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Follow-up studies on 3,195 patients from 161 centers in Japan undergoing continuous ambulatory peritoneal dialysis (CAPD) were performed for 1–104 months to clarify the incidence as well as the clinical features of acute hydrothorax. In these studies, 50 patients (1.6%) developed this complication. Twenty-seven (54%) were men, and 23 (46%) were women, ranging in age form 6 to 79 (average 49) years. The interval between onset of CAPD and hydrothorax ranged from 1 day to 8 years. Four had left-sided, and 2 had bilateral hydrothorax, but the majority (88%) were right-sided. Dyspnea was experienced by 37 of these 50 patients, but the remaining 13 (26%) patients were asymptomatic. Hydrothorax was fully resolved in 27 of them following a brief interruption of CAPD or the combined use of small exchange volumes in a semi-sitting position and pleurodesis with tetracycline or other agents. The remaining 23 patients (46%) were switched to hemodialysis permanently. Despite recurrence, 1 patient continued successfully on CAPD. It was concluded that acute hydrothorax is one important possible complication, although the risk may be low. Constant surveillance is necessary to detect pleural effusions in patients during CAPD.

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The use of a high-flux membrane, which eliminates larger molecular weight solutes with better biocompatibility, has steadily increased since the discovery of beta-2 microglobulin (beta 2m) amyloidosis in 1985. The long-term effects of a dialyzer membrane on morbidity and mortality are not completely understood. To examine the membrane effect as a factor of carpal tunnel syndrome onset and mortality, multivariate Cox regression analysis with time-dependent covariate was conducted on 819 patients from March 1968 to November 1994 at a single center. Two hundred and forty-eight of the patients were either switched from the conventional to high-flux membrane or treated only with a high-flux membrane. Fifty-one patients underwent a CTS operation and 206 died. Membrane status (on high-flux or on conventional) was considered as time-dependent covariate and risk was adjusted for age, gender, type of renal disease and calendar year of dialysis initiation. The relative risk of CTS was reduced to 0.503 (P < 0.05) and mortality 0.613 (P < 0.05) by dialysis on the high-flux membrane, compared to the conventional membrane. Serial measurements of beta 2m indicated significantly lower beta 2m to persist in patients on the high-flux membrane. The high-flux membrane decreased the risk of morbidity and mortality substantially. Larger molecule elimination was shown important not only for preventing beta 2m amyloidosis, but for prolonging survival of dialysis patients as well.

Chitosan with phenolic hydroxyl groups (Chit-Ph) was synthesized by conjugating chitosan with 3-(phydroxyphenyl)propionic acid using aqueous-phase carbodiimide activation chemistry. By this conjugation, we could obtain chitosan derivatives soluble at neutral pH and gellable via a peroxidasecatalyzed reaction within seconds: The Chit-Ph with higher content of Ph groups showed higher solubility at neutral pH. The neutral Chit-Ph solutions gelated via an enzymatic reaction by consuming H 2 O 2 . The time necessary for gelation decreased with increasing content of Ph groups, temperature, peroxidase concentration, and decreasing H 2 O 2 concentration. The content of Ph groups also influenced the mechanical property of the resultant gels. In addition, L929 cells, which were contacted to the enzymatically crosslinked Chit-Ph gels for 20 h, showed 96.5% viability, and were observed to grow next to the gels. These results demonstrate that Chit-Ph has the potency for use as injectable hydrogels in applications such as tissue engineering and drug delivery.

Glucose is a common component of body fluids. We describe a hydrogel wound dressing that can be obtained by pouring an aqueous solution of a polyvinyl alcohol derivative possessing phenolic hydroxyl moieties (PVA-Ph), containing glucose oxidase (GOx) and horseradish peroxidase (HRP), onto a wound. The in situ hydrogelation progresses through GOx-catalysed hydrogen peroxide (H 2 O 2 ) generation from glucose in the wound exudate and HRP-catalysed cross-linking between phenolic hydroxyl moieties in PVA-Ph by consuming the H 2 O 2 . The potency as a wound dressing is demonstrated by experiments which reveal that the existence of the conditions inducing hydrogelation within 20 s at normal blood glucose concentration, the durability of the resultant hydrogels to compression and stretching, and the faster closure of full-thickness wounds created on rats treated with the in situ formed hydrogel than those treated by a commercially available hydrogel dressing.