attributes of GSF at varying power density (Pd: 1-3W/g) and duration (3-9min). The ANFs were determined using a colorimetric assay and a Fourier transform infrared spectrum. At 3Pd-9min, the maximum reduction in ANFs (tannin, phytic acid, saponin, and trypsin inhibitor activity) was observed. Higher Pd and treatment duration increased antioxidant activity and total phenolic content, except for total flavonoid content. Furthermore, compared to the control sample (78.38%), the IVPD of the GSF samples increased to 3.28% (3Pd-9min). An increase in Pd and duration of MW treatment improved the thermal and pasting properties of GSF samples up to 2Pd-9min. Due to inter- and intramolecular hydrogen bonding degradation, the relative crystallinity of the 3Pd-9min treated GSF sample was 30.58%, which was lower than that of the control (40.08%). In MW-treated samples, SEM images revealed smaller clusters with rough and porous structures. However, no noticeable color (ΔE) changes were observed in MW-treated samples. Aside from water absorption capacity and water solubility index, MW treatment reduced oil absorption capacity, foaming capacity, and emulsifying capacity. As demonstrated by principal component analysis, MW irradiation with moderate Pd (2-3) was more effective in reducing ANFs, retaining nutritional contents, and improving the digestible properties of GSF, which could be a potential ingredient for developing gluten-free products.

Ab. No. 2 Physiotherapy for Managing Tremors in Patients With Parkinson’s – A Systematic Review

Introduction: Primary parkinsonism is one of the most prevalent movement disorders characterized by hypokinesia, rigidity, and tremor. The number of PD cases is anticipated to rise on a global scale, making it crucial to find effective and affordable interventions. physiotherapy interventions have shown promise in managing tremors, but high-quality systematic reviews are limited. This systematic review aims to evaluate the benefits of physiotherapy treatments in managing tremors in Parkinson’s disease. Methods: The study followed the Centre for Reviews and Dissemination and PRISMA guidelines. A comprehensive search was conducted using multiple databases, including PubMed, EMBASE, AMED, and PsycINFO. Keywords related to PD, physiotherapy, and tremors were used. The eligibility of studies was assessed independently by two reviewers, and the quality of included studies was evaluated using the JBI risk of bias tool. Data extraction was performed, focusing on study characteristics, participant demographics, intervention details, and outcome measures. Result: A total of seven studies met the inclusion criteria. The sample sizes ranged from 10 to 79 participants, and the interventions varied from standard exercises to technological interventions. The findings from the included studies demonstrated the positive effects of physiotherapy interventions on tremor reduction and motor function improvement. However, due to the heterogeneity among the studies in terms of the classification of PD, outcomes measured, and intervention duration, it was challenging to draw definitive conclusions. Conclusion: In conclusion, while limited evidence exists, physiotherapy interventions have shown temporary benefits in reducing tremors and improving motor function in patients with PD.

Evaluation of bidirectional gut-brain axis and anorectal function in Parkinson's disease with constipation.

Parkinson's disease (PD) is a neurodegenerative movement disorder with prodromal and highly prevalent gastrointestinal (GI) symptoms, especially constipation. Although PD models suggest gut-brain axis dysfunction, the mechanistic underpinnings and their correlation with GI symptoms are poorly understood. To examine the bidirectional gut-brain axis function in PD and correlate it with constipation severity, PD duration, and severity. Rectal sensory thresholds and afferent cortical evoked potentials (CEP) were assessed using a 4-ring EMG electrode probe. Efferent anal and rectal motor evoked potentials (MEPs) were obtained following transcranial and lumbosacral magnetic stimulation. Bowel symptoms were assessed by prospective stool diary. The CEP and MEP latencies, rectal sensory thresholds, and anorectal sensorimotor data were compared between PD subjects and age-adjusted healthy subjects. Twenty-five PD subjects with constipation (F/M = 6/19) and 20 healthy subjects (F/M = 14/6) were enrolled. The first and pain sensation thresholds were higher in PD subjects than healthy subjects (p < 0.002) but lost significance after adjustment for age. Age-adjusted rectal CEP and right-sided cortico-anal MEP latencies were prolonged in PD subjects compared to healthy subjects (p < 0.04). Also, half (4 of 8) age-adjusted spino-anal and rectal MEP latencies in PD subjects were significantly longer. In multivariate linear analysis, first rectal sensation and right-sided MEP latencies showed moderate correlation with constipation severity. Parkinson's disease is associated with significant bidirectional gut-brain axis dysfunction as evidenced by prolonged afferent and efferent neuronal signaling. Constipation severity in PD is correlated to abnormal rectal sensation and lateralized disturbance of efferent brain-gut signaling.

Neuropathic Pain and Related Factors in Female Patients with Rheumatoid Arthritis

Purpose : Neuropathic pain (Np) can accompany Rheumatoid arthiritis (Ra)like many other diseases. Aim of our study was to investigate the frequency of Np and related factors in female patients with Ra. Methods : Age, disease duration, body mass index (BMI), erythrocyte sedimentation rate (ESR) were recorded. A pain visual analog scale (VAS) was used to record pain intensity and paindetect questionnaire (Pd) was used to record Np score. Ra disease activity was calculated with DAS28 score. Health Assesment Questionnaire (HAQ) was used for functional status. Results : Np scores of the patients were high. A significant correlation was found between Pd and VAS, BMI and HAQ values. The correlation value between Pd and disease duration, age, inflammation, disease activity was not significant Conclusion : All of the patients' pain may not be caused by inflammation. If this is the case, treatment can change. If the pain pattern is questioned and treated, unnecessary use of anti-inflammatory drugs can be prevented.

#5664 PERITONEAL DIFFUSE PODOPLANIN EXPRESSION IS ASSOCIATED WITH SEVERE ARTERIOLOPATHY IN CHILDREN ON PERITONEAL DIALYSIS

Abstract Background and Aims Podoplanin is a transmembrane glycoprotein binding chemokines and modulating inflammatory reactions. In healthy peritoneum, it is expressed in mesothelial cells and in lymphatic endothelium, expression beyond these structures (diffuse podoplanin staining, DPS) has been observed in adult patients with encapsulating peritoneal sclerosis (EPS). Method Parietal peritoneal tissues from 71 children on PD fluids with low glucose degradation product (GDP) content underwent digital histomorphometry. DPS and pathomechanisms of peritoneal membrane transformation and vasculopathy were hierarchically clustered. A panel of 13 peritoneal cell markers was selected and tissue sections were stained with metal conjugated antibodies and acquired using imaging mass cytometry (IMC; Hyperion Imaging System®). After single-cell segmentation, spillover correction, and normalization, cell types were identified using manual gating to train a random forest classifier for final cell type identifications using published workflows. Single-cell analysis was used to characterize peritoneal cells with positive podoplanin signals. Results DPS was present in 22% of the PD patients, all devoid of any clinical, radiological or histological feature of EPS. DPS positive patients were younger, had higher dialytic glucose exposure (median 103 vs. 154 g/m²/day, p = 0.002), and lower peritoneal arteriolar lumen to vessel (L/V) ratio, i.e. exhibited more arteriolar lumen narrowing. PD duration [median 20 (14.5, 48) months] and peritonitis incidence were similar as in non-DPS patients. In multivariable analysis, glucose exposure, PD duration, epithelial-to-mesenchymal transformed (EMT) cells and lower patient body surface area (BSA) independently predicted the presence of DPS. DPS and lower mesothelial surface coverage predicted lower arteriolar L/V ratio. In subgroups matched for BSA, PD duration and dialytic glucose exposure, DPS patients had a lower L/V ratio, (0.44 ± 0.13 vs. 0.31 ± 0.18, p = 0.003) and higher submesothelial CD45 leucocyte, CD68 macrophage and EMT cell count. Submesothelial lipopolysaccharide and hyaluronic acid receptor CD44 were increased in DPS positive patients, hyaluronan synthase 1 and 2 were similar. Among DPS positive patients, DPS intensity grade was higher in those with history of bacterial or fungal peritonitis (7 out of 15). Two patients had three and four peritonitis episodes respectively, their DPS pattern did not differ from patients with history of only one peritonitis episode. Hierarchical clustering demonstrated highest similarity of DPS positive areas with CD68 positive areas. In IMC analysis of DPS positive areas, highest podoplanin signals were derived from M2 classified macrophages (CD68+CD163+) and fibroblastic cells [αSMA positive/non-endothelial/non-macrophage (αSMA+PROX1-CD31-CD68-CD163-)], signals derived from M1 classified macrophages (CD68+CD163-) were lowest. Conclusion Peritoneal DPS in pediatric patients on low-GDP PD is associated with lower BSA, higher dialytic glucose exposure, history of infectious peritonitis and peritoneal inflammatory and EMT cell invasion, and predicts obliterating peritoneal vasculopathy. We identified M2 macrophages as major source of extra-lymphatic peritoneal podoplanin accumulation, suggesting their role in severe peritoneal transformation.

#5462 METABOLIC PROFILING IN CHILDREN WITH END STAGE RENAL DISEASE ON PERITONEAL DIALYSIS: PRELIMINARY RESULTS OF AN ONGOING PRESPECTIVE STUDY

Abstract Background and Aims Peritoneal dialysis (PD) is the main renal replacement treatment for children and adolescents with end stage kidney disease (ESRD). Peritoneal fibrosis is a major complication in long-term PD patients. Aim of the present study is to record the metabolic "fingerprint" of children on PD and to investigate its correlation with PD history and dialysis adequacy as well as the emergence of potential biomarkers that could detect early or predict peritoneal dysfunction. Method Serum samples from 15 patients undergoing peritoneal dialysis were analyzed. Two targeted LC-MS methodologies were used for the determination of 107 metabolites in total. The obtained results were compared based on demographic and clinical parameters, both before and after the dialysis procedure. Serum samples were further divided into subgroups, based on PD duration, creatine clearance, sex, anuria. Reragding metabolic techologies used, all samples were analyzed by a hydrophilic interaction liquid chromatography coupled to mass spectrometry (HILIC-MS / MS) method previously developed and validated in our laboratory for the simultaneous determination of amino acids and their derivatives in biological fluids. Αlso, high flow analysis was carried out (LC-qTOF analysis – HPLC /MS). Results 8-OH-2-deoxyguanosine (8-hydroxy-2' -deoxyguanosine (8-OHdG) was the only metabolite found to differentiate between serum samples collected before and after PD (p&amp;lt;0.05). Grouping the samples by age groups (child, teen and late teen-young adult) we found out that succinate like lactate, N-acetyl-β-d-glucosaminidase (NAG), are potential markers for the quality of PD. Grouping the patients by number of peritonitis episodes (3 groups: no episodes, 1-2 episodes and &amp;gt;3 episodes) cytosine, riboflavin, glutamic acid, methylxantine and malate found to differentiate between the three groups (p &amp;lt;0.05). Regrading the creatinine cleranace, xylose, dCDP, HIAA, pyroglutamic, A CoA and methylxantine seems to be significan biomarkers. Grouping the patients based on the presence or absence of diuresis,HIAA, kynurenic,glucuronic and pantothenic acid found to differentiate between the two groups (p&amp;lt;0.05) Conclusion Based on the literatute the majority of the metabolites showed a statistically significant difference are involved in the inflammation process. Our results are the preliminary results of an ongoing prospective study. Limitation of the study, is the small sample of patients, which does not allow safe clinical interpretation. In any case, metabolomics seems to be a useful tool for the study and identification of biomarkers in patients with ESRD on PD.

#6062 EFFECT OF KIDNEY TRANSPLANTATION ON ARTERIOLAR MOLECULAR PATHWAYS IN CHILDREN WITH PRECEDING PERITONEAL DIALYSIS

Abstract Background and Aims Patients on peritoneal dialysis suffer from progressive peritoneal membrane transformation and accelerated vascular disease, underlying molecular machineries have recently been described. Molecular effects of kidney transplantation (KTx) on vascular and peritoneal pathophysiology following PD are hardly understood. Method Fat surrounded omental arterioles (i.e. not directly exposed to PD fluids) from age-matched (median 6,5 years) children with chronic kidney disease (CKD5, n = 8), 5 children on PD [neutral pH, low glucose degradation product content, median PD duration 22 (5,50) months] and 6 children, who underwent successful KTx 4-5 weeks after a median 22 (12, 36) months of PD were analyzed by digital histomorphometry. Following microdissection from fat tissue, arterioles underwent transcriptome and proteome analyses, followed by Gene Set Enrichment Analysis (GSEA), weighted gene co-expression network analysis (WGCNA), gene ontology (GO) and protein interaction analysis (string-db.org). Key pathways were validated in independent, matched cohorts by quantitative immunohistochemistry (n = 15/group) and in vitro. Results 5000 most variable arteriolar transcripts (cut off p-value&amp;lt;0.05 and |r| &amp;gt;0.5) were grouped into 23 modules by WGCNA, of which 8 significantly differed between CKD5, PD and KTx. Seven were specifically related to KTx and one module to PD. Four out of seven KTx specific modules resulted in significant GO terms summarized as fatty acid biosynthesis, negative regulation of RNA metabolism, cell cycle arrest, and apoptosis. The PD specific module was associated with muscle cell proliferation, detoxification and complement activation (with thrombospondin as most interconnected gene). Multi-omics analysis of KTx vs. PD demonstrated concordant upregulation of lipid and fatty acid biosynthesis with the hub gene fatty acid synthase (FASN) and downregulation of positive cell cycle regulation. In independent, matched cohorts, arteriolar abundance of thrombospondin and terminal complement complex were higher in children on PD, arterioles from children after KTx had levels comparable to arterioles from children with CKD5. Key drivers of fibrotic process, arteriolar TGF-ß and pSMAD2/3, were also higher in PD arterioles compared to CKD5 and persistently high after KTx. Arteriolar cell cycle arrest marker p16 and apoptosis marker cleaved Casp3 were higher after KTx as compared to PD and CKD5. FASN was abundant in intima and media layers of all arterioles, and three-fold higher after KTx then in children with PD and CKD5, respectively. Neutral lipids (oil red staining) were present in all three groups, more abundant in the media than in the intima, and two-fold increased in the media of children after KTx compared to children on PD (p = 0.018) and with CKD5 (p = 0.002). In vitro, methylprednisolone and tacrolimus, but not mycophenolate mofetil increased FASN abundance and activity in human umbilical arterial endothelial and vascular smooth muscle cells compared to media controls. Conclusion We for the first time comprehensively describe molecular pathways activated after KTx in children following a standard immunosuppressive regime. After KTx, arteriolar fatty acid biosynthesis, apoptosis and cell cycle arrest markers are increased as compared to arterioles from children with PD and CKD5; profibrotic pathways induced by PD are persistently activated. Arteriolar hubgene FASN is three-fold more abundant after KTx and neutral lipid deposition is increased, presumably due to the induction of FASN activity by methylprednisolone and tacrolimus.

#3478 THE EFFECT ON NET ULTRAFILTRATION WHEN TRANSFERRING PATIENTS FROM NOCTURNAL INTERMITTENT (NIPD) TO CONTINUOUS CYCLING PERITONEAL DIALYSIS (CCPD)

Abstract Background and Aims Peritoneal Dialysis (P.D.) Adequacy includes a variety of targets such as the sufficient uremic toxins removal (Κt/V), patients’ euvolemia, acid-base and electrolyte balance etc.. Based on incremental PD prescription NIPD is often a reasonable modality choice when there is adequate Residual Renal Function (RRF). Eventually due to RRF decrease patients need to increase their PD adequacy by adding a solution during the day i.e Icodextrin (CCPD). The aim of this study was to evaluate the alteration of Cyclers’ ultrafiltration(UF) as well as Total Ultrafiltration (sum of Cycler ultrafiltration and the UF of the initial drainage) when transferring patients from NIPD to CCPD Method This is a single center retroprospective study of 16 patients (m = 9,f = 7). These patients were transferred from NIPD to CCPD due to inadequate PD adequacy. The patients’ mean age was 53.4±19 years, their mean PD duration was 74.3±25.7 months and their mean Peritoneal Solute Transfer Rate (PSTR-D/Pcr) was 0.69±0.12. We evaluated small solute clearance targets (Kt/V – t:total,p:peritoneal,r:renal), RRF (eGFR, Vurine), Cycler’ ultrafiltration, the UF of the initial drainage and the sum of them (Total UF) on three consecutive days before the initiation of CCPD and three consecutive days after the initiation. The patients’ cycler treatment program remain constant and all of them received an initial day volume of 1000 ml with Icodextrin. Results We compared the alterations with Paired t-Test (normal distripution) We found a statistically significant improvement of the peritoneal fraction of Kt/V when applying CCPD (p = 0.01), on the other hand we found a statistically significant decrease from Cycler's UF (p&amp;lt;0.05) as well as from Total UF (p&amp;lt;0.05) without any statistically significant increase in urine's volume. Additionally, from the regression analysis there was statistically significant correlation between PSTR and ΔUF(UFNIPD-UFCCPDtotal) showing that the faster the transporter the greater the ultrafiltration loss (p = 0.035, R = 0.58). Conclusion Transferring patients with adequacy problems from NIPD to CCPD improves small solute clearances but in some cases the risk for total ultrafiltration decrease is important and may lead to overhydration. It is necessary to contact perspective studies with hydration status evaluation ie Bioimpedance Spectroscopy.

(481) Experience with Plaque Excision and Dermal Grafting in the Surgical Treatment of Peyronie's Disease

Abstract Introduction Plaque incision and grafting (PIG) is indicated for men with complex or severe penile curvature, several surgical options to treat PD have been performed. Surgical treatment use graft, as these procedures aim to maintain penile length. Objective To assess outcomes following plaque excision and dermal grafting in the surgical treatment of Peyronie's disease. Methods A prospective study, was performed at Binh Dan Hospital (Ho Chi Minh City – VietNam), from 1/2016 – 12/2020. Surgical correction for curvature is indicated when the PD duration is &amp;gt;12 months, and when the stable phase of PD is &amp;gt;6 months, all case use plaque excision and dermal grafting technique. Results our study have 52 patients, - History illnes: 42.1% diabetes, 26.3% hypertension, 36.84% hyperlipid. - Age mean: 58.31 ± 8.5 years (min: 48 – max 72). - Chief complaine: penile deformities (36.8%), pain (31.6%), palpable lumps (26.3%). - 52.6% have psychological effects. - Fibrous plaque on corpus: Anterior (5.2%), Mid (47.37%), Posterior (47.37%). - Plaque size: 72.59 ± 75.78mm2 (15.51 mm2 – 207 mm2). + Primary outcome measures - Complications (follow one month): alter sensation (16.7%), edema (21.05%), infection (1.9%), pain (10.53%) - Penile straightening: 89%. - Penile length: no changes (82.7%), shorter (17.3%). + Secondary outcome measures - Recurrent curvature: 3 cases – 01 case need operation second time. - Post-operative erectile dysfunction: 7 cases (13.46%). - Patient satisfaction: 82.3% Conclusions Surgical correction of penile curvature is the mainstay for PD treatment. Dermal graft: effectiveness in terms of satisfaction, length change, straightening, economic efficiency and complications. Suitable for patients with underlying medical conditions. Adequate preoperative patient counseling. Disclosure No

Effect of the duration of prone position in ARDS patients during the SARS-CoV-2 pandemic

ObjectiveTo describe the characteristics of patients with acute respiratory distress syndrome (ARDS) due to bilateral COVID-19 pneumonia on invasive mechanical ventilation (IMV), and to analyze the effect of prone position >24 h (prolonged) (PPP) compared to prone decubitus <24 h (PP). DesignA retrospective observational descriptive study was carried out, with uni- and bivariate analyses. SettingDepartment of Intensive Care Medicine. Hospital General Universitario de Elche (Elche, Alicante, Spain). ParticipantsPatients with SARS-CoV-2 pneumonia (2020−2021) on IMV due to moderate-severe ARDS, ventilated in prone position (PP). InterventionsIMV. PP maneuvers. Main variables of interestSociodemographic characteristics, analgo-sedation, neuromuscular blockade (NMB), PD duration, ICU stay and mortality, days of IMV, non-infectious complications, healthcare associated infections. ResultsFifty-one patients required PP, and of these, 31 (69.78%) required PPP. No differences were observed in terms of patient characteristics (gender, age, comorbidities, initial severity, antiviral and antiinflammatory treatment received). Patients on PPP had poorer tolerance to supine ventilation (61.29% vs 89.47%, p = 0.031), longer hospital stay (41 vs 30 days, p = 0.023), more days of IMV (32 vs 20 days, p = 0.032), longer duration of NMB (10.5 vs 3 days, p = 0.0002), as well as a higher percentage of episodes of orotracheal tube obstruction (48.39% vs 15%, p = 0.014). ConclusionsPPP was associated with greater resource use and complications in patients with moderate-severe ARDS due to COVID-19.

MP36-05 CLINIC SCORE - A NOVEL PREDICTION MODEL OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM OUTCOMES IN MEN WITH PEYRONIE’S DISEASE

You have accessJournal of UrologyCME1 Apr 2023MP36-05 CLINIC SCORE - A NOVEL PREDICTION MODEL OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM OUTCOMES IN MEN WITH PEYRONIE’S DISEASE Courtney Pierce, Benjamin Green, Joshua Savage, Klint Brearton, Matthew Ziegelmann, Sevann Helo, Tobias Kohler, and Landon Trost Courtney PierceCourtney Pierce More articles by this author , Benjamin GreenBenjamin Green More articles by this author , Joshua SavageJoshua Savage More articles by this author , Klint BreartonKlint Brearton More articles by this author , Matthew ZiegelmannMatthew Ziegelmann More articles by this author , Sevann HeloSevann Helo More articles by this author , Tobias KohlerTobias Kohler More articles by this author , and Landon TrostLandon Trost More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003270.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since the FDA approval of Collagenase Clostridium Histolyticum (CCH), few studies have been able to identify variables which predict curve improvements, with baseline extent of curvature most highly correlated. In addition to extent of baseline curvature, our team has previously identified curve direction and plaque calcification as additional predictive variables. We therefore sought to create an integrated predictive model which incorporated several factors to better estimate anticipated outcomes. METHODS: A prospective database has been maintained of men undergoing CCH injections for PD. Data were reviewed to identify variables predictive of curve improvements in men with isolated curvature as well as among those with key characteristics, including indentations, hourglass deformities, penile tapering, and calcification. A predictive model was subsequently developed to improve correlations between disease factors and subsequent CCH outcomes. The final model (CLINiC Score) assigned points as follows: +1 point for every 10 degrees of curvature (C for Curvature), +5 points for penile narrowing >25% (IN for INdent), +3 points for narrowing 0-25%, -4 points for pure lateral curvatures (L for Lateral), and -2 points for plaque calcification (C for Calcification). Patients were assigned scores based on the CLINiC model, and results were correlated with final curve outcomes. RESULTS: A total of 476 PD men were included in the current analysis. Baseline variables for the cohort included a mean age of 55.6 yrs (SD 10.9), PD duration 31.9 months (SD 61.4), composite curvature 64.6 degrees (SD 23.9), 47% with indentations, 42% with hourglass deformity, and 17% with calcification. The mean CLINiC score for the cohort was 6.9 (SD 3.4). For the overall cohort, the use of the CLINiC score increased the correlation coefficient from 0.35 to 0.46 (r-squared 0.13 vs 0.21), with a predictive linear formula of 2.1 - 3.2*CLINiC score. The difference was more pronounced among a subset cohort of men who had pure lateral curvatures, plaque calcification, or narrowing deformity. In comparing the CLINiC predictive model to baseline curve alone, the correlation coefficient increased to 0.54 (r-squared 0.29, p<0.0001) compared to 0.38 (r-squared 0.15, p<0.001). The linear equation to predict curve improvement outcomes using the CLINiC score was 2.2 - 3.5*total CLINiC score. CONCLUSIONS: Use of a novel scoring system (CLINiC) improves upon baseline curvature alone to predict post-CCH curve improvements, with the difference more pronounced among men with pure lateral curvatures, plaque calcification, and/or narrowing deformities. External validation is warranted. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e480 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Courtney Pierce More articles by this author Benjamin Green More articles by this author Joshua Savage More articles by this author Klint Brearton More articles by this author Matthew Ziegelmann More articles by this author Sevann Helo More articles by this author Tobias Kohler More articles by this author Landon Trost More articles by this author Expand All Advertisement PDF downloadLoading ...

Efecto de la duración del decúbito prono en pacientes con SDRA durante la pandemia por SARS-CoV-2

ObjectiveTo describe the characteristics of patients with acute respiratory distress syndrome due to bilateral COVID-19 pneumonia on invasive mechanical ventilation (IMV) and analyze the effect of prolonged prone decubitus>24h (PPD) compared to prone decubitus<24h (PD). DesignRetrospective observational descriptive study. Uni and bivariate analysis. SettingDepartment of Intensive Care Medicine. General University Hospital of Elche. ParticipantsPatients with SARS-CoV-2 pneumonia (2020–2021) in VMI for moderate-severe acute respiratory distress syndrome, ventilated in PD. InterventionsIMV. PD maneuvers. Main variables of interestSociodemographic; analgo-sedation; neuromuscular blockade; PD (duration), ICU stay and mortality, days of IMV; non-infectious complications; health care-associated infections. ResultsFifty-one patients required PD and of these 31 (69.78%) required PPD. No differences were found in patient characteristics (sex, age, comorbidities, initial severity, antiviral and anti-inflammatory treatment received). Patients on PPD had lower tolerance to supine ventilation (61.29 vs. 89.47%, p=0.031), longer hospital stay (41 vs. 30 days, p=0.023), more days of IMV (32 vs. 20 days, p=0.032), longer duration of neuromuscular blockade (10.5 vs. 3 days, p=0.0002), as well as a higher percentage of episodes of orotracheal tube obstruction (48.39 vs. 15%, p=0.014). ConclusionsPPD was associated with higher resource use and complications in patients with moderate-severe acute respiratory distress syndrome by COVID-19.

Gender differences in motor and non-motor symptoms in individuals with mild-moderate Parkinson's disease.

Parkinson's disease (PD) affects both men and women with documented gender differences across functional domains, with findings varying among reports. Knowledge regarding gender differences in PD for different geographic locations is important for further understanding of the disease and for developing personalized gender-specific PD assessment tools and therapies. This study aimed to examine gender differences in PD-related motor, motor-cognitive, cognitive, and psychosocial function in people with PD from the southern United States (US). 199 (127 men and 72 women; M age: 69.08±8.94) individuals with mild-moderate idiopathic PD (Hoehn &Yahr (H&Y) Median = 2, stages I-III) from a large metro area in the southeastern US were included in this retrospective, cross-sectional study. Motor, motor-cognitive, cognitive, and psychosocial data were obtained using standardized and validated clinical tests. Univariate analyses were performed, adjusting for age and housing type. After adjustment for age, housing, PD duration and fall rate, men exhibited statistically significantly greater motor (Movement Disorders Society (MDS)-Unified Parkinson Disease Rating Scale (UPDRS)-II) and non-motor (MDS-UPDRS-I) impact of PD, and more severe motor signs (MDS-UPDRS-III). Men exhibited worse PD-specific health-related quality of life related to mobility, activities of daily living, emotional well-being, cognitive impairment, communication, and more depressive symptoms. Men performed worse on a subtraction working memory task. Women had slower fast gait speed. In the southeastern United States, men may experience worse PD-related quality of life and more depression than women. Many non-motor and motor variables that are not PD specific show no differences between genders in this cohort. These findings can contribute to the development of gender-sensitive assessment and rehabilitation policies and protocols for people with PD.

Added value of the instrumented Timed-Up and Go test (iTUG) in the long-term assessment of PD patients with bilateral subthalamic nucleus deep brain stimulation (STN-DBS)

STN-DBS is an effective long-term treatment in PD, improving a broad spectrum of symptoms, including tremor, rigidity, and bradykinesia (Fig. 1a) together with dopaminergic treatment. Among axial symptoms, gait disorders are common in PD. This study examines the long-term effects of different combinations of these two treatments in a cohort of advanced PD patients by means of the iTUG. Observational study on consecutive PD patients previously treated with bilateral STN-DBS. Disease severity was assessed using the UPDRS part III. Accelerometric data were acquired using an inertial sensor (G-WALK, BTS Bioengineering). Three iTUG trials were recorded in each of four stimulation and drug conditions: on-stimulation/off-medication, off-stimulation/off-medication, on-stimulation/on- medication and while preforming a cognitive task (counting backward, DUAL TASK) with both stimulation and medication on. Data were segmented into six phases (e.g., rising from chair, walking) as in [1]. A set of indices was computed including durations, RMS amplitudes, peak accelerations, peak angular velocities, indices of symmetry (improved Harmonic Ratio) and smoothness (Spectral Arc) [1]. A one-way non-parametric ANOVA was carried out, with the condition as a factor, followed by paired comparisons when appropriated. Statistical significance was set at 5% for all analyses. Twenty-five patients were re-evaluated 3 to 7 years after STN-DBS surgery, with a mean five-year postoperative follow-up. Clinical characteristics were age 64(5) y, 8/17 F/M, PD duration 16(5) y, distance from STN-DBS intervention 5(1) y, median (IQR) UPDRS-III 12(12), WHS 5(1), FAC 5(2). Most patients were able to perform the test in all conditions. Both STN-DBS alone and the combination of STN-DBS and medications led to an improvement of clinical motor scores and most iTUG parameters (p<0.001). In particular: 1) the elevation/sitting gestures and the turn phases differently improved in the different conditions; 2) on average, the effect of the DUAL TASK condition led to indices similar to those in the off-off condition 3) data from the DUAL TASK condition suggest the existence of two subgroups of patients, whose performance is either affected or not affected by the cognitive task ( Fig. 1 ). The protocol resulted feasible. Our results indicate that both STN-DBS and levodopa can improve walking ability even in the long-term after surgery. Results during DUAL TASK suggest the use of attentional strategies in the rehabilitation of selected patients, as indicated in the EU physiotherapy guidelines for PD [2]. A rehabilitative intervention should be strongly recommended in those patients whose performance in DUAL TASK becomes so impaired as in the STIM-OFF/MED-OFF, as measured by the iTUG. In conclusion, the iTUG test could be used in PD patients with STN-DBS to support the selection of tailored rehabilitative interventions and to identify patients whose performance is highly affected during cognitive tasks.

Longitudinal Cohort Study of Verbatim-Reported Postural Instability Symptoms as Outcomes for Online Parkinson's Disease Trials.

Background:The Parkinson’s Disease Patient Report of Problems (PD-PROP) captures the problems and functional impact that patients report verbatim. Online research participation and advances in language analysis have enabled longitudinal collection and classification of symptoms as trial outcomes.Objective:Analyze verbatim reports longitudinally to examine postural-instability symptoms as 1) precursors of subsequent falling and 2) newly occurring symptoms that could serve as outcome measures in randomized controlled trials.Methods:Problems reported by >25,000 PD patients in their own words were collected online in the Fox Insight observational study and classified into symptoms by natural language processing, clinical curation, and machine learning. Symptoms of gait, balance, falling, and freezing and associated reports of having fallen in the last month were analyzed over three years of longitudinal observation by a Cox regression model in a cohort of 8,287 participants. New onset of gait, balance, falling, and freezing symptoms was analyzed by Kaplan-Meier survival techniques in 4,119 participants who had not previously reported these symptoms.Results:Classified verbatim symptoms of postural instability were significant precursors of subsequent falling among participants who were older, female, and had longer PD duration. New onset of symptoms steadily increased and informed sample size estimates for clinical trials to reduce the onset of these symptoms.Conclusion:The tools to analyze symptoms reported by PD patients in their own words and capacity to enroll large numbers of research participants online support the feasibility and statistical power for conducting randomized clinical trials to detect effects of therapeutic interventions.

High intraperitoneal interleukin-6 levels predict ultrafiltration (UF) insufficiency in peritoneal dialysis patients: A prospective cohort study.

IntroductionUF insufficiency is a major limitation in PD efficiency and sustainability. Our study object to investigate the efficacy of intraperitoneal inflammation marker, IL-6 level as a predictor of UF insufficiency in continuous ambulatory peritoneal dialysis (CAPD) patients.MethodsStable prevalent CAPD patients were enrolled in this prospective study. IL-6 concentration in the overnight effluent was determined and expressed as the IL-6 appearance rate (IL-6 AR). Patients were divided into two groups according to the median of IL-6 AR and prospectively followed up until death, transfer to permanent HD, recovery of renal function, kidney transplantation, transfer to other centers, lost to follow-up or to the end of study (January 31, 2021). Factors associated with UF capacity as well as dialysate IL-6 AR were assessed by multivariable linear regression. Cox proportional hazards model was used to examine the association between dialysate IL-6 AR and UF insufficiency.ResultsA total of 291 PD patients were enrolled, including 148 males (51%) with a mean age of 56.6 ± 14.1 years and a median PD duration of 33.4 (12.7–57.5) months. No correlation was found between dialysate IL-6 AR and UF capacity at baseline. PD duration was found positively correlated with baseline dialysate IL-6 AR, while 24h urine volume was negatively correlated with baseline dialysate IL-6 AR (P < 0.05). By the end of study, UF insufficiency was observed in 56 (19.2%) patients. Patients in the high IL-6 AR group showed a significantly inferior UF insufficiency-free survival when compared with their counterparts in the low IL-6 AR group (P = 0.001). In the multivariate Cox regression analysis, after adjusting for DM, previous peritonitis episode and 24h urine volume, higher baseline dialysate IL-6 AR (HR 3.639, 95% CI 1.776–7.456, P = 0.002) were associated with an increased risk of UF insufficiency. The area under the ROC curve (AUC) for baseline IL-6 AR to predict UF insufficiency was 0.663 (95% CI, 0.580–0.746; P < 0.001).ConclusionOur study suggested that the dialysate IL-6 AR could be a potential predictor of UF insufficiency in patients undergoing PD.

MO690: Overview of Peritoneal Dialysis Outcomes in Northern Cyprus: A Nation-Based Study

Abstract BACKGROUND AND AIMS Prevalence of patients with end stage renal disease (ESRD) undergoing renal replacement therapies (RRT) is increasing worldwide (Stel et al. Supplemented ERA-EDTA Registry data evaluated the frequency of dialysis, kidney transplantation, and comprehensive conservative management for patients with kidney failure in Europe. Kidney Int. 2021;100(1):182–95 and Bikbov et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020; 395(10 225): 709–33). Epidemiology of ESRD and treatment options for these patients should be considered in health system planning (Bikbov et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020; 395(10 225):709–33). By an enhanced national PD program, more patients may have chance to take advantage of this treatment option. In this study we aim to investigate whether PD is preferred as first dialysis treatment modality in Northern Cyprus and to evaluate PD duration, and outcomes in order to improve PD program. METHOD PD patients aged above 18 years who were followed between 2003 and 2021 in Northern Cyprus were screened retrospectively. Demographic data, primary kidney diseases, comorbidities and previous RRT modalities were investigated. Episodes of peritonitis, transfer to automated PD in the follow-up, total duration on PD treatment, transfer to renal transplantation or HD and mortality rate were evaluated. Reasons for shifting from PD to HD were analysed. Outcomes of elderly (aged 65 years and above) and diabetic patients who were dropped out from PD were found out. RESULTS A total of 123 patients (33 female/90 male) aged 18–83 years were included to the study. A total of 25 patients were actively doing PD, 2 moved to another country on PD therapy and 96 dropped out of PD. A total of 40% of 123 PD patients initiated RRT with PD (Fig. 1). Median time was found 1 month in the rest of patients to transfer PD from other modalities. Sixteen (16.8%) patients had renal transplantation during follow-up. Thirty-three patients (34.7%) transferred to HD. Insufficient dialysis (40.7%) and PD-related infections (29.6%) were the most common reasons for shifting from PD to HD (Fig. 2). Forty-six (48.4%) patients were died on PD therapy at the age of 67 ± 11. Cardiovascular events (50%) and various infections (35%) were the leading causes of mortality. A total of 48 (43.2%) PD patients had at least one episode of peritonitis. Automated PD was used by 58 (53.2%) patients. PD duration was 36 (1–150) months in patients who were dropped out of PD. Total duration on PD treatment was longer for males than females. Total duration on PD treatment, initiation RRT with PD, prevalence of hypertension, diabetes mellitus (DM), peritonitis and use of automated PD were not significantly different between elderly (patients aged ≥ 65 years, n = 34) and younger individuals (18–65 years). Comorbidity index was found significantly higher in elderly group (P &amp;lt; 0.001). PD duration was longer for males then females (P = 0.044) and the duration was similar in patients with or without DM, in the dropped-out patients (P = 0.205). CONCLUSION A significant amount of patients (60%) required HD before initiation of PD. Early admission of patients to nephrology department and timely initiation of education program may contribute to decrease need of HD before PD (Briggs et al. International variations in peritoneal dialysis utilization and implications for practice. Am J Kidney Dis. 2019; 74(1): 101–10). As elderly patients had similar results with younger ones, age should not be considered as a challenging barrier for PD initiation. Precautions to prevent development of peritonitis, ultrafiltration failure and dialysis insufficiency may contribute to extent total duration on PD treatment.