40070884
Relative plasma volume monitoring for identifying volume-sensitive and -resistant hypertension.
The measurement and management of volume state among long-term dialysis patients has not received much attention. Recent reports suggest that relative plasma volume monitoring may be useful in identifying patients who have volume excess. Among patients who have evidence of excess volume by relative plasma volume monitoring, excess volume removal leads to improvement in interdialytic ambulatory blood pressure. Implementation of this technique can result in improved classification of patients into volume-sensitive and -resistant categories and therefore improve the management of hypertension.
26646564
Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States.
BACKGROUND
Hypertension is common in chronic hemodialysis patients, yet there are limited data on the epidemiology of hypertension in these patients in the United States.


METHODS
We assessed the prevalence, treatment, and control of hypertension in a cohort of 2535 clinically stable, adult hemodialysis patients who participated in a multicenter study of the safety and tolerability of an intravenous iron preparation. Hypertension was defined as an average predialysis systolic blood pressure >150 mm Hg or diastolic blood pressure >85 mm Hg, or the use of antihypertensive medications.


RESULTS
Hypertension was documented in 86% (n = 2173) of patients. The prevalence of hypertension, in contrast to that observed in the general population, did not increase linearly with age and was not affected by sex or ethnicity. Hypertension was controlled adequately in only 30% (n = 659) of the hypertensive patients. In the remaining patients, hypertension was either untreated (12% [252/2173]) or treated inadequately (58% [1262/2173]).


CONCLUSION
Control of hypertension, particularly systolic hypertension, in chronic hemodialysis patients in the United States is inadequate, despite recognition of its prevalence and the frequent use of antihypertensive drugs. Optimizing the use of medications and closer attention to nonpharmacologic interventions, such as adjustment of dry weight, a low-sodium diet, and exercise, may improve control.
10080320
Unfavourable results with distraction in craniofacial skeleton
Distraction osteogenesis has revolutionised the management of craniofacial abnormalities. The technique however requires precise planning, patient selection, execution and follow-up to achieve consistent and positive results and to avoid unfavourable results. The unfavourable results with craniofacial distraction stem from many factors ranging from improper patient selection, planning and use of inappropriate distraction device and vector. The present study analyses the current standards and techniques of distraction and details in depth the various errors and complications that may occur due to this technique. The commonly observed complications of distraction have been detailed along with measures and suggestions to avoid them in clinical practice.
25362267
Multiple comparisons, interaction effects, and statistical inference: lessons from chronic kidney disease progression among blacks.
A post hoc analysis of a randomized trial comparing progression of chronic kidney disease among blacks and non-blacks provides an opportunity to explore statistical inference. Multiple comparisons without penalizing the P-value can lead to false positive results; this is illustrated using simulation. Tests of statistical interaction are then applied and interpreted to understand effect modification (or lack thereof) in the context of this trial.
206198477
A new technique for repair of acquired split-ear-lobe deformity: the free conchal cartilage sandwich graft.
BACKGROUND
Split-ear-lobe repair is one of the commonest requests in cosmetic facial surgery. Frequently, the ear lobe split is prone to recurrence following surgical repair. A new technique is described that strengthens the ear lobe tissues using locally available conchal cartilage to prevent recurrence. A new classification of split ear lobe is also presented.


METHODS
Twenty-two women in the age range from 18 to 62 years with varying grades of split ear lobe were operated using the technique of conchal cartilage reinforcement of ear lobe. Eight females had bilateral involvement, and a total of 30 split ear lobes were repaired. A conchal cartilage disc was harvested at the time of repair of the ear lobe. This disc was placed in a pocket created in the ear lobe, and the ear lobe was repaired over this pocket. Simultaneous re-perforation of the ear lobe was done in a central location through the implanted conchal disc, and stud earring was applied.


RESULTS
Satisfactory aesthetic and functional results have been obtained in the series using the technique of conchal cartilage-graft augmentation of the ear lobe. All patients had high degree of satisfaction in being able to come out of the operating room with earrings on. There has been no stretching or re-tear of the ear lobe following implantation of conchal cartilage, over a follow-up period of 36 months.


CONCLUSION
The conchal cartilage-graft sandwich procedure allows immediate re-perforation of the repaired ear lobe at the time of repair in a central aesthetic location, as well as providing necessary strength to the ear lobe; thus preventing recurrence in primary and recurrent, acquired split-ear-lobe deformity.
8481821
Ambulatory blood pressure monitoring trumps estimated glomerular filtration rate in predicting cardiovascular risk in low-risk populations.
See related article, pp 18–26 

Identifying risk factors that predict cardiovascular morbidity and mortality has been the holy grail of epidemiologists. Identifying such risk factors can be used to target individuals in whom modifiable risk factor should be mitigated. Among the first studies to identify cardiovascular risk factors was the Framingham Heart Study. A cohort in the town of Framingham, MA was followed for many years, and the risk of cardiovascular events was related to the presence of several risk factors such as age, sex, smoking, total cholesterol, high-density lipoprotein cholesterol, antihypertensive therapy, systolic blood pressure (BP), and diabetes mellitus. In 1961, after 6 years of follow-up, the term “factors of risk in the development of coronary heart disease” was used by Dr William Kannel.1 These factors of risk, now known as cardiovascular risk factors, have been validated by many studies2; they are now the basis of guiding cardiovascular risk-reduction such as lowering cholesterol.3 For example, the current Adult Treatment Panel III guidelines use the Framingham risk calculator to direct cholesterol lowering therapy.3 However, these risk factors that relied on simple measures of cardiovascular risk were not found to be perfect in predicting outcomes.2 Although a number of investigations have tried to identify additional risk factors, the number of markers that can predict cardiovascular events and more importantly improve the Framingham risk score is few.4 Nonetheless, novel risk factors, such as the assessment of kidney damage, and better ways to measure BP merit further study.

In this …
7140714
Anticoagulation in sepsis: Is low-dose heparin as effective as activated protein C?
[2, 3, 8]. There were no data on the severity scores (APACHE II or SAPS II scores) of the subgroup of patients who received heparin vs none, but one study does mention that patients who did not receive heparin were in general sicker [3]. We then analyzed the placebo arms of these three mega-trials of anticoagulants in sepsis and compared heparin administration against none. In each trial, heparin use was associated with improved survival among placebo recipients only (Table 1). Among 2987 pooled placebo recipients from the three trials, the odds of death for the patients who received heparin, as compared with those who did not, was 0.65 (95% CI: 0.55–0.76; p<0.00001; Fig. 1). Moreover, based on this analysis, the number-needed-to-treat (NNT) to prevent one death with heparin is 10 (95% CI: 7–16), which is very much comparable to the benefit of aPC as shown in the in various subgroups of the PROWESS trial (NNT of 9, 95% CI: 6–15); and 13, 95% CI: 9–25) in patients with APACHE II scores ≥25 and in patients with two or more organ dysfunction, respectively. However, this being a post-hoc analysis has obvious limitations. The placebo group was not randomized to receive heparin at baseline, and it is possible that patients who did not receive heparin were probably sicker. A selection bias favoring heparin Intensive Care Med (2005) 31:1297–1298 DOI 10.1007/s00134-005-2723-0 C O R R E S P O N D E N C E
37563683
High-attenuation mucus in allergic bronchopulmonary aspergillosis: another cause of diffuse high-attenuation pulmonary abnormality.
7956158
Obstructive granulomatous bronchiolitis obliterans due to Mycobacterium tuberculosis.
Bronchiolitis obliterans is an uncommon cause of obstructive airway disease in adults characterised by progressive irreversible airway obstruction. Granulomatous bronchiolitis is a rare entity and tuberculosis presenting as bronchiolitis is distinctly uncommon. The authors present a case of tubercular granulomatous bronchiolitis obliterans, confirmed on histopathology, who responded completely to anti-tubercular chemotherapy.
5649152
Differential distribution of pigment-protein complexes in the Thylakoid membranes of Synechocystis 6803
AbstractThylakoids in Synechocystis 6803, though apparently uniform in appearance in ultrastructure, were found to consist of segments which were functionally dissimilar and had distinct proteomes. These thylakoid segments can be isolated from Synechocystis 6803 by successive ultracentrifugation of cell free extracts at 40,000×g (40 k segments), 90,000×g (90 k segments) and 150,000×g (150 k segments). Electron microscopy showed differences in their appearance. 40 k segments looked feathery and fluffy, whereas the 90 k and 150 k thylakoid membrane segments appeared tiny and less fluffy. The absorption spectra showed heterogeneous distribution of pigment-protein complexes in the three types of segments. The photochemical activities of Photosystem I (PSI) and Photosystem II (PSII) showed unequal distributions in 40 k, 90 k and 150 k segments which were substantiated with low temperature fluorescence measurements. The ratio of PSII/PSI fluorescence emission at 77 K (λex = 435 nm) was highest in 150 k segments indicating higher PSII per unit PSI in these segments. The chlorophyll fluorescence lifetimes in the membranes, determined with a time-correlated single-photon counting technique, could be resolved in three components: τ1 
 = <40 ps, τ2 
 = 425–900 ps and τ3 
 = 2.4–3.2 ns. The percentage contribution of the fastest component (τ1) decreased in the order 40 k > 90 k > 150 k segments whereas that of the other two components showed a reversed trend. These studies indicated differential distribution of pigment-protein complexes in the three membrane segments suggesting heterogeneity in the thylakoids of Synechocystis 6803.
31378323
Immunosuppressive therapy in lung injury due to paraquat poisoning: a meta-analysis.
INTRODUCTION
Immunosuppressive therapy has been shown to improve outcomes in patients with paraquat poisoning. The objective of this study was to evaluate the efficacy of immunosuppressive therapy in the management of lung injury due to paraquat poisoning.


METHODS
We searched the MEDLINE, OVID, and CINAHL databases for relevant studies published from 1980 to 2006. We included studies if (a) the study design was a randomised controlled trial, observational study with historical controls or observational study; (b) the study population included patients with paraquat poisoning, and received immunosuppressive therapy; and (c) the study provided data on mortality. We calculated the survival rate with 95 percent confidence intervals (CI) for observational studies, and relative risk and 95 percent CI for dichotomous outcomes.


RESULTS
12 studies--four non-randomised, six non-randomised comparing historical controls, and two randomised controlled trials--had employed immunosuppressive therapy in the management of paraquat poisoning. The survival rate in the four non-randomised studies (39 patients) was 74.4 percent (95 percent CI 58.9-85.4). The relative risk of immunosuppressive therapy in decreasing mortality with paraquat poisoning was 0.55 (95 percent CI 0.39-0.77) and 0.6 (95 percent CI 0.27-1.34) for the non-randomised studies (comparing historical controls) and randomised controlled studies, respectively. There was significant heterogeneity and evidence of publication bias.


CONCLUSION
One out of four patients (95 percent CI 3-5) were successfully treated with immunosuppressive therapy for paraquat poisoning. However, due to significant heterogeneity and publication bias, a large randomised controlled trial will be required to affirm the role of immunosuppression in paraquat poisoning.