Abstract only Identification of chronic kidney disease (CKD) after pediatric heart transplantation (PHT) is limited by inaccuracies in creatinine-based estimates of glomerular filtration rate (GFR); ...iohexol plasma clearance is a proven method of measuring GFR. We hypothesized that GFR can be measured by a modified iohexol clearance protocol during routine coronary angiography in PHT recipients, and that the recently developed CKiD GFR estimating formula, utilizing serum creatinine and cystatin C, provides a better estimate of GFR than creatinine or cystatin equations alone. We performed a cross-sectional study of PHT recipients, ages 2-18 yrs, undergoing surveillance coronary angiography. GFR was measured by obtaining iohexol levels at 2, 4, and 5 hours post-iohexol infusion for angiography, then calculating area under the curve of iohexol disappearance from plasma. Agreement between measured GFR and multiple GFR estimating equations was assessed with Bland Altman plots, correlation, and % of estimates within +/- 10 and 30% of measured GFR. Of 40 enrolled subjects, 31 had complete GFR data. Median age was 15.0 yrs IQR 7.6, 16.6, time since HT was 5.9 yrs 2.0, 10.8, height %ile was 26 (7, 48), serum creatinine was 0.7 (0.5, 0.8) mg/dL, cystatin C was 0.83 (0.72, 0.91) mg/L, and measured GFR was 89.5 (78.7-107.0) ml/min/1.73m 2 (mean 93.8, SD22.5). A comparison of measured GFR to estimated GFR is shown in Table 1; the full CKiD formula showed best agreement with measured GFR. Conclusions: 1. We describe a novel modified iohexol plasma clearance method to measure GFR in PHT recipients undergoing coronary angiography. 2. Measured median GFR in this cohort is 89.5 ml/min/1.73m2, suggesting early CKD. 3. The full CKiD formula performs best with respect to bias, accuracy, and correlation.
A 17-year-old girl recently diagnosed with systemic lupus erythematosus (SLE) presented to the Emergency Room with acute onset of psychosis. A variety of potential etiologies, including those related ...to SLE, to the treatment of her SLE, or to another psychiatric condition, are discussed. In addition, the work-up and management decisions for this patient are reviewed in detail.
Background
Hospitalization costs for treatment of hemodialysis (HD) catheter-associated blood stream infections (CA-BSI) in adults are high. No studies have evaluated hospitalization costs for HD ...CA-BSI in children or identified factors associated with high-cost hospitalizations.
Methods
We analyzed 160 HD CA-BSIs from the Standardizing Care to Improve Outcomes in Pediatric End-stage Kidney Disease (SCOPE) collaborative database linked to hospitalization encounters in the Pediatric Health Information System (PHIS) database. Charge-to-cost ratios were used to convert hospitalization charges reported in PHIS database to estimated hospital costs. Generalized linear mixed modeling was used to assess the relationship between higher-cost hospitalization (cost above 50
th
percentile) and patient and clinical characteristics. Generalized linear regression models were used to assess differences in mean service line costs between higher- and lower-cost hospitalizations.
Results
The median (IQR) length of stay for HD CA-BSI hospitalization was 5 (3–10) days. The median (IQR) cost for HD CA-BSI hospitalization was $18,375 ($11,584–$36,266). ICU stay (aOR 5.44, 95% CI 1.62–18.26,
p
= 0.01) and need for a catheter procedure (aOR = 6.08, 95% CI 2.45–15.07,
p
< 0.001) were associated with higher-cost hospitalization.
Conclusions
Hospitalizations for HD CA-BSIs in children are often multiple days and are associated with substantial costs. Interventions to reduce CA-BSI may reduce hospitalization costs for children who receive chronic HD.
Graphical abstract
A higher resolution version of the Graphical abstract is available as
Supplementary information
One of the enigmas in tumor biology is that different types of cancers are prevalent in different age groups. One possible explanation is that the ability of a specific oncogene to cause ...tumorigenesis in a particular cell type depends on epigenetic parameters such as the developmental context. To address this hypothesis, we have used the tetracycline regulatory system to generate transgenic mice in which the expression of a c-MYC human transgene can be conditionally regulated in murine hepatocytes. MYC's ability to induce tumorigenesis was dependent upon developmental context. In embryonic and neonatal mice, MYC overexpression in the liver induced marked cell proliferation and immediate onset of neoplasia. In contrast, in adult mice MYC overexpression induced cell growth and DNA replication without mitotic cell division, and mice succumbed to neoplasia only after a prolonged latency. In adult hepatocytes, MYC activation failed to induce cell division, which was at least in part mediated through the activation of p53. Surprisingly, apoptosis is not a barrier to MYC inducing tumorigenesis. The ability of oncogenes to induce tumorigenesis may be generally restrained by developmentally specific mechanisms. Adult somatic cells have evolved mechanisms to prevent individual oncogenes from initiating cellular growth, DNA replication, and mitotic cellular division alone, thereby preventing any single genetic event from inducing tumorigenesis.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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