The first in this series of five papers concerns the evaluation and management of renal injuries. The authors of this paper come from four continents and seven countries, and they reviewed all papers ...on renal injury published between 1966 and April 2002. The results of the authors’ deliberations are present here as a consensus document.
OBJECTIVE
To determine the optimal evaluation and management of renal injuries by review of the world's English‐language literature on the subject.
METHODS
A consensus conference convened by the World Health Organization and the Societé Internationale d’Urologie met to critically review reports of the diagnosis and treatment of renal trauma. The English‐language literature about renal trauma was identified using Medline, and additional cited works not detected in the initial search obtained. Evidence‐based recommendations for the diagnosis and management of renal trauma were made with reference to a five‐point scale.
RESULTS
There were many Level 3 and 4 citations, few Level 2, and one Level 1 which supported clinical practice patterns. Findings of nearly 200 reviewed citations are summarized.
CONCLUSIONS
Published reports on renal trauma still rely heavily on expert opinion and single‐institution retrospective case series. Prospective trials of the most significant issues, when possible, might improve the quality of evidence that dictates the behaviour of practitioners.
Functional inhibition of tissue factor (TF) has been shown to improve coronary blood flow after myocardial ischemia/reperfusion (I/R. injury. TF initiates the coagulation protease cascade, resulting ...in the generation of the serine protease thrombin and fibrin deposition. Thrombin can also contribute to an inflammatory response by activating various cell types, including vascular endothelial cells. We used a rabbit coronary ligation model to investigate the role of TF in acute myocardial I/R injury. At-risk areas of myocardium showed increased TF expression in the sarcolemma of cardiomyocytes, which was associated with a low level of extravascular fibrin deposition. Functional inhibition of TF activity with an anti-rabbit TF monoclonal antibody administered either 15 minutes before or 30 minutes after coronary ligation reduced infarct size by 61% (
P = 0.004) and 44% (
P = 0.014), respectively. Similarly, we found that inhibition of thrombin with hirudin reduced infarct size by 59% (
P = 0.014). In contrast, defibrinogenating the rabbits with ancrod had no effect on infarct size, suggesting that fibrin deposition does not significantly contribute to infarct size. Functional inhibition of thrombin reduced chemokine expression and inhibition of either TF or thrombin reduced leukocyte infiltration. We propose that cardiomyocyte TF initiates extravascular thrombin generation, which enhances inflammation and injury during myocardial I/R.
Neutrophil extracellular traps (NET) expose modified antigens for autoantibodies in vasculitis. Little is known about levels and removal pathways of NET in systemic lupus erythematosus (SLE), ...especially in lupus nephritis (LN). We determined circulating levels and defined NET removal in large subsets of patients with incident SLE (iSLE), some of whom had new-onset nephritis.
Serum levels of NET (ELISA), DNase1/DNase1L3 (ELISA), and DNase activity (functional assay) were determined in 216 patients with iSLE 103 had incident LN (iLN), in 50 patients with other primary glomerulonephritis, and in healthy controls.
NET production by neutrophils purified from a random selection of patients was quantified as elastase/DNA release and by immunofluorescence techniques.
Serum NET levels were very high in iSLE/iLN compared to all groups of controls and correlated with anti-dsDNA, C3-C4, and proteinuria; iLN had the highest levels. DNase activity was decreased in iLN compared to SLE (20% had one-half DNase activity) despite similar serum levels of DNase1/DNase1L3. In these cases, pretreatment of serum with protein A restored DNase efficiency; 1 patient was homozygous for a c.289_290delAC variant of
.
NET production by neutrophils purified from LN, SLE, and normal controls was similar in all cases.
Patients with iLN have increased circulating NET and reduced DNase activity, the latter being explained by the presence of inhibitory substances in circulation and/or by rare
mutations. Accumulation of NET derives from a multifactorial mechanism, and is associated and may contribute to disease severity in SLE, in particular to renal lesions. (Clinical trial registration: The Zeus study was registered at ClinicalTrials.gov, study number NCT02403115).
Antimony-doped tin oxide (ATO) nanostructures were prepared using chemical precipitation technique starting from SnCl
2, SbCl
3 as precursor compounds. The antimony composition was varied from 5 to ...20
wt%. The lower resistance was observed at composition of Sn:95 and Sb:05, when compared with undoped and higher doping concentration of antimony. The average crystalline size of undoped and doped tin oxide was calculated from the X-ray diffraction (XRD) pattern and found to be in the range of 30–11
nm and it was further confirmed from the transmission electron microscopy (TEM) studies. The scanning electron microscopy (SEM) analysis showed that the nanoparticles agglomerates forming spherical-shaped particles of few hundreds nanometers. The samples were further analyzed by energy dispersive spectroscopy (EDS), X-ray photoelectron spectroscopy (XPS), Fourier transform infrared spectroscopy (FTIR) and electrical resistance measurements.
Thin films of Al
2O
3 have been deposited on polished silica glass substrates at room temperature by sol–gel dip coating technique followed by two different exposure methods. One set was annealed at ...different temperatures ranging from 200
°C to 800
°C for 10
h and a second set was exposed to microwave (2.45
MHz) radiation at different powers for 10
min. The lower temperature and shorter time with microwave irradiation might be ascribed to the activating and facilitating effect of microwaves on solid phase diffusion. Unlike other preparation methods, microwave heating is generally quite faster, and energy efficient. X-ray diffraction (XRD) and scanning electron microscopy (SEM), energy dispersive X-ray analysis techniques have been employed to characterize structural, morphological and elemental compositions of the films. Adhesion strength failure measurements on films performed by scratch test in progressive loading sequence have shown critical loads up to 25
N (partial perforation) for both annealed films and films exposed to microwave irradiation. Nanohardness indentation tests of the films exposed (800
W) to microwave have shown hardness of 8.3
GPa with elastic modulus of 120
GPa compared to the conventional annealed film (800°) of 4.5
GPa with elastic modulus of 90
GPa.
EAU Guidelines on Urological Trauma Lynch, Thomas H.; Martínez-Piñeiro, Luis; Plas, Eugen ...
European urology,
2005, 2005-Jan, 2005-01-00, 20050101, Letnik:
47, Številka:
1
Journal Article
Recenzirano
To determine the optimal evaluation and management of genitourinary (renal, ureteral, bladder, urethral and genital) injuries by review of the world's literature on the subject.
A consensus committee ...convened by the Health Care Office of the European Association of Urology (EAU) to summarize the literature concerning the diagnosis and treatment of genitourinary trauma.
Findings of 350 citations are reviewed.
The genitourinary trauma literature still relies heavily on expert opinion and single-institution retrospective series. Future prospective trials of the most significant issues, when possible, might improve the quality of evidence that dictates practitioner behavior. This paper represents a 5000 word summary of the full 35,000 word report. Full text of this review is available online at
http://www.europeanurology.com.
Objectives. To compare the urodynamic parameters and continence rates among five different continent urinary reservoirs.
Methods. Continent urinary reservoirs were constructed in 40 patients with an ...average age of 60 years (range 23 to 81). Twenty-three had orthotopic neobladders (“neobladders”), and in 17 the reservoirs exited by way of an abdominal wall stoma as “stomal urinary reservoirs.” In the neobladders, the detubularized segment was ileum (Hautmann) in 5, ileocecal (Mainz) in 8, sigmoid in 4, and gastric in 6. In the stomal urinary reservoirs, the segment was ileocecal in 11 (Mainz) and right colon in 6 (Indiana). Urodynamic studies were performed at a mean of 9.1 months.
Results. Stomal urinary reservoirs had the best continence rates (Indiana pouch 100%, Mainz pouch 91%). Neobladder continence rates were as follows: Hautmann, 80%; Mainz, 75%; sigmoid, 50%; and gastric, 33%. Day and night incontinence rates were nearly identical. Compared with the other pouches, gastric and sigmoid reconstructions had the smallest capacity, were the least compliant, and were the most contractile.
Conclusions. Stomal urinary reservoirs using ileocecal valve and right colon, with or without an overlying patch of ileum, provide similar excellent results. Continence approached 100% in compliant patients without the need for revision. Patients with neobladders were less continent, although those with ileal or ileocecal configurations still had very good continence rates. Neobladders of sigmoid or stomach can be used when necessary, but with greater incontinence rates. This poorer continence can be explained by the decreased capacity, decreased compliance, and a tendency toward high pressure spikes despite detubularization.
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