The extracellular fluid-to-intracellular fluid volume ratio is associated with large-artery structure and function in hemodialysis patients buy bystolic visa. Maggiore Q purchase 2.5 mg bystolic free shipping, Nigrelli S order bystolic online pills, Ciccarelli C, Grimaldi C, Rossi GA, Michelassi C. Nutritional and prognostic correlates of bioimpedance indexes in hemodialysis patients. Extracellular volume expansion, measured by multifrequency bioimpedance, does not help preserve residual renal function in peritoneal dialysis patients. Predialysis NTproBNP predicts magnitude of extracellular volume overload in haemodialysis patients. Nongnuch A, Campbell N, Stern E, El-Kateb S, Fuentes L, Davenport A. Increased postdialysis systolic blood pressure is associated with extracellular overhydration in hemodialysis outpatients. Ohashi Y, Tai R, Aoki T, Mizuiri S, Ogura T, Tanaka Y, et al. The associations of malnutrition and aging with fluid volume imbalance between intra- and extracellular water in patients with chronic kidney disease. Omichi Y, Srivareerat M, Panorchan K, Greenhall GH, Gupta S, Davenport A. Measurement of muscle strength in haemodialysis patients by pinch and hand grip strength and comparison to lean body mass measured by multifrequency bio-electrical impedance. Panorchan K, Nongnuch A, El-Kateb S, Goodlad C, Davenport A. Changes in muscle and fat mass with haemodialysis detected by multi-frequency bioelectrical impedance analysis. Comparison of volume status in asymptomatic haemodialysis and peritoneal dialysis outpatients. Pillon L, Piccoli A, Lowrie EG, Lazarus JM, Chertow GM. Vector length as a proxy for the adequacy of ultrafiltration in hemodialysis. Santi Xavier P, Perez Vogt B, Cuadrado Martin L, Vaninni F, Araujo Antunes A, Ponce D, et al. Total body water and failure to control blood pressure by medication in hemodialysis patients. Segall L, Moscalu M, Hogas S, Mititiuc I, Nistor I, Veisa G, Covic A. Protein-energy wasting, as well as overweight and obesity, is a long-term risk factor for mortality in chronic hemodialysis patients. Body fat percentage as a risk factor for atherosclerosis but not for inflammation for hemodialysis patients: differences between genders. Sivalingam M, Vilar E, Mathavakkannan S, Farrington K. The role of natriuretic peptides in volume assessment and mortality prediction in Haemodialysis patients. Monitoring of body water composition by the simultaneous use of bioelectrical impedance analysis and Crit-Line(®) during hemodialysis. Longitudinal bioimpedance vector plots add little value to fluid management of peritoneal dialysis patients. Tian N, Guo QY, Yao FJ, Zhou Q, Yang X, Lin JX, Yu XQ. Bioimpedance-guided fluid management can improve clinical outcomes in peritoneal dialysis patients: a prospective randomized control trial. Tian N, Guo Q, Zhou Q, Cao P, Hong L, Chen M, et al. The impact of fluid overload and variation on residual renal function in peritoneal dialysis patient. Unal A, Sipahioglu M, Oguz F, Kaya M, Kucuk H, Tokgoz B, et al. Pulmonary hypertension in peritoneal dialysis patients: prevalence and risk factors. Volume status and blood pressure in continuous ambulatory peritoneal dialysis patients. Yashiro M, Ochiai M, Fujisawa N, Kadoya Y, Kamata T. The evaluation of filtration coefficients of microvasculature for the assessment of fluid status in hemodialysis patients. Zhou YL, Liu J, Sun F, Ma LJ, Han B, Shen Y, Cui TG. Calf bioimpedance ratio improves dry weight assessment and blood pressure control in hemodialysis patients. Zhou YL, Liu J, Ma L, Sun F, Shen Y, Huang J, Cui T. Impact of dry weight determined by calf bioimpedance ratio on carotid stiffness and left ventricular hypertrophy in hemodialysis patients. Zimmerman DL, Ruzicka M, Hebert P, Fergusson D, Touyz RM, Burns KD. Short daily versus conventional hemodialysis for hypertensive patients: a randomized cross-over study. Ineligible participants (N = 3) Keane DF, Lindley E. Use of hand-to-hand measurements for body composition monitoring in patients with inaccessible or amputated feet. Hung SC, Kuo KL, Peng CH, Wu CH, Lien YC, Wang YC, Tarng DC. Volume overload correlates with cardiovascular risk factors in patients with chronic kidney disease. Tsai YC, Tsai JC, Chiu YW, Kuo HT, Chen SC, Hwang SJ, et al. Is fluid overload more important than diabetes in renal progression in late chronic kidney disease? Ineligible outcomes (N = 8) Broers NJH, Usvyat LA, Marcelli D, Bayh I, Scatizzi L, Canaud B, et al. Season affects body composition and estimation of fluid overload in haemodialysis patients: variations in body composition; a survey from the European MONDO database. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals 111 provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising.
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MARGOLIS Huntington disease (HD) is a progressive neurodegenera- The nature of the motor symptoms changes over time. Early complaints include toms that are referable to specific regions of brain disease. In addition to limb and truncal movements, pa- the pathogenesis of the disorder and are leading to ap- tients may have motor tics or chorea involving respiratory, proaches designed to develop rational treatments. Thus, laryngeal, pharyngeal, oral, or nasal musculature. Chorea HD serves as a model for the future study of those psychiat- often plateaus and even wanes in the later stages of the ric disorders in which abnormal brain function is thought disease, but disturbances in voluntary movement continue to arise from predominantly genetic factors. In late-stage HD, patients typically become akinetic and largely nonverbal, with severe rigidity and joint contractures. At this point, they may have few involuntary CLINICAL FEATURES movements except for occasional movements of the entire body, resembling myoclonic jerks, when disturbed. Diffi- HD can be described as a triad of motor, cognitive, and culties with swallowing commonly lead to death in HD, emotional disturbances (1,2). Symptoms usually begin be- either directly from suffocation or aspiration or indirectly tween the ages of 35 and 50 years, although the onset may from starvation. Death occurs When HD begins in childhood or adolescence (juvenile- an average of 15 to 20 years after symptoms first appear, onset HD), the presentation is often somewhat different, with some patients dying earlier from falls or suicide and with prominent bradykinesia, rigidity and dystonia, and others surviving for 30 to 40 years (Fig. Involuntary movements may take the form of tremors, and patients may develop seizures and myo- Movement Disorders clonus. The movement disorder of HD consists of two components: involuntary movements and abnormal voluntary move- Cognitive Disorders ments. Chorea, or choreoathetosis, is the movement abnor- Cognitive difficulties usually begin about the same time and mality most frequently associated with HD. It consists of proceed at the same rate as the abnormal movements (4), continuous and irregular jerky or writhing motions. Distur- although some patients may have considerable motor im- bances of voluntary movement, however, are more highly pairment with very little dementia, or the reverse. Early in correlated with functional disability and disease severity, as the course of HD, aphasia and agnosia are usually much measured by the degree of brain disease. The disordered less obvious than in the cortical dementias such as Alzheimer voluntary movements observed in HD include the follow- disease, whereas deficits in cognitive speed and flexibility ing: abnormal eye movements, such as slow, hypometric are more common. In contrast to Alzheimer disease, patients saccades and catchy pursuit; uncoordinated, arrhythmic, with HD seem to have trouble with retrieval rather than and slow fine motor movements; dysphagia and dysarthria; storage of memories. They are more apt than patients with dysdiadochokinesis; rigidity; and gait disturbances. Alzheimer disease to recognize words from a previously memorized list or to respond to other cues to help them recall information. This distinction has led to the classifica- ChristopherA. Ross: DepartmentsofPsychiatry andNeuroscience,Johns tion of HD as a subcortical dementia (5). Cognitive losses Hopkins University School of Medicine, Baltimore, Maryland. Margolis: Department of Psychiatry, Johns Hopkins Univer- accumulate progressively. Deficits in memory, visuospatial sity School of Medicine, Baltimore, Maryland. Severe irritability is another common symptom, present in one-third of patients in the Maryland HD survey (2). Irritability and aggression may occur in patients without a prior history of a short temper, but these symptoms are more common in patients who have had these traits all their lives. Apathy may become evident at any time in the course of the disease. Either apathy or irrita- bility may exist independently or as part of an affective syndrome. Patients with HD occasionally develop classic obsessive- compulsive disorder, with typical symptoms such as fear of contamination or excessive hand washing. The percentage of patients however, patients may display an obsessive preoccupation surviving as a function of years since disease onset. Rarely, patients develop a schizo- Reviews in molecular medicine: Huntington disease and the re- phrenia-like syndrome, with prominent delusions, halluci- lated disorder, dentatorubral-pallidoluysian atrophy (DRPLA). Clinical Course HD demonstrate profound global impairment similar to In summary, adult-onset HD falls roughly into three stages.