The incidence of acute kidney injury (AKI) after open (OAR) or endovascular (EVAR) aortic repair is unknown. This research assessed the proportion of patients who develop AKI after aortic ...intervention using validated criteria, and explored AKI risk factors.
This was a multicentre national prospective cohort study. Eleven centres recruited patients undergoing EVAR or OAR (September 2017–December 2018). Serum creatinine (SCr) and urine outputs were measured over a minimum of 48 h or throughout the index inpatient stay to define post-operative AKI using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Renal decline at 30 days was calculated using estimated glomerular filtration rate (eGFR) and the Major Adverse Kidney Events (MAKE) 30 day composite endpoint (consisting of: death, new dialysis, > 25% eGFR decline).
300 patients (mean age: 71 years, standard deviation SD 4 years; 9% females) were included, who underwent: infrarenal endovascular aneurysm repair (EVAR) 139 patients, fenestrated EVAR (fEVAR) 30, branched EVAR (bEVAR) seven, infrarenal open aneurysm repair (OAR) 98, juxtarenal OAR 26. Overall, 24% of patients developed stage 1 AKI (defined at 48 h as per KDIGO), 2.7% stage 2 AKI and 1% needed renal replacement therapy before discharge. AKI proportions per intervention were: infrarenal EVAR 18%; fEVAR 27%; bEVAR 71%; infrarenal OAR 41%; juxtarenal OAR 63%. Older age (odds ratio OR 1.44 for EVAR, 1.58 for OAR), lower baseline eGFR (OR 0.88 EVAR, 0.74 OAR), and ischaemic heart disease (OR 4.42 EVAR, 5.80 OAR) were the main predictors of AKI for infrarenal EVAR and OAR. Overall, 24% developed the MAKE30 endpoint. All patients who died (0.6%) or developed a major cardiac event (5.6%) at one year had developed AKI.
AKI and short term renal decline after aortic intervention are common. Age, renal function, and cardiovascular disease are the main risk factors. Research should now focus on AKI prevention in this high risk group.
Background:
Identification of MS registries and databases that are currently in use in Europe as well as a detailed knowledge of their content and structure is important in order to facilitate ...comprehensive analysis and comparison of data.
Methods:
National MS registries or databases were identified by literature search, from the results of the MS Barometer 2011 and by asking 33 national MS societies. A standardized questionnaire was developed and sent to the registries’ leaders, followed by telephone interviews with them.
Results:
Twenty registries were identified, with 13 completing the questionnaire and seven being interviewed by telephone. These registries differed widely for objectives, structure, collected data, and for patients and centres included. Despite this heterogeneity, common objectives of the registries were epidemiology (n=10), long-term therapy outcome (n=8), healthcare research (n=9) and support/basis for clinical trials (n=8). While physician-based outcome measures (EDSS) are used in all registries, data from patients’ perspectives were only collected in six registries.
Conclusions:
The detailed information on a large number of national MS registries in Europe is a prerequisite to facilitating harmonized integration of existing data from MS registries and databases, as well as comprehensive analyses and comparison across European populations.
Astrocytes take up glucose from the bloodstream to provide energy to the brain, thereby allowing neuronal activity and behavioural responses
. By contrast, astrocytes are under neuronal control ...through specific neurotransmitter receptors
. However, whether the activation of astroglial receptors can directly regulate cellular glucose metabolism to eventually modulate behavioural responses is unclear. Here we show that activation of mouse astroglial type-1 cannabinoid receptors associated with mitochondrial membranes (mtCB
) hampers the metabolism of glucose and the production of lactate in the brain, resulting in altered neuronal functions and, in turn, impaired behavioural responses in social interaction assays. Specifically, activation of astroglial mtCB
receptors reduces the phosphorylation of the mitochondrial complex I subunit NDUFS4, which decreases the stability and activity of complex I. This leads to a reduction in the generation of reactive oxygen species by astrocytes and affects the glycolytic production of lactate through the hypoxia-inducible factor 1 pathway, eventually resulting in neuronal redox stress and impairment of behavioural responses in social interaction assays. Genetic and pharmacological correction of each of these effects abolishes the effect of cannabinoid treatment on the observed behaviour. These findings suggest that mtCB
receptor signalling can directly regulate astroglial glucose metabolism to fine-tune neuronal activity and behaviour in mice.
ObjectivesThe 2020 RCPCH State of Child Health report highlighted that active participation in research by paediatricians is a priority for children and young people.1 Academic paediatrics faces ...numerous challenges including limited research opportunities, particularly outside integrated academic training IAT.2–4 The LSP academic subgroup strives to improve research accessibility for London-based paediatric doctors by organising research-focussed events. Herein, we report the methodology and effectiveness of a selection of these strategies in the hope of encouraging implementation of similar approaches across the UK to tackle the current threats to paediatric research.MethodsFirstly, a year-long mentorship scheme was implemented, matching senior academic clinicians to junior doctors. Mentorship groups independently organised virtual and in- person meetings. Secondly, IAT evenings focussing on Academic Clinical Fellowship (ACF) applications were held. These consisted of talks by previous ACFs and doctors taking other routes into research (e.g., out-of-programme experience). Lastly, three research evenings were organised in which junior doctors could present research or audit findings on a regional platform. All implemented approaches were freely available to paediatric doctors in London and advertised via mailing lists and social media. Utility of each approach was evaluated by pre- and post-event surveys, including measures of confidence in research-related topics.ResultsWithin the mentorship scheme, 46 mentees were assigned to 13 senior mentors. 52.2% of mentees reported low confidence in pursuing an academic career at the start of the scheme. Feedback (n=16) highlighted that confidence remained low following the scheme, with 43.8% of mentees still reporting low confidence. However only 50% of respondents had met their mentorship group primarily due to busy work schedules. Those able to meet found the experience beneficial. ACF events were attended by 26 paediatric doctors. 70% (n=18) of doctors reported low pre-event confidence in applying for IAT, which improved to only one doctor in post event feedback (n=12). Forty doctors attended research evenings, of which 30% (n=12) provided feedback. All respondents found the events helpful, and part icularly appreciated presentation variety and the opportunity to present their own work.ConclusionConfidence in pursuing research within paediatrics is low. Implementing successful mentorship, targeted IAT and research even ings can improve confidence and research accessibility. Time constraints limited successful mentorship relationships and future schemes will include greater meeting structure to allow advanced scheduling and ensure mentee/mentor commitment. Junior doctor collaboration across the UK to implement similar strategies may further improve nationwide access to paediatric research opportunities to address children and young people’s priorities.ReferencesRCPCH report: State of Child Health – What can health professionals do? RCPCH. 2020.RCPCH Trainees participation in child health research survey Report. Trainee Research Network Task and Finish Group. August 2023.Dore R, D’Souza M, Ghosh N, Carr D, Loucaides E, collaborative TR. 317 Paediatric trainee experience of multi-site audit and research (PEAR), a cross sectional London REACH network study. Archives of Disease in Childhood 2023.Hunter L, Greenough A, Modi N. RCPCH report – turning the tide: five years on. March 2018.
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