Acute kidney injury in polymorbid patients Lebedeva, Marina V.; Kamyshova, Elena S.; Taranova, Marina V. ...
Kliničeskij razbor v obŝej medicine,
1/2024, Letnik:
5, Številka:
1
Journal Article
Recenzirano
Odprti dostop
The presented clinical observation shows the role of a multidisciplinary team of doctors in the treatment of acute kidney injury (AKI) in a patient suffering from bronchial asthma and metabolic ...syndrome (morbid obesity, arterial hypertension, type 2 diabetes mellitus). The importance of correcting metabolic disorders (diet, self-monitoring of glycemia, urate- and glucose-lowering therapy) has been demonstrated both as part of the complex therapy of AKI and for the prevention/slowing of further kidney damage.
The results of a pilot study of the serum marker of cardiac damage sST2 in patients with chronic generalized sarcoidosis are presented. Correlations between the activity of sarcoidosis, sST2 levels ...and the risk of developing heart failure have been demonstrated.
Aim. To determine biomarkers of anemia of chronic disease (ACD) in patients with glomerulonephritis (GN) in the early stages of CKD, to assess their role as risk factors for cardiovascular ...complications (CVС). Materials and methods. Seventy nine patients with GN were studied, among them: 40 with primary сhronic GN (CGN), 39 with secondary forms:19 – GN with ANCA-associated systemic vasculitis, 20 – GN with systemic lupus erythematosus (SLE) at early (all I–II) CKD stages. In all patients, the level of serum C-reactive protein (CRP), hepcidin, interferon γ, and the circulating form of protein Klotho (s-Klotho) were determined. When a relative iron deficiency was detected transferrin iron saturation coefficient (TSAT) 20%, patients were administered parenterally iron III sucrose hydroxide complex (Venofer). Results. The frequency of anemia among patients with systemic diseases is 3.2 times higher than among patients with primary CGN. Patients with anemia (group I; n=43) had higher rates of daily proteinuria (p0.001), systolic blood pressure (p0.05), serum levels of interferon γ (p0.001) and hepcidin (p0.001) and lower values of eGFR (p0.05) than patients without anemia (group II; n=36). A strong inverse correlation was noted between the level of hepcidin and the content of iron in serum (r=-0.856; p0.001), between the level of hemoglobin and the level of interferon γ (r=-0.447; p0.05), hepcidin (r=-0.459; p0.05) and CRP (r=-0.453; p0.05). A significant inverse correlation was found between the level of hemoglobin and CVC risk factors – the value of systolic blood pressure (r=-0.512; p0.05) and the mass index of the left ventricular myocardium (r=-0.619; p0.01). At the same time, the contribution of 2 from 6 analyzed factors, hepcidin and eGFR, to the development of ACD was 92.5%, of which 86.6% accounted for hepcidin. A strong direct correlation was also found between a decrease in hemoglobin level and a decrease in the level of s-Klotho protein (r=0.645; p0.001), a decrease in the level of s-Klotho and an increase in the level of serum hepcidin (r=-0.541; p0.05). The leading value of anemia (beta -0,29; p=0,04) and depression of the s-Klotho level (beta -0,44; p=0,02) as independent cardiovascular risk factors in this group of patients was confirmed by multivariate analysis. In patients with identified deficiency of iron (n=40), after 3–4 weeks of intravenous administration of venofer, the target level of hemoglobin (Нb120 g/l) and transferrin saturation with iron (TSAT20%) were achieved. Conclusion. Among the biomarkers of ACD in patients with immunoinflammatory diseases of the kidneys (primary and secondary СGN), the increase in the serum level of hepcidin is greatest importance. The concomitant to anemia decrease in s-Klotho is a leading risk factor for CVС in CKD. Early correction of ACD with iron supplements makes it possible to achieve target levels of Hb and TSAT and have subsequently a positive effect on the production of s-Klotho and the severity of left ventricular hypertrophia.
Supercapacitors (SCs) currently attract great attention from researchers working in the field of energy storage over the world. This review article is focused on the recent advances in the ...development of biomass-derived activated carbons and their application as electrode materials for electric double layer capacitors (EDLCs) based on organic electrolytes and ionic liquids. Such EDLCs are known to have such features as the high energy and power density at very high stability (more than several hundred thousand charge-discharge cycles), the ability to operate at low temperatures as well as the simple principle of charge storage and construction.
The features of various approaches to production of activated (porous) carbons (ACs) from biomass are highlighted in detail as well as their performance as materials for EDLC application. A contribution of various properties of the ACs like pore size distribution, graphitization, and other features to their characteristics as non-aqueous electrolyte based supercapacitor electrode materials are considered. Requirements to desirable properties of ACs to achieve EDLCs with high energy accumulating characteristics, as well as to approaches to AC synthesis are formulated.
Display omitted
A clinical observation of the onset of pancreatogenic diabetes mellitus with neurological manifestations is presented. Difficulties in glycemic control, the importance of self-monitoring of glycemic ...indicators by the patient are shown. Pathological substantiation of the high risk of hypoglycemic conditions in patients with pankeatogenic diabetes mellitus is given.
Activated carbons were prepared from rice husk carbonized in the fluidized catalysts bed reactor. Using the different activating agents, samples with BET surface area in the range from 540 to 3060 m
...2
/g were achieved. Using sodium or potassium carbonates results in the BET surface area up to 1400 m
2
/g. Hydroxides of sodium or potassium yield the samples with the higher BET surface area (up to 3060 m
2
/g). Textural peculiarities of the carbons were studied by the adsorption of nitrogen at 77 K and of carbon dioxide at 273 K. As active materials for supercapacitors, the porous carbon samples were examined by cyclic voltammetry and chronopotentiometry in galvanostatic mode in 1 M H
2
SO
4
as the electrolyte using home-made three-electrode electrochemical glass cell. Gravimetric capacitance of the carbons is linearly proportional to the BET surface area and reaches 230 and 196 F/g at discharge current density of 0.2 and 1 A/g, respectively, for the samples with the highest surface area.
Objectives
. To investigate the possibility of preventing hydrogen absorption into the functional structural materials of hydrogen-generating membrane electrode assemblies based on porous nickel, ...carbon black, and reduced graphene oxide with platinum–nickel and palladium–nickel nanoparticles.
Methods.
The hydrogen absorption into materials of membrane electrode assemblies of alkaline electrolyzers was evaluated using an electrolyzer with variable temperature, reagent feed rate, and gas content.
Results.
The study established the need to use reduced graphene oxide, in order to reduce hydrogen absorption and degradation of hydrogen-generating membrane electrode assemblies.
Conclusions.
The service life test results and performance of the designed variants of prototypes of membrane electrode assemblies with nanostructured electrodes based on reduced graphene oxide, preventing hydrogen absorption into functional materials and their degradation, demonstrated the creation of hydrogen generators with high energy efficiency shows potential.
Aim. To investigate the association of variation in lipid-lowering response and endothelial function (EF) parameters after atorvastatin therapy in patients with type 2 diabetes mellitus (T2DM) with ...genetic markers of atherosclerosis.Methods. We included 97 patients with T2DM who were prescribed atorvastatin. Fasting lipid profiles and EF parameters were assessed before and after 12 months of statin therapy. For EF evaluation, we performed pulse-wave analysis during reactive hyperaemia. The genotypes for polymorphic markers were identified by real-time polymerase chain reaction with TaqMan probes. The statistical analysis included Wilcoxon, Mann–Whitney and Kruskal–Wallis tests. P-values 0.05 were considered statistically significant.Results. With statin therapy, PPARG2Pro/Pro patients had significantly lower TC and LDL-C levels than PPARG2 Pro/Ala and PPARG2 Ala/Ala patients (TC: 20.74% vs. 4.6% and 5.61%; p = 0.04 and LDL-C: 26.00% vs. 6.11% and 7.32%; p = 0.029). Patients with АРОЕЕ4/Е4 had significantly lower TC and TG levels than other АРОЕ patients (TC: -46.25% for Е4/Е4 vs. +33.33% for Е4/Е2, +5.73% for Е3/Е2, +11.80% for Е3/Е4, -10.92% for Е3/Е3, р = 0,01; TG: -56.52% for Е4/Е4 vs. +24.43% for Е4/Е2, +19.63% for Е3/Е2, +8.05% for Е3/Е4, -20.00% for Е3/Е3, р = 0.04). The patients with GG for TNFα G(238)A and GA for TNFα G(308)A had significantly greater amplitude of post-occlusive wave increase (Apw) than patients with GA for TNFα G(238)A and GG for TNFα G(308)A (+8.16 % vs. -0.93%, р = 0,04; +44% vs. -4.4%, p = 0.004, respectively).Conclusion. PPARG2Pro12Ala and АРОЕE2/Е3/Е4 polymorphism contributed to the between-patient variability in the response to statin therapy in patients with T2DM. Significant associations of the TNFαgene polymorphism with EF in patients with T2DM suggest an important role of inflammation in the pathogenesis of MVD.
Background. Prior to the introduction of new agents — immune checkpoint inhibitors — for inoperable and/or metastatic melanoma (IMM), chemotherapy outcomes were generally poor. The median (Me) ...overall survival (OS) in IMM was no more than 6-9 months, and the Me of progression-free survival (PFS) was about 2 months. The introduction of immune checkpoint inhibitors and targeted therapy changed the prognosis for the life of IMM patients dramatically. The development, studies, and approval of a new original PD-1 inhibitor, prolgolimab, in Russia in 2020 prompted the professional community to conduct a prospective observational study in the Russian Federation to assess its real-world efficacy and safety. Aim To evaluate the real-world efficacy and safety of prolgolimab in patients with IMM. Materials and methods. From October 2020 to October 2022, 700 patients with IMM receiving prolgolimab in real clinical settings in oncological institutions of various levels in the Russian Federation were included in the study. The main inclusion criteria were: pathology-confirmed diagnosis of melanoma; metastatic and/or inoperable type; use of prolgolimab outside of clinical trials; and signed informed consent. Objective response rate in the general population and the Intention-to-treat and Per Protocol populations was considered the main criterion for evaluating the efficacy of therapy, and the safety criterion was the incidence of grade 3-4 adverse events (AEs). PFS and OS rates were also assessed. Statistical analysis was performed using the SPSS 25.0 software package. Results. The objective response rate for the Per Protocol population (with radiographic assessment available) was 42% (n=235/559). Disease progression was reported in 26.7% (n=149) of patients, stabilization in 31.3% (n=175), and disease control in 73.3% of patients with IMM, regardless of the line of therapy. At the follow-up Me of 12 months (0-36), PFS for all patients regardless of the line of therapy was 8 months (95% confidence interval Cl 6.537-9.463), 6-month PFS was 55%, and 12-month PFS was 41%. OS Me for all included patients was 32 months, 6-month OS was 82%, and 12-month OS was 69%. Depending on the line of therapy, the OS Me was: line 1 - not reached, line 2-30 months (95% Cl 16.007-43.993), line 3 and subsequent- 22 months (95% Cl 14.264-29.736); p=0.736. According to the CTCAE 5.0 general terminology criteria for AEs, a total of 136/693 (19.6%) AEs of varying degrees were reported, in particular: grade 1-2 - 105/693 (15.2%), grade 3-4 - 25/693 (3.6%), unknown grade - 5/693 (0.7%), as well as one fatal case (0.1%) due to thromboembolism in the vascular center with an unclear (according to the investigator's assessment) relation with prolgolimab. Conclusion The results obtained at 12 months of follow-up confirm the high efficacy and satisfactory tolerability of prolgolimab in patients with IMM in real-world practice, regardless of the line of therapy and other characteristics.
PDF
