Rationale and study design of a three‐period, 58‐week trial of ferric citrate as a phosphate binder in patients with ESRD on dialysis

Chronic kidney disease associated mineral and bone disorders arise as a result of aberrant bone mineral metabolism in patients with advancing levels of renal dysfunction and end‐stage renal disease. One of the cornerstones of treatment is the use of phosphate‐binding agents. We describe the rationale and study design for a clinical trial to assess the safety and efficacy of ferric citrate as a phosphate binder. This trial is a three‐period, international, multicenter, randomized, controlled clinical trial to assess the safety and efficacy of ferric citrate as a phosphate binder, consisting of a 2‐week washout period, a 52‐week safety assessment period in which subjects are randomized to ferric citrate or active control, and a 4‐week efficacy assessment period in which subjects randomized to ferric citrate in the safety assessment period are randomized to ferric citrate or placebo. Eligible subjects include end‐stage renal disease patients who have been treated with thrice‐weekly hemodialysis or peritoneal dialysis for at least 3 months in dialysis clinics in the United States and Israel. Primary outcome measure will be the effect of ferric citrate vs. placebo on the change in serum phosphorus. Safety assessments will be performed by monitoring adverse events, concomitant medication use, and sequential blood chemistries (including iron parameters, phosphorus, and calcium). This three‐period trial will assess the efficacy of ferric citrate as a phosphate binder. If proven safe and efficacious, ferric citrate will likely provide an additional phosphate binder to treat chronic kidney disease associated mineral and bone disorders.     

Younger black patients have a higher risk of infection mortality that is mostly non‐dialysis related: A national study of cause‐specific mortality among U.S. maintenance dialysis patients

Introduction: While it has been well documented that in the U.S., black and Hispanic dialysis patients have overall lower risks of death than white dialysis patients, little is known whether their lower risks are observed in cause‐specific deaths. Additionally, recent research reported that younger black patients have a higher risk of death, but the source is unclear. Therefore, this study examined cause‐specific deaths among US dialysis patients by race/ethnicity and age. Methods: This national study included 1,255,640 incident dialysis patients between 1995 and 2010 in the United States Renal Data System. Five cause‐specific mortality rates, including cardiovascular (CVD), infection, malignancy, other known causes (miscellaneous), and unknown, were compared across blacks, Hispanics, and whites overall and stratified by age groups. Findings: After multiple adjustments, Hispanic patients had the lowest risk of mortality for every major cause in almost all ages. Compared with whites, blacks had a lower risk of death from CVD, malignancy and miscellaneous causes in most age groups, but not from infection. In fact, blacks had a higher risk of infection death than whites in ages 18–30 years (HR [95% CI] 1.94 [1.69–2.23]; P < 0.001), 31–40 years (HR 1.51 [1.40–1.63]; P < 0.001) and 41–50 years (HR 1.07 [1.02–1.12]; P = 0.009), which were partially attributed to their higher prevalence of AIDS nephropathy. For each race/ethnicity, more than two‐thirds of infection deaths were due to non‐dialysis related infections. Discussion: Hispanics had the lowest risk for each major cause of death. Blacks were less likely to die than whites from most causes, except infection. The previously reported higher overall mortality rate for younger blacks is attributed to their two‐fold higher infection mortality, which is mostly non‐dialysis related, suggesting a new direction to improve their overall health status. Research is greatly needed to determine social and biological factors that account for the survival gap in dialysis among different racial/ethnic groups.     

Effect of incident nocturnal home hemodialysis versus incident continuous ambulatory peritoneal dialysis on employment rate,clinical, and laboratory outcomes: A 1‐year retrospective observation study

Introduction: While studies demonstrated favorable outcomes of nocturnal home hemodialysis (NHHD), direct comparison on employment rate, clinical and laboratory outcomes between the NHHD and continuous ambulatory peritoneal dialysis (CAPD) had not been previously performed. Methods: A 1‐year retrospective observation study was performed in 20 incidents alternate night NHHD and 81 incident CAPD patients of Chinese ethnicity, who were sex, diabetic status, and Charlson comorbidity index matched, but not age due to our center's age limit for NHHD enrollment. The primary outcome was the difference in employment rate at 1 year. Secondary outcomes included differences in clinical parameters (weight, blood pressure, number of antihypertensive medication, dosage of phosphate binders, and erythropoietin stimulating agent) and laboratory parameters (residual renal function, mineral metabolic markers, hemoglobin). Findings: NHHD subjects were 5 years younger than CAPD patients, and they had higher employment rate (80% vs. 33.3%, P < 0.01) at 1 year, with age‐adjusted odds ratio for employment was 6.10 (95% confidence interval 1.77–20.99, P = 0.04). They consumed less aluminum‐based phosphate binder (0 vs. 1800 mg, P < 0.01), but showed no significant disparities in other clinical parameters. Residual renal function in both groups declined comparably, nonetheless NHHD group had lower serum phosphate (1.37 vs. 1.71 mmol/L, P = 0.01) and calcium phosphate product (3.13 vs. 4.12 mmol²/L², P < 0.01), with similar hemoglobin levels. Discussion: NHHD appeared to offer higher employment rate, lower dosage of aluminum‐based phosphate binder and mineral metabolic markers at 1 year compared with CAPD in Hong Kong.     

Driving under the influence (DUI) among U.S. ethnic groups

OBJECTIVE: To report nationwide survey data on driving under the influence of alcohol and drugs (DUI) among U.S. ethnic groups. METHODS: Data come from a probability sample of 39,250 adults 18 years of age and older interviewed by the U.S. National Household Survey on Drug Abuse in 2000. Interviews averaging 1h in length were conducted in respondents' homes by trained interviewers. The survey response rate was 74%. RESULTS: Self-reported rates of DUI were highest among White men (22%), Native American/Native Alaskan men (20.8%) and men of Mixed race (22.5%). Twelve-month arrest rates for DUI were highest among men of Mixed race (5%) and Native American/Native Alaskan men (3.2%). Drinkers who DUI are more likely to be men (regardless of ethnicity), not married, consume more alcohol, and be alcohol dependent than drinkers who do not engage in alcohol-impaired driving. However, important ethnic specific predictors are also identified across the different ethnic groups.     

The Fatality Analysis Reporting System as a tool for investigating racial and ethnic determinants of motor vehicle crash fatalities

The Fatality Analysis Reporting System (FARS) is a Department of Transportation database in the public domain that contains detailed information about fatalities resulting from motor vehicle crashes on public roadways in the United States since 1975. However, data on race and Hispanic ethnicity were not collected by FARS until 1999. Since then, completeness of reported racial and ethnic information has varied from State to State. To assess utility of FARS for investigating race- and ethnicity-specific risk factors associated with motor vehicle crash mortality, we examined yearly national and State-specific reporting rates of race and Hispanic ethnicity for 168,863 motor vehicle crash fatalities from 1999 to 2002. In 1999, national reporting was 85% for race and 78% for Hispanic ethnicity. Over the 4-year study period, a significant linear increase in annual reporting for both race and Hispanic ethnicity was evident at the national level, as reporting by individual States improved over time. In 2002, national reporting rates reached 90% for race and 88% for Hispanic ethnicity. Our findings indicate that FARS has become a valuable resource for population-based studies of motor vehicle crash mortality disparities that exist among racial and ethnic subpopulations in the United States.     

Effectiveness of a hepatitis B vaccination program at two tertiary hemodialysis centers

Introduction: Hemodialysis (HD) patients are at increased risk of hepatitis B infection in comparison to the general population. Despite a more intensified hepatitis vaccination regimen, response rates in HD patients are typically low. The study was conducted to quantify response rate to a new hepatitis B vaccination protocol initiated in late 2015, determine risk factors affecting response rate, and assess adherence to protocol. Methods: This retrospective chart review evaluated all HD patients eligible for hepatitis B vaccination in two large dialysis clinics from initiation of the hepatitis B protocol to July 2017. Recombinant hepatitis vaccine (Recombivax® HB) 40 μg was administered in a 3‐dose regimen at months 0, 1, and 6 to patients with hepatitis B surface antibodies (anti‐HBs) <10 mIU/mL. A repeat series was given if anti‐HBs levels remained below 10 mIU/mL after the first series. A booster dose was given if anti‐HBs titers fell below 10 mIU/mL after initial response to a second series vaccination. Findings: Of 411 patients at the two HD centers, 142 patients received hepatitis B vaccination with a total of 168 vaccine courses given, series 1: n = 86, series 2: n = 60 and booster: n = 22. Response rates to vaccination were 61.4%, 58.3%, and 81.8%, respectively. In univariate analysis, adherence to protocol significantly affected response rate (P = 0.035). A multivariate analysis assessing response rates to series 1, 2 or booster confirmed that adherence was a significant risk factor (OR = 2.2; 95% CI 1.4–3.4; P = 0.0005). Discussion: This was the first study to examine adherence to regimen and identified adherence as an important predictor of vaccine response. Adherence is one of the few modifiable risk factors that can be optimized in an effort to improve response to hepatitis B vaccination.     

Fe/Fe_(3)C/Fe_(3)O_(4)@C磁性微球的制备及吸波性能研究EI北大核心CSCD

薄、轻、宽、强是人们对高效电磁波吸收材料的追求。用食品级柠檬酸铁与蔗糖经过水热反应,高温煅烧制备Fe/Fe_(3)C/Fe_(3)O_(4)@C磁性微球,并通过改变柠檬酸铁与蔗糖的摩尔比,探究柠檬酸铁的含量对复合材料吸波性能的影响,有效地调控电磁参数,从而优化阻抗匹配。实验结果表明,当柠檬酸铁与蔗糖的摩尔比为5∶3时,具有较好的吸波性能:当厚度为2.5 mm时,最小反射损耗为-50.17 dB,小于-10 dB的有效吸收频宽为3.52 GHz,优异的电磁波吸收性能主要得益于微球丰富的界面、孔状结构和Fe/Fe_(3)C/Fe_(3)O_(4)磁学性能的协同作用。     

Carboxymethyl chitosan/poly(ethylene oxide) water soluble binder:Challenging application for 5V LiNi_(0.5)Mn_(1.5)O_4 cathode

Carboxymethyl chitosan/poly(ethylene oxide)(CCTS/PEO) composite is firstly reported as a water soluble binder for the application of 5V LiNi_(0.5)Mn_(1.5)O_4 cathode in Li-ion batteries. Both CCTS and PEO show a high electrochemical oxidation potential of above 5.0 V(vs. Li/Li+). The electrochemical performances of LiNi_(0.5)Mn_(1.5)O_4(LNMO) cathodes with CCTS/PEO composite binders of different mass rates are investigated, it is found that LiNi_(0.5)Mn_(1.5)O_4 cathode with an optimized CCTS/PEO(85/15, w/w) composite exhibits a slightly better cycling performance than that of polyvinylidene fluoride(PVDF), retaining 81.4% capacity as compared with 79.8% for PVDF at 0.5C rate after 200 cycles. LNMO with PEO/CCTS(85/15,w/w) exhibited the better rate capability than that of PVDF. These results demonstrate that CCTS/PEO composite can be potentially used as a water-soluble binder for 5 V LNMO cathode.     

Injectability and mechanical properties of magnesium phosphate cements

Up to now magnesium phosphate cements are mainly being utilized in wastewater treatment due to their adsorptive properties. Recently they also have been shown to have a high potential as degradable biocements for application as replacement materials for bone defects. In comparison to degradable calcium phosphate cements they have the advantage of setting at neutral pH, which is favorable in biological environment. In this study two parameters of the cement composition, namely powder-to-liquid ratio (PLR) and citrate content, were varied in order to optimize the injectability properties of the cement paste and the mechanical properties of the reaction product. These properties were determined by means of testing setting time and temperature, paste viscosity, and injectability as well as phase composition and compressive strength of the set cements. Best results were obtained, when the cements were prepared with a PLR of 2.5 and a binder liquid consisting of an aqueous solution of 3 mol/l diammonium hydrogen phosphate and 0.5 mol/l diammonium citrate.     

溶胶直接自蔓燃法制备NiZn铁氧体粉末研究

以柠檬酸铁或硝酸铁、硝酸锌、硝酸镍和柠檬酸为原料,利用溶胶直接自蔓延燃烧反应成功制备了尖晶石结构的NiZn铁氧体粉末.研究结果表明,溶胶直接自蔓延燃烧法形成的NiZn铁氧体粉末的颗粒尺寸总体较小,在含柠檬酸铁体系中晶粒平均尺寸仅为16～23nm,当柠檬酸量与金属盐总量的摩尔比为2时,形成的NiZn铁氧体粉末晶粒尺寸达最大.溶胶直接自蔓延燃烧法得到的NiZn铁氧体粉末的饱和磁化强度相对较小,约为10.54emu/g,矫顽力较大,约为412.5Oe .     

In-vitro study of bacterial adherence to different types of intraocular lenses

The aim of this study was to determine the adherence of Staphylococcus epidermidis to intraocular lenses made of five different biomaterials: polymethylmethacrylate (PMMA), heparinized PMMA, silicone, hydrophilic acrylic, and hydrogel. The extent of bacterial binding was measured by counting. The results were compared using a one-factor variance analysis. Adherence was weakest on hydrogel and strongest on the silicone polymer. Bacterial adherence to the implant surface must therefore depend on the hydrophobicity or hydrophilicity of the biomaterial.     

Regional citrate anticoagulation in CVVH: A new protocol combining citrate solution with a phosphate‐containing replacement fluid

Regional citrate anticoagulation (RCA) is a valid anticoagulation method in continuous renal replacement therapies (CRRT) and different combination of citrate and CRRT solutions can affect acid‐base balance. Regardless of the anticoagulation protocol, hypophosphatemia occurs frequently in CRRT. In this case report, we evaluated safety and effects on acid‐base balance of a new RCA‐ continuous veno‐venous hemofiltration (CVVH) protocol using an 18 mmol/L citrate solution combined with a phosphate‐containing replacement fluid. In our center, RCA‐CVVH is routinely performed with a 12 mmol/L citrate solution and a postdilution replacement fluid with bicarbonate (protocol A). In case of persistent acidosis, not related to citrate accumulation, bicarbonate infusion is scheduled. In order to optimize buffers balance, a new protocol has been designed using recently introduced solutions: 18 mmol/L citrate solution, phosphate‐containing postdilution replacement fluid with bicarbonate (protocol B). In a cardiac surgery patient with acute kidney injury, acid‐base status and electrolytes have been evaluated comparing protocol A (five circuits, 301 hours) vs. protocol B (two circuits, 97 hours): pH 7.39 ± 0.03 vs. 7.44 ± 0.03 (P < 0.0001), bicarbonate 22.3 ± 1.8 vs. 22.6 ± 1.4 mmol/L (NS), Base excess ?2.8 ± 2.1 vs. ?1.6 ± 1.2 (P = 0.007), phosphate 0.85 ± 0.2 vs. 1.3 ± 0.5 mmol/L (P = 0.027). Protocol A required bicarbonate and sodium phosphate infusion (8.9 ± 2.8 mmol/h and 5 g/day, respectively) while protocol B allowed to stop both supplementations. In comparison to protocol A, protocol B allowed to adequately control acid‐base status without additional bicarbonate infusion and in absence of alkalosis, despite the use of a standard bicarbonate concentration replacement solution. Furthermore, the combination of a phosphate‐containing replacement fluid appeared effective to prevent hypophosphatemia.     

Improvement of the temperature resistance of aluminium-matrix composites using an acid phosphate binder

The use of phosphate binders instead of the widely used silica binder resulted in improved temperature resistance, increased tensile strength and decreased coefficient of thermal expansion. The effects were largest for the phosphate binder which contained the largest amount of phosphoric acid (P/Al atom ratio = 24 in the liquid binder). These effects were probably due to the protection of the SiC whiskers by the binder phases (aluminium metaphosphate or aluminium orthophosphate), the binder-SiC reaction product (SiP₂O₇) and the binder-aluminium reaction product (AIP) from further reaction between the SiC and aluminium. The tensile strength of the composite containing the SiC whisker preform made with the phosphate binder (P/Al atom ratio = 6 or 24 in the liquid binder) was increased after heating at up to 600 °C for 240 h. The silicon phosphate (SiP₂O₇) acted as an in situ binder and was primarily responsible for increasing the compressive strength of the preform and increasing the temperature resistance of the composite. The carbon fibre composite containing the preform made by using the phosphate binder (P/Al atom ratio = 24 in the liquid binder) with either water or acetone as the liquid carrier during wet forming of the preform had a higher tensile strength than the carbon fibre composite made by using the silica binder. After composite heat exposure to 600 °C for 14 h, the carbon fibre composite made by using this phosphate binder with acetone as the liquid carrier during wet forming of the preform showed the best temperature resistance, while the carbon fibre composites made by using this phosphate binder with water as the carrier showed the second best temperature resistance, and that made by using silica binder was the worst. The reason for the better effect of the phosphate binder than the silica binder is probably due to the ability of the phosphate binder and the binder-aluminium reaction product (AIP) to protect the carbon fibres from the undesirable reaction between the carbon fibres and aluminium. The lack of a binder-fibre reaction contributed to making the carbon fibre composites less temperature resistant than the SiC whisker composites. The use of a higher binder concentration is attractive for increasing the temperature resistance of the composites. The binder concentration in the preform can be increased by increasing the binder concentration in the slurry used in the wet forming of the preform.     

Understanding removal of phosphate or arsenate onto water treatment residual solids

Chemical and physical characterization methods were used to analyze ferric, alum, and lime water treatment residual solids (WTRSs) in order to describe why phosphate or arsenate adsorption occurred on the WTRSs, and why ferric WTRSs were the stronger adsorbent for both phosphate and arsenate. In total, five WTRSs, two ferric, two alum, and one lime, were analyzed. Elemental analysis of the WTRSs showed lime residuals contained the greatest molar amount of the primary element (7.04 mol Ca/kg solid), followed by the ferric residuals (4.86-4.96 mol Fe/kg solid) whereas alum residuals contained the least amount of primary element as compared to the ferric or alum residual solids (3.62-4.67 mol Al/kg solid). Mercury porosimetry identified more small pores (<0.006 μm) in a ferric WTRSs when compared to an alum WTRSs, indicating that a more detailed pore structure allowing for intraparticle phosphate or arsenate diffusion might be present in the ferric solid. Similarly, SEM images at 1000 times magnification showed a porous surface in both ferric WTRSs, whereas the alum WTRSs showed a smooth surface at the same magnification. Several general equations to describe phosphate or arsenate adsorption on WTRSs were provided.     

Time trends in the association of ESRD incidence with area‐level poverty in the US population

The objective of this study was to examine the temporal trends of the association between area‐level poverty status and end‐stage renal disease (ESRD) incidence. We hypothesized that the association between area‐level poverty status and ESRD incidence has increased significantly over time. Patient data from the United States Renal Data System were linked with data from the 2000 and 2010 US census. Area‐level poverty was defined as living in a zip code‐defined area with ≥20% of households living below the federal poverty line. Negative binomial regression models were created to examine the association between area‐level poverty status and ESRD incidence by time period in the US adult population while simultaneously adjusting for the distribution of age, sex, and race/ethnicity within a zip code. Time was categorized as January 1, 1995 through December 31, 2004 (Period 1) and January 1, 2005 through December 31, 2010 (Period 2). The percentage of adults initiating dialysis with area‐level poverty increased from 27.4% during Period 1 to 34.0% in Period 2. After accounting for the distribution of age, sex, and race/ethnicity within a zip code, area‐level poverty status was associated with a 1.24 (95% confidence interval [CI] 1.22, 1.25)‐fold higher ESRD incidence. However, this association differed by time period with 1.04‐fold (95% CI 1.02, 1.05) higher ESRD incidence associated with poverty status for Period 2 compared with the association between ESRD and poverty status in Period 1. Area‐level poverty and its association with ESRD incidence is not static over time.     

Improving an alumina fiber filter membrane for hot gas filtration using an acid phosphate binder

Alumina fiber based filter membranes were prepared using acid phosphate (phosphoric acid plus aluminum hydroxide), colloidal alumina, monoaluminum phosphate and three types of colloidal silica binders at various binders contents. The filter membranes containing between 5% and 10% by weight of acid phosphate binder exhibited the highest flexural strength, compressive strength, work of fracture and elastic modulus in comparison to those containing the other binders at equivalent binder contents, and exhibited the lowest pressure drop in comparison to membranes with other binders and having equivalent flexural and compressive strengths. Microscopy showed that the acid phosphate caused the fibers to bond at their junctions only, whereas colloidal alumina or colloidal silica binders caused free binder particles within the fiber network.     

多维度评定计量法在面部识别中的运用

研究采用多维度评定计量法(MultidimensionalScaling),让46名被试对成对人脸作相似性判断及对单个人脸作主观评价,以此来探索面部识别中的心理过程。结果表明:①男女被试对人脸相似性判断的标准有差异,女性被试判断维度是人脸的性别、种族和异常性,而男性被试的判断依据是人脸的年龄、种族和异常性;②人脸的社会意义在相似性判断中并未起作用,但是男女被试对同一人脸的主观评价上有差异。     

An auger analysis of substrate-layer interactions in the chemical vapor deposition and activated reactive evaporation of TiC

A formalism for quantitative Auger analysis is developed to account for “matrix effects” and peak shape changes in WCTiCTa(Nb)CCo materials by including shape factors and a linear term in the inverse sensitivity factors of carbide single crystals and binary carbide alloys. Atomic concentration profiles are then obtained for carbon, titanium, W+Ta(Nb) and cobalt across the interface between WCTiC Ta(Nb)CCo substrates and TiC coatings deposited by chemical vapor deposition (CVD) and activated reactive evaporation (ARE). Phase compositions of the near- surface region of the substrate estimated from the atomic concentrations indicate that the concentration of carbon dissolved in the binder phase drops from approximately 28 at.% prior to deposition to approximately 10 at.% after the deposition by both processes of TiC coatings about 5 μm thick. The amount of binder phase near the CVD substrate surface was found to be approximately twice as great as that near the ARE substrate surface, probably because of significant transport of cobalt at the higher temperatures used for CVD.     

The impact of education and cooking methods on serum phosphate levels in patients on hemodialysis: 1‐year study

Introduction: Control of serum phosphate is important for patients on hemodialysis. The aim of the study was to determine if education based on phosphorus‐reducing techniques in food preparation and thermal processing, and accordingly prepared and applied diets, will lead to better outcomes than a standard education program to improve phosphate control in patients on hemodialysis. Methods: Forty‐seven patients on hemodialysis were divided between an intervention and a control group. All subjects received training about nutrition for hemodialysis patients by trained dietitian. In addition, subjects in the intervention group received additional training in phosphorus‐reducing techniques in food preparation and received two hospital meals prepared using suggested cooking methods to reduce the phosphate content of food during dialysis treatment. Serum phosphate, serum albumin, and anthropometric parameters were measured, while nPCR was calculated, at the baseline and during the 1‐year study. Findings: No differences in serum phosphate levels were observed between intervention (1.68 mmol/L [1.48–2.03]) and control group (1.88 mmol/L [1.57–2.2]) at baseline (P = 0.130). Although not statistically significant between groups the mean reduction was more apparent in the intervention group (?0.3 mmol/L (?0.4 to 0.1) vs. ?0.2 (?0.5 to 0.1)), and lead to significantly reduction of phosphate binder therapy. During the study, the nPCR and anthropometric status of the patients did not change significantly. Discussion: Providing additional education to hemodialysis patients on the specific cooking methods and accordingly prepared meals may decrease serum phosphate levels without significantly affecting nutritional status which may be useful in helping to prevent and treat hyperphosphatemia.