Abstract
Background and Aims
We analyzed the incidence of acute kidney injury (AKI) after major abdominal surgery, as well as demographic, clinical, laboratory and surgical factors that might have ...contributed in it's development.
Method
Retrospective data analysis of 83 pts who underwent major abdominal surgery at the emergency surgery department (intraperitoneal approach, hospitalization longer than 48 hours, surgery duration over one hour). Demporaphic data, comorbidities, biochemical parameters (blood count, serum concentrations of nitrogenous substances, electolytes etc), type of surgery, intraoperative characteristics (duration of surgery, blood pressure, use of vasoactive substances), postoperative complications including AKI, defined as serum creatinine concentrations increase of 0.3mg/dl and more or reduction in diuresis, as well as intrahospital mortality.
Results
The mean age of the patients was 60.9 ± 12.9 years. A total of 45 (54.2%) patients were male. AKI was registered in 15 (18.1%) patients with an average age of 69.5 ± 9.2 years, of which 8 (53.3%) were male. The average duration of surgery in the group of patients with AKI was 2.5 ± 0.8 hours, and the most common operations performed in this group involved reconstruction of the small and large intestine. The total intrahospital mortality was 10.8% and in the AKI group 33.3%.
Conclusion
Patients with AKI were significantly older, with more comorbidities and more frequent surgery that involved resection of the small and large intestine. The development of AKI was accompanied by a higher mortality rate. Given the specific pathophysiological mechanisms in abdominal surgery, further study of the factors responsible for the development of AOB is required to contribute to the development of preventive protocols and to reduce the rate of this serious postoperative complication.
A challenging task in routine practice is finding the distinction between benign and malignant paragangliomas and pheochromocytomas. The aim of this study is to conduct a comparative analysis of ...angiogenesis by assessing intratumoral microvascular density (MVD) with immunohistochemical (IHC) markers (CD31, CD34, CD105, ERG), and S100 immunoreactivity, Ki67 proliferative index, succinate dehydrogenase B (SDHB) expressiveness, tumor size with one the most utilized score Pheochromocytoma of Adrenal Gland Scales Score (PASS), using tissue microarray (TMA) with 115 tumor samples, 61 benign (PASS < 4) and 54 potentially malignant (PASS ≥ 4). We found no notable difference between intratumoral MVD and potentially malignant behavior. The group of potentially malignant tumors is significantly larger in size, has lower intratumoral MVD, and a decreased number of S100 labeled sustentacular cells. Both groups have low proliferative activity (mean Ki67 is 1.02 and 1.22, respectively). Most tumors maintain SDHB expression, only 6 cases (5.2%) showed a loss of expression (4 of them in PASS < 4 group and 2 in PASS ≥ 4). PASS score is easily available for assessment and complemented with markers of biological behavior to complete the risk stratification algorithm. Size is directly related to PASS score and malignancy. Intratumoral MVD is extensively developed but it is not crucial in evaluating the malignant potential.
Polymorphisms of the multi drug resistance (MDR1) gene cause variability in P-glycoprotein mediated metabolism of tacrolimus. The aim of this study was to examine the relationship between MDR1 gene ...single nucleotide polymorphisms (SNPs) and their haplotypes with dosage of tacrolimus in kidney transplant recipients who were cytochrome (CYP) 3A5*3 homozygotes. This study included 91 kidney transplant recipients followed two years after transplantation. Detection and analysis of MDR1 gene polymorphisms in positions C1236T, G2677T/A and C3435T were performed using PCR method. Patients with variant alleles for SNPs G2677T/A and C3435T required higher doses of tacrolimus and had a lower level/dose (L/D) ratio than patients with wild alleles or heterozygotes. That difference was the most obvious for SNP G2677T/A where TT homozygotes required significantly higher doses of tacrolimus during whole follow-up. Their L/D was significantly lower in the first month after transplantation. Recipients with CTT/TTT haplotype also had lower L/D than those with CGC/TTT and CGC/CGC, significantly in the 10th and 20th days after transplantation respectively (p<0.05). Our results demonstrate that TT homozygotes at positions G2677T/A and C3435T required a higher tacrolimus dose than those with wild alleles or heterozygotes. It may be helpful in the prevention of tacrolimus nephrotoxicity early after transplantation.
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The global outbreak of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has prompted significant public health concerns. This study focuses on 442 chronic ...hemodialysis patients diagnosed with COVID-19, emphasizing the impact of vaccination status on clinical outcomes. The study investigates the correlation between vaccination status and laboratory findings, aiming to identify predictive factors for mortality. Results indicate that vaccination status plays a crucial role in outcomes. Full vaccination, evidenced by two or three doses, is associated with better outcomes, including reduced incidence of bilateral pneumonia and lower risks of complications such as hemorrhage and thrombosis. Laboratory analyses reveal significant differences between vaccinated and unvaccinated patients in parameters like C-reactive protein, ferritin, and white blood cell counts. Univariate and multivariate Cox proportional hazards regression analyses identify several factors influencing mortality, including comorbidities, pneumonia development, and various inflammatory markers. In conclusion among hemodialysis patients affected by COVID-19 infection, vaccination with at least three doses emerges as a protective factor against fatal outcomes. Independent predictors of mortality are CRP levels upon admission, maximum CRP values during the illness and cardiovascular comorbidities. Noteworthy lymphocytopenia during infection exhibits a notable level of specificity and sensitivity in predicting mortality.
Objectives: Our objective was to evaluate the influence
of pretransplant risk factors on posttransplant anemia
recovery.
Materials and Methods: This single-center obser -
vational retrospective study ...included 80 deceased
donor kidney transplant recipients who had been
followed up to 16 months after kidney transplant.
Time point of posttransplant anemia recovery was
considered the time when hemoglobin of 11.0 g/dL
was achieved and maintained for 3 consecutive
monthly visits. We collected donor/transplant charac -
teristics (age, sex, hypertension history, cause of
death, donor kidney function, expanded criteria donor
status, deceased donor score, HLA mismatch, and cold
ischemia time) and recipient data (pretransplant
hemoglobin, parathyroid hormone, kidney graft
function, delayed graft function, acute rejection,
infections, surgical bleeding, posttransplant parathyroid
hormone, iron stores, and C-reactive protein and
tacrolimus levels). We used univariate and multivariate
Cox proportional hazards analyses and Kaplan-Meier
plots to determine associations between variables and
posttransplant anemia recovery rate. P < .05 was
considered significant. Results: We identified 62 deceased donors (33 male;
mean age 50 ± 15.1 years) and 80 kidney transplant
recipients (52 male; mean age 47.0 ± 10.6 years).
Mean pretransplant hemoglobin was 11.4 ± 1.5 g/dL.
Donor age, deceased donor score, pretransplant
parathyroid hormone, posttransplant transferrin
saturation (all P < .05), and tacrolimus level (P < .01) were significantly related to posttransplant anemia
recovery. Kaplan-Meier curve identified that recipients
of deceased donors below 60 years old achieved
hemoglobin of 11.0 g/dL more frequently and earlier
than recipients of deceased donors above 60 years old
(P < .05).
Conclusions: Deceased donor age, deceased donor
score, pretransplant serum parathyroid hormone,
posttransplant transferrin saturation, and tacrolimus
level were significantly associated with posttransplant
anemia recovery rate in deceased donor kidney
transplant recipients. Anemia recovery was more
frequent and earlier in recipients of deceased donors
below 60 years than in recipients of donors 60 years
old and above.
In this article, we seek to provide a new line of sight referring to specificities of the neoliberal turn in post-socialist societies and corresponding transformations of space. By employing the ...methodological approach that side-by-side explores two mutually exclusive strategies of analytical and empirical survey, we intend to tackle the question of irreducible antinomies pertinent to architectural research methodologies. Block 23 of the Central Zone of New Belgrade, designed by Branislav Karadžić, Božidar Janković, and Aleksandar Stjepanović (1968), has been widely recognised and aptly studied as one of the highlights of modern urban planning and design, conceived and realised in the period of late socialism in Belgrade (Serbia, former Yugoslavia). Featuring a notion of a “parallax gap,” we presume that the reading of Block 23 through two close yet clearly distinctive perspectives can bring a new scope of knowledge and point to the gap inscribed in the buildings themselves. The first point of view is empirical, centred on the notion of everyday life, and concerns the interpretation and use of space by its inhabitants. The second one is analytical, determined by the work of the architect and architectural theoretician, Branislav Milenković. We start from their point of contact and seek to find a shift in the diverging discursive positions producing a parallax gap. By way of architectural drawing, we explore and theorise new possibilities opened up by the actual buildings: interstitial, intermediary, transitional spaces, and spatial in-betweens. We hope to demonstrate the pursuit of both meticulously planned and dynamically conceived spaces open for the unpredictable was not only a way to respond to specific Yugoslav socio-political realities, but that it fostered the capacity of architecture to accommodate the future population and socio-economic transformations.
Over the last years, genetic studies have greatly improved our knowledge on the receptor subtypes mediating various pharmacological effects of positive allosteric modulators at GABA
A receptors. This ...stimulated the development of new benzodiazepine (BZ)-like ligands, especially those inactive/low-active at GABA
A receptors containing the α
1 subunit, with the aim of generating more selective drugs. Hereby, the affinity and efficacy of four recently synthesized BZ site ligands: SH-053-2′N, SH-053-S-CH3-2′F, SH-053-R-CH3-2′F and JY-XHe-053 were assessed. They were also studied in behavioral tests of spontaneous locomotor activity, elevated plus maze, and water maze in rats, which are considered predictive of, respectively, the sedative, anxiolytic, and amnesic influence of BZs. The novel ligands had moderately low to low affinity and mild to partial agonistic efficacy at GABA
A receptors containing the α
1 subunit, with variable, but more pronounced efficacy at other BZ-sensitive binding sites. While presumably α
1 receptor-mediated sedative effects of GABA
A modulation were not fully eliminated with any of the ligands tested, only SH-053-2′N and SH-053-S-CH3-2′F, both dosed at 30
mg/kg, exerted anxiolytic effects. The lack of clear anxiolytic-like activity of JY-XHe-053, despite its efficacy at α
2- and α
3-GABA
A receptors, may have been partly connected with its preferential affinity at α
5-GABA
A receptors coupled with weak agonist activity at α
1-containing subtypes. The memory impairment in water-maze experiments, generally reported with BZ site agonists, was completely circumvented with all four ligands. The results suggest that a substantial amount of activity at α
1 GABA
A receptors is needed for affecting spatial learning and memory impairments, while much weaker activity at α
1- and α
5-GABA
A receptors is sufficient for eliciting sedation.
Extensive experimental evidence confirms the role of oxidative stress as a major contributor to the pathogenesis of acute kidney injury (AKI). However, less information is available on the evolution ...of prooxidant-antioxidant parameters from early to end-phase renal function decline in humans. This study aimed to determine the oxidative status in dynamic throughout the evolutionary phases of the disease. The study included patients with cardiovascular pathology and AKI hospitalized in the intensive care unit (n = 69) and age-matched healthy controls (n = 30). They were followed through three phases of AKI; the first corrected phase was the phase of diagnosis, which is characterized by oliguria/anuria, the corrected second phase was established diuresis, and the corrected third phase was the polyuric phase. In these phases of the disease, blood samples were taken from the patients for biochemical analysis. From the collected whole blood, we measured spectrophotometrically prooxidants: index of lipid peroxidation, measured as Thiobarbituric acid reactive substances (TBARS), nitrite (NO₂⁻), superoxide anion radical (O₂⁻) and hydrogen peroxide (H₂O₂), and antioxidants: activity of superoxide dismutase (SOD), catalase (CAT) and reduced glutathione (GSH) from erythrocyte lysate. Comparing the results of the three measurements, a significant difference was found in the levels of NO₂⁻ and GSH, both of which increased in the second phase (P < 0.05) and then decreased in the third phase, and a significant increase in TBARS, which was elevated in the second phase (P < 0.05) and did not change significantly until the third phase. Our results showed phase-dependent modification in 3 parameters of the oxidative status (TBARS, NO₂⁻ and GSH). Whether these changes contribute to the deterioration of renal function in AKI remains to be established.
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