Comparison of reticulocyte hemoglobin equivalent with traditional markers of iron and erythropoiesis in pediatric dialysis

Background

Anemia is a major complication for patients on chronic dialysis. Erythropoietin is effective if iron is available, however unnecessary iron supplementation results in iron overload. Reticulocyte hemoglobin equivalent (Ret-He) may be useful for assessing iron status.

Methods

A national retrospective cohort study including all children on chronic dialysis in New Zealand between 2007 and 2013, pairing Ret-He with demographic information, anemia indices, and markers of iron status.

Results

In 606 observations, we found a modest relationship between Ret-He and transferrin saturation (TSAT) (r?=?0.34, p?<?0.001) and a poor correlation between Ret-He and ferritin (r?=?0.09, p?=?0.04). There was a negative correlation between ferritin and hemoglobin (r?=??0.14, p?=?0.002), a weak positive correlation between TSAT and hemoglobin (r?=?0.12, p?=?0.007), and a modest positive correlation between Ret-He and hemoglobin (r?=?0.22, p?<?0.001). The diagnostic performance of Ret-He to detect absolute iron deficiency (cut-off value 28.9 pg, sensitivity 90 %, specificity 75 %, AUC 0.87) was good.

Conclusions

Ret-He is a more relevant marker of iron status than ferritin and TSAT. This supports prospectively testing Ret-He to distinguish between iron deficiency and suboptimal erythropoietin dosing as competing causes for anemia. Ferritin is an unhelpful biomarker of iron deficiency in this setting.

     

Exploration of Fluid Dynamics in Perioperative Patients Using Bioimpedance Analysis

Introduction

Perioperative fluid restriction is advocated to reduce complications after major surgeries. Current methods of monitoring body fluids rely on indirect volume markers that may at times be inadequate. In our study, bioimpedance analysis (BIA) was used to explore fluid dynamics, in terms of intercompartmental shift, of perioperative patients undergoing operation for hepato-pancreato-biliary (HPB) diseases.

Methods

A retrospective review was conducted, examining 36 patients surgically treated for HPB diseases between March 2010 and August 2012. Body fluid compartments were estimated via BIA at baseline (1 day prior to surgery), immediately after surgery, and on postoperative day 1, recording fluid balance during and after procedures. Patients were stratified by net fluid status as balanced (≤500 mL) or imbalanced (>550 mL) and outcomes of BIA compared.

Results

Mean net fluid balance volumes in balanced (n?=?16) and imbalanced (n?=?20) patient subsets were 231.41?±?155.44 and 1050.18?±?548.77 mL, respectively. Total body water (TBW) (p?=?0.091), extracellular water (ECW) (p?=?0.125), ECW/TBW (p?=?0.740), and intracellular water (ICW) (p?=?0.173) did not fluctuate significantly in fluid-balanced patients. Although TBW (p?=?0.069) in fluid-imbalanced patients did not change significantly (relative to baseline), ECW (p?=?0.001), ECW/TBW (p?=?0.019), and ICW (p?=?0.012) showed significant postoperative increases.

Conclusion

The exploration of fluid dynamics using BIA has shown importance of balanced fluid management during perioperative period. Increased ECW/TBW in fluid-imbalanced patients suggests possible causality for the development of ascites or fluid collections during postoperative period in patients undergoing HPB operations.

     

Quality of life in children with chronic kidney disease

Background

Progressive chronic kidney disease (CKD), irrespective of the underlying etiology, affects the quality of life (QoL) of children due to the need for regular follow-up visits, a strict medication program and diet intake.

Methods

The Greek version of the KIDSCREEN-52 multidimensional questionnaire was used in children with CKD, renal transplantation (RT) and in a control group (CG) of healthy children.

Results

Fifty-five patients between 8 and 18 years, with CKD (n?=?25), RT (n?=?16) and with end-stage renal disease (ESRD) on peritoneal dialysis (PD) (n?=?14) were included. Each group of studied children was compared with the CG (n?=?55), the validation sample (VS) (n?=?1200) and the parent proxy scores. Physical well-being of all studied children was significantly lower compared to CG (p?=?0.004). In contrast, all studied children between 8 and 11 years showed better social acceptance compared to VS (p?=?0.0001). When QoL of children with CKD was compared with parent proxy QoL, conflicting opinions were observed in several dimensions, such as self-perception (p?=?0.023), autonomy (p?=?0.012), school environment (p?=?0.012) and financial resources (p?=?0.03).

Conclusions

QoL and mainly the dimension of physical well-being, may be affected dramatically in children with CKD unrelated to disease stage. In early school years children with CKD seem to feel higher social acceptance than the healthy controls, exhibiting better score in this dimension. Optimal care requires attention not only to medical management, but also to an assessment of QoL factors, that may help promote pediatric patient’s health.

     

The Correlation Between Obesity-Related Diseases and Non-alcoholic Fatty Liver Disease in Women in the Pre-operative Evaluation for Bariatric Surgery Assessed by Transient Hepatic Elastography

Background

Non-alcoholic fatty liver disease (NAFLD) is a common, severe disease in obese patients. However, NAFLD is usually underestimated by ultrasonography. Liver biopsy is not routinely done in bariatric surgery or during the follow-up. This study therefore examined the correlation between metabolic syndrome and NAFLD in morbidly obese patients based on an assessment using transient hepatic elastography (THE).

Material and Methods

This study involved 50 female patients in the pre-operative phase for bariatric surgery. Before surgery, we collected clinical, laboratory, and anthropometric variables. THE measurements were obtained using a FibroScan® device (Echosens, Paris, France), and steatosis was quantified using Controlled Attenuation Parameter software (CAP). Statistical analyses were done using linear correlation and the Kruskal-Wallis test.

Results

The mean of THE and CAP values were 7.56?±?4.78 kPa and 279.94?±?45.69 dB/m, respectively, and there was a significant linear correlation between the two measurements (r?=?0.651; p?<?0.001). The numbers of metabolic syndrome parameters did not influence the THE (p?=?0.436) or CAP (p?=?0.422) values. HbA1c and HOMA-IR showed a strong linear correlation with CAP (r?=?0.643, p?=?0.013 and r?=?0.668, p?=?0.009, respectively) and a tendency to some linear correlation with THE (r?=?0.500, p?=?0.05 and r?=?0.500, p?=?0.002, respectively).

Conclusion

Morbidly obese women submitted to FibroScan® presented a high prevalence of severe steatosis and advanced fibrosis in our sample. Insulin resistance parameters were correlated with steatosis, but less with fibrosis.

     

Ghrelin and acyl ghrelin levels are associated with inflammatory and nutritional markers and with cardiac and vascular dysfunction parameters in hemodialysis patients

Purpose

Exogenous ghrelin is associated with cardiovascular protection in experimental and human studies. Nevertheless ESRD patients have increased ghrelin levels and severe cardiovascular comorbidities. This study aims to elucidate the metabolic factors influencing endogenous ghrelin/acyl ghrelin levels and to analyze the relation between endogenous ghrelin/acyl ghrelin levels and cardiac and vascular function markers in hemodialysis patients.

Methods

The cross-sectional study was conducted in hemodialysis patients (n?=?88); 50 of them were men, mean age 61.1?±?13.5 years, 17% had diabetes. We assessed nutritional and inflammatory status and analyzed the determinants of ghrelin/acyl ghrelin and their relation with cardiac and vascular function.

Results

Ghrelin is correlated with IL-1β (r?=?0.88, p?<?0.0001), triglycerides, total cholesterol (TC), and Kt/V. IL-1β is the strongest predictor of ghrelin levels (p?<?0.0001). Acyl ghrelin is correlated with TC (r?=?0.36, p?=?0.001), LDL-cholesterol, serum bicarbonate, body mass index. TC is the strongest predictor for acyl ghrelin levels (p?=?0.038). Patients with high ghrelin levels had significantly decreased nitroglycerin-mediated dilation (p?=?0.05) and higher IL-1β levels (p?<?0.001); increased NT-proBNP is associated with lower levels of acyl ghrelin (r?=???0.33, p?=?0.02) in male patients.

Conclusion

The inflammatory marker IL-1β is in our study the strongest predictor of ghrelin levels while the nutritional marker-total cholesterol is the strongest predictor for acyl ghrelin levels in HD patients. High endogenous ghrelin level is associated with high IL-1β and with vascular smooth muscle cell dysfunction. Low acyl ghrelin level is associated with high NT-proBNP (a cardiac dysfunction marker) in male HD patients. There is a direct correlation between endogenous ghrelin level and inflammatory markers, which is not related with cardiovascular protection.

     

Increased Bile Acids and FGF19 After Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Correlate with Improvement in Type 2 Diabetes in a Randomized Trial

Background

Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are both effective bariatric procedures to treat type 2 diabetes (T2DM) and obesity. The contribution of changes in bile acids (BAs) and fibroblast growth factor19 (FGF19) to such metabolic improvements is unclear.

Methods

We examined associations between changes in BAs, FGF19 (fasting and prandial), with changes in body weight, glycemia, and other metabolic variables in 61 obese patients with T2DM before and 1 year after randomization to SG or RYGB.

Results

Weight loss and diabetes remission (defined by HbA1c <?39 mmol/mol [<?5.7%] in the absence of glucose-lowering therapy) after RYGB and SG was similar (mean weight loss ??29 vs ??31 kg, p?=?0.50; diabetes remission proportion 37.5 vs 34%, p?=?1.0). Greater increments in fasting and prandial levels of total, secondary, and unconjugated BAs were seen after RYGB than SG. Fasting and prandial increases in total (r?=???0.3, p?=?0.01; r?=???0.2, p?=?0.04), secondary (r?=???0.3, p?=?0.01; r?=???0.4, p?=?0.01) and unconjugated BA (r?=???0.3, p?=?0.01; r?=?0.4, p?<?0.01) correlated with decreases in HbA1c, but not weight. Changes in 12α-OH/non 12α-OH were positively associated with prandial glucose increments (r?=?0.2, p?=?0.03), HbA1c (r?=?0.3, p?=?0.01), and negatively associated with changes in insulinogenc index (r?=???0.3, p?=?0.01). Only changes in prandial FGF19 were negatively associated with HbA1c (r?=???0.4, p?<?0.01) and visceral fat (r?=???0.3, p?=?0.04).

Conclusions/interpretation

The association between increases in secondary, unconjugated BAs and improvements in HBA1c (but not weight) achieved after both RYGB and SG suggest manipulation of BA as a potential strategy for controlling T2DM through weight-independent means.

     

Continuous renal replacement therapy in children: fluid overload does not always predict mortality

Background

Mortality among critically ill children requiring continuous renal replacement therapy (CRRT) is high. Several factors have been identified as outcome predictors. Many studies have specifically reported a positive association between the fluid overload at CRRT initiation and the mortality of critically ill pediatric patients.

Methods

This study is a retrospective single-center analysis including all patients admitted to the pediatric intensive care unit (PICU) of our hospital who received CRRT between 2000 and 2012. One hundred thirty-one patients were identified and subsequently classified according to primary disease. Survival rates, severity of illness and fluid balance differed among subgroups. The primary outcome was patient survival to PICU discharge.

Results

Overall survival to PICU discharge was 45.8 %. Based on multiple regression analysis, mortality was independently associated with onco-hematological disease [odds ratio (OR) 11.7, 95 % confidence interval (CI) 1.3–104.7; p?=?0.028], severe multiple organ dysfunction syndrome (MODS) (OR 5.1, 95 % CI 1.7–15; p?= 0.003) and hypotension (OR 11.6, 95 % CI 1.4–93.2; p?= 0.021). In the subgroup analysis, a fluid overload (FO) of more than 10 % (FO>10 %) at the beginning of CRRT seems to be a negative predictor of mortality (OR 10.9, 95 % CI 0.78–152.62; p?=?0.07) only in children with milder disease (renal patients). Due to lack of statistical power, the independent effect of fluid overload on mortality could not be analyzed in all subgroups of patients.

Conclusions

In children treated with CRRT the underlying diagnosis and severity of illness are independent risk factors for mortality. The degree of FO is a negative predictor only in patients with milder disease.

     

Adiponectin is related to markers of endothelial dysfunction and neoangiogenesis in diabetic patients

Purpose

Adiponectin an adipokine, produced by mature adipocyte, has an important effect on several aspects of endothelial function, including leukocyte adhesion (mediated by adhesion molecules like intercellular adhesion molecule 1 (ICAM1) endothelial cell selective adhesion molecule ESAM). Recently, it has been linked to vascular endothelial growth factor (VEGF)-modulated angiogenesis. ESAM might also be involved in modulating VEGF-dependent actions. We studied relationship of adiponectin to ESAM, ICAM1, and VEGF in type 2 diabetic patients (T2DP) with or without microvascular complications.

Methods

Incident T2DP referred for nephrologic evaluation were included (patients with no nephropathy or stage 1–4 nephropathy). T2DP with stage 5 chronic kidney disease (CKD) were selected from a dialysis center. Clinical, standard laboratory assessment and adiponectin, ESAM, ICAM1, and VEGF (ELISA) were recorded.

Results

Eighty-seven patients were included, 15 had no CKD, 30 with stage 1 or 2 CKD, 20 with stage 3 or 4 CKD and 22 patients on dialysis. ESAM was higher in patients with CKD than in those without CKD (p?=?0.02), adiponectin, ICAM1, and VEGF were similar. Adiponectin correlated in univariate analysis to ESAM (r?=?0.32, p?=?0.002), ICAM1 (r?=?0.23, p?=?0.038), and CRP (r?=?0.31, p?=?0.012), and inversely to serum albumin (r?=???0.57, <?0.0001). In predialysis patients, adiponectin also correlated to albuminuria (r?=?0.54, p?<?0.0001) and glomerular filtration rate (r?=???0.46, p?=?0.0001). In multivariate regression ESAM (p?=?0.04), VEGF (p?=?0.03), and albumin (p?<?0.0001) are significant predictors of adiponectin. None of these cytokines were different when comparing patients with and without retinopathy.

Conclusion

Adiponectin is directly linked to adhesion molecules and VEGF in T2DP.

     

Platelet Counts and Liver Enzymes After Gastric Bypass Surgery

Background

Obesity is associated with chronic inflammation, liver steatosis and increased liver enzymes such as gamma-glutamyltransferase (GGT) and alanine aminotransferase (ALT), markers for non-alcoholic fatty liver disease (NAFLD) and liver fat content. Increased platelet counts (PCs) are a biomarker reflecting inflammation and the degree of fibrosis in NAFLD. We investigated alterations in PCs, GGT, ALT, C-reactive protein (CRP) and ferritin after Roux-en-Y gastric bypass (RYGBP).

Methods

One hundred twenty-four morbidly obese non-diabetic patients were evaluated before (baseline) and 12 months after (follow-up) RYGBP.

Results

Body mass index (BMI) was reduced from 43.5 kg/m² (baseline) to 31.1 kg/m² (follow-up), and p?<?0.001 and weight declined from 126.2 to 89.0 kg. PCs decreased from 303?×?10⁹ to 260?×?10⁹/l, p?<?0.001. GGT was reduced from 0.63 to 0.38 μkat/l, p?<?0.001. ALT decreased from 0.69 to 0.59 μkat/l, p?=?0.006. CRP was lowered from 7.3 to 5.4 mg/l p?<?0.001 and ferritin from 106 to 84 μg/l p?<?0.001. The alterations in PCs correlated with the changes in CRP (r?=?0.38, p?=?0.001), BMI (r?=?0.25, p?=?0.012), weight (r?=?0.24, p?=?0.015) and inversely correlated with ferritin (r?=?21, p?=?0.036).

Conclusions

PCs, GGT and ALT (markers for NAFLD), and CRP and ferritin (markers for inflammation) decreased in morbidly obese after RYGBP. The decrease in PCs correlated with alterations in CRP, BMI, weight and ferritin. The lowering of liver enzymes may reflect a lowered liver fat content and decreased general inflammation.

     

Academic Surgical Oncologists’ Productivity Correlates with Gender,Grant Funding,and Institutional NCI Comprehensive Cancer Center Affiliation

Background

A scholar’s h-index is defined as the number of h papers published, each of which has been cited at least h times. We hypothesized that the h-index strongly correlates with the academic rank of surgical oncologists.

Methods

We utilized the National Cancer Institute (NCI) website to identify NCI-designated Comprehensive Cancer Centers (CCC) and Doximity to identify the 50 highest-ranked general surgery residency programs with surgical oncology divisions. Demographic data of respective academic surgical oncologists were collected from departmental websites and Grantome. Bibliometric data were obtained from Web of Science.

Results

We identified 544 surgical oncologists from 64 programs. Increased h-index was associated with academic rank (p?<?0.001), male gender (p?<?0.001), number of National Institutes of Health (NIH) grants (p?<?0.001), and affiliation with an NCI CCC (p?=?0.018) but not number of additional degrees (p?=?0.661) or Doximity ranking (p?=?0.102). H-index was a stronger predictor of academic rank (r?=?0.648) than total publications (r?=?0.585) or citations (r?=?0.450).

Conclusions

This is the first report to assess the h-index within academic surgical oncology. H-index is a bibliometric predictor of academic rank that correlates with NIH grant funding and NCI CCC affiliation. We also highlight a previously unexpected and unappreciated gender disparity in the academic productivity of US surgical oncologists. When academic rank was accounted for, female surgical oncologists had lower h-indices compared with their male colleagues. Evaluation of the etiologies of this gender disparity is needed to address barriers to academic productivity faced by female surgical oncologists as they progress through their careers.

     

Altmetric Versus Bibliometric Perspective Regarding Publication Impact and Force

Background

Bibliometric and Altmetric analyses highlight key publications, which have been considered to be the most influential in their field. The hypothesis was that highly cited articles would correlate positively with levels of evidence and Altmetric scores (AS) and rank.

Methods

Surgery as a search term was entered into Thomson Reuter’s Web of Science database to identify all English-language full articles. The 100 most cited articles were analysed by topic, journal, author, year, institution, and AS.

Results

By bibliometric criteria, eligible articles numbered 286,122 and the median (range) citation number was 574 (446–5746). The most cited article (Dindo et al.) classified surgical complications by severity score (5746 citations). Annals of Surgery published most articles and received most citations (26,457). The country and year with most publications were the USA (n?=?50) and 1999 (n?=?11). By Altmetric criteria, the article with the highest AS was by Bigelow et al. (AS?=?53, hypothermia’s role in cardiac surgery); Annals of Surgery published most articles, and the country and year with most publications were USA (n?=?4) and 2007 (n?=?3). Level-1-evidence articles numbered 13, but no correlation was found between evidence level and citation number (SCC 0.094, p?=?0.352) or AS (SCC?=?0.149, p?=?0.244). Median AS was 0 (0–53), and in articles published after the year 2000, AS was associated with citation number (r?=?0.461, p?=?0.001) and citation rate index (r?=?0.455, p?=?0.002). AS was not associated with journal impact factor (r?=?0.160, p?=?0.118).

Conclusion

Bibliometric and Altmetric analyses provide important but different perspectives regarding article impact, which are unrelated to evidence level.

     

Clinical and ultrasonographic evaluation of the pelvic floor in primiparous women: a cross-sectional study

Introduction and hypothesis

We used clinical examination and transperineal 3D/4D ultrasound (US) to evaluate pelvic floor muscles (PFM) after different delivery modes.

Methods

Women were surveyed using validated questionnaires. PFM were evaluated and classified according to the Modified Oxford Scale following 3D/4D transperineal US. For statistical analysis, Kruskal–Wallis, Mann–Whitney, chi-square, and Fisher exact tests were used.

Results

Fifty-three women were evaluated: 32 with previous vaginal delivery (VD) and 21 with cesarean section (CS) (8 nonelective and 13 elective). No significant difference among groups was observed regarding urinary incontinence (UI) after delivery (p?=?0.39), loss of muscle strength referred by the patient (p?=?0.48), or evaluated through digital examination (p?=?0.87). No patient with elective CS had avulsion, with difference between VD and elective CS (p?=?0.008). US evaluation identified no differences in bladder-neck elevation (p?=?0.69) or descent (p?=?0.65) , and no difference in genital hiatus size (p?=?0.35), levator ani thickness (p?=?0.35 –0.44), or presence of major or minor levator ani avulsion (p?=?0.10).

Conclusions

We evaluated primiparous women within 12 to 24 months of delivery and found that VD was associated with PFM avulsion. There was no difference among VD and nonelective or elective CS in symptomatology or other anatomic alterations evaluated through 3D/4D transperineal US.

     

Effect of essential amino acid кetoanalogues and protein restriction diet on morphogenetic proteins (FGF-23 and Кlotho) in 3b–4 stages chronic кidney disease patients: a randomized pilot study

Background

A low protein diet (LPD) with essential amino acid ketoanalogue supplementation (KA) may contribute in improving of chronic kidney disease (CKD), while the exact mechanisms of KA’s effect are not established yet. We have conducted a prospective, randomized, controlled comparative study of LPD?+?KA and LPD alone in relation to serum Klotho, FGF-23 levels in CKD patients.

Methods

79 non-diabetic CKD 3b–4 stage patients, compliant with LPD diet (0.6 g/kg of body weight/day), had been selected. The patients were randomized into two groups. The first group (42 patients) received LPD + КA. The second group (37 patients) continued the LРD alone. In addition to routine tests, serum Klotho, FGF-23 levels, as well as bioimpedance analysis, sphygmography (stiffness (augmentation) indices (AI), central (aortal) blood pressure) with a «SphygmaCor» device; echocardiography (valvular calcification score (VCS) and LVMMI), were performed.

Results

There were body mass indices’ decrease (p?=?0.046), including muscle body mass in men (p?=?0.027) and woman (p?=?0.044) in the LPD group to the end of study (14th month). In addition, lower FGF-23 (p?=?0.029), and higher sKlotho (p?=?0.037) were detected in the LPD?+?KA group compared to the LPD one. The increase in AI (p?=?0.034), VCS (p?=?0.048), and LVMMI (p?=?0.023) was detected more often in the LPD group at the end of study.

Conclusion

LPD?+?KA provides support for nutrition status and contributes to more efficient correction of FGF-23 and Klotho abnormalities that may result in cardiovascular calcification and cardiac remodeling decreasing in CKD. At the same time, a prolonged LPD alone may lead to malnutrition.

     

Neurocognitive functions of pediatric kidney transplant recipients

Background

End-stage renal disease (ESRD) in children is associated with impaired neurocognitive function and development. However, data on factors associated with neurocognitive dysfunctions in children with kidney transplants are limited.

Methods

We conducted a cross-sectional analysis comparing cognitive functions (using the Woodcock-Johnson International Edition, WJIE) in 35 kidney transplant and 35 healthy control children. Data on laboratory measurements, comorbidities, and social characteristics were collected.

Results

Transplant children had significantly worse scores on the intelligence quotient (IQ) test compared with controls [Full Scale IQ score 85 (26) vs 107 (10), p <0.001]. Lower maternal education level was significantly associated with lower WJIE cognitive test scores; however, no association was found between laboratory values and WJIE scores. Among children with kidney transplants, those with medical comorbid conditions had significantly lower Verbal Ability and Full Scale IQ scores. Earlier age of dialysis onset and a longer total time on dialysis (>9 months) were associated with lower test scores. Age-standardized duration of hospitalization was inversely correlated with IQ (r?=??0.46, p <0.01) and was an independent significant predictor (Beta?=??0.38, p?=?0.02) of IQ scores in transplanted children.

Conclusions

Child kidney transplant recipients have neurocognitive function impairments that are associated with markers of socioeconomic status (SES) and factors related to disease severity.

     

Validation of the International Consultation on Incontinence Questionnaire–Vaginal Symptoms (ICIQ-VS) in two south- Asian languages

Introduction

The multifaceted nature of pelvic floor disorders means that a systematic evaluation is required for optimal treatment outcome. It is also generally acknowledged that a valid tool is necessary to objectively assess symptoms reported by affected women.

Methods

The International Consultation on Incontinence Questionnaire—Vaginal Symptoms (ICIQ-VS) questionnaire was translated to Sinhala and Tamil and a validation study carried out among women attending gynecology clinics at North Colombo Teaching Hospital, Ragama, and the district general hospitals Mannar and Vavuniya.

Results

Content validity was assessed by the level of missing answers, which was < 4% and 2% for each item in Sinhala and Tamil, respectively. Construct validity was assessed by the ability of the questionnaire to differentiate between patients and controls. Both differentiated patients from controls on vaginal symptoms score (VSS) (p?<?0.001), sexual symptoms score (SSS) (p?<?0.01), and quality of life (QoL) (p?<?0.001). There was a strong positive correlation between Pelvic Organ Prolapse Quantification (POP-Q) scores and VSS (Sinhala r _s ?=?0.64, p?<?0.001, Tamil r _s ?=?0.65, p?<?0.001), and QoL (Sinhala r _s ?=?0.49, p?<?0.001, Tamil r _s ?=?0.60, p?<?0.001). Internal consistency as assessed using Cronbach’s coefficient alpha: 0.78 (0.76–0.78) and 0.83 (0.80–0.84) in Sinhala and Tamil, respectively. Test–retest reliability was assessed by weighted kappa scores (Sinhala 0.58–0.88 and Tamil 0.76–0.90). Both questionnaires were sensitive to change and showed that VSS and QoL improved following surgery (Wilcoxon matched-pairs signed-rank test p?<?0.001).

Conclusion

The validated Sinhala and Tamil translations of ICIQ-VS will be useful for assessing vaginal and sexual symptoms among women speaking Sinhala and Tamil.

     

Reliability and validity of a Turkish version of the Global Pelvic Floor Bother Questionnaire

Introduction and hypothesis

The aim of this study was to translate the Global Pelvic Floor Bother Questionnaire (GPFBQ) into Turkish and to assess its validity and reliability.

Methods

The Turkish adaptation of the GPFBQ was created by following the stages of the intercultural adaptation process. A test–retest interval of 1 week was used to assess the reliability, which was examined by the intraclass correlation coefficient. The validity of the GPFBQ was assessed and compared with the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) using Spearman’s rank correlation coefficients. For construct validity, confirmatory factor analysis was performed.

Results

A total of 131 women, whose mean age was 46.83 years, were included in the study. The test–retest reliability of the GPFBQ was excellent (0.998, p?<?0.0001). The GPFBQ correlated significantly with the PFDI-20 (r?=?0.860, p?=?0.00) and PFIQ-7 (r?=?0.802, p?=?0.00). Confirmatory factor analysis was performed to determine construct validity, and it was found that it had four dimensions.

Conclusions

The Turkish version of the GPFBQ is a valid and reliable tool for assessing the symptoms of bother and severity in Turkish-speaking women with pelvic floor dysfunction.

     

The significance of tubulointerstitial lesions in childhood Henoch–Schönlein nephritis

Background

Little information is currently available on the development of tubulointerstitial lesions in children with Henoch–Schönlein nephritis (HSN). To identify the impact of the development of tubulointerstitial changes in HSN, we retrospectively analyzed renal biopsies obtained from children with HSN.

Methods

Twenty-eight children with HSN from whom serial renal biopsies had been obtained before and after immunosuppressive therapy were enrolled in the study. The patients were divided into two groups according to the observed change in tubulointerstitial lesion development: group I (n?=?15), with stable or improved tubulointerstitial lesions, and group II (n?=?13), with worsened tubulointerstitial lesions. Group II patients had longer duration of proteinuria than group I patients (3.7?±?3.7 years vs. 1.7?±?1.7 years, p?=?0.052).

Results

The change in serum albumin level was negatively correlated with the change in tubulointerstitial scores before and after treatment (γ?=??0.444, p?=?0.018). Group II patients showed a significant decrease in immunoglobulin G (IgG) and IgA deposits after treatment (p?=?0.039 and 0.003, respectively), while group II patients did not (p?=?0.458 and 0.506, respectively).

Conclusions

Although the International Study of Kidney Disease in Children classification of HSN does not include tubulointerstitial lesions, they can progress during treatment and could have significant clinical implications in association with the duration of proteinuria.

     

Long term outcomes in the use of ileal ureter for radiation-induced ureteral strictures

Purpose

Radiation-induced ureteral stricture disease poses significant surgical challenges. Ureteral substitution with ileum has long been a versatile option for reconstruction. We evaluated outcomes in patients undergoing ileal ureter replacement for ureteral reconstruction due to radiation-induced ureteral stricture versus other causes.

Methods

Between July 1989 and June 2013, 155 patients underwent consecutive ileal ureter creation. The study cohort included 104 patients with complete data sets and at least 7 months of follow up. Records were retrospectively reviewed with regard to demographics, indications, complications, and renal deterioration.

Results

Surgical indications included radiation-induced stricture in 23 (22%) and non-radiation-induced stricture in 81 (78%). Comparing ileal ureter substitution due to radiation versus other stricture etiologies, no statistical significance was observed in regard to age (45.6 vs. 51.2, p?=?0.141), hospital length of stay in days (8.8 vs. 7.7, p?=?0.216), percent GFR loss (MDRD-4 vs. -5%, p?=?0.670 and CKD-EPI-7 vs. -6%, p?=?0.914), 30-day surgical complications (26.1 vs. 30.1%, p?=?0.658), metabolic acidosis (8.7 vs. 1.2%, p?=?0.059), and renal failure requiring dialysis (4.3 vs. 1.2%, p?=?0.337). Fistula formation (13.0 vs. 3.7%, p?=?0.095), partial small bowel obstructions (21.7 vs. 7.4%, p?=?0.063), and small bowel obstructions requiring reoperation (13.0 vs. 1.2%, p?=?0.033) approached or reached statistical significance. Using Kaplan–Meier methodology, there was no difference in time to worsening renal outcome between the radiation and non-radiation groups (p?>?0.05).

Conclusion

Ureteral substitution with ileum is an effective reconstructive option for radiation-induced ureteral strictures in carefully selected patients.

     

The unresolved problem of beta-2 microglobulin amyloid deposits in the intervertebral discs of long-term dialysis patients

Background

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.

     

Prognostic Value of Lymph Node Status and Extent of Lymphadenectomy in Pancreatic Neuroendocrine Tumors Confined To and Extending Beyond the Pancreas

Background

The impact of lymph node (LN) status and lymphadenectomy (LA) on survival in pancreatic neuroendocrine tumors (pNETs) remains controversial. We evaluated the impact of tumor extension and grade on nodal metastasis and survival.

Methods

Surgical pNET patients were queried in the Surveillance Epidemiology and End Results (SEER) database (1998–2012, N?=?981). Factors associated with LN status were analyzed by logistic regression and by Cox analyses.

Results

For T1–T2 tumors, N status was associated only with tumor size. N status (p?=?0.001), grade (p?<?0.001), age (p?=?0.001), and sex (p?=?0.007) predicted overall survival (OS). For T3–T4, grade (p?<?0.001), sex (p?=?0.004), size (p?=?0.013), and age (p?=?0.007) but not N status (p?=?0.789) predicted OS. For T1–T2, disease-specific survival (DSS; p?=?0.003) and OS (p?=?0.008) were longer for N0 vs N1, while N0 vs NX had similar OS (p?=?0.59) and DSS (p?=?0.80). While a difference was seen in DSS for NX vs N1 (p?=?0.04), no significant difference in OS was seen (p?=?0.08). For T3–T4, N status did not affect DSS (p?=?0.365) or OS (p?=?0.454). For all T groups and any N status, extended LA (≥10 nodes resected) was not associated with OS.

Conclusion

While in T1–T2 pNET N1 status is a predictor of negative OS, similar outcome between NX and N0 supports limited LN resection in selected patients. Extended LA is unlikely to be helpful in T3–T4.