PHV Dialysezentrum

Dissolved inorganic carbon (DIC) - including aqueous CO2, carbonic acid, bicarbonate, and carbonate - is often the largest pool of carbon in aquatic systems. Biogeochemical processes result in exchanges of carbon between the various DIC components and may act to move carbon into or out of the DIC pool. The isotopic composition of carbon is a product of both its source and mass-dependent fractionation as carbon changes form through the processes acting on it. Consequently, measurement of the stable carbon isotope composition of DIC is a valuable tool for understanding biogeochemical processes in aquatic systems. However, differences in isotopic composition are small, and separating source contributions requires precise measurement.Measurement of DIC can be done by conversion to CO2 in the presence of a strong acid and quantification of liberated CO2 by gas analysis. To determine isotopic composition of the liberated CO2 (δ13C) historical methods used isotope ratio mass spectrometry (IRMS). More recently, tunable diode laser absorption spectrometry (TDLAS) based gas analyzers have been adopted for these measurements but have continued to base methodological considerations on those developed for IRMS. While IRMS and TDLAS can both be used to determine δ13C, there are fundamental differences in the technology, which should be considered during application. In particular, this has meant δ13C - DIC measurements have been unable to take full advantage of TDLAS performance characteristics. Here we describe methodological advancements from integration of a TDLAS (LI-7825 carbon isotope analyzer) with a DIC measurement system (LI-5370A), that include changes to the pneumatic and analytical approach used in the DIC system. Pneumatic modifications allow the TDLAS to operate at an independent flow rate from the DIC system and serve to manipulate the residence time for CO2 along the flow path. We describe use of a non-CO2 free carrier gas, which allows the DIC measurement to take full advantage of analyzer precision and minimize errors intrinsic to δ13C as determined by TDLAS. We present data demonstrating measurement precision over a range of conditions and show that under similar conditions, these methodological changes result in precision exceeding that published previously for TDLAS-DIC measurements.

BackgroundCardiopulmonary resuscitation (CPR) is vital for improving patient outcomes in medical emergencies. Both laypersons and health care professionals often seek guidance on performing CPR. In today’s digital age, many turn to easily accessible platforms such as YouTube for practical skills.ObjectiveThis study evaluates the didactic and content quality of CPR videos on YouTube using comprehensive checklists and investigates the association between the assigned quality scores and type of publisher, view count, and video rankings.MethodsVideos were included based on defined search terms and exclusion criteria. Two emergency physicians rated each video independently using validated checklists concerning content and didactic quality. Linear regression analysis was performed to assess the relationships between video quality scores and view counts, as well as video rankings.ResultsOf the 250 videos identified, 74 (29.6%) met the inclusion criteria. On the content checklist, videos scored an average of 56.5% (SD 19.2%), and on the didactic checklist, they scored 66.6% (SD 14.3%); none achieved the maximum score. Videos from official medical institutions scored significantly higher in content quality compared to nonofficial sources (P=.04). Video quality scores were not associated with video rankings or view counts.ConclusionsThe study highlights substantial variability in the didactic and content quality of CPR-related videos on YouTube. For medical educators, this underlines the need to curate and recommend reliable online resources or to develop new high-quality content aligned with established checklists. For the general public, the findings caution against relying on popularity metrics as indicators of accuracy and emphasize the importance of guidance from trusted institutions.

Abstract Background and Aims Intradialytic hypotension (IDH) is a common complication of hemodialysis that negatively affects patients’ quality of life and increases mortality risk. One strategy to mitigate IDH involves lowering the ultrafiltration rate (UFR) to reduce dialysis strain; however, this often requires longer treatment times and may not benefit all patients. We developed an artificial intelligence (AI) model to predict IDH risk [1] and performed an in-silico simulation to characterize which patients are sensitive versus insensitive to changes in UFR. Our aim was to identify patient subgroups that could benefit from tailored UFR adjustments to reduce IDH events. Method We included 4,966 adult patients who underwent 1,187,298 hemodialysis sessions between 2021 and 2023 in Fresenius Medical Care Clinics in Czech Republic, Portugal, Spain, and Singapore (machine data available for these countries). Mean age was 68.9 ± 13.9 years, dialysis vintage 5.58 ± 5.73 years, and median UFR 7.0 [5.1–9.0] ml/hr/kg. The AI model used demographic, biochemical, and clinical treatment data. The final model demonstrated good discrimination (AUC = 0.75). Using model-based predictions, we then simulated the dose–response relationship between UFR and IDH risk per patient. We defined patients as “UFR-insensitive” when a substantial decrease in UFR (e.g., from the 85th to the 15th percentile) produced a small reduction in IDH risk (threshold 2.2%, i.e. IDH risk reduction median value) in more than 75% of their treatments. On the contrary, we defined patients as “UFR-sensitive” when a substantial decrease in UFR produced a substantial reduction in IDH risk (threshold 2.2%) in more than 75% of their treatments. We compared characteristics and observed IDH rates between UFR-insensitive and UFR-sensitive patients. Results Of the 4,966 patients analyzed, 1,177 were classified as UFR-insensitive and 1,394 as UFR-sensitive. Despite similar level of hydration status as judged by body composition monitoring, UFR-insensitive patients had fewer hypotensive events. Notably, they showed a negative change in systolic pressure from pre- to post-dialysis (versus a positive change in UFR-sensitive patients) and had lower pre-dialysis systolic pressures. UFR-insensitive patients also tended to have higher blood flow and blood volume during treatment, higher UFRs, greater small solute clearance, lower recirculation rates, and were less likely to have diabetes. Figure 1 illustrates simulated IDH risk curves at varying UFR values for a representative UFR-sensitive and UFR-insensitive patient. Conclusion Identifying patients whose IDH risk responds favorably to UFR adjustments is essential for optimizing dialysis treatment. Our findings suggest that UFR-sensitive patients experience more hypotensive events overall, highlighting the potential benefit of precisely targeted UFR modifications to reduce IDH. This approach could help improve dialysis outcomes and patient quality of life by tailoring treatment to individual risk profiles.

Abstract Background and Aims The heart and kidneys are vital organs that influence each other's function. Dysfunction in one inevitably leads to dysfunction in the other and is known as cardiorenal syndrome (CRS). CRS type 4 is defined by chronic kidney disease (CKD) causing impaired cardiac function, primarily through diastolic dysfunction and structural remodelling, including fibrosis and hypertrophy. This is accompanied by metabolic alterations, characterized by disrupted energy substrate utilization and a metabolic shift towards glycolysis instead of beta-oxidation. The progression of CRS IV occurs dynamically and gradually thus identifying key changes could prove beneficial for treatment and prediction of outcome for the patients. The present study assessed heart remodelling and function after 12 and 24 weeks of chronic kidney disease in rats undergoing subtotal nephrectomy (respectively SNx12 and SNx24). Method At 12 weeks, male Sprague Dawley rats underwent 5/6 nephrectomy (SNx) or Sham operation and were sacrificed after 12 or 24 weeks. Serum creatinine was measured with the epoc® Blood Analysis System. Before sacrifice, a carotid artery catheter was inserted to measure systolic arterial pressure (SAP). Left ventricular function was assessed by echocardiography (VisualSonics/Fujifilm) under isoflurane anaesthesia. Fibrosis (Sirius Red staining) in both kidney and heart, and cardiomyocyte size (H&E staining) were quantified. Vevolab 3.1.0 software was used to evaluate left ventricle posterior wall thickness during systole (LVPW_S), diastolic dysfunction by measurement of isovolumic relaxation time (IVRT), early diastolic strain rate (E/SRE) and Doppler mitral inflow velocities of the peak early (E) ‘/ Tissue doppler parameter e′ (E/e’). To further assess molecular alterations in the left ventricle, proteomics analysis was performed using LC-MS/MS method (n = 5 animals from each of Sham and SNx groups). Samples were prepared according to FASP protocol. Gene Set Variation Analysis (GSVA) was conducted using pathway terms from the Molecular Signatures Database and results were analysed using the limma method. Statistical analysis and GSVA was performed using GraphPad Prism 8 and R Studio, two-way ANOVA, non-parametric tests, with log transformation when applicable. Results Plasma creatinine levels were increased in both SNx12 and SNx24 animals (Table 1). Fibrosis in the kidney increased between SNx12 and SNx24 versus their corresponding Sham (Table 1). SNx24 rats exhibited increased heart fibrosis, cardiomyocyte size, and SAP in comparison to the respective Sham (Table 1). Cardiac remodelling between SNx12 and SNx24 was observed through the increase in the left ventricle wall thickness (Fig. 1A). In SNx24 diastolic dysfunction was observed through measurement of E/SRE, IVRT and E/e’ (Fig. 1B, Table 1). To better understand the molecular changes that correspond to pronounced hypertrophy and diastolic dysfunction, LC-MS/MS analysis was performed with a focus on the group SNx24. A heatmap was generated to illustrate top 20 up- and top 20 down-regulated proteins of SNx24 versus Sham 24 (Fig. 1C). When compared to Sham24, GSVA results indicated that SNX24 samples were associated with disrupted mitochondrial processes, downregulation of fatty acid oxidation, but also with overactivation of extracellular pathways including infiltration of immune cells, wound healing and cell-ECM interactions (Fig. 1D). Conclusion These results indicate that the SNx model captures key events in CRS development, cardiac remodelling and dysfunction, and suggest that the observed mitochondrial changes play a supportive role in these processes. This preclinical model also provides an opportunity to evaluate novel anti-fibrotic treatments and assess their impact on mitochondrial function, paving the way for potential therapeutic advancements.

Introducción: El adenocarcinoma pulmonar es el subtipo histológico más común de cáncer de pulmón. Es una neoplasia cuyos principales sitios de metástasis son ósea, cerebro, hígado y glándulas suprarrenales. La metástasis cutáneas se presenta en 0,7 al 12% y generalmente con un curso clínico más agresivo y de pobre pronóstico a corto y largo plazo. Presentación del caso: Masculino de 62 años con cuadro clínico de 1 año de evolución caracterizado por aumento progresivo de tamaño de tumoración perlada en fosa nasal derecha de 2x2 cm, sin otra sintomatología asociada, cuya biopsia describe adenocarcinoma metastásico de probable origen pulmonar. Posteriormente, a los 5 meses, inicia con pérdida del 34% del peso corporal total, tos con esputo hemoptóico, disfonía y adenopatías cervicales. Discusión: La piel es un sitio inusual de metástasis de neoplasia, aunque dentro de las mismas, el pulmón representa un 24% de las metástasis cutáneas en el sexo masculino. Usualmente en estos casos, se asocia a etapas avanzadas de la enfermedad y la apariencia de las lesiones puede imitar lesiones benignas particularmente si es una sola lesión, siendo el nódulo firme indoloro la manifestación más común. Conclusión: La metástasis cutánea del cáncer de pulmón es un indicador de mal pronóstico, con una sobrevida global estimada de 12-18 meses sin tratamiento. Sin embargo, nuevas terapias dirigidas a mutaciones como la identificación de la deleción del exón 19 de receptor del factor de crecimiento epidérmico (EGFR) y el uso de osimertimib han cambiado el paradigma de supervivencia hasta 38 meses.

Background: Patients on chronic hemodialysis (HD) are highly vulnerable during natural disasters due to their strict dependence on regular treatment. In October 2024, a DANA storm caused severe flooding in the Valencian Community (Spain), severely affecting extra-hospital HD centers. This report describes the organized response that ensured continuity of care for over 1,700 patients. Methods: Retrospective descriptive analysis of the emergency response implemented in Diaverum Spain centers in Valencia during the 2024 DANA. The intervention was based on ten pillars of the Contingency Plan: (1) Crisis Committee activation; (2) Multilevel communication plaN; (3) Access to patient data; (4) Advanced contingency preparation; (5) Supply chain maintenance; (6) Reinforcement of staff; (7) Help points; (8) Medicine bank; (9) Psychological support; and (10) Social assistance. A specific protocol for “Preventive and Complementary Care in Floods” was also activated, including education, triage, and clinical management. Results: Of 13 HD centers in Valencia, 3 became inoperative. Within 24 hours, 98% of the 280 affected patients were relocated and treated. Total service coverage reached 99% for 1,770 patients. Emergency transport routes were enabled via taxis, UME, Civil Guard, and firefighters. Staff and communication were reinforced across provinces. Internal clinical protocols were activated. Only one death was reported, not directly linked to dialysis interruption. Conclusion: This case demonstrates that integrating HD into disaster preparedness plans is feasible and effective. Key factors included early planning, logistical agility, and coordination between professionals and authorities. The model represents a replicable best practice for protecting chronic patients in crisis scenarios and highlights that continuity of care in emergencies is a core element of safety and quality.

Renal dysfunction causes dyslipidemia, and the progression of kidney disease is associated with treatment-requiring lipid disorders. However, there is little data on the association between the severity of dyslipidemia and various treatment modalities with renal function. A total of n = 214 prevalent patients from a lipidology and nephrology practice were investigated in an unicentric cross-sectional study and divided into 4 groups based on the severity and therapeutic regimen of an existing lipid metabolism disorder: a lipid apheresis-treated group (LA), a drug-treated group (MG), a control group (CG) that included patients with lipid disorder not needing any treatment, and a diabetes group that comprised all diabetes patients. We examined fat metabolism parameters, renal parameters and urinary protein excretion, and compared these between study groups. Lipid apheresis therapy leads to the effective lowering of low density lipoprotein-concentration and to a reduction in the presumably protective high density lipoprotein-concentration. We found that S-crea was significantly higher in the LA, MG, and diabetes group than in the CG, while electronic glomerular filtration rate (eGFR) was correspondingly lower. On the other hand, proteinuria was not elevated in the LA- and MG-groups compared to CG. Multiple regression analysis revealed lipoprotein (a) values as a predictor for eGFR decline and increased proteinuria. Elevated lipoprotein (a) levels are associated with decreased eGFR and worse proteinuria, highlighting that regular monitoring and effective treatment, to date especially lipid apheresis, are of utmost importance to mitigate detrimental effects on renal function.

Objectives. We report here the results of the 9th National Census (Cs-24) of Peritoneal Dialysis in Italy, carried out in 2025 by the Italian Society of Nephrology's Peritoneal Dialysis Project Group and relating to 2024. Methods. The Census was conducted in the 228 non pediatric centers which performed Peritoneal Dialysis (PD) in 2024. The results have been compared with previous Censuses carried out since 2005. Results. Incidence: in 2024, 1,398 patients (CAPD = 55.1%) started on PD (1st treatment for ESRD). PD was started incrementally by 40.2% of these in 155 Centers. The catheter was positioned exclusively by a Nephrologist in 19.2% of known cases. Prevalence: of the 4,322 patients on PD at 31/12/2024 (CAPD=43.7%), 21.4% were on assisted PD (family member caregiver: 86.2%). Out: in 2024 the PD dropout rate (ep/100 pt-yrs) was: 12.7 to HD; 9.7 death; 8.5 Tx. The main cause of transfer to HD remains peritonitis (21.8%), although it is still decreasing (Cs-05: 37.9%). Peritonitis/EPS: the incidence of peritonitis in 2024 was 0.164 ep/pt-yr (647 episodes). The incidence of new cases of EPS in 2023-24 (9 cases) was unchanged. Other results: 3.86%-PET remains the most widely-used test (58.1%); most of the Centers do not carry out Home Visits (54.1%); training is mainly carried out in-Center (49.1% of the Centers). Conclusions. Cs-24 confirms the good results PD is having in Italy, where it is experiencing a slight upturn.

Stick and leaf insects (Phasmatodea) are a moderately diverse order that comprises almost 3,500 extant species of large to very large often impressively camouflaged nocturnal herbivores. The order also stands out as one of the few insect orders that have until lately lacked a robust higher-level phylogeny and still the relationships between many New World taxa in particular remain unknown. The Diapheromerinae is one of the main lineages of the Occidophasmata and comprises a bulk of the diversity of New World stick insects. The clade is endemic to the Americas and includes the longest insects of that region. During the past 25 years Diapheromerinae has experienced various often inconsistent attempts of a classification, which have resulted in a complicated history that has meanwhile constituted a heterogenous mixture of historical and contemporary views. To counter these challenges workers have made use of rank-free taxa to provisionally group supposedly monophyletic clades. Currently the Diapheromerinae are sub-divided into the two tribes Diapheromerini and Oreophoetini and recent molecular analyses have shown taxa of the Cladomorphinae Günther, 1953 to belong to Diapheromerinae. Certainly, the clade still deserves much work to delimit meaningful sub-groups within Diapheromerinae reflective of their evolutionary history and the results of the latest comprehensive molecular-based phylogenetic studies already imply sub-divisions within the Diapheromerini. The rank-free taxon Cladomorformia tax. n. is established to comprise former Cladomorphini, Cranidiini, Otocrania Redtenbacher, 1908 as well as sections of Diapheromerini sensu Robertson et al., 2018, which are the genera that have previously been placed in the “Phanocles group” sensu Zompro, 2001 as well as two genera of the “Bacteria group” and one genus of the “Clonistria group”: Alienobostra, Bostriana, Calynda, Globocalynda, Laciphorus, Phanocles, Phanocloidea and Trychopeplus. The genus Cranidium and all genera of Cladomorphini sensu Hennemann et al., 2016 are here formally transferred to Diapheromerinae, this is Aplopocranidium, Cladomorphus, Jeremia, Jeremiodes, Otocraniella and Xylodus. A holistic review of Cladomorformia at the genus level is conducted herein and new diagnoses, differentiations and keys to all 25 genera that are now contained in that clade are presented. Lists of species are provided for all genera, which include detailed type data, synonymies and distributional records. Moreover, identification keys to all 163 known valid species are provided to render identification of species within the 25 known genera possible. In total, 232 species are covered if the 69 synonymous taxa are included. The subfamily Haplopodinae is introduced to comprise all genera of the tribes Haplopodini, Hesperophasmatini and Pterinoxylini as classified by Hennemann et al. (2016) as well as the recently described Teruelphasmini. Renaming former Cladomorphinae sensu Robertson et al. (2018) into Haplopodinae is necessary, because the type-genus Cladomorphus can no longer be considered a member of that lineage and belongs in Diapheromerinae. Haplopodinae is the only New World clade that belongs into the Old World Oriophasmata. Bostranova Villet, 2023 has been introduced to replace the preoccupied Bostra Stål, 1875. The type-species of Bostranova, Bacteria turgida Westwood, 1859, however is here shown to belong in Phanocloidea Zompro, 2001. Thus, Bostranova is synonymised under Phanocloidea (n. syn.) and all species are transferred to Phanocloidea and other genera. Paraphanocles Zompro, 2001 (Type-species: Mantis keratosqueleton Olivier, 1792) is synonymised with Phanocles Stål, 1875 (syn. n.). Seven new genera are described: Globocrania gen. n. (Type-species: Bacteria emesa Westwood, 1859), Hirtuleiodes gen. n. (Type-species: Phibalosoma gibbosa Chopard, 1911), Lanceobostra gen. n. (Type-species: Bacteria aetolus Westwood, 1859), Ocreatophasma gen. n. (Type-species: Ocreatophasma elegans sp. n.), Parotocrania gen. n. (Type-species: Parotocrania panamae sp. n.), Phanoclocrania gen. n. (Type-species: Bostra dorsuaria Stål, 1875) and Spinocloidea gen. n. (Type-species: Spinocloidea panamaense sp. n.). All seven genera are described from both sexes and the eggs, with the exception of Ocreatophasma gen. n., which is known from the females only. Forty-one new species are described: Globocalynda cornuta sp. n. from Ecuador, Globocalynda marcapatae sp. n. from Peru, Globocalynda ruficollis sp. n. from Bolivia, Hirtuleiodes peruanus sp. n. from Peru, Jeremiodes costaricensis sp. n. from Costa Rica, Jeremiodes ecuadoricus sp. n. from Ecuador, Jeremiodes peruanus sp. n. from Peru, Lanceobostra chapalaense sp. n. from Mexico, Lanceobostra glabra sp. n. from Mexico, Lanceobostra oaxacaee sp. n. from Mexico, Lanceobostra ornata sp. n. from Mexico, Lanceobostra torquata sp. n. from Mexico, Lanceobostra tuckerae sp. n. from Mexico, Ocreatophasma elegans gen. n., sp. n. from Peru, Ocreatophasma fragile gen. n., sp. n. from Peru, Ocreatophasma modestum gen. n., sp. n. from Peru, Parotocrania acutilobata gen. n., sp. n. from Ecuador, Parotocrania curvata gen. n., sp. n. from Peru, Parotocrania panamae gen. n., sp. n. from Panama, Phanocles acutecornutus sp. n. from Ecuador, Phanocles barbadosense sp. n. from Barbados, Phanocles berezini sp. n. from Mexico, Phanocles brevipes sp. n. from Peru, Phanocles chiapasense sp. n. from Mexico, Phanocles cuzcoense sp. n. from Peru, Phanocles ecuadoricus sp. n. from Ecuador, Phanocles falcatus sp. n. from Ecuador, Phanocles maximus sp. n. from Panama, Phanocles mexicanus sp. n. from Mexico, Phanocles pleurospinosus sp. n. from Costa Rica, Phanocles rehni sp. n. from Honduras, Phanocles solidus sp. n. from Ecuador, Phanocles spectabilis sp. n. from Costa Rica, Phanocles superbus sp. n. from Ecuador, Phanocloidea sanguinea sp. n. from Ecuador, Phanocloidea semiptera sp. n. from Venezuela, Phanocloidea venezuelica sp. n. from Venezuela, Spinocloidea panamaense gen. n., sp. n. from Panama, Spinocloidea splendida gen. n., sp. n. from Colombia and Spinocloidea tumescens gen. n., sp. n. from Costa Rica. With a maximum recorded body length of 285.0 mm the new species Phanocles maximus sp. n. from Panama is the longest extant insect of the Americas and the Occidophasmata clade. A total of 132 taxonomic changes are conducted: 64 species are transferred to other genera and 43 new synonyms are established. Lectotypes are designated for 25 taxa to ensure stability of the concerned names or new synonymies here established. Moreover, the previously unknown females of five and males of twelve species are described and illustrated for the first time. Colour illustrations are presented of the eggs of 39 species, of which those of 26 species are formally described and illustrated for the first time.