How to Adjust the Sodium Concentration in Dialysate Individually and Practically?

The optimal dialysate sodium concentration for chronic hemodialysis patients remains controversial. Conflicting data from small observational studies and large cohort study data have not convinced nephrologists to choose either a high or low sodium dialysate. Despite a lack of evidence, I would prescribe individualized dialysate sodium concentrations for patients with a risk of hypertension or volume overload, aligning the dialysate sodium concentration with patients’ predialysis serum sodium level. The concentration of dialysate sodium would usually be 0–2 mEq/L below the patient’s serum sodium concentration. I believe that this strategy would help improve hypertension, intradialytic weight gain, cardiac outcomes, and deliver precision medicine.

A Large Cohort Study of SARS-CoV-2 Detection in Saliva: A Non-Invasive Alternative Diagnostic Test for Patients with Bleeding Disorders

Diagnosis of SARS-CoV-2 infections is mostly based on the nasopharyngeal swabs (NPS). However, this collection is invasive and uncomfortable, especially for children and patients with coagulopathies, whose NPS collection often causes bleeding. Thus, the aim of this study was to evaluate the usefulness and accuracy of saliva for the diagnosis of COVID-19 in patients presenting bleeding disorders. Samples of NPS, oropharyngeal swabs (OPS), and saliva were collected simultaneously from 1159 hospitalized patients with hematological diseases and from 524 healthcare workers, both symptomatic and asymptomatic for SARS-CoV-2. All samples were evaluated for SARS-CoV-2 by qRT-PCR. SARS-CoV-2 was detected in NPS, OPS and saliva from 16.9%, 14.4% and 15.6% individuals, respectively. Tests in saliva showed sensitivity, specificity, and overall agreement of 73.3%, 96.9% and 92.7% (=0.74), respectively. Salivary tests had good accuracy (AUC = 0.7) for discriminating negative and positive qRT-PCR for SARS-CoV-2. Higher sensitivity was observed in symptomatic than in non-symptomatic patients, as well as in healthy subjects than in patients with hematological disease, in both OPS and saliva. The mean viral load in NPS was significantly higher than in OPS and in saliva samples (p < 0.001). Saliva is a good diagnostic tool to detect SARS-CoV-2, especially among patients symptomatic for COVID-19, and is a valuable specimen for mass screening of hospitalized patients with hematological diseases, especially for those that with bleeding disorders.

Assessment of sagittal spinopelvic alignment in asymptomatic Chinese juveniles and adolescents: a large cohort study and comparative meta-analysis

Study design Retrospective study and comparative meta-analysis. Objective To document the sagittal spinopelvic alignment in a large cohort study in asymptomatic Chinese juveniles and adolescents, and to explore whether these parameters were different from various regions using meta-analysis. Methods Medical records of 656 asymptomatic Chinese juveniles and adolescents were reviewed, whose mean age was 13.14 ± 3.41 years old, including 254 male and 402 female volunteers. Demographic and lateral radiological parameters were evaluated. Furthermore, a systematic online search was performed to identify eligible studies. Weight mean difference (WMD) with 95% confidence interval (CI) were used to evaluate whether these sagittal parameters were different from various regions. Results The mean value of sagittal spinopelvic alignment in this study was calculated and analyzed respectively. Significant differences of PI (34.20 ± 4.00 vs. 43.18 ± 7.12, P < 0.001) and PT (3.99 ± 6.04 vs. 8.42 ± 7.08, P < 0.001) were found between juveniles and adolescents. A total of 17 studies were recruited for meta-analysis. For juvenile populations, TK, PI and SS of Caucasians were significantly larger than those of our study (all P < 0.001). As for adolescent populations, PI (P = 0.017), TK (P = 0.017) and SS (P < 0.001) of Caucasians was found to be greater when compared with that of our study. All in all, TK, PI and SS in Chinese pre-adult populations were significantly smaller than those populations in Caucasian regions (all P < 0.001). Conclusion Our study was the first large-scale study that reported the mean values of sagittal parameters in asymptomatic Chinese juveniles and adolescents. There were significant differences in TK, PI and SS between our study and other previous reported populations, which reminded us for using specific mean values in different populations when restoring a relatively normal sagittal spinopelvic balance in spinal deformity.

Effectiveness of SPECT/CT Imaging for Sentinel Node Biopsy Staging of Primary Cutaneous Melanoma and Patient Outcomes

Purpose Coregistered SPECT/CT can improve accuracy of sentinel node biopsy (SNB) for staging melanoma. This benefit has implications for pathology services and surgical practice with increased diagnostic and surgical workload. The purpose of this study was to investigate the effectiveness of SPECT/CT imaging. Methods SNB data were collected over a 10-year period. Preoperative SLN mapping was performed by using planar lymphoscintigraphy (LSG) for all patients (n = 1522) and after October 2015, patients underwent a second co-registered SPECT/CT scan (n = 559). The patients were stratified according to the imaging protocol. The number of nodes and nodal basins were assessed. The reasons for cancellation also were assessed. Results A total of 95% (1446/1522) of patients underwent a successful SNB procedure. Significantly more sentinel nodes were identified by the SPECT/CT protocol (3 vs. 2; p < 0.0001). More patients were cancelled in the SPECT/CT cohort (9.3% vs. 2.5%; p < 0.0001). Head & neck, lower limb, and AJCC IB primaries were significantly less likely to proceed to SNB. SPECT/CT identified significantly more positive SNBs (20.9% vs. 16.5%; p = 0.038). SPECT/CT imaging was associated with improved disease-free (hazard ratio [HR] = 0.74; 95% confidence interval [CI]: 0.54–1.0); p = 0.048) and disease-specific survival (HR = 0.48; 95% CI: 0.3–0.78; p = 0.003). Patients who did not proceed to SNB had a significantly increased nodal relapse rate (23.5% vs. 6.8%; HR = 3.4; 95% CI: 1.9–6.2; p < 0.0001) compared with those who underwent SNB. Conclusions This large cohort study confirms the increased accuracy of SPECT/CT for identifying SLN metastases, which would appear to have a significant therapeutic benefit, although an increased risk of cancellation of the SNB procedure on the day of surgery.