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  1. Article ; Online: Data-Driven Identification of Risk Factors of Patient Satisfaction at a Large Urban Academic Medical Center.

    Li, Li / Lee, Nathan J / Glicksberg, Benjamin S / Radbill, Brian D / Dudley, Joel T

    PloS one

    2016  Volume 11, Issue 5, Page(s) e0156076

    Abstract: Background: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is the first publicly reported nationwide survey to evaluate and compare hospitals. Increasing patient satisfaction is an important goal as it aims to ... ...

    Abstract Background: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is the first publicly reported nationwide survey to evaluate and compare hospitals. Increasing patient satisfaction is an important goal as it aims to achieve a more effective and efficient healthcare delivery system. In this study, we develop and apply an integrative, data-driven approach to identify clinical risk factors that associate with patient satisfaction outcomes.
    Methods: We included 1,771 unique adult patients who completed the HCAHPS survey and were discharged from the inpatient Medicine service from 2010 to 2012. We collected 266 clinical features including patient demographics, lab measurements, medications, disease categories, and procedures. We developed and applied a data-driven approach to identify risk factors that associate with patient satisfaction outcomes.
    Findings: We identify 102 significant risk factors associating with 18 surveyed questions. The most significantly recurrent clinical risk factors were: self-evaluation of health, education level, Asian, White, treatment in BMT oncology division, being prescribed a new medication. Patients who were prescribed pregabalin were less satisfied particularly in relation to communication with nurses and pain management. Explanation of medication usage was associated with communication with nurses (q = 0.001); however, explanation of medication side effects was associated with communication with doctors (q = 0.003). Overall hospital rating was associated with hospital environment, communication with doctors, and communication about medicines. However, patient likelihood to recommend hospital was associated with hospital environment, communication about medicines, pain management, and communication with nurse.
    Conclusions: Our study identified a number of putatively novel clinical risk factors for patient satisfaction that suggest new opportunities to better understand and manage patient satisfaction. Hospitals can use a data-driven approach to identify clinical risk factors for poor patient satisfaction to support development of specific interventions to improve patients' experience of care.
    MeSH term(s) Academic Medical Centers ; Adult ; Communication ; Female ; Health Care Surveys ; Health Personnel/standards ; Health Personnel/trends ; Humans ; Male ; Middle Aged ; Pain Management ; Patient Discharge ; Patient Satisfaction/statistics & numerical data ; Quality of Health Care/standards ; Risk Factors
    Language English
    Publishing date 2016-05-26
    Publishing country United States
    Document type Journal Article ; Observational Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0156076
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Retained catheter fragment from a fractured tunneled catheter--a rare and potentially lethal complication.

    Reddy, Anand / Stangl, Anondo / Radbill, Brian

    Seminars in dialysis

    2010  Volume 23, Issue 5, Page(s) 536–539

    Abstract: Despite efforts to curtail central vein catheter use for dialysis catheters are frequently used in the treatment of end-stage renal disease (ESRD). In 2006, 82% of patients in the USA initiated dialysis via a catheter. The overall of tunnelled cuffed ... ...

    Abstract Despite efforts to curtail central vein catheter use for dialysis catheters are frequently used in the treatment of end-stage renal disease (ESRD). In 2006, 82% of patients in the USA initiated dialysis via a catheter. The overall of tunnelled cuffed catheter (TCC) use was 35% greater in 2005 compared with 1996. Dialysis catheter tip fracture is a rare and potentially serious complication. Herein, we present the case of an incidental finding of a retained catheter fragment from a fractured TCC in the right atrium. Fragment retrieval (via snare technique) and subsequent placement of a new central venous catheter are outlined.
    MeSH term(s) Adult ; Catheterization, Central Venous/adverse effects ; Catheterization, Central Venous/instrumentation ; Device Removal ; Equipment Failure ; Female ; Fluoroscopy ; Foreign Bodies/diagnostic imaging ; Foreign Bodies/therapy ; Humans ; Incidental Findings ; Jugular Veins ; Kidney Failure, Chronic/therapy ; Renal Dialysis ; Tomography, X-Ray Computed
    Language English
    Publishing date 2010-09
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 1028193-9
    ISSN 1525-139X ; 0894-0959
    ISSN (online) 1525-139X
    ISSN 0894-0959
    DOI 10.1111/j.1525-139X.2010.00756.x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Data-Driven Identification of Risk Factors of Patient Satisfaction at a Large Urban Academic Medical Center.

    Li Li / Nathan J Lee / Benjamin S Glicksberg / Brian D Radbill / Joel T Dudley

    PLoS ONE, Vol 11, Iss 5, p e

    2016  Volume 0156076

    Abstract: BACKGROUND:The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is the first publicly reported nationwide survey to evaluate and compare hospitals. Increasing patient satisfaction is an important goal as it aims to achieve ...

    Abstract BACKGROUND:The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is the first publicly reported nationwide survey to evaluate and compare hospitals. Increasing patient satisfaction is an important goal as it aims to achieve a more effective and efficient healthcare delivery system. In this study, we develop and apply an integrative, data-driven approach to identify clinical risk factors that associate with patient satisfaction outcomes. METHODS:We included 1,771 unique adult patients who completed the HCAHPS survey and were discharged from the inpatient Medicine service from 2010 to 2012. We collected 266 clinical features including patient demographics, lab measurements, medications, disease categories, and procedures. We developed and applied a data-driven approach to identify risk factors that associate with patient satisfaction outcomes. FINDINGS:We identify 102 significant risk factors associating with 18 surveyed questions. The most significantly recurrent clinical risk factors were: self-evaluation of health, education level, Asian, White, treatment in BMT oncology division, being prescribed a new medication. Patients who were prescribed pregabalin were less satisfied particularly in relation to communication with nurses and pain management. Explanation of medication usage was associated with communication with nurses (q = 0.001); however, explanation of medication side effects was associated with communication with doctors (q = 0.003). Overall hospital rating was associated with hospital environment, communication with doctors, and communication about medicines. However, patient likelihood to recommend hospital was associated with hospital environment, communication about medicines, pain management, and communication with nurse. CONCLUSIONS:Our study identified a number of putatively novel clinical risk factors for patient satisfaction that suggest new opportunities to better understand and manage patient satisfaction. Hospitals can use a data-driven approach to identify ...
    Keywords Medicine ; R ; Science ; Q
    Subject code 616
    Language English
    Publishing date 2016-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Rationale and strategies for early detection and management of diabetic kidney disease.

    Radbill, Brian / Murphy, Barbara / LeRoith, Derek

    Mayo Clinic proceedings

    2008  Volume 83, Issue 12, Page(s) 1373–1381

    Abstract: Diabetic kidney disease (DKD) occurs in 20% to 40% of patients with diabetes mellitus and is the leading cause of chronic kidney disease and end-stage renal disease in the United States. Despite the American Diabetes Association and the National Kidney ... ...

    Abstract Diabetic kidney disease (DKD) occurs in 20% to 40% of patients with diabetes mellitus and is the leading cause of chronic kidney disease and end-stage renal disease in the United States. Despite the American Diabetes Association and the National Kidney Foundation advocating annual screening of diabetic patients, DKD remains underdiagnosed in the diabetic population. Early recognition of diabetic nephropathy by health care professionals is vital for proper management. The presence of microalbuminuria is particularly important as even low levels of dipstick-negative albuminuria indicate early disease long before a diminished glomerular filtration rate and are associated with an elevated cardiovascular disease risk. Like all forms of chronic kidney disease, DKD causes a progressive decline in renal function that, despite current treatment strategies, is largely irreversible. Many patients with DKD might be expected to develop end-stage renal disease, but many more patients will likely die of a cardiovascular event before renal replacement therapy is needed. Therefore, a renewed focus on cardiovascular risk factor reduction and a timely nephrology consultation with an emphasis on patient education is essential to proper DKD management.
    MeSH term(s) Cardiovascular Diseases/prevention & control ; Diabetic Nephropathies/physiopathology ; Diabetic Nephropathies/prevention & control ; Disease Progression ; Early Diagnosis ; Humans ; Kidney Failure, Chronic/physiopathology ; Kidney Failure, Chronic/prevention & control ; Kidney Function Tests ; Mass Screening ; Renal Insufficiency, Chronic/physiopathology ; Renal Insufficiency, Chronic/prevention & control
    Language English
    Publishing date 2008-12
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 124027-4
    ISSN 1942-5546 ; 0025-6196
    ISSN (online) 1942-5546
    ISSN 0025-6196
    DOI 10.1016/S0025-6196(11)60786-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: The Impact of Bedside Interdisciplinary Rounds on Length of Stay and Complications.

    Dunn, Andrew S / Reyna, Maria / Radbill, Brian / Parides, Michael / Colgan, Claudia / Osio, Tobi / Benson, Ari / Brown, Nicole / Cambe, Joy / Zwerling, Margo / Egorova, Natalia / Kaplan, Harold

    Journal of hospital medicine

    2017  Volume 12, Issue 3, Page(s) 137–142

    Abstract: Background: Communication among team members within hospitals is typically fragmented. Bedside interdisciplinary rounds (IDR) have the potential to improve communication and outcomes through enhanced structure and patient engagement.: Objective: To ... ...

    Abstract Background: Communication among team members within hospitals is typically fragmented. Bedside interdisciplinary rounds (IDR) have the potential to improve communication and outcomes through enhanced structure and patient engagement.
    Objective: To decrease length of stay (LOS) and complications through the transformation of daily IDR to a bedside model.
    Design: Controlled trial.
    Setting: 2 geographic areas of a medical unit using a clinical microsystem structure.
    Patients: 2005 hospitalizations over a 12-month period.
    Interventions: A bedside model (mobile interdisciplinary care rounds [MICRO]) was developed. MICRO featured a defined structure, scripting, patient engagement, and a patient safety checklist.
    Measurements: The primary outcomes were clinical deterioration (composite of death, transfer to a higher level of care, or development of a hospital-acquired complication) and length of stay (LOS). Patient safety culture and perceptions of bedside interdisciplinary rounding were assessed pre- and postimplementation..
    Results: There was no difference in LOS (6.6 vs 7.0 days, P = 0.17, for the MICRO and control groups, respectively) or clinical deterioration (7.7% vs 9.3%, P = 0.46). LOS was reduced for patients transferred to the study unit (10.4 vs 14.0 days, P = 0.02, for the MICRO and control groups, respectively). Nurses and hospitalists gave significantly higher scores for patient safety climate and the efficiency of rounds after implementation of the MICRO model.
    Limitations: The trial was performed at a single hospital.
    Conclusions: Bedside IDR did not reduce overall LOS or clinical deterioration. Future studies should examine whether comprehensive transformation of medical units, including co-leadership, geographic cohorting of teams, and bedside interdisciplinary rounding, improves clinical outcomes compared to units without these features. Journal of Hospital Medicine 2017;12:137-142.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Interprofessional Relations ; Length of Stay/trends ; Male ; Middle Aged ; Patient Care Team/standards ; Patient Care Team/trends ; Teaching Rounds/methods ; Teaching Rounds/standards ; Teaching Rounds/trends ; Tertiary Care Centers/standards ; Tertiary Care Centers/trends
    Language English
    Publishing date 2017-03-09
    Publishing country United States
    Document type Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2233783-0
    ISSN 1553-5606 ; 1553-5592
    ISSN (online) 1553-5606
    ISSN 1553-5592
    DOI 10.12788/jhm.2695
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Clinical and molecular epidemiology of methicillin-resistant Staphylococcus aureus among patients in an ambulatory hemodialysis center.

    Patel, Gopi / Jenkins, Stephen G / Mediavilla, José R / Kreiswirth, Barry N / Radbill, Brian / Salgado, Cassandra D / Calfee, David P

    Infection control and hospital epidemiology

    2011  Volume 32, Issue 9, Page(s) 881–888

    Abstract: Objective: To describe the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) carriage and transmission in an ambulatory hemodialysis population.: Design: Prospective cohort study.: Setting: Outpatient hemodialysis facility ... ...

    Abstract Objective: To describe the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) carriage and transmission in an ambulatory hemodialysis population.
    Design: Prospective cohort study.
    Setting: Outpatient hemodialysis facility affiliated with a large academic medical center.
    Participants: Of the 170 facility patients, 103 (61%) participated in the study.
    Methods: Swab specimens of the nares, axillae, and vascular access site were collected from participants weekly for 3 weeks and then monthly for 5 months. Demographic and clinical data were collected monthly for 12 months. Molecular analysis of MRSA isolates was performed.
    Results: The baseline MRSA carriage prevalence was 12%. Factors associated with MRSA carriage included a history of MRSA; failed renal transplantation; hospital admission within 6 months; and receipt of a first-generation cephalosporin, cefepime, or vancomycin. Six subjects acquired MRSA after enrollment (incidence, 1.2 per 100 patient-months at-risk; overall prevalence, 18%). Molecular analysis suggested that transmission occurred within the facility. The incidence of MRSA infection among carriers was 1.76 per 100 patient-months. Community-associated strains (ie, USA300) were isolated from 28% of carriers and at least 25% of infections.
    Conclusions: The prevalence of MRSA carriage and the incidence of infection among carriers were high among ambulatory hemodialysis patients, and community-associated MRSA was responsible for a large portion of the MRSA burden. A relatively high rate of MRSA acquisition was observed, with indirect evidence of intrafacility transmission. Additional studies are needed to confirm these findings and to identify effective and feasible methods to prevent MRSA transmission and infection among hemodialysis patients.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Ambulatory Care ; Axilla/microbiology ; Bacterial Typing Techniques ; Carrier State/epidemiology ; Carrier State/transmission ; Catheters, Indwelling/microbiology ; Community-Acquired Infections/epidemiology ; Cross Infection/epidemiology ; Female ; Humans ; Incidence ; Male ; Methicillin-Resistant Staphylococcus aureus/genetics ; Methicillin-Resistant Staphylococcus aureus/isolation & purification ; Nose/microbiology ; Prevalence ; Renal Dialysis/adverse effects ; Renal Insufficiency, Chronic/therapy ; Staphylococcal Infections/epidemiology ; Staphylococcal Infections/transmission ; Staphylococcal Protein A/genetics
    Chemical Substances Staphylococcal Protein A
    Language English
    Publishing date 2011-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639378-0
    ISSN 1559-6834 ; 0195-9417 ; 0899-823X
    ISSN (online) 1559-6834
    ISSN 0195-9417 ; 0899-823X
    DOI 10.1086/661598
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Protein kinase-X interacts with Pin-1 and Polycystin-1 during mouse kidney development.

    Li, Xiaohong / Hyink, Deborah P / Radbill, Brian / Sudol, Marius / Zhang, Haojiang / Zheleznova, Nadezda N / Wilson, Patricia D

    Kidney international

    2009  Volume 76, Issue 1, Page(s) 54–62

    Abstract: The regulation of epithelial branching morphogenesis by bone morphogenetic protein-7 depends, in part, on functionally defined cyclic adenosine monophosphate (cAMP)-dependent protein kinases. We previously identified protein kinase-X (PRKX), a cAMP- ... ...

    Abstract The regulation of epithelial branching morphogenesis by bone morphogenetic protein-7 depends, in part, on functionally defined cyclic adenosine monophosphate (cAMP)-dependent protein kinases. We previously identified protein kinase-X (PRKX), a cAMP-dependent kinase, as a regulator of epithelial morphogenesis during kidney development and found that it binds to and phosphorylates Polycystin-1. Overexpression of PRKX stimulates renal epithelial cell migration, tubulogenesis, ureteric bud branching, and glomerular induction in embryonic mouse kidney explants in organ cultures. Here we determined the physiological functions of endogenous PRKX. Knockdown by siRNA of PRKX gene expression in a human fetal collecting tubule (HFCT) cell line exceeded 70% and resulted in decreased cell migration and increased adhesion of the cells to a collagen I matrix. In embryonic mouse kidney explants, the same degree of knockdown decreased ureteric bud branching and glomerular induction. Because PRKX BAG-3 PIN-1 and MAGI-1 are all expressed in ureteric bud derivatives, we tested for interactions among them and found that PRKX binds to all three proteins through its WW domain as determined by TransSignal domain arrays, and it coimmunoprecipitated with Pin-1 in HFCT cell lysates. These studies suggest that Polycystin-1 and Pin-1 may mediate the function of PRKX in kidney development.
    MeSH term(s) Animals ; Cell Adhesion/genetics ; Cell Movement/genetics ; Cyclic AMP-Dependent Protein Kinases/metabolism ; Female ; Kidney/cytology ; Kidney/embryology ; Mice ; Morphogenesis/genetics ; NIMA-Interacting Peptidylprolyl Isomerase ; Organ Culture Techniques ; Peptidylprolyl Isomerase/metabolism ; Pregnancy ; Protein Kinases/metabolism ; TRPP Cation Channels/metabolism
    Chemical Substances NIMA-Interacting Peptidylprolyl Isomerase ; TRPP Cation Channels ; polycystic kidney disease 1 protein ; Protein Kinases (EC 2.7.-) ; PRKX protein, mouse (EC 2.7.11.1) ; Cyclic AMP-Dependent Protein Kinases (EC 2.7.11.11) ; PIN1 protein, human (EC 5.2.1.8) ; Peptidylprolyl Isomerase (EC 5.2.1.8) ; Pin1 protein, mouse (EC 5.2.1.8)
    Language English
    Publishing date 2009-04-15
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 120573-0
    ISSN 1523-1755 ; 0085-2538
    ISSN (online) 1523-1755
    ISSN 0085-2538
    DOI 10.1038/ki.2009.95
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Effect of cholecalciferol supplementation on inflammation and cellular alloimmunity in hemodialysis patients: data from a randomized controlled pilot trial.

    Li, Lily / Lin, Marvin / Krassilnikova, Maria / Ostrow, Katya / Bader, Amanda / Radbill, Brian / Uribarri, Jaime / Tokita, Joji / Leisman, Staci / Lapsia, Vijay / Albrecht, Randy A / García-Sastre, Adolfo / Branch, Andrea D / Heeger, Peter S / Mehrotra, Anita

    PloS one

    2014  Volume 9, Issue 10, Page(s) e109998

    Abstract: Background: Memory T-cells are mediators of transplant injury, and no therapy is known to prevent the development of cross-reactive memory alloimmunity. Activated vitamin D is immunomodulatory, and vitamin D deficiency, common in hemodialysis patients ... ...

    Abstract Background: Memory T-cells are mediators of transplant injury, and no therapy is known to prevent the development of cross-reactive memory alloimmunity. Activated vitamin D is immunomodulatory, and vitamin D deficiency, common in hemodialysis patients awaiting transplantation, is associated with a heightened alloimmune response. Thus, we tested the hypothesis that vitamin D3 supplementation would prevent alloreactive T-cell memory formation in vitamin D-deficient hemodialysis patients.
    Methods and findings: We performed a 12-month single-center pilot randomized, controlled trial of 50,000 IU/week of cholecalciferol (D3) versus no supplementation in 96 hemodialysis patients with serum 25(OH)D<25 ng/mL, measuring effects on serum 25(OH)D and phenotypic and functional properties of T-cells. Participants were randomized 2:1 to active treatment versus control. D3 supplementation increased serum 25(OH)D at 6 weeks (13.5 [11.2] ng/mL to 42.5 [18.5] ng/mL, p<0.001) and for the duration of the study. No episodes of sustained hypercalcemia occurred in either group. Results of IFNγ ELISPOT-based panel of reactive T-cell assays (PRT), quantifying alloreactive memory, demonstrated greater increases in the controls over 1 year compared to the treatment group (delta PRT in treatment 104.8+/-330.8 vs 252.9+/-431.3 in control), but these changes in PRT between groups did not reach statistical significance (p = 0.25).
    Conclusions: D3 supplements are safe, effective at treating vitamin D deficiency, and may prevent time-dependent increases in T-cell alloimmunity in hemodialysis patients, but their effects on alloimmunity need to be confirmed in larger studies. These findings support the routine supplementation of vitamin D-deficient transplant candidates on hemodialysis and highlight the need for large-scale prospective studies of vitamin D supplementation in transplant candidates and recipients.
    Trial registration: Clinicaltrials.gov NCT01175798.
    MeSH term(s) Administration, Oral ; Cholecalciferol/administration & dosage ; Cholecalciferol/adverse effects ; Cholecalciferol/pharmacology ; Dietary Supplements/adverse effects ; Female ; Humans ; Immunity, Cellular/drug effects ; Inflammation/etiology ; Inflammation/prevention & control ; Male ; Middle Aged ; Monocytes/drug effects ; Monocytes/immunology ; Phenotype ; Pilot Projects ; Renal Dialysis/adverse effects ; Safety ; T-Lymphocytes/drug effects ; T-Lymphocytes/immunology ; Time Factors
    Chemical Substances Cholecalciferol (1C6V77QF41)
    Language English
    Publishing date 2014-10-08
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0109998
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: The surgical management of renal hyperparathyroidism.

    Madorin, Catherine / Owen, Randall P / Fraser, William D / Pellitteri, Phillip K / Radbill, Brian / Rinaldo, Alessandra / Seethala, Raja R / Shaha, Ashok R / Silver, Carl E / Suh, Matthew Y / Weinstein, Barrie / Ferlito, Alfio

    European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

    2011  Volume 269, Issue 6, Page(s) 1565–1576

    Abstract: Secondary and tertiary hyperparathyroidism (HPT) develop in patients with renal failure due to a variety of mechanisms including increased phosphorus and fibroblast growth factor 23 (FGF23), and decreased calcium and 1,25-dihydroxy vitamin D levels. ... ...

    Abstract Secondary and tertiary hyperparathyroidism (HPT) develop in patients with renal failure due to a variety of mechanisms including increased phosphorus and fibroblast growth factor 23 (FGF23), and decreased calcium and 1,25-dihydroxy vitamin D levels. Patients present with various bone disorders, cardiovascular disease, and typical laboratory abnormalities. Medical treatment consists of controlling hyperphosphatemia, vitamin D/analog and calcium administration, and calcimimetic agents. Improved medical therapies have led to a decrease in the use of parathyroidectomy (PTX). The surgical indications include parathyroid hormone (PTH) levels >800 pg/ml associated with hypercalcemia and/or hyperphosphatemia despite medical therapy. Other indications include calciphylaxis, fractures, bone pain or pruritis. Transplant recipients often show decreased PTH, calcium and phosphorus levels, but some will have persistent HPT. Evidence suggests that PTX may cause deterioration in renal graft function in the short-term calling into the question the indications for PTX in these patients. Pre-operative imaging is only occasionally helpful except in re-operative PTX. Operative approaches include subtotal PTX, total PTX with or without autotransplantation, and possible thymectomy. Each approach has its proponents, advantages and disadvantages which are discussed. Intraoperative PTH monitoring has a high positive predictive value of cure but a poor negative predictive value and therefore is of limited utility. Hypocalcemia is the most common complication requiring aggressive calcium administration. Benefits of surgery may include improved survival, bone mineral density and alleviation of symptoms.
    MeSH term(s) Calcium/metabolism ; Humans ; Hyperparathyroidism, Secondary/etiology ; Hyperparathyroidism, Secondary/metabolism ; Hyperparathyroidism, Secondary/surgery ; Kidney Transplantation ; Parathyroid Hormone/blood ; Parathyroidectomy ; Phosphorus/metabolism ; Renal Insufficiency/complications ; Renal Insufficiency/metabolism ; Renal Insufficiency/therapy ; Treatment Outcome
    Chemical Substances Parathyroid Hormone ; Phosphorus (27YLU75U4W) ; Calcium (SY7Q814VUP)
    Language English
    Publishing date 2011-11-20
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 1017359-6
    ISSN 1434-4726 ; 0937-4477
    ISSN (online) 1434-4726
    ISSN 0937-4477
    DOI 10.1007/s00405-011-1833-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Loss of Matrix Metalloproteinase-2 Amplifies Murine Toxin-Induced Liver Fibrosis by Upregulating Collagen I Expression

    Radbill, Brian D / Gupta, Ritu / Ramirez, Maria Celeste M / DiFeo, Analisa / Martignetti, John A / Alvarez, Carlos E / Friedman, Scott L / Narla, Goutham / Vrabie, Raluca / Bowles, Robert / Saiman, Yedidya / Bansal, Meena B

    Digestive diseases and sciences. 2011 Feb., v. 56, no. 2

    2011  

    Abstract: Background and Aims Matrix metalloproteinase-2 (MMP-2), a type IV collagenase secreted by activated hepatic stellate cells (HSCs), is upregulated in chronic liver disease and is considered a profibrotic mediator due to its proliferative effect on ... ...

    Abstract Background and Aims Matrix metalloproteinase-2 (MMP-2), a type IV collagenase secreted by activated hepatic stellate cells (HSCs), is upregulated in chronic liver disease and is considered a profibrotic mediator due to its proliferative effect on cultured HSCs and ability to degrade normal liver matrix. Although associative studies and cell culture findings suggest that MMP-2 promotes hepatic fibrogenesis, no in vivo model has definitively established a pathologic role for MMP-2 in the development and progression of liver fibrosis. We therefore examined the impact of MMP-2 deficiency on liver fibrosis development during chronic CCl₄ liver injury and explored the effect of MMP-2 deficiency and overexpression on collagen I expression. Methods Following chronic CCl₄ administration, liver fibrosis was analyzed using Sirius Red staining with quantitative morphometry and real-time polymerase chain reaction (PCR) in MMP-2−/− mice and age-matched MMP-2+/+ controls. These studies were complemented by analyses of cultured human stellate cells. Results MMP-2−/− mice demonstrated an almost twofold increase in fibrosis which was not secondary to significant differences in hepatocellular injury, HSC activation or type I collagenase activity; however, type I collagen messenger RNA (mRNA) expression was increased threefold in the MMP-2−/− group by real-time PCR. Furthermore, targeted reduction of MMP-2 in cultured HSCs using RNA interference significantly increased collagen I mRNA and protein, while overexpression of MMP-2 resulted in decreased collagen I mRNA. Conclusions These findings suggest that increased MMP-2 during the progression of liver fibrosis may be an important mechanism for inhibiting type I collagen synthesis by activated HSCs, thereby providing a protective rather than pathologic role.
    Language English
    Dates of publication 2011-02
    Size p. 406-416.
    Publisher Springer US
    Publishing place Boston
    Document type Article
    ZDB-ID 304250-9
    ISSN 1573-2568 ; 0163-2116
    ISSN (online) 1573-2568
    ISSN 0163-2116
    DOI 10.1007/s10620-010-1296-0
    Database NAL-Catalogue (AGRICOLA)

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