Febuxostat is tolerable in chronic kidney disease (CKD) patients with hyperuricemia. However, the long-term effect of lowering uric acid with febuxostat on renal function and blood pressure has not been elucidated.
Methods
This was a 2 years retrospective observational study. 86 CKD patients with hyperuricemia who continued with allopurinol (allopurinol group, n?=?30), switched from allopurinol to febuxostat (switched group, n?=?25), or were newly prescribed febuxostat (febuxostat group, n?=?31) were included in this study. Serum uric acid, estimated glomerular filtration rate (eGFR), blood pressure, and urinary protein were analyzed. Moreover, the impact of serum uric acid reduction on renal function and blood pressure was assessed.
Results
Serum uric acid in the switched and febuxostat groups was significantly reduced at 6 months (switched group; 8.49?±?1.32–7.19?±?1.14 mg/dL, p?<?0.0001, febuxostat group; 9.43?±?1.63–6.31?±?0.90 mg/dL, p?<?0.0001). In the allopurinol group, serum uric acid was increased (6.86?±?0.87–7.10?±?0.85 mg/dL, p?=?0.0213). eGFR was significantly increased (35.2?±?12.8–37.3?±?13.9 mL/min/1.73 m2, p?=?0.0232), while mean arterial pressure (93.1?±?10.8–88.2?±?9.5 mmHg, p?=?0.0039) was significantly decreased at 6 months in the febuxostat group, resulting in the retention of eGFR for 2 years.
Conclusions
The impact of serum uric acid reduction might have beneficial effects on CKD progression and blood pressure. However, a large prospective study is needed to determine the long-term efficacy of febuxostat therapy in CKD patients with hyperuricemia.
Bartter syndrome (BS) may be associated with different degrees of hypercalciuria, but marked parathyroid hormone (PTH) abnormalities have not been described.
Methods
We compared clinical and laboratory data of patients with either ROMK-deficient type II BS (n?=?14) or Barttin-deficient type IV BS (n?=?20).
Results
Only BS-IV patients remained mildly hypokalemic in spite of a higher need for potassium supplementation. Estimated glomerular filtration rate (eGFR) was mildly decreased in only four BS-IV patients. Average PTH values were significantly higher in BS-II (160.6?±?85.8 vs. 92.5?±?48 pg/ml in BS-IV, p?=?0.006). In both groups, there was a positive correlation between age and log(PTH). Levels of 25(OH) vitamin D were not different. Total serum calcium was lower (within normal limits) and age-related serum phosphate (Pi)-SDS was increased in BS-II (1.19?±?0.71 vs. 0.01?±?1.04 in BS-IV, p?<?0.001). The GFR threshold for Pi reabsorption was higher in BS-II (5.63?±?1.25 vs. 4.36?±?0.98, p?=?0.002). Spot urine calcium/creatinine ratio and nephrocalcinosis rate (100 vs. 16 %) were higher in the BS-II group.
Conclusions
PTH, serum Pi levels, and urinary threshold for Pi reabsorption are significantly elevated in type II vs. type IV BS, suggesting a PTH resistance state. This may be a response to more severe long-standing hypercalciuria, leading to a higher rate of nephrocalcinosis in BS-II.
Trabecular bone score (TBS) seems to provide additive value on BMD to identify individuals with prevalent fractures in T1D. TBS did not significantly differ between T1D patients and healthy controls, but TBS and HbA1c were independently associated with prevalent fractures in T1D. A TBS cutoff <1.42 reflected prevalent fractures with 91.7 % sensitivity and 43.2 % specificity.
Introduction
Type 1 diabetes (T1D) increases the risk of osteoporotic fractures. TBS was recently proposed as an indirect measure of bone microarchitecture. This study aimed at investigating the TBS in T1D patients and healthy controls. Associations with prevalent fractures were tested.
Methods
One hundred nineteen T1D patients (59 males, 60 premenopausal females; mean age 43.4?±?8.9 years) and 68 healthy controls matched for gender, age, and body mass index (BMI) were analyzed. The TBS was calculated in the lumbar region, based on two-dimensional (2D) projections of DXA assessments.
Results
TBS was 1.357?±?0.129 in T1D patients and 1.389?±?0.085 in controls (p?=?0.075). T1D patients with prevalent fractures (n?=?24) had a significantly lower TBS than T1D patients without fractures (1.309?±?0.125 versus 1.370?±?0.127, p?=?0.04). The presence of fractures in T1D was associated with lower TBS (odds ratio?=?0.024, 95 % confidence interval (CI)?=?0.001–0.875; p?=?0.042) but not with age or BMI. TBS and HbA1c were independently associated with fractures. The area-under-the curve (AUC) of TBS was similar to that of total hip BMD in discriminating T1D patients with or without prevalent fractures. In this set-up, a TBS cutoff <1.42 discriminated the presence of fractures with a sensitivity of 91.7 % and a specificity of 43.2 %.
Conclusions
TBS values are lower in T1D patients with prevalent fractures, suggesting an alteration of bone strength in this subgroup of patients. Reliable TBS cutoffs for the prediction of fracture risk in T1D need to be determined in larger prospective studies.
We compared renal functional outcomes of robotic (RPN) and open partial nephrectomy (OPN) in patients with chronic kidney disease (CKD), a definite indication for nephron-sparing surgery.
Methods
A multicenter retrospective analysis of OPN and RPN in patients with baseline ≥?CKD Stage III [estimated glomerular filtration rate (eGFR) <?60 mL/min/1.73 m2] was performed. Primary outcome was change in eGFR (ΔeGFR, mL/min/1.73 m2) between preoperative and last follow-up with respect to RENAL nephrometry score group [simple (4–6), intermediate (7–9), complex (10–12)]. Secondary outcomes included eGFR decline >?50%.
Results
728 patients (426 OPN, 302 RPN, mean follow-up 33.3 months) were analyzed. Similar RENAL score distribution (p?=?0.148) was noted between groups. RPN had lower median estimated blood loss (p?<?0.001), and hospital stay (3 vs. 5 days, p?<?0.001). Median ischemia time (OPN 23.7 vs. RPN 21.5 min, p?=?0.089), positive margin (p?=?0.256), transfusion (p?=?0.166), and 30-day complications (p?=?0.208) were similar. For OPN vs. RPN, mean ΔeGFR demonstrated no significant difference for simple (0.5 vs. 0.3, p?=?0.328), intermediate (2.1 vs. 2.1, p?=?0.384), and complex (4.9 vs. 6.1, p?=?0.108). Cox regression analysis demonstrated that decreasing preoperative eGFR (OR 1.10, p?=?0.001) and complex RENAL score (OR 5.61, p?=?0.03) were independent predictors for eGFR decline >?50%. Kaplan–Meier analysis demonstrated 5-year freedom from eGFR decline >?50% of 88.6% for OPN and 88.3% for RPN (p?=?0.724).
Conclusions
RPN and OPN demonstrated similar renal functional outcomes when stratified by tumor complexity group. Increasing tumor age and tumor complexity were primary drivers associated with functional decline. RPN provides similar renal functional outcomes to OPN in appropriately selected patients.
This study aims to quantify changes in fibroblast growth factor 19 (FGF19) and bile acids (BAs) in patients with uncontrolled type 2 diabetes randomized to Roux-en-Y gastric bypass (RYGB) vs intensive medical management (IMM) and matched for similar reduction in HbA1c after 1 year of treatment.
Methods
Blood samples were drawn from patients who underwent a test meal challenge before and 1 year after IMM (n?=?15) or RYGB (n?=?15).
Results
Mean HbA1c decreased from 9.7 to 6.4 % after RYGB and from 9.1 to 6.1 % in the IMM group. At 12 months, the number of diabetes medications used per subject in the RYGB group (2.5?±?0.5) was less than in the IMM group (4.6?±?0.3). After RYGB, FGF19 increased in the fasted (93?±?15 to 152?±?19 pg/ml; P?=?0.008) and postprandial states (area under the curve (AUC), 10.8?±?1.9 to 23.4?±?4.1 pg?×?h/ml?×?103; P?=?0.006) but remained unchanged following IMM. BAs increased after RYGB (AUC ×103, 6.63?±?1.3 to 15.16?±?2.56 μM?×?h; P?=?0.003) and decreased after IMM (AUC ×103, 8.22?±?1.24 to 5.70?±?0.70; P?=?0.01). No changes were observed in the ratio of 12α-hydroxylated/non-12α-hyroxylated BAs. Following RYGB, FGF19 AUC correlated with BAs (r?=?0.54, P?=?0.04) and trended negatively with HbA1c (r?=??0.44; P?=?0.09); these associations were not observed after IMM.
Conclusions
BA and FGF19 levels increased after RYGB but not after IMM in subjects who achieved similar improvement in glycemic control. Further studies are necessary to determine whether these hormonal changes facilitate improved glucose homeostasis.
To compare the effects of the sleeve gastrectomy with transit bipartition (SG?+?TB) procedure with standard medical therapy (SMT) in mildly obese patients with type II diabetes (T2D).
Methods
This is a prospective, randomized, controlled trial. Twenty male adults, ≤?65 years old, with T2D, body mass index (BMI)?>?28 kg/m2 and <?35 kg/m2, and HbA1c level?>?8% were randomized to SG?+?TB or to SMT. Outcomes were the remission in the metabolic and cardiovascular risk variables up to 24 months.
Results
At 24 months, SG?+?TB group showed a significant decrease in HbaA1c values (9.3?±?2.1 versus 5.5?±?1.1%, P?=?<?0.05) whereas SMT group maintained similar levels from baseline (8.0?±?1.5 versus 8.3?±?1.1%, P?=?NS). BMI values were lower in the SG?+?TB group (25.3?±?2.8 kg/m2 versus 30.9?±?2.5 kg/m2; P?=?<?0.001). At 24 months, none patient in SG?+?TB group needed medications for hyperlipidemia/hypertension. HDL-cholesterol levels increased in the SG?+?TB group (33?±?8 to 45?±?15 mg/dL, P?<?0.001). After 24 months, the area under the curve (AUC) of GLP1 increased and in the SG?+?TB group and the AUC of the GIP concentrations was lower in the SG?+?TB group than in the SMT. At 3 months, SG?+?TB group showed a marked increase in FGF19 levels (74.1?±?45.8 to 237.3?±?234 pg/mL; P?=?0.001).
Conclusions
SG?+?TB is superior to SMT and was associated with a better metabolic and cardiovascular profile.
There is no consensus on the most appropriate type of anesthesia for placement of a midurethral sling. Our objective was to compare intra- and perioperative outcomes for this procedure performed under general anesthesia versus monitored anesthesia care.
Methods
Retrospective cohort analysis of women undergoing outpatient placement of synthetic retropubic midurethral sling under general anesthesia (n?=?141) or monitored anesthesia care (n?=?84). Patients undergoing concomitant procedures were excluded. Primary outcome was operating room time. Secondary outcomes included surgical and recovery times, cost, discharge home with a catheter, and postoperative pain and/or nausea.
Results
In the general anesthesia group, both operating room time (mean?±?SD, 67.6?±?13.3 min vs 56.9?±?11.8 min, p?<?0.001) and recovery room time (240.0?±?69.8 min vs 190.1?±?78.3 min, p?<?0.001) were longer, whereas there was no difference in surgical time (30.0?±?8.9 min vs 29.0?±?9.7 min, p?=?0.43). Cost was significantly higher in the general anesthesia group ($4,095?±?715 vs $3,877?±?777, p?=?0.03). There was no difference in rates of bladder perforation (6.4 % vs 11.9 %, p?=?0.33). Patients who underwent general anesthesia had higher rates of discharge with a catheter (27.0 % vs 15.8 %, p?=?0.04).
Conclusion
Monitored anesthesia care may offer significant benefits over general anesthesia in women undergoing retropubic midurethral sling, including shorter operating room and recovery times, lower costs, and less voiding dysfunction in the immediate postoperative period.
The objective of the study was to evaluate the usefulness of trabecular bone score (TBS) and bone mineral density (BMD) for identifying vertebral fractures (VFx) in well-compensated type 2 diabetic (T2D) patients. TBS and femoral neck BMD below certain cutoffs may be useful for identifying VFx in well-compensated T2D patients.
Introduction
In T2D, the prevalence of VFx is increased, especially in poorly compensated and complicated diabetic patients. The possibility of predicting the fracture risk in T2D patients by measuring BMD and TBS, an indirect parameter of bone quality, is under debate. Therefore, the objective was to evaluate the usefulness of TBS and BMD for identifying VFx in well-compensated T2D patients.
Methods
Ninety-nine T2D postmenopausal women in good metabolic control (glycosylated haemoglobin 6.8?±?0.7 %) and 107 control subjects without T2D were evaluated. In all subjects, we evaluated the following: the BMD at the lumbar spine (LS) and the femoral neck (FN); the TBS by dual X-ray absorptiometry; and VFx by radiography. In T2D subjects, the presence of diabetic retinopathy, neuropathy, and nephropathy was evaluated.
Results
T2D subjects had increased VFx prevalence (34.3 %) as compared to controls (18.7 %) (p?=?0.01). T2D subjects presented higher BMD (LS ?0.8?±?1.44, FN ?1.06?±?1.08), as compared to controls (LS ?1.39?±?1.28, p?=?0.002; FN ?1.45?±?0.91, p?=?0.006, respectively). TBS was not different between diabetics and controls. In fractured T2D patients, LS-BMD, FN-BMD, and TBS were reduced (?1.2?±?1.44; ?1.44?±?1.04; 1.072?±?0.15) and the prevalence of retinopathy (15.4 %) was increased than in nonfractured T2D subjects (?0.59?±?1.4, p?=?0.035; ?0.87?±?1.05, p?=?0.005; 1.159?±?0.15, p?=?0.006; 1.8 %, p?=?0.04, respectively). The combination of TBS ≤1.130 and FN-BMD less than ?1.0 had the best diagnostic accuracy for detecting T2D fractured patients (SP 73.8 %, SN 63.6 %, NPV 78.9 %, PPV 56.8 %).
Conclusions
TBS and FN-BMD below certain cutoffs may be useful for identifying VFx in well-compensated T2D patients.
This study aimed to estimate the validity and applicability of Vela laser enucleation of the prostate (VoLEP) in the management of benign prostatic hyperplasia (BPH).
Methods
A retrospective chart review of 112 patients with BPH who underwent VoLEP (n?=?60) or holmium laser enucleation of the prostate (HoLEP) (n?=?56) was conducted at our institution from January 2015 to June 2015. The general and perioperative characteristics of the patients were collected. The 12-month follow-up data, including the lower urinary tract symptom (LUTS) indexes (International Prostate Symptom Score [I-PSS], quality-of-life [QoL] score and maximum flow rate [Qmax]), as well as rates of perioperative and late complications, were analyzed.
Results
No significant differences were observed in pre- and perioperative parameters, including operation time (58.05?±?10.14 vs. 60.14?±?12.30 min, P?=?0.44), serum sodium decrease (3.49?±?0.83 vs. 3.48?±?0.84 mmol/L, P?=?0.97), hemoglobin decrease (1.28?±?0.38 vs. 1.24?±?0.77 g/dL, P?=?0.71), catheterization time (3.63?±?1.10 vs. 3.89?±?1.11 days, P?=?0.21) and hospital stay (4.57?±?1.25 vs. 4.68?±?1.18 days, P?=?0.63) between the two groups of patients. Compared with the HoLEP group, the noise during operation was lower in VoLEP group (47.22?±?10.31 vs. 59.45?±?9.65 db, P?<?0.05). During 1, 6 and 12 months of follow-up visits, the LUTS indexes (I-PSS, QoL score and Qmax) were remarkably improved in both groups when comparing with the baseline values. Furthermore, LUTS indexes were comparable in both groups (P?>?0.05).
Conclusion
Similarly as the holmium laser, the Vela laser is a potent, safe, efficient durable and surgical treatment option for minimally invasive surgery in patients with BPH-induced LUTS.
The aim of our study was to investigate the impact of the ABO blood groups and blood-based biomarkers on the growth kinetics of renal angiomyolipoma (AML).
Methods
A total of 124 patients with AML who were followed-up between 2010 and 2018 were retrospectively reviewed. The patients’ characteristics were recorded, including age, body mass index (BMI), blood pressure, smoking history, and ABO blood group. Baseline laboratory test results, including serum creatinine, AST, ALT, platelet, neutrophil and lymphocyte count, were used to calculate the estimated glomerular filtration rate (eGFR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and De Ritis ratio. The Cox regression analysis was used to evaluate the relationship between variables and tumor growth.
Results
The study population comprised 71 women and 44 men with a median age of 47.3 (28–65) years. Among patients classified according to the blood groups, no significant differences were observed regarding age, BMI, smoking history, co-morbidities, NLR, PLR, De Ritis ratio, eGFR, or tumor size and localisation. The mean growth rate from baseline to the last scan was 0.36?±?0.27 cm, 0.21?±?0.21 cm, 0.14?±?0.11 cm, and 0.19?±?0.17 cm for blood type O, A, B, and AB, respectively. In multivariate analysis, eGFR?<?60 (p?=?0.044), central tumor localisation (p?=?0.030), presence of blood group-0 (p?=?0.038), and De Ritis ratio?≥?1.24 (p?=?0.047) were statistically associated with tumor growth.
Conclusion
Our study demonstrates that both the ABO blood groups and the De Ritis ratio might represent independent predictors of tumor growth rate in patients with renal AML.
To assess the impact of coital incontinence (CI) on health-related quality of life (HRQoL) and quality of sexual function (QSF) in women with urodynamic stress urinary incontinence (SUI).
Methods
Women were recruited for this cross-sectional study from among 289 patients with lower urinary tract symptoms, underwent clinical and urodynamic evaluation. Of these 289 women, 127 sexually active women with SUI completed the King’s Health Questionnaire (KHQ) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ), of whom 97 were enrolled for the study. The study group comprised 53 women with CI occurring ‘sometimes’, ‘usually’ or ‘always’, and the control group comprised 44 women without CI. Total and individual domain scores were evaluated.
Results
CI was reported by 65.35 % of the women. The frequency of CI was correlated with lower educational level and higher body mass index (r?=?0.22 and r?=?0.23, respectively; p?=?0.01). The KHQ results showed significantly lower HRQoL in women with CI in all domains (p?<?0.05) apart from Sleep/energy’ (p?=?0.054). PISQ revealed no significant differences in QSF in the Behavioral/emotive and Partner–related domains (34.3?±?10.0 vs. 33.0?±?12.2 and 18.0?±?2.9 vs. 18.2?±?3.6, respectively). Women with CI reported a significantly lower QSF in the Physical domain (29.1?±?6.6 vs. 35.0?±?4.6, p?=?0.001), and the total PISQ score was lower but the difference was not significant (81.4?±?14.3 vs. 86.2?±?16.5). Total PISQ score was correlated with age (r?=??0.28, p?=?0.001). Women with CI were significantly more likely to admit that fear of incontinence or fear of embarrassment restricted their sexual activity (p?<?0.001).
Conclusions
A large percentage (65.35 %) of women with SUI reported CI, which had a negative impact on HRQoL and QSF in the Physical domain, but no significant impact on overall QSF.
Dialysis-related destructive spondyloarthropathy caused by beta-2 microglobulin (β2M) amyloid deposits in intervertebral discs is a major burden for patients undergoing long-term dialysis. This study aimed to quantify the presence of β2M amyloid deposits in the intervertebral disc tissue of such patients and analyze whether there was a significant correlation between β2M accumulation and the duration of dialysis.
Methods
Two groups of patients who had undergone surgery for degenerative spinal pathologies were selected: the dialysis group (n?=?29) with long-term dialysis and the control group (n?=?10) with no renal impairment. Tissue sections were prepared from specimens of intervertebral disc tissue obtained during spinal surgery and analyzed via histological staining, including immunohistochemistry (IHC) and Congo red.
Results
There was a statistically significant multifold increase of β2M expression in the disc tissue of long-term dialysis patients when compared to non-dialysis patients, as shown by both IHC (0.019?±?0.023 μm2 vs. 0.00020?±?0.00033 μm2, respectively; p?=?0.012) and Congo red staining (0.027?±?0.041 μm2 vs. 9.240?×?10?5?±?5.261?×?10?5 μm2, respectively; p?=?0.047). We also note a moderate strength positive correlation between the duration of dialysis and positive IHC (r?=?0.39; p?=?0.015) and Congo-red staining (r?=?0.42; p?=?0.007).
Conclusions
The problem of β2M amyloidosis in long-term dialysis patients remains unresolved even with predominant use of high-flux dialysis membranes. This highlights the insufficiency of current dialysis modalities to effectively filter β2M.
Obesity has become prevalent in patients with inflammatory bowel disease (IBD). Bariatric surgery can be considered to be contraindicated in IBD patients. We aimed to evaluate feasibility, safety, and efficacy of bariatric surgery in IBD patients.
Methods
We retrospectively identified all morbidly obese patients with a known diagnosis of IBD, who underwent bariatric surgery between January 2005 and December 2012. Postoperative outcomes and status of IBD in patients on maintenance therapy for their disease were assessed.
Results
We identified 20 IBD patients including 13 ulcerative colitis (UC) and 7 Crohn’s disease (CD) patients with a mean age of 54.0?±?10.5 years, BMI of 50.1?±?9.0 kg/m2, and duration of IBD of 11.3?±?5.2 years. Eleven patients were on medication for IBD at baseline. Bariatric procedures included sleeve gastrectomy (N?=?9), gastric bypass (N?=?7), gastric banding (N?=?3), and one conversion of band to gastric bypass. There were no intraoperative complications, but two conversions to laparotomy due to adhesions. Mean BMI change and excess weight loss at 1 year was 14.3?±?5.7 kg/m2 and 58.9?±?21.1 %, respectively. Seven early postoperative complications occurred including dehydration (N?=?5), pulmonary embolism (N?=?1), and wound infection (N?=?1). During a mean follow-up of 34.6?±?21.7 months, five patients developed complications including pancreatitis (N?=?2), ventral hernia (N?=?2), and marginal ulcer (N?=?1). Nine out of ten eligible patients experienced improvement in their IBD status.
Conclusions
Bariatric surgery is feasible and safe in morbidly obese patients suffering from IBD. In addition to being an effective weight loss procedure, bariatric surgery may help mitigate symptoms in this patient population.
To evaluate and compare flexible ureteroscopy (f-URS) and mini-percutaneous nephrolithotomy (mPNL) for 20–30 mm renal stones in obese patients regarding efficacy and safety.
Methods
Between May 2011 and June 2017, 254 obese patients who had 20–30 mm kidney stone were consecutively included in the study; 106 patients underwent mPNL and 148 underwent f-URS by the same surgeon. The following parameters were retrospectively assessed: patient and stone characteristics, surgical details, perioperative outcomes, and stone-free rates (SFR).
Results
F-URS group was similar to mPNL group in terms of the mean duration of surgery (92.8?±?26.1 vs 87.4?±?31.5 min, P?=?0.137) and the final SFR (89.1 vs 92.5%, P?=?0.381). The f-URS group had significantly shorter postoperative stay (1.0?±?0.8 vs 4.3?±?1.7 days, P?<?0.001) and lower postoperative complications (11.5 vs 26.4%, P?=?0.002). However, the f-URS group had a lower SFR after first session (67.2 vs 87.4%, P?<?0.001) and needed more number of procedures (1.5?±?0.4 vs 1.3?±?0.4, P?<?0.001) than the mPNL group.
Conclusions
MPNL has a higher efficacy (higher SFR after first session and lower number of procedures); however, f-URS offers advantages regarding safety (lower complication rate). Therefore, both options can be offered to obese patients with renal stones from 20 to 30 mm in size. Nevertheless, these results must be confirmed by further prospective randomized trials.
To examine the characteristics of the midstream urine microbiome in adults with stage 3–5 non-dialysis-dependent chronic kidney disease (CKD).
Methods
Patients with non-dialysis-dependent CKD (estimated glomerular filtration rate [eGFR]?<?60 ml/min/1.73 m2) and diuretic use were recruited from outpatient nephrology clinics. Midstream voided urine specimens were collected using the clean-catch method. The bacterial composition was determined by sequencing the hypervariable (V4) region of the bacterial 16S ribosomal RNA gene. Extraction negative controls (no urine) were included to assess the contribution of extraneous DNA from possible sources of contamination. Midstream urine microbiome diversity was assessed with the inverse Simpson, Chao and Shannon indices. The diversity measures were further examined by demographic characteristics and by comorbidities.
Results
The cohort of 41 women and 36 men with detectable bacterial DNA in their urine samples had a mean age of 71.5 years (standard deviation [SD] 7.9) years (range 60–91 years). The majority were white (68.0%) and a substantial minority were African-American (29.3%) The mean eGFR was 27.2 (SD 13.6) ml/min/1.73 m2. Most men (72.2%) were circumcised and 16.6% reported a remote history of prostate cancer. Many midstream voided urine specimens were dominated (>?50% reads) by the genera Corynebacterium (n?=?11), Staphylococcus (n?=?9), Streptococcus (n?=?7), Lactobacillus (n?=?7), Gardnerella (n?=?7), Prevotella (n?=?4), Escherichia_Shigella (n?=?3), and Enterobacteriaceae (n?=?2); the rest lacked a dominant genus. The samples had high levels of diversity, as measured by the inverse Simpson [7.24 (95% CI 6.76, 7.81)], Chao [558.24 (95% CI 381.70, 879.35)], and Shannon indices [2.60 (95% CI 2.51, 2.69)]. Diversity measures were generally higher in participants with urgency urinary incontinence and higher estimated glomerular filtration rate (eGFR). After controlling for demographics and diabetes status, microbiome diversity was significantly associated with estimated eGFR (P?<?0.05).
Conclusions
The midstream voided urine microbiome of older adults with stage 3–5 non-dialysis-dependent CKD is diverse. Greater microbiome diversity is associated with higher eGFR.
Along with the development of technology, robotic approach is being performed for laparoscopic Roux-en-Y gastric bypass (LRYGB). Some literatures reported same or better peri-operative outcomes with the robotic procedure. The aim of this study is to compare our experience in robot-assisted LRYGB (RA-LRYGB) with LRYGB in terms of peri-operative outcomes.
Methods
From January 1, 2012 to April 30, 2014, a total of 270 patients underwent LRYGB by one surgeon at a single institution. Of these, 64 cases were done robotically. A retrospective review was performed for these patients, noting the outcomes and complications of the procedure.
Results
The 64 RA-LRYGB patients had a mean age of 45.9?±?10.0 years (range, 23–67) and a mean preoperative body mass index (BMI) of 48.4?±?7.9 kg/m2 (range, 33.8–76.4). The 207 LRYGB patients had a mean age of 45.0?±?10.7 years (range, 21–67) and a mean preoperative BMI of 48.4?±?8.1 kg/m2 (range, 34.0–80.4). These two groups were clinically comparable. Mean length of hospital stay was 3.0?±?4.1 days (range, 1–19) in RA-LRYGB patients, significantly longer than 1.6?±?1.7 days (range, 1–17) in LRYGB patients (p?<?0.01). Thirty-day readmission rate was 9.3 % (n?=?6) in the RA-LRYGB group and 6.8 % (n?=?14) in the LRYGB group. Higher leak rate was noticed in RA-LRYGB patients at 7.8 % (n?=?5), compared to 0.5 % (n?=?1) in LRYGB patients (p?<?0.01). All the leaks occurred at the pouch level in the RA-LRYGB group, while one leak from the LRYGB group occurred at the gastrojejunal anastomosis site.
Conclusions
Robot-assisted Roux-en-Y gastric bypass may result in higher leak rate at the pouch level, when compared to that of laparoscopic procedures.
Chronic kidney disease (CKD) predisposes to accelerated atherosclerosis that is measured by carotid artery intima-media thickness (cIMT) and brachial artery flow-mediated dilation (FMD). Information on the association of these parameters with dyslipidemia in pre-dialysis pediatric CKD is limited.
Methods
Eighty patients aged 9.9?±?3.2 years, with estimated glomerular filtration rate of 38.8?±?10.8 ml/1.73 m2/min, and 42 pediatric controls underwent cross-sectional analysis of lipid profile, cIMT, and brachial artery FMD. Significant differences in these parameters between patients and controls were analyzed using Student’s t test. Predictors of cIMT and dyslipidemia were assessed using linear and logistic regression respectively.
Results
Patients had elevated blood levels of triglyceride and of total and LDL cholesterol than controls (P?≤?0.001); 73.8 % were dyslipidemic. Mean cIMT was higher (0.421?±?0.054 mm vs 0.388?±?0.036 mm, P?=?0.001) and brachial artery FMD was reduced (10.6?±?4.9 % vs 18.9?±?4.1 %, P?<?0.0001) in patients compared with controls. On multivariate analysis, hypertension (OR 3.68, P?=?0.044) and male gender (OR 10.21, P?=?0.004) were associated with dyslipidemia; cIMT was significantly associated with LDL cholesterol (β?=?28.36, P?=?0.033).
Conclusion
Dyslipidemia was prevalent and cIMT significantly elevated in pre-dialysis pediatric CKD, indicating increased cardiovascular risk. Elevated LDL cholesterol predicted increased cIMT, strengthening the association between dyslipidemia and atherosclerosis in early CKD.
Diuretic therapy has been the mainstay of treatment in chronic kidney disease (CKD) patients, primarily for hypertension and fluid overload. Apart from their beneficial effects, diuretic use is associated with adverse renal outcomes. The current study is aimed to determine the outcomes of diuretic therapy.
Methodology
A prospective observational study was conducted by inviting pre-dialysis CKD patients. Fluid overload was assessed by Bioimpedance analysis (BIA).
Results
A total 312 patients (mean age 64.5?±?6.43) were enrolled. Among 144 (46.1%) diuretic users, furosemide and hydrochlorothiazide (HCTZ) were prescribed in 69 (48%) and 39 (27%) patients, respectively, while 36 (25%) were prescribed with combination therapy (furosemide plus HCTZ). Changes in BP, fluid compartments, eGFR decline and progression to RRT were assessed over a follow-up period of 1 year. Maximum BP control was observed with combination therapy (?19.3 mmHg, p?<?0.001) followed by furosemide [?10.6 mmHg with 80 mg thrice daily (p?<?0.001)], ?9.3 mmHg with 40–60 mg (p?<?0.001) and ?5.9 mmHg with 20–40 mg (p?=?0.02) while HCTZ offered minimal SBP control [?3.7 mmHg with 12.5–25 mg (p?=?0.04)]. Decline in extracellular water (ECW) ranged from ?1.5 L(p?=?0.01) with thiazide diuretics to ?3.8 L(p?<?0.001) with combination diuretics. Decline in eGFR was maximum (?3.4 ml/min/1.73 m2, p?=?0.01) with combination diuretics and least with thiazide diuretics (?1.6 ml/min/1.73 m2, p?=?0.04). Progression to RRT was observed in 36 patients.
Conclusion
It is cautiously suggested to discourage the use of diuretic combination therapy and high doses of single diuretic therapy. Prescribing of diuretics should be done by keeping in view benefit versus harm for each patient.
Over the past decade, minimal invasive surgery for correction of pectus carinatum has gained worldwide acceptance. This study reviews our clinical experience with minimally invasive repair of pectus carinatum (MIRPC) since 2008.
Methods
Between 2008 and 2018, 101 patients (77 male, 24 female) underwent correction of pectus carinatum with the MIRPC technique. The mean age of the patients was 14.7?±?4.8 (3–38) years. Over an 8 years’ experience we slightly modified the original Abramson technique. All patients presented with cosmetic complaints and all had a flexible chest wall on “compression test”. Early follow-up was on postoperative day 15 and 30.
Results
The mean operative time was 42.1?±?16.9 min. The mean hospital stay was 4.2?±?0.9 days. Postoperative complications included pneumothorax (n?=?2, 1.9%), wound infection (n?=?2, 1.9%), skin perforation (n?=?2, 1.9%), intolerable pain (n?=?1, 0.9%), skin hyperpigmentation (n?=?1, 0.9%), and overcorrection (n?=?1, 0.9%). Initial postoperative results were excellent in all patients. The bars were removed at a median of 24.8?±?4.5 months in 44 of 101 patients. 43 of 44 (97.7%) patients whose bar were removed reported excellent results.
Conclusions
MIRPC is a feasible procedure with low morbidity and excellent cosmetic results in the treatment of pectus carinatum deformities in selected patients.
To investigate the different cervical strategies for maintaining horizontal gaze in asymptomatic subjects.
Methods
One hundred and forty-four asymptomatic adults filled the SF-36 quality of life questionnaire and underwent full-body biplanar radiographs. Chin brow vertical angle (CBVA) and postural and cervical parameters were measured. Subjects were grouped according to cervical spine curvature (C2–C7 angle): kyphotic (<???5°), straight [??5°, 5°], lordotic (>?5°). Demographics, SF-36 component scores and CBVA were compared between groups. All other parameters were compared between groups, while controlling for confounding factors (ANCOVA). A correlation test was conducted between all cervical parameters.
Results
32% of subjects had kyphotic (??12°?±?7°), 27% straight (0°?±?3°) and 41% lordotic (12°?±?7°) cervical spines. While demographic and SF-36 data did not differ between groups, CBVA differed between lordotic and kyphotic groups (2° vs. 6.5°, p?=?0.002). Sagittal vertical axis (SVA) and thoracic kyphosis (TK) were lower in the kyphotic group (SVA: K?=???26?±?20 mm vs. L?=???2?±?21 mm, p?<?0.001; TK: K?=?40°?±?6° vs. L?=?51°?±?8°, p?<?0.001). C2 slope (K?=?29°?±?6° vs. L?=?18°?±?6°, p?<?0.001), C0–C2 (K?=?42°?±?8° vs. L?=?30°?±?8°, p?<?0.001) and C1–C2 (K?=?33°?±?6° vs. L?=?28°?±?6°, p?=?0.004) were higher in the kyphotic group. Significant correlations were found between almost all cervical parameters and C2–C7 angle.
Conclusions
Subjects with cervical kyphosis presented with more posterior global alignment and lower TK than subjects with lordosis. In order to maintain horizontal gaze, subjects with cervical kyphosis presented with a more lordotic upper cervical spine than subjects with cervical lordosis. Subjects with straight cervical curvature presented with an intermediate sagittal alignment.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
