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The present study aims to analyze the elemental distribution in erythrocytes from five hemodialysis patients treated with erythropoietin in comparison to four healthy controls. Using in-air micro-PIXE we determined that iron dots were distributed in the peripheral region of control erythrocytes, which were made up of two to four compartments. Iron dots tend to aggregate partially in hemodialysis patients. Calcium was rendered to form small dense nodules in erythrocytes of controls, and small dense nodules became marked in some hemodialysis patients. Nodular formation of phosphorous was weakened in both control and hemodialysis patients. Potassium aggregated focally and formed small dense granules in erythrocytes of healthy controls. On the other hand, hemodialysis patients showed enrichment of potassium, with diffuse spreading partially to all over erythrocytes. These findings indicate that in-air micro-PIXE is a useful tool for analyzing the elemental distributions in erythrocytes of hemodialysis patients.

Muscle cramps are one of the most common complications of hemodialysis (HD), and often are a source of great pain in spite of various clinical measures. The traditional herbal medicine, Shao-Yao-Gan-Cao-Tang (Japanese name: Shakuyaku-kanzo-to), consists of equal amounts of paeony and licorice roots, and has been used in Japan and China for muscle pain or skeletal muscle tremors. To determine whether this medicine is able to prevent frequent and unendurable muscle cramps in patients undergoing HD, Shakuyaku-kanzo-to at 6 g per day was prospectively administered for 4 weeks to five patients on HD who were suffering from frequent muscle cramps. The frequency and severity of cramping before and after the treatment were carefully observed and compared. Skeletal muscle cramps completely disappeared in two of the treated patients after the start of oral administration of Shakuyaku-kanzo-to. Moreover, the frequency of cramping was significantly decreased in two of the remaining three patients after persistent administration. The severity of muscle cramps was also decreased by this treatment in the responsive patients. No serious side effects were detected during the treatment period. The inhibitory effect of Shakuyaku-kanzo-to on muscle contraction was also experimentally examined by using phrenic nerve-diaphragm preparations from male Wistar rats. Differences between the twitch responses were determined when the diaphragms and the nerves were stimulated in the presence and absence of the extract of Shakuyaku-kanzo-to. The results demonstrated that extracts of paeony and licorice roots inhibit contraction of skeletal muscles in rats. Taken together, we suggest that administration of Shakuyaku-kanzo-to is a safe, effective treatment for preventing muscle cramps in patients undergoing HD.

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The aim of the present study was to search for the differential gene expression and measure the serum level of a number of biochemical parameters in the cold Zheng (CZ) and non-cold Zheng (NCZ) in patients receiving hemodialysis. Hemodialysis (HD) patients were randomly selected from the CZ and NCZ groups. The between-group differences in gene expression were assessed using complementary DNA (cDNA) microarray. Differential gene expression was further validated by real-time reverse transcriptase polymerase chain reaction (RT-PCR). Our results demonstrated that the up-regulation of the inflammation-associated genes, ALOX5AP, S100A8 and S100A12, down-regulation of the genes related to immunity (DEFA4), metabolism (GNG11, PYGB, PRKAR2B), and growth/proliferation (HSF2, DDR2, TK1) were found in the CZ group. Furthermore, the CZ HD patients had significantly lower serum albumin levels compared with their NCZ counterparts (3.31 ± 0.08 g/dL versus 4.18 ± 0.12 g/dL). It appears reasonable to conclude that up-regulated inflammatory-gene expression (ALOX5AP, S100A8 and S100A12) may play an important role in CZ HD patients.

Chronic kidney disease (CKD) is an increasing major public health problem worldwide. The number of CKD patients on hemodialysis is growing rapidly as well. Acupuncture technique is one of the traditional Chinese medicine methods and has been used in a variety of diseases. Nowadays, the clinical application of acupuncture technique for CKD patients has become the focus for its effectiveness and security. In this paper, we will review the therapeutic effects and mechanisms of different acupuncture techniques for CKD patients. In patients with CKD, acupuncture improves renal function, reduces proteinuria, controls hypertension, corrects anemia, relieves pain, and controls many hemodialysis-related complications such as uremic pruritus, insomnia and fatigue. The mechanisms are related to the regulation of sympathetic nerve and the activation of bioactive chemicals. In conclusion, acupuncture is proved to be beneficial for CKD patients. More research, however, is needed to verify the potential mechanisms.

Objectives: To test the capacity of the digital tool, fractal dimension (FD) analysis, in identifying subtle differences in bone pattern in patients with renal osteodystrophy (RO), correlated with the time of hemodialysis, in different regions of interest, delineated on panoramic and periapical radiographs. Study design: A total of 34 patients with chronic renal disease undergoing hemodialysis were submitted to panoramic and periapical radiographs. Different regions of interest were delineated on the mandibular body and ramus. FD was analyzed by means of the software program ImageJ and correlated with the time of hemodialysis. Results: The sample consisted of 34 subjects. The time of hemodialysis varied from 1 to 286 months. There was significant correlation between the time of hemodialysis and the FD values in the region delineated in the mandibular angle ($r=0.498;p=0.003$) and this was shown in the periapical radiographs as well ($r=-0.349;p=0.043$). Conclusions: FD analysis was a useful tool in detecting alterations caused by RO in bone pattern, in panoramic and periapical radiographs.

The purpose of this study was to evaluate risk factors for re-recurrent carpal tunnel syndrome (CTS) in long-term renal hemodialysis (HD) patients. Fifteen wrists of ten HD patients, follow-up period of minimum seven years after reoperation of CTS, were included in this study. Duration of HD, period from first operation to reoperation, shunt side was involved or not, presence of trigger finger and cervical destructive spondyloarthritis, and operative procedure performed during the reoperation (synovectomy was performed or not) were evaluated. Re-recurrent CTS was identified in four out of 15 wrists (27%). The period from first operation to reoperation, which was 3.8 years in the re-recurrence group and eight years in the no re-recurrence group, and the operative procedure had significant differences (synovectomy groups had no re-recurrence vs. no synovectomy groups had 82% re-recurrence). The results of this study suggested that synovectomy would be necessary for recurrent CTS in HD patients.

Purpose: Diseases of the coronary arteries represent critical cardiovascular bleakness and mortality around the world. The main focus of this study is to simulate hemodialysis patients undergoing Coronary Artery Bypass Graft (CABG) surgery by the left internal mammary artery. The survey is to investigate whether subclavian-coronary steal syndrome will occur in patients with stenosis in their left subclavian.

Methods: A three-dimensional model of Brachial—Radial—Ulnar tree arterial system and dialysis graft are constructed and then simulated by the implementation of fluid–structure interaction (FSI) and non-FSI models. After consent was obtained, data attributed to dialysis patients who had undergone coronary bypass surgery at the Tehran Heart Center (THD) was collected.

Results: Stenosis in the subclavian artery causes the left internal mammary artery (LIMA) graft to lack flow that, in CABG cases, is supplying the heart muscle. With the increase of stenosis from zero to 54%, the flow results show a negative flow indicating reversed flow in the artery. Meanwhile, the comparison between flow quantity of a normal Left Anterior Descending (LAD) and LIMA in case of 38% stenosis in subclavian shows that the amount of flow reaching the heart is less than standard. The threshold stenosis in the subclavian artery for which subclavian-coronary steal phenomena occurs is simulated to be around 54%. Furthermore, investigation of the effect of flow quantity in cases of hemodialysis versus nonhemodialysis shows that the flow is lessened in case of hemodialysis.

Conclusions: In hemodialysis patients with more than 38% stenosis in left subclavian, it is well advised that LIMA bypass graft is not the preferred graft choice, and at 54% of subclavian stenosis, the steal phenomenon occurs.

The objective of this study is to show how important a compliant wall technique is in simulating non-Newtonian and pulsatile blood flows in arteriovenous fistula (AVF). The three-dimensional idealized geometry is used to investigate the local hemodynamics in the end-to-side, radio-cephalic AVF using computational fluid-stricture interaction (FSI) simulation. The third-order Yeoh law is used to model the behavior of the hyperelatic vessel walls. Hemodynamic parameters such as velocity, wall shear stress (WSS), oscillatory shear index (OSI), vorticity, and venous outflow rate are calculated. The results extracted for WSS on comparison of rigid and compliance wall, rigid wall WSS are 45–48.5% larger values than the compliance wall. The difference between compliance wall and rigid wall OSI is 11.5% and the rigid wall is a 10.86% decrease in compliance wall. The difference between the rigid wall AVF vorticity and the compliance wall vorticity is 18.34%, and the vorticity in the compliance wall is a 20.2% increase over the rigid wall. Maximum principle stress occurs at anastomosis (1335Pa) and 507Pa, 93Pa on vein and artery, respectively. Finally, we conclude that the artery bed and heel of AVF are prone areas of Intimal Hyperplasia. The structural result shows the tendency of the inflammation pattern of the vein required for AVF maturation. ANSYS is a highly effective commercial tool for modeling real-world problems and performing multi-physics numerical simulations.

Hemodialysis (HD) is a treatment supporting decreased kidney function, via a catheter inserted into the heart’s Right Atrium (RA). Recirculation is a source of inefficiency for treatment, where blood is dialyzed again due to poor catheter design. Lab-testing is still relatively unexplored, hence, a mechanical testing system was designed with the intention of providing a consistent and repeatable environment for testing HD catheters. System geometry was composed using a Computer-Aided Design (CAD) model of a heart, with the RA scaled to appropriate dimensions, and a PolyDiMethylSiloxane (PDMS) model produced through 3D printing and negative wax casting. Pulsatile blood flow was mimicked by peristaltic pumps driving a blood analogue (BA). Recirculation was induced by adding dyed BA to the system via the catheter and measured using a colorimeter. The developed platform was initially evaluated using two catheters, demonstrating the capability to accurately replicate atrial hemodynamic conditions. Two step-tipped catheters, A and B, were tested at 350 ml/min, producing recirculation values of 13.11% and 18.58%, respectively. The results exhibit the ability of the system developed to evaluate HD catheter performance, with the potential to explore a wider range of tip geometries relevant to clinical preference. Furthermore, this advancement towards an anatomically accurate lab-based test system could be paired with computational methods to progress the evaluation of such medical devices and enhance their development.

This work purpose was to estimate the implication of suspected adrenal function deficiencies, which was influenced by oxidative stress (OS) that are generating brain plasticity, and reorganization of the functional control. This phenomenon was revealed in two-hemodialysis patients described in this paper. Blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI) revealed a significant activation of the motor cortex. Hemodialysis seems to originate an inflammatory state of the cerebral tissue reflected by increased OS, while expected to decrease since hemodialysis eliminates free radicals responsible for OS. Considering adrenal function deficiencies, sensitivity to OS and assessed hyponatremia and hypercalcemia, adrenal function deficiencies is strongly suspected in both patients. This probably contributes to amplify brain plasticity and a reorganization of functional control after hemodialysis that is compared to earlier reported studies. Brain plasticity and functional control reorganization was revealed by BOLD-fMRI with a remarkable sensitivity. Brain plastic changes are originated by elevated OS associating indices of adrenal function deficiencies. These results raise important issues about adrenal functional deficiencies impact on brain plasticity in chronic hemodialysis-patients. This motivates more global studies of plasticity induced factors in this category of patients including adrenal functional deficiencies and OS.

A 15-year-old mixed-breed dog that was presented with anorexia and lethargy for four months was diagnosed with chronic kidney disease (CKD) and cardiac disease. The patient was presented clinically in poor physical condition showing stupor and acute vomiting. Complete blood count (CBC) and serum biochemical analysis showed severe anemia and blood urea nitrogen (BUN, 145 mg/dL), creatinine (3.9 mg/dL) and phosphorus (17.2 mmol/L) were also elevated. Hemodialysis was performed after fluid therapy did not improve the condition of the patient. Hemodialysis successfully treated the acute-phase CKD and improved the kidney compensation function.

We consider the process of hemodialysis performed by means of a hollow fiber dialyzer with a special focus on the dynamics of the light solutes (including metabolic waste products) through the porous fibers membrane. The model we illustrate here completes the one formulated in a previous paper in which solutes concentrations in the dialyzate were neglected. Exploiting the large difference between the characteristic time of the processes in the machine and the relaxation time to equilibrium in the body, we confine our study to the case of constant input data in order to emphasize the role of the solute transport mechanisms. Numerical solutions show that diffusion is dominant at the early stage of filtration.

Dialysis hypotension is one of the most prevalence symptoms of dialysis and occurs in 40% of treatment sessions. Detection and prediction of hypotension is important for the well-being of the patient and for optimizing treatment. The aim of this study was to construct optical system to monitor blood pressure (BP) continuously and without cuff in hemodialysis based on pulse transit time (PTT) method. To measure the BP changes, dual-channel optical system were developed. In this study, individuals were classified into two groups of normal and hemodialysis. In both groups, BP and consequently PTT were earned three times in different positions. After the initial calibration, the regression equation was drawn for each subject. In normal group, each subject was placed in the supine position and BP was measured both by designed system and sphygmomanometer cuff. During BP measurements, in addition to BP, blood pressure decline was also monitored by optical system. For hemodialysis group, the same measurement setup was adopted. In both groups, the error between cuff method and PTT was calculated. Correlation coefficients for BP_cuff vs BP_PTT were calculated and Bland–Altman plot was performed for the normal and hemodialysis groups. In this study 16 subjects participated. The results for normal group showed that maximum difference between cuff method and the present method was 14mmHg and for dialysis group was 16mmHg. Bland–Altman plot in normal group revealed limits of agreement from $-$13.98 to 13.18mmHg. Considering hemodialysis group, limits of agreement were from $-$15.94 to 13.88mmHg. The correlation coefficient was 0.74 for normal group and was 0.72 for hemodialysis group. The proposed system can monitor BP continuously and diagnose sudden hypotension. So it can be recommended as a useful method to indicate hypotension and can be used for dialysis unit.