Background and objectives: Patients with chronic kidney disease (CKD) receiving dialysis often develop secondary hyperparathyroidism with disturbed calcium and phosphorus metabolism. The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (KDOQI) was established to guide treatment practices for these disorders. The ACHIEVE study was designed to test two treatment strategies for achieving KDOQI goals.Design, setting, participants, measurements: Individuals on hemodialysis treated with vitamin D sterols were enrolled in this 33-week study. Subjects were randomly assigned to treatment with either cinacalcet and low-dose vitamin D (Cinacalcet-D) or flexible vitamin D alone (Flex-D) to achieve KDOQI-recommended bone mineral targets. ACHIEVE included a 6-week screening phase, including vitamin D washout, a 16-week dose-titration phase, and an 11-week assessment phase.Results: Of 173 subjects enrolled, 83% of Cinacalcet-D and 67% of Flex-D subjects completed the study. A greater proportion of Cinacalcet-D versus Flex-D subjects had a >30% reduction in parathyroid hormone (PTH) (68% versus 36%, P < 0.001) as well as PTH <300 pg/ml (44% versus 23%, P ‫؍‬ 0.006). The proportion of subjects simultaneously achieving targets for intact PTH (150 -300 pg/ml) and calcium-phosphorus product (Ca؋P) (<55 mg 2 /dl 2 ) was also greater (21% versus 14%), but this was not statistically significant. This was attributable to 19% of Cinacalcet-D subjects with a PTH value below the KDOQI target range.Conclusions: Achievement of KDOQI targets was difficult, especially with Flex-D. Maintaining calcium and phosphorus target values precluded the use of vitamin D doses necessary to lower PTH to within the narrow target range and highlighted limitations inherent to the KDOQI treatment algorithm.

Conclusions: There is appreciable CBI at higher EPO doses, and EPO dose was not associated with increased mortality in marginal structural model analyses that more completely addressed this confounding.

Multi-frequency bioimpedance analysis-derived TBW chan e has the best agreement with acute clinical volume change during haemodialysis compared to ECV or ICV change alone, but overall degree of precision remains poor. Nutritional assessment using LBM and BCM measurements is significantly confounded by hydration status.

Vibrant Soundbridge (VSB) has been recommended for both adults and children with all types of hearing loss. The aim of this study was to evaluate the objective and subjective benefits with VSB and the difference in benefits for patients with different types of hearing loss. A retrospective case review was conducted on seven consecutive patients who had received VSB implantations at the National University Hospital of Singapore from March 2006 to November 2009. Patients were divided into the Sensorineural Hearing Loss (SNHL) Group and Conductive Hearing Loss (CHL)/Mixed Hearing Loss (MHL) Group. Surgical complications were evaluated, and objective and subjective results were compared between the two groups. No major complications were observed during the follow-up of up to 4 years. Greater objective and subjective benefits were observed in the CHL/MHL Group. Subjective benefits were consistent with objective improvements. Pre-operative counseling for realistic expectations is important, especially for patients with SNHL.

Chitosan oligosaccharides graft polycaprolactone copolymer (PHCSO-g-PCL) has been synthesized via initiating the polymerization of ε-caprolactone (CL) monomer through an amino group protection route using phthaloyl chitosan oligosaccharide (PHCSO) as intermediate. The grafting reaction was carried out in Pyridine at 120°C with the hydroxyl group of the chitosan oligosaccharide (CSO) as initiator and the tin 2-ethylhexanoate (Sn (Oct) 2) as catalyst. The PHCSO-g-PCL nanoparticles with and without bovine serum albumin (BSA) drug were prepared through the self-assembled approach in Dimethylformamide (DMF) organic solvents. PHCSO-PCL copolymer was investigated by Fourier transform infrared spectroscopy (FTIR), 1 H NMR spectrum and scanning electron microscopy (SEM). The physicochemical properties of the hydrophobized PHCSO-g-PCL nanoparticles were characterized by fluorescence spectroscopy and dynamic light scattering (DLS). The results of DLS showed that the hydrodynamic diameters and particle size distribution with various concentrations of PHCSO-g-PCL nanoparticles were from 69.82 nm to 195.9 nm with a narrow polydispersity factor of 0.212 to 0.172. The results of DLS also showed that the hydrodynamic diameters and particle size distribution of PHCSO-g-PCL (5 mg/ml) nanoparticles without and with BSA drug (0.4 mg/ml) were from 168.44 nm to 200.7 nm. The polydispersity factor was from 0.119 to 0.159.