Impact of patient training patterns on peritonitis rates in a large national cohort study

Background. Ideal training methods that could ensure best peritoneal dialysis (PD) outcome have not been defined in previous reports. The aim of the present study was to evaluate the impact of training characteristics on peritonitis rates in a large Brazilian cohort.Methods. Incident patients with valid data on training recruited in the Brazilian Peritoneal Dialysis Multicenter Study (BRAZPD II) from January 2008 to January 2011 were included. Peritonitis was diagnosed according to International Society for Peritoneal Dialysis guidelines; incidence rate of peritonitis (episodes/patient-months) and time to the first peritonitis were used as end points.Results. Two thousand two hundred and forty-three adult patients were included in the analysis: 59 +/- 16 years old, 51.8% female, 64.7% with <= 4 years of education. The median training time was 15 h (IQI 10-20 h). Patients were followed for a median of 11.2 months (range 3-36.5). The overall peritonitis rate was 0.29 per year at risk (1 episode/41 patient-months). The mean number of hours of training per day was 1.8 +/- 2.4. Less than 1 h of training/day was associated with higher incidence rate when compared with the intervals of 1-2 h/day (P = 0.03) and > 2 h/day (P = 0.02). Patients who received a cumulative training of > 15 h had significantly lower incidence of peritonitis compared with < 15 h (0.26 per year at risk versus 0.32 per year at risk, P = 0.01). The presence of a caregiver and the number of people trained were not significantly associated with peritonitis incidence rate. Training in the immediate 10 days after implantation of the catheter was associated with the highest peritonitis rate (0.32 per year), compared with training prior to catheter implantation (0.28 per year) or > 10 days after implantation (0.23 per year). More experienced centers had a lower risk for the first peritonitis (P = 0.003).Conclusions. This is the first study to analyze the association between training characteristics and outcomes in a large cohort of PD patients. Low training time (particularly < 15 h), smaller center size and the timing of training in relation to catheter implantation were associated with a higher incidence of peritonitis. These results support the recommendation of a minimum amount of training hours to reduce peritonitis incidence regardless of the number of hours trained per day.

No periodic orbits for the type A Bianchi's systems

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Evidence-based medicine: an update on treatments for peritoneal dialysis-related peritonitis

Peritonitis continues to be a major complication of peritoneal dialysis (PD), and adequate treatment is crucial for a favorable outcome. There is no consensus regarding the optimal therapeutic regimen, and few prospective controlled studies have been published. The objective of this manuscript is to review the results of PD peritonitis treatment reported in narrative reviews, systematic reviews, and proportional meta-analyses. Two narrative reviews, the only existing systematic review and its update published between 1991 and 2014 were included. In addition, we reported the results of a proportional meta-analysis published by our group. Results from systematic reviews of randomized control trials (RCT) and quasi-RCT were not able to identify any optimal antimicrobial treatment, but glycopeptide regimens were more likely to achieve a complete cure than a first generation cephalosporin. Compared to urokinase, simultaneous catheter removal and replacement resulted in better outcomes. Continuous and intermittent IP antibiotic use had similar outcomes. Intraperitoneal antibiotics were superior to intravenous antibiotics in reducing treatment failure. In the proportional meta-analysis of RCTs and the case series, the resolution rate (86%) of ceftazidime plus glycopeptide as initial treatment was significantly higher than first generation cephalosporin plus aminoglycosides (66%) and glycopeptides plus aminoglycosides (75%). Other comparisons of regimens used for either initial treatment or treatment of gram-positive rods or gram-negative rods did not show statistically significant differences. The superiority of a combination of a glycopeptide and a third generation cephalosporin was also reported by a narrative review study published in 1991, which reported an 88% resolution rate.

Guidelines for the management and treatment of periodic fever syndromes Familial Mediterranean Fever

To establish guidelines based on scientific evidence for the management of familial Mediterranean fever. The Guideline was prepared from 5 clinical questions that were structured through PICO (Patient, Intervention or indicator, Comparison and Outcome), to search in key primary scientific information databases. After defining the potential studies to support the recommendations, these were graduated considering their strength of evidence and grade of recommendation. 10,341 articles were retrieved and evaluated by title and abstract; from these, 46 articles were selected to support the recommendations. 1. The diagnosis of FMF is based on clinical manifestations, characterized by recurrent febrile episodes associated with abdominal pain, chest or arthritis of large joints; 2. FMF is a genetic disease presenting an autosomal recessive trait, caused by mutation in the MEFV gene; 3. Laboratory tests are not specific, demonstrating high serum levels of inflammatory proteins in the acute phase of the disease, but also often showing high levels even between attacks. SAA serum levels may be especially useful in monitoring the effectiveness of treatment; 4. The therapy of choice is colchicine; this drug has proven effectiveness in preventing acute inflammatory episodes and progression towards amyloidosis in adults; 5. Based on the available information, the use of biological drugs appears to be an alternative for patients with FMF who do not respond or are intolerant to therapy with colchicine.

The dynamic behavior of a parametrically excited time-periodic MEMS taking into account parametric errors

Micro-electromechanical systems (MEMS) are micro scale devices that are able to convert electrical energy into mechanical energy or vice versa. In this paper, the mathematical model of an electronic circuit of a resonant MEMS mass sensor, with time-periodic parametric excitation, was analyzed and controlled by Chebyshev polynomial expansion of the Picard interaction and Lyapunov-Floquet transformation, and by Optimal Linear Feedback Control (OLFC). Both controls consider the union of feedback and feedforward controls. The feedback control obtained by Picard interaction and Lyapunov-Floquet transformation is the first strategy and the optimal control theory the second strategy. Numerical simulations show the efficiency of the two control methods, as well as the sensitivity of each control strategy to parametric errors. Without parametric errors, both control strategies were effective in maintaining the system in the desired orbit. On the other hand, in the presence of parametric errors, the OLFC technique was more robust.

Periodic sterility assessment of materials stored for up to 6 months at continuous microbial contamination risk: Laboratory study

An investigation was conducted to test the hypothesis that the storage time of packaging sterility has no effect on contamination susceptibility even under deliberate bacterial exposure (Serratia marcescens). No growth of the test microorganisms was identified in the experimental group in any of the storage intervals (7, 14, 28, 90, and 180 days). Current recommendations/guidelines suggest that contamination of packaging occurs only because of events. This study, done in vitro, supports these recommendations. Copyright (c) 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Periodic averaging theorems for various types of equations

We prove a periodic averaging theorem for generalized ordinary differential equations and show that averaging theorems for ordinary differential equations with impulses and for dynamic equations on time scales follow easily from this general theorem. We also present a periodic averaging theorem for a large class of retarded equations.

Periodic solutions of abstract neutral functional differential equations

We characterize the existence of periodic solutions of some abstract neutral functional differential equations with finite and infinite delay when the underlying space is a UMD space. (C) 2011 Elsevier Inc. All rights reserved.

Effect of treatment delay on disease severity and need for resuscitation in porcine fecal peritonitis

Objective: Early treatment in sepsis may improve outcome. The aim of this study was to evaluate how the delay in starting resuscitation influences the severity of sepsis and the treatment needed to achieve hemodynamic stability. Design: Prospective, randomized, controlled experimental study. Setting: Experimental laboratory in a university hospital. Subjects: Thirty-two anesthetized and mechanically ventilated pigs. Interventions: Pigs were randomly assigned (n = 8 per group) to a nonseptic control group or one of three groups in which fecal peritonitis (peritoneal instillation of 2 g/kg autologous feces) was induced, and a 48-hr period of protocolized resuscitation started 6 (Delta T-6 hrs), 12 (Delta T-12 hrs), or 24 (Delta T-24 hrs) hrs later. The aim of this study was to evaluate the impact of delays in resuscitation on disease severity, need for resuscitation, and the development of sepsis-associated organ and mitochondrial dysfunction. Measurements and Main Results: Any delay in starting resuscitation was associated with progressive signs of hypovolemia and increased plasma levels of interleukin-6 and tumor necrosis factor-alpha prior to resuscitation. Delaying resuscitation increased cumulative net fluid balances (2.1 +/- 0.5 mL/kg/hr, 2.8 +/- 0.7 mL/kg/hr, and 3.2 +/- 1.5 mL/kg/hr, respectively, for groups.T-6 hrs, Delta T-12 hrs, and.T-24 hrs; p < .01) and norepinephrine requirements during the 48-hr resuscitation protocol (0.02 +/- 0.04 mu g/kg/min, 0.06 +/- 0.09 mu g/kg/min, and 0.13 +/- 0.15 mu g/kg/min; p = .059), decreased maximal brain mitochondrial complex II respiration (p = .048), and tended to increase mortality (p = .08). Muscle tissue adenosine triphosphate decreased in all groups (p < .01), with lowest values at the end in groups Delta T-12 hrs and.T-24 hrs. Conclusions: Increasing the delay between sepsis initiation and resuscitation increases disease severity, need for resuscitation, and sepsis-associated brain mitochondrial dysfunction. Our results support the concept of a critical window of opportunity in sepsis resuscitation. (Crit Care Med 2012; 40:2841-2849)

Turing patterns in the chlorine dioxide-iodine-malonic acid reaction with square spatial periodic forcing

We use the photosensitive chlorine dioxide-iodine-malonic acid reaction-diffusion system to study wavenumber locking of Turing patterns to two-dimensional "square" spatial forcing, implemented as orthogonal sets of bright bands projected onto the reaction medium. Various resonant structures emerge in a broad range of forcing wavelengths and amplitudes, including square lattices and superlattices, one-dimensional stripe patterns and oblique rectangular patterns. Numerical simulations using a model that incorporates additive two-dimensional spatially periodic forcing reproduce well the experimental observations.

On S-asymptotically omega-periodic functions and applications

Let (X, parallel to . parallel to) be a Banach space and omega is an element of R. A bounded function u is an element of C([0, infinity); X) is called S-asymptotically omega-periodic if lim(t ->infinity)[u(t + omega) - u(t)] = 0. In this paper, we establish conditions under which an S-asymptotically omega-periodic function is asymptotically omega-periodic and we discuss the existence of S-asymptotically omega-periodic and asymptotically omega-periodic solutions for an abstract integral equation. Some applications to partial differential equations and partial integro-differential equations are considered. (C) 2011 Elsevier Ltd. All rights reserved.

Self-similarities of periodic structures for a discrete model of a two-gene system

We report self-similar properties of periodic structures remarkably organized in the two-parameter space for a two-gene system, described by two-dimensional symmetric map. The map consists of difference equations derived from the chemical reactions for gene expression and regulation. We characterize the system by using Lyapunov exponents and isoperiodic diagrams identifying periodic windows, denominated Arnold tongues and shrimp-shaped structures. Period-adding sequences are observed for both periodic windows. We also identify Fibonacci-type series and Golden ratio for Arnold tongues, and period multiple-of-three windows for shrimps. (C) 2012 Elsevier B.V. All rights reserved.

Spinal cord injury as a trigger to develop periodic leg movements during sleep: an evolutionary perspective

The primary trigger to periodic limb movement (PLM) during sleep is still unknown. Its association with the restless legs syndrome (RLS) is established in humans and was reported in spinal cord injury (SCI) patients classified by the American Spinal Injury Association (ASIA) as A. Its pathogenesis has not been completely unraveled, though recent advances might enhance our knowledge about those malfunctions. PLM association with central pattern generator (CPG) is one of the possible pathologic mechanisms involved. This article reviewed the advances in PLM and RLS genetics, the evolution of CPG functioning, and the neurotransmitters involved in CPG, PLM and RLS. We have proposed that SCI might be a trigger to develop PLM.

Time lags of the kilohertz quasi-periodic oscillations in the low-mass X-ray binaries 4U 1608−52 and 4U 1636−53

We studied the energy and frequency dependence of the Fourier time lags and intrinsic coherence of the kilohertz quasi-periodic oscillations (kHz QPOs) in the neutron-star lowmass X-ray binaries 4U 1608−52 and 4U 1636−53, using a large data set obtained with the Rossi X-ray Timing Explorer. We confirmed that, in both sources, the time lags of the lower kHz QPO are soft and their magnitude increases with energy. We also found that: (i) In 4U 1636−53, the soft lags of the lower kHz QPO remain constant at∼30 μs in the QPO frequency range 500–850 Hz, and decrease to ∼10 μs when the QPO frequency increases further. In 4U 1608−52, the soft lags of the lower kHz QPO remain constant at 40 μs up to 800 Hz, the highest frequency reached by this QPO in our data. (ii) In both sources, the time lags of the upper kHz QPO are hard, independent of energy or frequency and inconsistent with the soft lags of the lower kHz QPO. (iii) In both sources the intrinsic coherence of the lower kHz QPO remains constant at ∼0.6 between 5 and 12 keV, and drops to zero above that energy. The intrinsic coherence of the upper kHz QPO is consistent with being zero across the full energy range. (iv) In 4U 1636−53, the intrinsic coherence of the lower kHz QPO increases from ∼0 at ∼600 Hz to ∼1, and it decreases to ∼0.5 at 920 Hz; in 4U 1608−52, the intrinsic coherence is consistent with the same trend. (v) In both sources the intrinsic coherence of the upper kHz QPO is consistent with zero over the full frequency range of the QPO, except in 4U 1636−53 between 700 and 900 Hz where the intrinsic coherence marginally increases. We discuss our results in the context of scenarios in which the soft lags are either due to reflection off the accretion disc or up-/down-scattering in a hot medium close to the neutron star. We finally explore the connection between, on one hand the time lags and the intrinsic coherence of the kHz QPOs, and on the other the QPOs’ amplitude and quality factor in these two sources.

Die Mastzelle als Schlüsselzelle in der natürlichen Immunität bei septischer Peritonitis: Rolle von Endothelin-1

In den letzten Jahren hat sich die Erkenntnis durchgesetzt, dass Endothelin-1 (ET-1) eine wichtige Rolle im Rahmen bakterieller Sepsis spielt. Gleichzeitig gibt es immer mehr Hinweise, dass Mastzellen (MZ) -neben ihrer weit bekannten Funktion als Vermittler allergischer Reaktionen - zur Aufrechterhaltung der natürlichen Immunität gegen Bakterien beitragen. In der vorliegenden Arbeit wird zum ersten Mal anhand eines etablierten Mausmodells der septischen Peritonitis (durch Ligatur und Punktion des Caecums, CLP) der Frage nachgegangen, welche Rolle peritonealen MZ in der Regulation der durch ET-1-induzierten Morbidität und Mortalität zukommt.Im experimentellen Teil der Arbeit wird zunächst der Nachweis erbracht, dass ET-1 zur Mortalität nach CLP beiträgt. Durch Versuche an MZ-defizienten KitW/KitW-v Mäusen wird weiterhin gezeigt, dass MZ, zumindest zum Teil, vor der ET-1 induzierten Morbidität und Mortalität schützen. Diese Funktion erfüllen die MZ durch eine verstärkte Elimination von ET-1 aus der Bauchhöhle und einer damit einhergehenden Reduktion der lokalen toxischen ET-1 Konzentrationen.In dieser Arbeit wird erstmals ein möglicher neuer Mechanismus aufgezeigt, durch den MZ zur Immunabwehr beitragen können: Durch die Regulation lokaler Konzentrationen eines toxischen, endogenen Mediators. Die Ergebnisse dieser Arbeit bestätigen die Beteiligung von ET-1 bei septischer Peritonitis und weisen erstmals darauf hin, dass MZ in der Regulation der ET-1 vermittelten Morbidität und Mortalität eine protektive Rolle spielen.