This study focused on the local hemodynamic changes created by hemodialysis therapy in the forearm with arteriovenous fistulas for hemodialysis. Arteriovenous fistulas were created in the distal site of the forearm in all the patients who participated in this study. We measured the blood flow volume and blood flow rate in the arteriovenous fistulas using the Doppler ultrasonic flowmeter, and oxygen saturation using the pulse oxymeter and wave height using the plethysmogram in all the fingers of the forearm with arteriovenous fistulas as makers of local hemodynamics before and after hemodialysis therapy was given. After hemodialysis therapy, the patients' body weight reduced by an average of 2.5kg. Reduction of body weight (body fluids) led to decreases in mean blood pressure (99±4 vs. 80±5mmHg) and increases in heart rate (68±2 vs. 72±3 bpm) and hematocrit level (35±1vs. 38±1%) compared with those before hemodialysis. Furthermore, the reduction of body weight tended to decrease the blood flow volume and blood flow rate in arteriovenous fistulas. However, no significant changes were found in blood flow volume and blood flow rate in arteriovenous fistulas between before and after hemodialysis. We further studied the changes in oxygen saturation and wave height in all the fingers of the forearm with arteriovenous fistulas. No significant change was found in oxygen saturation between before and after hemodialysis. However, wave height tended to decrease after hemodialysis.These results suggest that the changes in body weight (body fluid), blood pressure, heart rate, and blood viscosity created by an usual hemodialysis therapy less affect the local hemodynamics in the forearm with arteriovenous fistulas.

At present, among the types of viral hepatitis, hepatitis C virus (HCV) appears to be the major cause of hepatitis in hemodialysis units. Previously, we took blood samples from the blood tubing at the inlet and the outlet of different dialyzers and measured serum HCV-RNA levels in hemodialysis patients with HCV. We found a significant reduction in serum HCV-RNA levels through the use of a polymethylmethacrylate (PMMA) membrane in dialysis. In the present paper, we report on a case in which HCV was extinct during hemodialysis treatment. The patient was a 72- year-old woman. The duration of hemodialysis was 259 months. The biochemical findings revealed high levels of serum alkaline phosphatase and TTT. The data of other liver enzymes were within normal range. The serum HCV-RNA level, which had been tending downward, was 32 KIU/ml, when the dialyzing membrane was changed to a PMMA membrane. Thereafter, the serum HCV-RNA level further reduced and reached below 0.5 KIU/ml in 12 months. This result suggests that HCV reduction efficiency should be considered when dialyzing membranes are selected from among many.

It has been known that access recirculation is positively related to dialyzer blood flow and is negatively related to access blood flow in the vascular access in hemodialysis patients. The present study was designed to examine whether an increase in access recirculation generated by an increase in dialyzer blood flow is related to access blood flow. All patients had native end-to-side arteriovenous anastomoses at the radial site. We measured access recirculation at two different dialyzer blood flow rates (85 and 170 ml/min) using a three-needle technique. Access blood flow rates (mean 668 ml/min ranging from 493 to 1038 ml/min) were measured using Doppler ultrasound sonography. We confirmed that an increase in dialyzer blood flow rate led to an increase in access recirculation (5.4±1.1 vs. 9.9±1.9%, p<0.05), and that access recirculation was negatively related to the access blood flow rate (y=-30.78x+972.20, r=-0.79, p<0.05). We further found a negative correlation between the increase in access recirculation generated by the increase in dialyzer blood flow rate and access blood flow rate (y=-33.88x+821.57, r=-0.75, p<0.05). These results suggested that dialyzer blood flow less affects access recirculation when access blood flow is higher.

Ischemic peripheral circulatory disorders have been observed more and more frequently in maintenance hemodialysis patients in recent years. This tendency is associated with the progression of arteriosclerosis characteristic of such patients. In the present study, we made inquiries about the presence or absence of subjective symptoms of ischemic peripheral circulatory disorders in maintenance hemodialysis patients and examined pulsation of dorsal artery and cyanosis of foot to make early diagnosis of the circulatory disorders possible. Furthermore, we measured the ankle brachial pressure index (API) and examined the calcification in thoracic and abdominal aortae on X-rays. According to clinical symptoms, the subjects were classified into no clinical symptom, sensory disorder, and motor disorder. Of the participants in the present study, 31.0% had API below 1.0. The mean age and hemodialysis period of the patients with API below 1.0 were more than those of the patients with API 1.0 or over. However, the differences were not significant. Of the patients with no clinical symptom, 21.2% had API below 1.0. We found a patient with no clinical symtom who had no pulsation of dorsal artery and cyanosis of foot. Of the patients who complained sensory and motor disorders, 35.0% and 45.5%, respectively, had API below 1.0. In the examination of calcification of thoracic and abdominal aortae, 23.8% of the patients with no calcification, 22.2% of the patients with the calcification in thoracic aorta alone, 27.8% of the patients with the calcification in abdominal aorta alone, and 29.6% of the patients with the calcification in both thoracic and abdominal aortae had API below 1.0. We believe that these results will make for early diagnosis and care treatment of ischemic peripheral circulatory disorders in hemodialysis patients.

Background: The need for palliative care is increasing, and psychological care for cancer patients has been recognized to have an important role in palliative care. Purpose: To determine the medical knowledge and skills (especially in psychiatry) required in palliative care and to propose psychiatric training for palliative care education. Subjects/Methods: Using a questionnaire, palliative care doctors (working less than 3years) and nurses were asked their opinions on the necessity of palliative care and requested to self-evaluate their knowledge and skills in palliative care. Results: The survey revealed that many doctors and nurses felt the need for an "Interdisciplinary team approach" "Good communication with patient and family", an "Understanding of total pain" and "Listening". Palliative care doctors had low self-evaluations of their psychiatric knowledge and skills with regard to palliative care, but they recognized the necessity for greater knowledge and skills in this area. Conclusions: In a palliative care setting, it is important to establish training programs for consultation-liaison psychiatry that provide opportunities for learning about psychiatric practices, including diagnostic evaluation, psychotherapeutic and pharmacologic treatment, as well as skills for communicating with cancer patients, families and staff. Palliat Care Res 2009: 4(1): 101-111

Dialysis hypotension is one of the most common complications observed during hemodialysis. As it may be due to vasodilatation, vasoconstrictors are usually given to patients to control blood pressure. Howerver, there are some patients who are resistant to the medication with vasoconstrictors. Recently, it has been reported that as one of the treatments of dialysis hypotension, the cooling of dialysate is effective in inducing vasoconstriction via stimulating the sympathetic nerve system. Also, the application of the interaction of citrus juices with some kinds of drugs to the treatment of dialysis hypotension has been reported effective. In the present study, we examined the effectiveness of those two methods in nine hemodialysis patients in whom dialysis hypotension had not been improved with vasoconstrictors. Dialysate temperatures were lowered from 36.0 to 35.0 C during hemodialysis and/or 100m1 of citrus juice (grapefruit juice) were given to the patients before hemodialysis in addition to vasoconstrictors. Lowering dialysate temperaturse reduced the incidence of intradialytic hypotension and helped improve the patients' quality of life after hemodialysis therapy. Body temperature remained unchanged between before and after hemodialysis. However, we observed cramps in two patients and an impairment of consciousness in one patient during hemodialysis. Thus, we concluded due caution should be exercise against the side effects during hemodialysis when dialysate temperatures are lowered. Meanwhile, the intake of grapefruit juice before hemodialysis was not effective for the improvement of intradialytic hypotension and the patients' quality of life.

We experienced a case of severe alcoholic hepatitis. Combination treatment of continuous hemodiafiltration and steroid hormone was started immediately after admission. This treatment was very effective for severe alcoholic hepatitis, resulting in the shortening of the length of hospital stay. The reasons why this treatment was effective were; 1. The patient was younger, so the regeneration ability of liver cells was stronger. 2. The infection and bleeding of digestive organs except for acute renal failure were not found, resulting in the enhancement of the effectiveness for steroid hormone treatment. 3. The intensive blood purification treatment was started immediately. From this experience, we realized again that a fine collaboration of doctors, nurses and clinical engineers was very important in the intensive care of the severe diseases.
therapeutic aspects ; Steroid hormone, NOS ; Hepatitis, Alcoholic ; Combined ; Review [Publication Type]

OBJECTIVETo evaluate the effects of indoor and outdoor PM2.5 (fine particulate matter, particulate matter with an aerodynamic diameter ≤ 2.5 µm) on lung function of college students in autumn and winter in Wuhan.

METHODSIn this panel study, 37 college students (excluded subject of respiratory disease and smoking history) aged 19 - 21 were investigated by cluster sampling in a university in Wuhan. The follow-up study lasted for 28 days in total, including two study periods, Oct. 29 to Nov. 11, 2009 (autumn) and Dec. 23, 2009 to Jan.5, 2010 (winter), the peak expiratory flow (PEF) of the college students were measured daily in the morning and evening in the university. PM10 and PM2.5 were monitored indoors and outdoors. The effects of PM on lung function of college students were analyzed by using generalized estimating equation (GEE).

RESULTSAverage daily concentrations of indoor, outdoor PM2.5 in autumn were (91.3 ± 43.7) and (104.2 ± 49.4) µg/m(3) respectively, while in winter the concentrations of indoor and outdoor PM2.5 were (110.6 ± 42.3) and (143.5 ± 51.2) µg/m(3). The single pollutant model showed that in winter, the evening PEF decrement was significantly associated with increasing outdoor PM2.5. With an increase of 10 µg/m(3) outdoor PM2.5, the PEF measured in the evening decreased 1.27 L/min (95%CI: 0.02 - 2.52 L/min, respectively). Meanwhile, the results showed that 2-days lagged outdoor PM2.5 was also significantly associated with morning PEF. An increase of 10 µg/m(3) 2-days lagged outdoor PM2.5 caused the decrease of 1.82 L/min (95%CI: -3.53 - -0.11 L/min) of PEF measured in the morning. Controlling the influence of gaseous pollutants and building the two pollutants models, the results indicated that no significant changes of PEF of students being exposed to PM2.5 on same day (lag 0) were observed. However, under consideration of SO2 effect, significant association between an increase of 10 µg/m(3) 2-days lagged outdoor PM2.5 and changes of morning PEF (-1.81 L/min, 95%CI: -3.51 - -0.11 L/min, P = 0.037) was found. The relationship between changes of concentrations and PEF was not observed in autumn in this study.

CONCLUSIONIn our panel study, exposure to outdoor PM2.5 is significantly associated with PEF among college students in winter, but not in autumn.

Air Pollutants ; China ; epidemiology ; Environmental Exposure ; Female ; Humans ; Male ; Maximal Midexpiratory Flow Rate ; Particulate Matter ; Respiratory Function Tests ; Seasons ; Students ; Young Adult

OBJECTIVETo evaluate the acute effects of indoor and outdoor particulate matter on lung function and respiratory symptoms of college students in winter.

METHODSA panel of 37 college students aged 19-21 in Wuhan were included and the investigation was carried out from 12/23/2009 to 01/05/2010. Daily morning/evening forced expiratory volume in one second (FEV1) and respiratory symptoms (cough, phlegm and runny) were measured and reported by subjects, respectively. Meanwhile, daily data of indoors and outdoors PM10, PM2.5, temperature, and relative humidity were collected. Generalized Estimating Equations (GEEs) were used to estimate the association between particulate matters exposure and respiratory symptoms and FEV1).

RESULTSAverage daily concentrations of indoor, outdoor PM2.5 during the study period were (110.6 ± 42.3), (143.5 ± 51.2) µg/m³, (148.2 ± 43.2) and (239.1 ± 71.3) µg/m³ for indoor, outdoor PM10, respectively. Outdoor exposure to PM2.5 on lag 0 had little effect on evening FEV1). However, researchers observed a significant lagging effect (lag 1 d) and accumulative effect (lag 0-1 d and lag 0-2 d). A rise in the PM2.5 concentration of 10 µg/m³ resulted in the change of evening FEV1) of -0.28% (95% CI: -0.52%, -0.03%), -0.45% (95% CI: -0.81%, -0.08%) and -0.63% (95% CI: -1.15%, -0.11%), respectively. For respiratory symptoms of coughing up phlegm, 10 mg/m³ increase of indoor/outdoor PM2.5 concentration were associated with odds ratio of 1.18 (95% CI: 1.02-1.36) and 1.08 (95% CI: 0.97-1.19), respectively. Moreover, risk of coughing up phlegm increased with lagging time, and accumulative time of indoor and outdoor PM2.5 and PM10.

CONCLUSIONOur study suggested that short-term exposure to particulate matters in winter was significantly associated with acute changes of respiratory symptoms and FEV1) of college students in Wuhan. Moreover, the effects of particulate matters tended to be larger as the increase of lagged and accumulative days.

Air Pollutants ; Cough ; Forced Expiratory Volume ; Humans ; Humidity ; Mucus ; Particulate Matter ; Respiratory Tract Diseases ; Seasons ; Students ; Temperature

BACKGROUND: As society is aging, the number of elderly patients with psychiatric disorder, such as dementia, is increasing. The hospitalization period of elderly patients in psychiatric wards tends to be prolonged. In this study, we have determined the factors that inhibit early discharge from the psychiatric emergency ward for elderly patients in Japan. METHODS: The information was collected from patients admitted to our hospital's emergency ward for elderly patients with psychiatric disorders between May 2015 and April 2016. We compared various factors between the early discharge group and the non-early discharge group. In addition, we used a multiple logistic regression model to clarify the risk factors for non-early discharge. RESULTS: Of the 208 elderly patients, body mass index (BMI) and serum albumin level were significantly lower in the non-early discharge group. In addition, we also showed that higher serum C-reactive protein (CRP) (> 0.5 mg/dL) and use of seclusion or physical restraint significantly inhibited the early discharge of patients. The results of multiple logistic analysis showed that the BMI ≤ 17.5 kg/m (OR, 2.41 [95% confidence interval (CI) 1.06-5.46]), serum albumin level ≤ 30 g/L (OR, 3.78 [95% CI 1.28-11.16]), and use of seclusion or physical restraint (OR 3.78 [95% CI 1.53-9.37]) are particularly important explanatory factors. CONCLUSIONS Hypoalbuminemia, low BMI, and the use of seclusion or physical restraint were identified as the factors that inhibit early discharge from the psychiatric emergency ward for elderly patients. These factors reflect malnutrition and extremely serious psychiatric symptoms.
Aged ; Aged, 80 and over ; Dementia ; diagnosis ; psychology ; therapy ; Emergency Service, Hospital ; statistics & numerical data ; Female ; Hospitalization ; statistics & numerical data ; Hospitals, Psychiatric ; statistics & numerical data ; Humans ; Japan ; Length of Stay ; statistics & numerical data ; Male ; Patient Discharge ; statistics & numerical data ; Risk Factors