Immunoglobulin A (IgA) nephropathy (IgAN) treatment consists of maximal supportive care and, for high-risk individuals, immunosuppressive treatment (IST). There are conflicting results regarding IST. ...Therefore, we aimed to investigate IST results among IgAN patients in Turkiye.
The data of 1656 IgAN patients in the Primary Glomerular Diseases Study of the Turkish Society of Nephrology Glomerular Diseases Study Group were analyzed. A total of 408 primary IgAN patients treated with IST (65.4% male, mean age 38.4 ± 12.5 years, follow-up 30 (3-218) months) were included and divided into two groups according to treatment protocols (isolated corticosteroid CS 70.6% and combined IST 29.4%). Treatment responses, associated factors were analyzed.
Remission (66.7% partial, 33.7% complete) was achieved in 74.7% of patients. Baseline systolic blood pressure, mean arterial pressure, and proteinuria levels were lower in responsives. Remission was achieved at significantly higher rates in the CS group (78%
66.7%,
= 0.016). Partial remission was the prominent remission type. The remission rate was significantly higher among patients with segmental sclerosis compared to those without (60.4%
49%,
= 0.047). In the multivariate analysis, MEST-C S1 (HR 1.43, 95% CI 1.08-1.89,
= 0.013), MEST-C T1 (HR 0.68, 95% CI 0.51-0.91,
= 0.008) and combined IST (HR 0.66, 95% CI 0.49-0.91,
= 0.009) were found to be significant regarding remission.
CS can significantly improve remission in high-risk Turkish IgAN patients, despite the reliance on non-quantitative endpoints for favorable renal outcomes. Key predictors of remission include baseline proteinuria and specific histological markers. It is crucial to carefully weigh the risks and benefits of immunosuppressive therapy for these patients.
When multiple robots are supposed to operate together, coordination and communication issues arise. “Which robot should execute which task?” is the key question of the multi-robot task allocation ...problem. Properly allocating tasks among robots so as to obtain optimality is a primary research problem in the multi-robot coordination domain. Based on a simultaneous consideration of the team cost and computation time, a new approach for integrating path planning into a robot’s bids for tasks is presented. A practical path finding technique is proposed and combined with the Travelling Salesman Problem solution and Dijkstra shortest path solution for calculating bids. This combination produces a good alternative for path planning. By using this model for bid valuation, the cost is calculated without sacrificing the performance. Simulation experiments prove that the approach addressed in this paper has great advantages, including less computation, better real-time performance, a stronger ability to find the optimal result, etc.
Introduction. The fibrosis 4 (FIB-4) index was developed to predict advanced fibrosis in patients with liver disease. We aimed to evaluate the association of FIB-4 with risk factors for progression ...to critical illness in middle-aged patients hospitalized for coronavirus disease 2019 (COVID-19). Method. We included patients aged 35–65 years who were hospitalized following a positive RT-PCR SARS-Cov-2 test in a tertiary hospital. All data were obtained from the medical records of the patients during the first admission to the hospital. The FIB-4 index was calculated according to the equation (age (years) x AST (IU/L)/platelet count (109/L)/√ALT (IU/L)). The FIB-4 index was divided into three categories according to the score categorisation: <1.3 = low risk, 1.3–2.67 = moderate risk, and >2.67 = high risk. Results. A total of 619 confirmed COVID-19 patients (mean age = 52 yrs.) were included in this study; 37 (6.0%) were admitted to the intensive care unit (ICU), of which 44% were intubated and eight (1.3%) patients died during follow-up. The results of patients with high FIB-4 scores were compared with those with low FIB-4 scores. In patients with high FIB-4 scores, male gender, and advanced age, decreased neutrophil, lymphocyte, thrombocyte, and albumin counts, elevated AST, LDH, CK, ferritin, CRP, and D-dimer, and low GFR were the high-risk factors for critical illness. Additionally, the number of patients referred to ICU with high FIB-4 who died had higher scores than from those with low scores. Conclusion. The FIB-4 index derived from baseline data obtained during hospitalisation can be used as a simple, inexpensive, and straightforward indicator to predict ICU requirement and/or death in middle-aged hospitalized COVID-19 patients.
•A new approach on the surface roughness modeling-optimization process in Si wafer lapping.•New rational regression models and stochastic optimization methods on minimization of surface ...roughness.•First study on lapping process design and modeling for surface roughness.
The thinning of the silicon wafers and the smoothening of the surface are carried out by grinding and lapping processes. The lapping process is especially preferred to produce less surface damage of the silicon wafer in the production of high-efficiency solar cells. In this process, the surface roughness of the sample is the most influential parameter of pressure, rotation speed, lapping time and solution characteristics. In this study, rotation speed and lapping time were determined as design variables in the lapping processes of wire-sawn silicon wafers of 105 mm in diameter using a lapping and polishing machine. Although there are many studies about surface preparation in lapping process, the studies investigating this issue with theoretical or statistical modeling are very few in the literature. In addition, as a similar engineering process, many studies on the cutting process are available including experimental, modeling and optimization sections, which provides a good realistic design and prediction capability for the phenomenon. A similar study also needs to be done for the lapping process, which is especially preferred for the preparation of the surfaces of sensitive materials. The present study was conducted to fill this gap. In order to optimize the lapping parameters with a success, firstly, multiple nonlinear regression analyzes of experimental data were performed in terms of process parameters. Secondly, optimization studies were carried out based on Differential Evaluation, Nelder-Mead, Random Search and Simulated Annealing algorithms with the proposed regression models. It can be concluded that the present paper introduces significance of collaboration on the surface roughness experimental-modeling-optimization triple in silicon wafer lapping process for photovoltaic applications.
Abstract
Background
Chronic kidney disease (CKD) and immunosuppression, such as in renal transplantation (RT), stand as one of the established potential risk factors for severe coronavirus disease ...2019 (COVID-19). Case morbidity and mortality rates for any type of infection have always been much higher in CKD, haemodialysis (HD) and RT patients than in the general population. A large study comparing COVID-19 outcome in moderate to advanced CKD (Stages 3–5), HD and RT patients with a control group of patients is still lacking.
Methods
We conducted a multicentre, retrospective, observational study, involving hospitalized adult patients with COVID-19 from 47 centres in Turkey. Patients with CKD Stages 3–5, chronic HD and RT were compared with patients who had COVID-19 but no kidney disease. Demographics, comorbidities, medications, laboratory tests, COVID-19 treatments and outcome in-hospital mortality and combined in-hospital outcome mortality or admission to the intensive care unit (ICU) were compared.
Results
A total of 1210 patients were included median age, 61 (quartile 1–quartile 3 48–71) years, female 551 (45.5%) composed of four groups: control (n = 450), HD (n = 390), RT (n = 81) and CKD (n = 289). The ICU admission rate was 266/1210 (22.0%). A total of 172/1210 (14.2%) patients died. The ICU admission and in-hospital mortality rates in the CKD group 114/289 (39.4%); 95% confidence interval (CI) 33.9–45.2; and 82/289 (28.4%); 95% CI 23.9–34.5) were significantly higher than the other groups: HD = 99/390 (25.4%; 95% CI 21.3–29.9; P < 0.001) and 63/390 (16.2%; 95% CI 13.0–20.4; P < 0.001); RT = 17/81 (21.0%; 95% CI 13.2–30.8; P = 0.002) and 9/81 (11.1%; 95% CI 5.7–19.5; P = 0.001); and control = 36/450 (8.0%; 95% CI 5.8–10.8; P < 0.001) and 18/450 (4%; 95% CI 2.5–6.2; P < 0.001). Adjusted mortality and adjusted combined outcomes in CKD group and HD groups were significantly higher than the control group hazard ratio (HR) (95% CI) CKD: 2.88 (1.52–5.44); P = 0.001; 2.44 (1.35–4.40); P = 0.003; HD: 2.32 (1.21–4.46); P = 0.011; 2.25 (1.23–4.12); P = 0.008), respectively, but these were not significantly different in the RT from in the control group HR (95% CI) 1.89 (0.76–4.72); P = 0.169; 1.87 (0.81–4.28); P = 0.138, respectively.
Conclusions
Hospitalized COVID-19 patients with CKDs, including Stages 3–5 CKD, HD and RT, have significantly higher mortality than patients without kidney disease. Stages 3–5 CKD patients have an in-hospital mortality rate as much as HD patients, which may be in part because of similar age and comorbidity burden. We were unable to assess if RT patients were or were not at increased risk for in-hospital mortality because of the relatively small sample size of the RT patients in this study.
Abstract Background and Aims Focal segmental glomerulosclerosis (FSGS) is a glomerulonephritis characterized by segmental sclerosis in at least one of the glomeruli and may develop due to primary, ...secondary, genetic etiology. We compared clinical, histopathological, and laboratory findings, treatment options, and response to treatment in patients with secondary and genetic FSGS. Method This study analyzed 172 patients with secondary and genetic FSGS at our Glomerular Diseases Clinic (1987-2022). Criteria included at least 16 weeks of follow-up, absence of other primary glomerular diseases, and age over 18. Retrospective data were collected on demographics, diagnosis, renal biopsies, genetic tests, imaging, treatments, treatment responses, end-stage renal disease (ESRD) development, and transplantation. The focus was on predicting genetic FSGS and ESRD. Results 103 of our patients were female (59.8%), and the mean age at diagnosis was 38.46 ± 13.75 years. Of these patients, 29 were diagnosed with genetic FSGS and 141 with non-genetic secondary FSGS. Forty-one patients with non-genetic secondary FSGS were obese, and 21 had a single kidney. The patients had a median follow-up of 78 (38-134) months. 28 patients developed ESRD during follow-up, 16 of whom underwent renal transplantation. Familial renal disease (p < 0.001), familial ESRD (p < 0.001), and hematuria at diagnosis (p = 0.005) were more common in patients with genetic FSGS. Comparison of genetic FSGS and non-genetic secondary FSGS patients shown in Figure 1. The number of glomeruli with global sclerosis (p = 0.006) and C3 accumulation (p = 0.048) on renal biopsy was more frequent in patients with ESRD. Comparison of ESRD and non-ESRD patients are shown in Figure 2. Conclusion Differentiating genetic and non-genetic secondary FSGS is vital in clinical practice. For those with a family history of renal disease, hematuria, or unresponsive to immunosuppressive therapy, consider genetic FSGS and request genetic testing. Patients with secondary FSGS, diagnosed with high creatinine, a substantial presence of sclerosing glomeruli on biopsy, and C3 accumulation, should be closely monitored for ESRD.
Aim: We investigated demographic features and systemic diseases which affect mortality and the importance of the biochemical analyzes on admission in patients admitted to intensive care unit (ICU). ...Methods: We included 1748 patients (55% male) who were admitted to the ICU at our hospital between 2012 and 2014. The mean age of the patients was 61.8±19.2 years. Data on age, gender, presence of systemic diseases and surgery, duration of hospitalization and biochemical parameters on admission were analyzed. Results: The mean length of hospitalization was 18.4±34.3 (median=6) days. 32.1% of patients were postoperative patients. 45.7% of patients died. The rate of presence of multiple diseases, nervous system, cerebrovascular, and cardiovascular diseases and laboratory parameters including urea, creatinine, lactate dehydrogenase (LDH), and leucocytes were significantly higher and the mean albumin level was lower in patients who died compared to those in patients who were discharged from the hospital. Age, creatinine, albumin and LDH values were found to be significantly important factors by multivariate analysis conducted to examine predictors of mortality while gender, presence of multiple diseases, diagnostic code and being post-operative or not were found to have no significant importance. Conclusion: Baseline evaluation of pathologies that may play a role in mortality of ICU patients may be important for survival prediction. Evaluation of these factors on admission may contribute to development of different approaches to high-risk patients.
One of the uncommon gram negative organisms causing peritonitis in peritoneal dialysis patients is Citrobacter. Because of this organism's resistant nature, treatment for Citrobacter peritonitis may ...be difficult, and removal of the catheter may be necessary in refractory cases. Here we present 2 cases of peritonitis caused by this organism and fully treated with antibiotics. The literature contains only a limited number of reports on Citrobacter peritonitis, mostly case reports or portions of general papers about the microbiological spectrum of peritonitis in the relevant units. Until enough data about this micro-organism have been accumulated to map out an approach, it is wise to individualize treatment by watching the response of the patient during the wait for the antibiogram result and not to hesitate to remove the catheter if the clinical situation deteriorates.
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