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Biomedical subjects

N K Man

Publications and source records attributed to N K Man.

At least 55 records · Page 3Linked to original sources
PubMed1992

Evaluation of parameters for adequate dialysis therapy: (2). Comparison between parameters according to UKM and other laboratory data.

Urea kinetic modeling (UKM) is often regarded as the best method for assessing the dialysis adequacy and consequently for the prescription of treatment time. However, other parameters are involved in the monitoring of end stage renal disease (ESRD) patients. Kt/V-urea and protein catabolic rate (pcr) were evaluated in 53 ESRD patients (25 males and 28 females; mean age, 60 +/- 2 years old; mean duration, 80 +/- 11 months), twice at an interval of 4 months, and pre-dialysis concentration of (pre-DC) plasma potassium, bicarbonate, calcium and phosphate were measured. The pre-dialysis systolic blood pressure and hematocrit were also recorded. The numbers of patients who were within the optimal range of Kt/V-urea and pcr recommended by Gotch and Sargent were 36 (67.9%) and 39 (73.6%), respectively, at the first control period, and 39 (73.6%) and 44 (83.0%) at the second control period. However, only about 50% of the patients were within the optimal range of pre-DC plasma calcium, phosphate and bicarbonate. Furthermore, very few patients fulfilled the conditions for all the parameters. It is concluded that (1) UKM is required to describe the domain of dialysis prescription, and (2) other parameters which are not dependent so much on dialysis should be taken into account for assessing the adequacy of dialysis.

Blood Chemical Analysis↗
PubMed1991

[Characteristics of artificial membranes].

The artificial membranes used in haemodialysis and haemofiltration are either cellulosic or made of synthetic polymers, such as polyacrylonitrile, polysulfone, polycarbonate, polymethylmetacrylate and ethyvinylalcohol. During dialysis the water and solute transfer primarily depends on hydraulic permeability and sieving coefficients. At present, high-flux membranes have sieving coefficients for urea (Mol. wt 60) to inulin (Mol. wt 5,200) that are similar to those of the glomerular basal lamina, whereas their hydraulic permeability remains well below that of the renal filter. Bioincompatibility factors responsible for acute, anaphylactoid-like reactions and chronic inflammatory complications have been identified. The choice of the correct dialysis membrane must rest not only on performance criteria but also on biocompatibility and economic criteria.

Biocompatible Materials↗
PubMed1991

The estimation of whole blood viscosity by a porous bed method.

A significant impediment in determining the relative contribution of whole blood viscosity to the pathogenesis of cardiovascular and cerebrovascular disease has been the lack of an uncomplicated method to measure whole blood viscosity. To address this problem, a simplified porous bed viscometer has been developed to measure whole blood viscosity. Whole blood is passed through a porous bed of branching channels with a mean pore diameter of 69.6 +/- 20.2 microns and an estimated mean shear rate of 19.6 seconds-1. The effects of sample collection, sample storage, and temperature are described. The mean whole blood viscosity of 242 healthy persons was 22.7 +/- 5.3 seconds, which, when corrected to centipoise using Darcy's equation, corresponds to an apparent viscosity of 5.7 +/- 1.3 cp. There was a significant difference in the whole blood viscosity of normal men and women related to their different packed cell volumes. Platelets and granulocytes influenced whole blood viscosity in proportion to their contribution to the total packed cell volume. Fibrinogen levels did not significantly influence measured whole blood viscosity, which is consistent with the disaggregating conditions and the mean shear rate of the instrument. The porous bed viscometer is a convenient means to measure whole blood viscosity and it should be useful as a screening test for clinical and epidemiologic studies.

Anticoagulants↗
PubMed1991

Influence of uremia on polymorphonuclear leukocytes oxidative metabolism in end-stage renal disease and dialyzed patients.

The oxygen (O2) consumption, and superoxide anion (O2-.) and hydrogen peroxide (H2O2) production by polymorphonuclear leukocytes (PMNs) were investigated in 5 end-stage renal disease patients, before and after the 1st, 4th and 10th dialysis sessions. Resting values of O2-. production and O2 consumption were not significantly different from values for PMNs from normal subjects. After stimulation by opsonized zymosan or phorbol myristate acetate, the three parameters measured were significantly (p less than 0.001) enhanced in comparison with healthy control values. Cross-incubation studies showed a lack of effect of patient plasma on O2-. production by stimulated control cells: PMN oxidative metabolism would therefore appear to be increased in these patients. The anomalies observed probably arise via a mechanism involving a cellular dysfunction resulting from the renal disease, rather than from the presence of a plasma factor.

Adult↗
PubMed1991

Evaluation of parameters for adequate dialysis therapy: (1). Monitoring of parameters by urea kinetic modeling.

In an attempt to evaluate the adequacy of regular dialysis therapy, calculations of Kt/V-urea and protein catabolic rate (pcr) from the data of routine laboratory examinations by means of urea kinetic modeling were performed in 59 regular dialysis patients (28 males and 31 females; mean age, 59 +/- 2 years old; mean dialysis duration, 83 +/- 10 months). The mean values of Kt/V-urea and pcr were 1.10 +/- 0.04 and 0.98 +/- 0.03 g/kgBW.day, respectively. The number of patients who were within the optimal range (0.9-1.4 for Kt/V urea and 0.9-1.5 for pcr) was 37 (62.7%) for Kt/V-urea and 38 (64.4%) for pcr. Furthermore, we inferred that, based on an appropriate dietary protein intake, removal of urea by intermittent dialysis should be adjusted to maintain the patient in equilibrium for a defined pre-dialysis plasma urea concentration. From the data obtained, we concluded that: (1) it is possible to apply urea kinetic modeling on the basis of routine laboratory examinations, (2) it is important to maintain the pre-dialysis plasma urea concentration at more than a certain level, and (3) it is also important to control the post-dialysis plasma urea concentration at a low level.

Creatinine↗
PubMed1991

[The future of hemodialysis in the adult].

By the year 2000, the perspectives for hemodialysis performed in adults will be oriented towards facilitation of the practice of hemodialysis as a better control of clinical symptoms observed in end stage renal failure treated by hemodialysis. Blood access is the main problem which remains to be solved. The authors describe the advantages and disadvantages of the methods presently used and give the "state of the art" of "blood access" prosthesis. Almost all symptoms encountered in renal failure patients treated by hemodialysis can be efficiently treated. Hypotensive drugs usually reduce hypertension which resists adequate treatment by hemodialysis. Most of the symptoms of osteodystrophy can be avoided by adequate diet associated with the prescription of vitamin D analogs. Nevertheless, the prolongation of hemodialysis treatment duration over 7 years has led to the apparition of destructive arthropathies which are very painful and handicapping. They are related to amyloid deposit of beta 2-microglobulins. Progress in hemodialysis technics and a better control of uremic symptoms allow application of this treatment at all ages of life. The authors examine specific problems concerning school-aged teenagers and aged persons. They show that results already achieved allow a daily treatment of these patients. This is a first step for the generalisation of this procedure to all patients and its advantages are described. Improvement of hemodialysis technics for the year 2000, as can be expected, mainly depends upon progress in knowledge of biocompatibility parameters between materials used in the artificial kidney and patients tissues, mainly blood vessels.

Adult↗
PubMed1991

[Membrane phospholipid peroxidation in renal insufficiency and chronic hemodialysis].

Lipid peroxidation is a result of the fatty acid side-chains of cellular membrane phospholipids attack by oxygen-derived free radicals. It has been suggested that some of the complications related to haemodialysis may be due to ineffective antioxidant systems and/or an increased free oxygen radical production. Serum antioxidant activity in patients undergoing regular dialysis treatment has been shown to be significantly decreased and to exhibit high malondialdehyde levels indicating that the patients were susceptible to cellular injury by lipid peroxidation. Superoxide dismutase and glutathion peroxidase activities are decreased in plasma and erythrocytes. Moreover, in uremia, blood cell and mononuclear cell membranes contents of vitamin E are reduced. Thus, chronic uremic patients seem to have defective plasma and cellular antioxidant mechanisms together with an increase of circulating free radical reaction products.

Antioxidants↗
PubMed1991

Phosphate kinetics in acetate-free biofiltration.

The phosphate kinetics during bicarbonate dialysis (BCD) and Acetate-free Biofiltration (AFB) were determined in 3 stable regular dialysis patients. These patients were switched to a 6-month period of AFB after a 12-month period of BCD. The plasma levels of phosphate, urea, and bicarbonate, and mass removal of phosphate and urea were measured every hour, during 3 consecutive dialysis sessions on BCD and AFB. The plasma phosphate behavior revealed a peculiar form with two main components, which differed from that of urea. The plasma phosphate level fell sharply during the first 2 hours of treatment, and then remained at a plateau towards to the end of the session. The plasma bicarbonate levels during the treatment sessions in the case of AFB were significantly higher than that in BCD. The actual mass removal in AFB was similar to that BCD, despite a significantly lower value of pre-plasma phosphate. A high ultrafiltration rate and better control of acidosis might be the reason for the better performance of phosphate mass removal in AFB. Better control of phosphatemia due to AFB can lead to a reduction in the amount of phosphate binders which have several untoward side effects.

Acidosis↗
PubMed1990

[The clinical value of correction of acidosis by acetate-free biofiltration in patients on regular dialysis treatment].

Effects of metabolic acidosis were compared between bicarbonate dialysis (BCD) and acetate-free biofiltration (AFB). Three stable dialysis patients (1M, 2F, mean age 30 yrs) were selected for the study because their bicarbonate (BC) pre-dialysis plasma concentration were always under 16 mmol/l while they were on 33 mmol/l-BCD thrice weekly for 12 months. They were switched to a 6 months period of AFB. Pre- and post-dialysis BC plasma concentration, other blood chemical parameters and mass removal (total collection of used dialysate) of urea (U), creatinine (Cr), uric acid (UA), and phosphate (P) were measured during the last week of each period, including 3 dialysis sessions. Mean calorie and protein intake were 29.4 KCal/kg.d and 1.5 g/Kg.d (BCD period) and 38.2 Kcal/Kg.d and 1.5 g/Kg.d (AFB period) respectively. BC plasma concentration (Mean +/- SE, mmol/l) at the pre and post-dialysis in AFB were significantly higher than those in BCD (16.6 +/- 0.7 vs 20.8 +/- 0.6; p less than 0.001, 22.7 +/- 0.8 vs 25.8 +/- 0.8; P less than 0.02). Pre- and post-dialysis U plasma concentration (Mean +/- SE, mmol/l) in AFB were significantly lower than those in BCD (34.3 +/- 2.51 vs 20.8 +/- 0.59, 10.5 +/- 1.32 vs 7.5 +/- 0.92; P less than 0.001). Pre-dialysis P plasma concentration (Mean +/- SE, mmol/l) in AFB was significantly lower than that in BCD (1.85 +/- 0.09 vs 1.50 +/- 0.15; P less than 0.01). Cr, UA and P mass removal in BCD and AFB were not significantly different. However, U mass removal in AFB was significantly lower than that in BCD.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetates↗
PubMed1988

Influence of the surface area of different dialysis membranes on granulocyte adherence and superoxide generation.

Granulocyte adherence and superoxide anion generation were investigated in vitro in the presence of dialysis membrane fragments incubated with normal human polymorphonuclear cells. Dialysis membranes made from cellulosic material or non-cellulosic material like polyacrylonitrile, polymethylmetacrylate, and polysulfone were tested. The membrane surface area varied (1-5 cm2) while the membrane surface/polymorphonuclear cells ratio was maintained constant (2 X 10(6) cells/cm2). The contact of polymorphonuclear cells with increasing membrane surface area generated a significant decrease of superoxide anion generation (5-80% of inhibition) and produced an increase of granulocyte adherence (5-52%). This phenomenon was observed for all the tested membranes, whether opsonized zymosan or phorbol myristate acetate were used as stimuli. Similar results were obtained after washing the dialysis membrane or when polymorphonuclear cells were suspended in homologous serum. In vitro exposure of granulocytes to cellulosic or non-cellulosic dialysis membranes caused a surface-area dependent modification of polymorphonuclear functions.

Cell Adhesion↗
PubMed1988

Characterization and identification of substances isolated from dialyzer extracts.

The organic phase of dialyzer dried extracts obtained from Cuprophan hollow fiber and polyacrylonitrile AN 69 parallel-plate dialyzers, all sterilized by ethylene oxide, were submitted to light and polarized light microscopy, infrared (IR) spectrophotometry, and gas chromatography coupled with mass spectrometry. Colorless polygonal (approximately 5 X 20 micron) and needle-like (approximately 3 X 50 micron) crystals were found in great quantity on microscopy examination. IR spectrophotometry of the crystals embedded in potassium bromide disc showed specific spectra in the 1400-800 cm-1 wave number range and typical peaks on wave number assigned for hydroxy or amine (3420 cm-1), aromatic hydrogen (3060 cm-1), methyl, methylenic, or methenyl (2960-2860 cm-1), and carbonyl (1715 cm-1) groups can be demonstrated. Seven peaks were detected on gas chromatography of the organic solution containing crystals. Fatty acids and undefined compounds could originate from the dialyzer. Phtalates may leach from blood tubing, used in the rinsing procedure, and BHT is a stabilizer of ethyl ether used as solvent. These compounds could also originate from the dialyzer since phtalates are widely used as a plasticizer and BHT an antioxidant for various polymers.

Acrylic Resins↗