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| 1 | Peritoneal dialysis associated infections: An update on diagnosis and management显示文摘Peritoneal dialysis(PD) is associated with a high risk of infection of the peritoneum, subcutaneous tunnel and catheter exit site. Although quality standards demand an infection rate < 0.67 episodes/patient/year on dialysis, the reported overall rate of PD associated infection is 0.24-1.66 episodes/patient/year. It is estimated that for every 0.5-per-year increase in peritonitis rate, the risk of death increases by 4% and 18% of the episodes resulted in removal of the PD catheter and 3.5% resulted in death. Improved diagnosis, increased awareness of causative agents in addition to other measures will facilitate prompt management of PD associated infection and salvage of PD modality. The aims of this review are to determine the magnitude of the infection problem, identify possible risk factors and provide an update on the diagnosis and management of PD associated infection. Gram-positive cocci such as Staphylococcus epidermidis, other coagulase negative staphylococcoci, and Staphylococcus aureus(S. aureus) are the most frequent aetiological agents of PD-associated peritonitis worldwide. Empiric antibiotic therapy must cover both gram-positive and gram-negative organisms. However, use of systemic vancomycin and ciprofloxacin administration for example, is a simple and efficient first-line protocol antibiotic therapy for PD peritonitis- success rate of 77%. However, for fungal PD peritonitis, it is now standard practice to remove PD catheters in addition to antifungal treatment for a minimum of 3 wk and subsequent transfer to hemodialysis. To prevent PD associated infections, prophylactic antibiotic administration before catheter placement, adequate patient training, exit-site care, and treatment for S. aureus nasal carriage should be employed. Mupirocin treatment can reduce the risk of exit site infection by 46% but it cannot decrease the risk of peritonitis due to all organisms. | Jacob A Akoh | 2012 | World Journal of Nephrology2012，1，4： | 13 |
| 2 | Kidney donation after cardiac death显示文摘There is continuing disparity between demand for and supply of kidneys for transplantation. This review describes the current state of kidney donation after cardiac death(DCD) and provides recommendations for a way forward. The conversion rate for potential DCD donors varies from 40%-80%. Compared to controlled DCD, uncontrolled DCD is more labour intensive, has a lower conversion rate and a higher discard rate. The super-rapid laparotomy technique involving direct aortic cannulation is preferred over in situ perfusion in controlled DCD donation and is associated with lower kidney discard rates, shorter warm ischaemia times and higher graft survival rates. DCD kidneys showed a 5.73-fold increase in the incidence of delayed graft function(DGF) and a higher primary non function rate compared to donation after brain death kidneys, but the long term graft function is equivalent between the two. The cold ischaemia time is a controllable factor that significantly influences the outcome of allografts, for example, limiting it to < 12 h markedly reduces DGF. DCD kidneys from donors < 50 function like standard criteria kidneys and should be viewed as such. As the majority of DCD kidneys are from controlled donation, incorporation of uncontrolled donation will expand the donor pool. Efforts to maximise the supply of kidneys from DCD include: implementing organ recovery from emergency department setting; improving familyconsent rate; utilising technological developments to optimise organs either prior to recovery from donors or during storage; improving organ allocation to ensure best utility; and improving viability testing to reduce primary non function. | Jacob A Akoh | 2012 | World Journal of Nephrology2012，1，3： | 10 |
| 3 | Current management of autosomal dominant polycystic kidney disease显示文摘Autosomal dominant polycystic kidney disease(ADPKD), the most frequent cause of genetic renal disease affecting approximately 4 to 7 million individuals worldwide and accounting for 7%-15% of patients on renal replacement therapy, is a systemic disorder mainly involving the kidney but cysts can also occurin other organs such as the liver, pancreas, arachnoid membrane and seminal vesicles. Though computed tomography and magnetic resonance imaging(MRI) were similar in evaluating 81% of cystic lesions of the kidney, MRI may depict septa, wall thickening or enhancement leading to upgrade in cyst classification that can affect management. A screening strategy for intracranial aneurysms would provide 1.0 additional year of life without neurological disability to a 20-yearold patient with ADPKD and reduce the financial impact on society of the disease. Current treatment strategies include reducing: cyclic adenosine monophosphate levels, cell proliferation and fluid secretion. Several randomised clinical trials(RCT) including mammalian target of rapamycin inhibitors, somatostatin analogues and a vasopressin V2 receptor antagonist have been performed to study the effect of diverse drugs on growth of renal and hepatic cysts, and on deterioration of renal function. Prophylactic native nephrectomy is indicated in patients with a history of cyst infection or recurrent haemorrhage or to those in whom space must be made to implant the graft. The absence of large RCT on various aspects of the disease and its treatment leaves considerable uncertainty and ambiguity in many aspects of ADPKD patient care as it relates to end stage renal disease(ESRD). The outlook of patients with ADPKD is improving and is in fact much better than that for patients in ESRD due to other causes. This review highlights the need for well-structured RCTs as a first step towards trying newer interventions so as to develop updated clinical management guidelines. | Jacob A Akoh | 2015 | World Journal of Nephrology2015，4，4： | 7 |
| 4 | Effect of ureteric stents on urological infection and graft function following renal transplantation显示文摘AIM: To compare urological infections in patients with or without stents following transplantation and to determine the effect of such infections on graft function.METHODS: All 285 recipients of kidney transplantation at our centre between 2006 and 2010 were included in the study. Detailed information including stent use and transplant function was collected prospectively and analysed retrospectively. The diagnosis of urinary tract infection was made on the basis of compatible symptoms supported by urinalysis and/or microbiological culture. Graft function, estimated glomerular filtration rate and creatinine at 6 mo and 12 mo, immediate graft function and infection rates were compared between those with a stent or without a stent.RESULTS: Overall, 196(183 during initial procedure, 13 at reoperation) patients were stented following transplantation. The overall urine leak rate was 4.3%(12/277) with no difference between those with or without stents- 7/183 vs 5/102, P = 0.746. Overall, 54%(99/183) of stented patients developed a urological infection compared to 38.1%(32/84) of those without stents(P = 0.0151). All 18 major urological infections occurred in those with stents. The use of stent(Wald χ2 = 5.505, P = 0.019) and diabetes mellitus(Wald χ2 = 5.197, P = 0.023) were found to have significant influence on urological infection rates on multivariate analysis. There were no deaths or graft losses due to infection. Stenting was associated with poorer transplant function at 12 mo.CONCLUSION: Stents increase the risks of urological infections and have a detrimental effect on early to medium term renal transplant function. | Jacob A Akoh Tahawar Rana | 2013 | World Journal of Transplantation2013，3，1： | 4 |
| 5 | Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient显示文摘Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons.Sometimes too much reliance is put on investigations that can lead to a misdiagnosis.This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase,which led to an assumed diagnosis of pancreatitis.She died within 24 h of admission and post mortem confirmed the cause of death as systemic sepsis due to perforated appendicitis,with no evidence of pancreatitis.Significantly elevated serum amylase level may occur in non-pancreatitic acute abdomen. | Michael J Forster Jacob A Akoh | 2008 | World Journal of Gastroenterology2008，14，11： | 2 |
| 6 | Rejection of Permacol~ mesh used in abdominal wall repair:A case report显示文摘Permacol mesh has shown promise when used in abdominal wall repair,especially in the presence of a contaminated surgical field.This biomaterial,derived from porcine dermis collagen,has proposed advantages over synthetic materials due to increased biocompatibility and reduced foreign body reaction within human tissues.However,we present a case report describing a patient who displayed rejection to a Permacol mesh when used in the repair of abdominal wound dehiscence following an emergency laparotomy.Review of the English language literature using PubMed and Medline, showed only two previously published cases of explantation of Permacoldue to sepsis or wound breakdown. The authors believe this is the first case of severe foreign body reaction leading to rejection of Permacol.Both animal and human studies show conflicting evidence of biocompatibility.There are several reports of successful use of Permacolto repair complex incisional herniae or abdominal walls in the presence of significant contamination.It appears from the literature that Permacolis a promising material,but as we have demonstrated,it has the potential to evoke a foreign body reaction and rejection in certain subjects. | Franchesca T Wotton Jacob A Akoh | 2009 | World Journal of Gastroenterology2009，15，34： | 2 |
| 7 | Structured Lipids: Synthesis and Applications显示文摘 | Lee K T Akoh C C | 1998 | Food Rev Int1998，14，1： | 1 |
| 8 | Phenolic compounds and antioxi- dant capacity of Georgia2grown blueberries and blackberries 显示文摘 | Sellappan S Akoh C C Krewer G | 2002 | Journal of Agricuhural and Food Chemistry2002，50，8： | 1 |
| 9 | Modeling and optimization of lipase-catalyzed synthesis of phytosteryl esters of oleic acid by response surface methodology 显示文摘 | Kim B H Akoh C C | 2007 | Food Chemistry2007，102，： | 1 |
| 10 | A compact surface decontami nation system for surface-sensitive magnetic imaging显示文摘 | Konoto M Akoh H Tokura Y | 2009 | Rev Sei Instrum2009，80，08： | 1 |
| 11 | Effects of phenolic com-pounds in blueberries and muscadine grapes on HepG2 cellviability and apoptosis 显示文摘 | Yi W Akoh C C Fischer J | 2006 | Food Research International2006，39，5： | 1 |
| 12 | Four-factor response surface optimization of the enzymatic modification of triolein to structured lipids显示文摘 | Chwen-Jen Shieh Casimir C. Akoh Philip E. Koehler | 1995 | Journal of the American Oil Chemists’ Society1995，，6： | 1 |
| 13 | Production of human milk fat analogue containing docosahexaenoic and araehidonie acids 显示文摘 | Turan D Sahin Yesil Ubuk N Akoh C C | 2012 | Journal of Agricultural and Food Chemistry2012，60，17： | 1 |
| 14 | Lipase-catalyzed stereoselective esterification of DL-menthol in organic solvents using acid anhydrides as acylating agents 显示文摘 | WU W H AKOH C C PHILLIPS R S | 1996 | Enzyme Microb Technol1996，18，7： | 1 |
| 15 | Synthesis of structured triglycerides by lipase - catalyzed acidolysis in a packed bed bioreactor 显示文摘 | XU X FOMUSO L B AKOH C C | 2002 | J Agric Food Chem2002，48，1： | 1 |
| 16 | Synthesis of Structured Triacylglycerols by Lipase-Catalyzed Acidolysis in a Packed Bed Bioreactor显示文摘 | Xu X L B Fomuso C C Akoh | 2000 | Agri Food Chem2000，48，： | 1 |
| 17 | Enzymatic modification of triacylglycerols of high eicosapentaenoic and docosahexaenoic acids content to produce structured lipids显示文摘 | B Jennings C Akoh | 1999 | Journal of the American Oil Chemists'' Society1999，76，10： | 1 |
| 18 | Pat- terns in the lives of African American women with diabetes显示文摘 | Pierre-Louis B Akoh V White P | 2011 | Nurs Sci Q2011，24，3： | 1 |
| 19 | Effects of sucrose fatty acid ester and blends on alveograph characteristics of wheat flour doughs 显示文摘 | Addo K Slepak M Akoh C C | 1995 | J Cereal Sci1995，22，： | 1 |
| 20 | Enzymatically modified beef tallow as a substitute for cocoa butter显示文摘 | Osborn HT Akoh CC | 2002 | Journal of Food Scienee2002，67，7： | 1 |
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