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1.
Małgorzata Baumert Piotr Surmiak Andrzej Więcek Zofia Walencka 《Clinical and experimental nephrology》2017,21(4):658-664
Background
Acute kidney injury (AKI) is the most common complication of perinatal asphyxia. Recent research indicates that serum neutrophil gelatinase-associated lipocalin (NGAL) is an early marker for AKI, but there are the lacks of data about its use in term neonates with perinatal asphyxia.Methods
A prospective cohort study was conducted on 43 term neonates. Umbilical cord blood and 24 h after birth serum NGAL, copeptin, creatinine, and molality were measured in all asphyxiated and controls neonates.Results
During the study period, 8 of asphyxiated nenates (18.6 %) suffered from AKI, while 35 newborns have no signs of AKI and 30 healthy infants. We did not observe any differences in creatinine and copeptin levels, as well as serum osmolality in all three investigated groups (AKI, no-AKI, and controls) in cord blood, and 24 h after birth. Serum NGAL levels in umbilical cord blood were significantly higher in the AKI group (174.3 ng/mL) compared with no-AKI (88.5 ng/mL, p = 0.01) and control groups (28.5 ng/mL, p < 0.001), and 24 h after birth (respectively, AKI 152.5 ng/mL vs no-AKI 74.9 ng/mL, p = 0.02 vs controls 39.1 ng/mL, p < 0.001). NGAL concentration showed a strong negative correlation to umbilical artery pH (Rho = ?0.42, p = 0.04), base excess (Rho = ?0.31, p = 0.03), and Apgar score in 1st min (Rho = ?0.41, p = 0.02) and 5th min of life (Rho = ?0.20, p = 0.001). ROC curve analysis demonstrated a good predictive value for NGAL levels (>140.7 ng/mL) which allows to diagnose AKI in asphyxiated patients with 88.9 % sensitivity (95 % CI 75–95 %) and 95.0 % specificity (95 % CI 76–99 %).Conclusion
NGAL seems to be a promising marker, even in subclinical AKI in neonates, due to its high specificity, but copeptin did not meet expectations.2.
Meng Gu Chong Liu Yan-bo Chen Huan Xu Shi Fu Qi Chen Zhong Wang 《International urology and nephrology》2018,50(5):819-823
Purpose
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.3.
Ville Wallenius Eveline Dirinck Lars Fändriks Almantas Maleckas Carel W le Roux Anders Thorell 《Obesity surgery》2018,28(6):1461-1472
Background
Roux-en-Y gastric bypass (LRYGB) has weight-independent effects on glycemia in obese type 2 diabetic patients, whereas sleeve gastrectomy (LSG) is less well characterized. This study aims to compare early weight-independent and later weight-dependent glycemic effects of LRYGB and LSG.Methods
Eighteen LRYGB and 15 LSG patients were included in the study. Glucose, insulin, GLP-1, and GIP levels were monitored during a modified 30 g oral glucose tolerance test before surgery and 2 days, 3 weeks, and 12 months after surgery. Patients self-monitored glucose levels 2 weeks before and after surgery.Results
Postoperative fasting blood glucose decreased similarly in both groups (LRYGB vs. SG; baseline—8.1?±?0.6 vs. 8.2?±?0.4 mmol/l, 2 days—7.8?±?0.5 vs. 7.4?±?0.3 mmol/l, 3 weeks—6.6?±?0.4 vs. 6.6?±?0.3 mmol/l, respectively, P <?0.01 vs. baseline for both groups; 12 months—6.6?±?0.4 vs. 5.9?±?0.4, respectively, P <?0.05 for LRYGB and P <?0.001 for LSG vs. baseline, P =?ns between the groups at all times). LSG, but not LRYGB, showed increased peak insulin levels 2 days postoperatively (mean?±?SEM; LSG +?58?±?14%, P <?0.01; LRYGB ??8?±?17%, P =?ns). GLP-1 levels increased similarly at 2 days, but were higher in LRYGB at 3 weeks (AUC; 7525?±?1258 vs. 4779?±?712 pmol?×?min, respectively, P <?0.05). GIP levels did not differ. Body mass index (BMI) decreased more after LRYGB than LSG (??10.1?±?0.9 vs. ??7.9?±?0.5 kg/m2, respectively, P <?0.05).Conclusion
LRYGB and LSG show very similar effects on glycemic control, despite lower GLP-1 levels and inferior BMI decrease after LSG.4.
Hisayo Fujita Masayoshi Shinjoh Tomohiro Ishii Midori Awazu 《Pediatric nephrology (Berlin, Germany)》2016,31(8):1349-1353
Introduction
The fractional excretion of sodium (FENa) has been used as an index for the differential diagnosis of acute tubular necrosis (ATN) and prerenal acute kidney injury (AKI). The reliability of this index, however, decreases with the use of the diuretic agent furosemide. The fractional excretion of urea nitrogen (FEUN) has been shown to be useful in such settings in adults. The objective of this study was to examine whether FEUN is also useful in these settings in children.Methods
We assessed 102 episodes of AKI in 74 children, classifying these into three groups based on history, physical examination, urine examination and subsequent clinical course: (1) prerenal AKI without furosemide (N?=?37), (2) prerenal AKI with furosemide (N?=?32) and (3) ATN (N?=?33).Results
Of the 37 prerenal AKI episodes without furosemide, 35 showed low FENa of <1 %, with an overall average of 0.35?±?0.11 %, whereas prerenal AKI with furosemide (1.63?±?0.37 %) and ATN (8.76?±?2.11 %) were associated with a higher FENa. FEUN in the clinical setting of prerenal AKI was lower than that in ATN (27.9?±?2.1 vs. 51.6?±?3.8 %, respectively) and, in contrast to FENa, not significantly different between the categories of prerenal AKI with and without furosemide (29.2?±?3.1 vs. 25.1?±?2.9, respectively). The sensitivity of FEUN <35 % was 75 % in prerenal AKI with furosemide, whereas that of FENa was 53 %.Conclusions
FEUN is useful in detecting prerenal AKI in children administered furosemide.5.
Bhumy A. Davé Camaleigh Jaber Alix Leader-Cramer Nicole Higgins Margaret Mueller Christina Lewicky-Gaupp Kimberly Kenton 《International urogynecology journal》2016,27(9):1327-1332
Introduction and hypothesis
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.6.
Jinqian Liang Jianhua Hu Chong Chen Hao Yin Fangliang Dong 《Journal of orthopaedic surgery and research》2017,12(1):196
Background
Although measures to reduce and treat the postoperative surgical drain output are discussed, along with the increased interest in causative factors related to the prevention and treatment reported by many studies, these are still controversial.Methods
A retrospective study was conducted on a consecutive series of 217 patients who had underwent ACCF between January 2016 and March 2017. Patients were categorized based on normal or increased total drain output. These two groups were compared for demographic distribution and clinical data to investigate the predictive factors of increased drain output by multivariate analysis.Results
The overall incidence rate of increased drain output after ACCF was 16.6%. There are no significant differences in sex, BMI, history of taking aspirin, and ASA classification between the two groups (P?>?0.05). Of the patients with increased drain output, a significantly higher proportion of patients have OPLL in the surgical level, 18 (50.0%) versus 33 (18.2%) (P?=?0.000). The mean age was 60.67?±?8.18 years versus 54.41?±?10.05 years (P?=?0.001). Number of discs involved was 2.42?±?0.50 versus 2.02?±?0.65 (P?=?0.001). Operation time was 112.22?±?16.49 min versus 105.21?±?17.89 min (P?=?0.031). Intraoperative blood loss was 109.86?±?62.02 mL versus 87.83?±?56.40 mL (P?=?0.036). Logistic regression analysis showed that age (OR, 1.075; p?=?0.003), history of smoking (OR, 2.792; p?=?0.021), OPLL in surgical level (OR, 2.107; p?=?0.001), and number of discs involved (OR, 2.764; p?=?0.003) maintained its significance in predicting likelihood of increased surgical drain output.Conclusions
The occurrence of increased drain output after ACCF is most likely multifactorial and is related to age, history of smoking, OPLL in surgical level, and number of discs involved.7.
Melika Fallah Gholamreza Askari Alireza Soleimani Awat Feizi Zatollah Asemi 《International urology and nephrology》2018,50(11):2073-2079
Purpose
The current study was conducted to determine the effects of coenzyme Q10 (CoQ10) supplementation on glycemic control and markers of lipid profiles risk in diabetic hemodialysis (HD) patients.Methods
This randomized, double blind, placebo-controlled clinical trial was performed among 60 diabetic HD patients. Subjects were randomly allocated into two groups to take either 120 mg/day of CoQ10 supplements or placebo (n?=?30 each group) for 12 weeks.Results
After 12 weeks of intervention, CoQ10 supplementation, compared with the placebo, resulted in a significant decrease in serum insulin concentrations (??2.5?±?4.0 vs. +?2.8?±?5.3 µIU/mL, P?<?0.001), homeostasis model of assessment-estimated insulin resistance (??0.9?±?2.1 vs. +?1.2?±?3.0, P?=?0.002), and significant increase in the quantitative insulin sensitivity check index (+?0.009?±?0.01 vs. ??0.02?±?0.05, P?=?0.003). In addition, a trend toward a greater decrease in serum triglycerides (??5?±?53 vs. +?17?±?44, P?=?0.078) and VLDL-cholesterol levels (??0.9?±?10 vs. +?3?±?9, P?=?0.078) was observed in the CoQ10 group compared to the placebo group. We did not observe any significant effect of CoQ10 supplementation on fasting glucose, HbA1c and other lipid profiles compared with the placebo.Conclusions
Overall, our study supported that CoQ10 supplementation to diabetic HD patients for 12 weeks had beneficial effects on markers of insulin metabolism, but did not affect fasting glucose, HbA1c, and lipid profiles. Clinical registration http://www.irct.ir: IRCT2016081811763N30.8.
Qingyan Zhang Miao Zhang Hengjin Wang Cheng Sun Yuan Feng Wei Zhu Dongwei Cao Qiuyuan Shao Nan Li Yangyang Xia Tianfeng Tang Cheng Wan Jing Liu Bo Jin Min Zhao Chunming Jiang 《International urology and nephrology》2018,50(5):923-927
Purpose
Hypovitaminosis D is common in chronic kidney disease (CKD) and is associated with endothelial dysfunction and cardiovascular events. This study aimed to investigate the effects of vitamin D supplementation on endothelial dysfunction in non-dialysis CKD patients.Materials and methods
Seventy-one non-dialysis CKD patients with low vitamin D (serum 25(OH)D < 30 ng/mL) were recruited. Patients received oral cholecalciferol 50,000 units once a week for 12 weeks. Changes in endothelial function by brachial artery flow-mediated dilation (FMD), soluble vascular cell adhesion molecule-1 (sVCAM-1), and sE-selectin were studied.Results
There was a significant increase in serum levels of 25(OH)D after cholecalciferol supplementation (33.7 ± 12.1 vs. 13.2 ± 5.4 ng/mL, P < 0.001). Multivariable regression analysis showed that higher proteinuria (β = ? 0.548, P < 0.001) and lower levels of 25(OH)D (β = 0.360, P < 0.001) at baseline were related to lower 25(OH)D level after supplementation. FMD increased significantly from 4.4 ± 1.3 to 5.1 ± 1.5% (P < 0.001), and soluble endothelial biomarkers decreased: sVCAM-1 from 926.9 ± 158.0 to 867.0 ± 129.0 ng/mL (P < 0.001), and sE-selectin 69.7 ± 15.8 to 63.3 ± 14.7 ng/mL (P < 0.001).Conclusions
Vitamin D supplementation can improve endothelial dysfunction in pre-dialysis CKD patients.9.
A. Lenore Ackerman Una J. Lee Forrest C. Jellison Nelly Tan Maitraya Patel Steven S. Raman Larissa V. Rodriguez 《International urogynecology journal》2016,27(1):77-83
Introduction and hypothesis
In interstitial cystitis/bladder pain syndrome (IC/BPS), pelvic floor dysfunction may contribute significantly to pelvic pain. To determine if pelvic floor hypertonicity manifests alterations on magnetic resonance imaging (MRI) in patients with IC/BPS, we retrospectively compared pelvic measurements between patients and controls.Methods
Fifteen women with IC/BPS and 15 age-matched controls underwent pelvic MRI. Two blinded radiologists measured the pelvic musculature, including the H- and M lines, vaginal length, urethral length and cross-sectional area, levator width and length, and posterior puborectalis angle. MRI measures and clinical factors, such as age, parity, and duration of symptoms, were compared using a paired, two-tailed t test.Results
There were no significant differences in age, parity, or symptom duration between groups. Patients with IC/BPS exhibited shorter levator muscles (right: 5.0?±?0.7 vs. 5.6?±?0.8, left: 5.0?±?0.8 vs. 5.7?±?0.8 cm, P?<?0.002) and a wider posterior puborectalis angle (35.0?±?8.6 vs. 26.7?±?7.9°, P?<?0.01) compared with controls. The H line was shorter in patients with IC/BPS (7.8?±?0.8 vs. 8.6?±?0.9 cm, P?<?0.02), while M line did not differ. Total urethral length was similar, but vaginal cuff and bladder neck distances to the H line were longer in patients with IC/BPS (5.7?±?0.6 vs. 5.1?±?0.9 cm, P?<?0.02; 1.9?±?0.4 vs. 1.4?±?0.2 cm, P?<?0.001, respectively).Conclusions
Patients with IC/BPS have pelvic floor hypertonicity on MRI, which manifests as shortened levator, increased posterior puborectalis angles, and decreased puborectal distances. We identified evidence of pelvic floor hypertonicity in patients with IC/BPS, which may contribute to or amplify pelvic pain. Future studies are necessary to determine the MRI utility in understanding pelvic floor hypertonicity in patients with IC/BPS.10.
Saachi Sachdev Qi Wang Charles Billington John Connett Leaque Ahmed William Inabnet Streamson Chua Sayeed Ikramuddin Judith Korner 《Obesity surgery》2016,26(5):957-965
Background
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.11.
Purpose
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.12.
Hyo-Seok Na Ah-Young Oh Jung-Hee Ryu Bon-Wook Koo Sun-Woo Nam Jihoon Jo Jae-Hee Park 《Journal of gastrointestinal surgery》2018,22(5):771-777
Background
We assessed whether intraoperative nefopam would reduce opioid consumption and relieve postoperative pain in patients undergoing laparoscopic gastrectomy.Methods
The 60 enrolled patients were randomly assigned to the control (n?=?32) or nefopam (n?=?28) group. All patients were blinded to their group assignment. We administered 100 ml of normal saline only (control group) or 20 mg of nefopam mixed in 100 ml normal saline (nefopam group) after anesthesia induction and at the end of surgery. The cumulative amount of fentanyl via intravenous patient-controlled analgesia (PCA), incidence of rescue analgesic medication, and numerical rating scale (NRS) for postoperative pain were evaluated along with the total remifentanil consumption.Results
The mean infusion rate of remifentanil was significantly lower in the nefopam group (0.08?±?0.05 μg/kg/min) than in the control group (0.13?±?0.06 μg/kg/min) (P?<?0.001). Patients in the nefopam group required less fentanyl via intravenous PCA than those in the control group during the first 6 h after surgery (323.8?±?119.3 μg vs. 421.2?±?151.6 μg, P?=?0.009). Additionally, fewer patients in the nefopam group than in the control group received a rescue analgesic during the initial 6 h postoperatively (78.6 vs. 96.9%, P?=?0.028). The NRS measured while patients were in the post-anesthetic care unit was significantly lower in the nefopam group than in the control group (3.8?±?1.1 vs. 4.8?±?1.4, P?=?0.012). The subsequent NRS obtained after patients had been transferred to the general ward was comparable between the two groups during the following postoperative period.Conclusions
Intraoperative nefopam decreased postoperative pain and opioid consumption in the acute postoperative period after laparoscopic gastrectomy. Hence, nefopam may be considered as a component of multimodal analgesia after laparoscopic gastrectomy.13.
Purpose
This study was performed to assess the effectiveness of the combined intravenous and intra-articular tranexamic acid (TXA) regimen in total knee arthroplasty (TKA).Methods
The perioperative blood loss in 75 consecutive patients undergoing unilateral TKA that received both 1000 mg of TXA intravenously and 1000 mg of intra-articular TXA (combined TXA group) was compared with a consecutive series of 77 patients that received 1000 mg of TXA intravenously (intravenous TXA group). An additional 1000 mg of intravenous TXA was administered 6 h after the initial administration in both groups. Neither a pneumatic tourniquet nor drain was used. The primary outcome was the perioperative blood loss at 3 days after TKA calculated using the blood volume and change in haemoglobin from the preoperative value.Results
The perioperative blood loss was significantly lower in the combined TXA group at 3 days after TKA than the intravenous TXA group (686?±?303 vs. 830?±?317 mL; 95% CI 44–244 mL; p?=?0.0049). The perioperative blood loss was also lower in the combined TXA group at 1 and 7 days after TKA (374?±?265 vs. 459?±?226 mL; 95% CI 7–165 mL; p?=?0.034 and 751?±?320 vs. 871?±?327 mL; 95% CI 16–224 mL; p?=?0.024, respectively). No thrombotic events were observed during the study periods.Conclusions
Combined intra-articular and intravenous TXA regimen significantly reduced perioperative blood loss compared with only intravenous TXA until 7 days after TKA.14.
Aurélie?Baillot Warner?M.?Mampuya Isabelle?J.?Dionne Emilie?Comeau Anne?Méziat-Burdin Marie-France?Langlois
Background
Experts recommend physical activity (PA) to optimize bariatric surgery (BS) results. However, evidence on the effect of PA before BS is missing. The aim of this study was to assess the impact of adding a Pre-Surgical Exercise Training (PreSET) to an interdisciplinary lifestyle intervention on physical fitness, quality of life, PA barriers, and anthropometric parameters of subjects awaiting BS.Methods
Thirty candidates for BS (43.2?±?9.2 years, 47.5?±?8.1 kg/m2) have been randomized in two groups: one group following the PreSET (endurance and strength training) and another receiving usual care. Before and after 12 weeks, we assessed physical fitness with a battery of tests (symptom-limited exercise test, 6-min walk test (6MWT), sit-to-stand test, half-squat test, and arm curl test), quality of life with the laval questionnaire, and PA barriers with the physical exercise belief questionnaire.Results
One control group subject abandoned the study. Subjects in the PreSET group participated in 60.0 % of the supervised exercise sessions proposed. Results showed significant improvements in the 6MWT (17.4?±?27.2 vs. ?16.4?±?42.4 m; p?=?0.03), half-squat test (17.1?±?17.9 vs. ?0.9?±?14.5 s; p?=?0.05), arm curl repetitions (4.8?±?2.3 vs. 1.0?±?4.1; p?=?0.01), social interaction score (10.7?±?12.5 vs. ?2.1?±?11.0 %; p?=?0.02), and embarrassment (?15.6?±?10.2 vs. ?3.1?±?17.8 %; p?=?0.02) in completers (n?=?8) compared to the non-completers (n?=?21). No significant difference between groups in BMI and other outcomes studied was observed after the intervention.Conclusions
Adding a PreSET to an individual lifestyle counselling intervention improved physical fitness, social interactions, and embarrassment. Post-surgery data would be interesting to confirm these benefits on the long term.15.
Priyanka Khandelwal Vijaya Murugan Smriti Hari Ramakrishnan Lakshmy Aditi Sinha Pankaj Hari Arvind Bagga 《Pediatric nephrology (Berlin, Germany)》2016,31(8):1313-1320
Background
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.16.
Ece A Kelekçi S Hekimoğlu A Kocamaz H Balik H Yolbaş I Erel O 《Pediatric nephrology (Berlin, Germany)》2007,22(8):1151-1157
The aim of this study was to investigate the role of neutrophil activation, protein oxidation and ceruloplasmin (CLP) in the pathogenesis of Henoch-Schönlein purpura (HSP), which has not been investigated previously. Serum activities of myeloperoxidase (MPO) and arylesterase (ARYL) and levels of free thiol groups, CLP and total oxidant status (TOS) were measured in 29 children with HSP at the onset of the disease and during remission in comparison with 30 healthy subjects. Patients at active stage had significantly higher MPO activity (391?±?277 vs. 155?±?154 U/l, P?0.001), higher CLP (832?±?120 vs. 682?±?114 mg/dl, P?0.001) and TOS values (20.7?±?11.8 vs. 7.5?±?2.8 μmol H2O2/l, P?0.001) than the controls, respectively. Patients had significantly lower ARYL activity (158?×?103?±?39?×?103 vs. 187?×?103?±?46?×?103 U/l, P?0.001) and lower free thiol levels (234?±?48 vs. 279?±?26 μmol/l, P?0.001) than the controls, respectively. Significantly positive correlations were found between TOS and MPO (r?=?0.437, P?=?0.018) and TOS and CLP (r?=?0.409, P?=?0.028) at disease onset, whereas a negative correlation was found between MPO and thiol (r?=??0.597, P?=?0.001) during remission. In conclusion, protein oxidation and neutrophil activation may play important roles in the pathogenesis of HSP. Further research is required to understand the potential linkage between oxidant stress and complications and to develop therapeutic strategies in HSP. 相似文献
17.
Tingshuai Zhai Bocheng Zhang Zhenan Qu Chen Chen 《International urology and nephrology》2018,50(5):845-850
Purpose
To examine the association between CT measures of visceral obesity and short-term postoperative outcomes in renal clear cell carcinoma (RCCC) patients.Methods
In this retrospective study, 76 patients treated with unilateral laparoscopic radical nephrectomy for stage I–III renal cancer were classified as obese or non-obese by preoperative CT-based measures of adiposity [obese: visceral fat area (VFA)?>?100 cm2, BMI?≥?28 kg/m2]. Clinical variables, Fuhrman grade, operation time, estimated blood loss (EBL), postoperative complications, postoperative stay, drainage time and hospitalization expenses were compared between the two groups.Results
Viscerally obese patients significantly had higher Fuhrman grade than the non-obese (p?=?0.018). The operation time of obese patients by VFA or BMI was more than the non-obese (171.6?±?68.9 vs. 140.8?±?35.5 min, p?=?0.012 and 197.2?±?67.2 vs. 153.2?±?57.7 min, p?=?0.013, respectively). And obese patients by VFA or BMI tended to have more EBL than non-obese (132.0?±?120.7 vs. 83.8?±?53.4 ml, p?=?0.018 and 215.3?±?165.0 vs. 92.5?±?68.8 ml, p?=?0.013, respectively). Viscerally obese patients by VFA (not BMI) were more likely to develop postoperative complications as compared to patients classified as non-obese: VFA (26.9 vs. 4.2%, p?=?0.045) and BMI (33.3 vs. 16.4%, p?=0.265). Furthermore, obese patients by VFA (not BMI) were more likely to have longer postoperative stay: VFA (8.7?±?2.5 vs. 7.5?±?1.4 dollars, p?=?0.013) and BMI (9.1?±?2.9 vs. 8.1?±?2.1 dollars, p?=?0.209). Obese patients expensed more than non-obese: VFA (7570.9?±?2674.3 vs. 6368.8?±?1289.8 dollars, p?=?0.040) and BMI (8390.8?±?2929.7 vs. 6896.3?±?2159.1 dollars, p?=?0.029).Conclusions
Elevated visceral obesity by VFA is associated with increased surgical complexity, postoperative morbidity, postoperative stay and hospitalization expenses for RCCC patients and may be superior to BMI for renal cancer outcome assessment. VFA may be a useful index for the evaluation and calculation of RCCC aggressiveness.18.
Purpose
To present a real-world experience of the elective treatment of abdominal aortic aneurysms (AAAs) using both open repair (OR) and endovascular repair (EVAR).Methods
Data from patients treated consecutively between January 1, 2000 and December 31, 2014 were collected retrospectively and reviewed. The primary outcomes were 30-day mortality and complication rates, freedom from reintervention, and survival in the long-term.Results
We analyzed data on 1112 patients (660 EVAR, 452 OR). The 30-day mortality and complications rates were higher after OR than after EVAR (2.9 vs. 1.1%, P?=?.03 and 24.7 vs. 1.1%, P?<?.0001, respectively). At 10 years, survival was 66.1 ± 3.2% after OR and 78.1 ± 2.2% after EVAR (P?=?.0006) and freedom from reintervention was 93.5 ± 1.8% after OR and 88.4 ± 1.8% after EVAR (P?=?.005). The preoperative aneurysm diameter was significantly associated with the development of type Ia endoleaks after EVAR (P?<?.0001) and of a proximal pseudoaneurysm after OR (P?<?.0001).Conclusion
In the long-term, EVAR was associated with higher reintervention rates, but better survival than OR. The preoperative AAA diameter was the most important predictor of the development of endoleaks after EVAR and proximal pseudoaneurysm after OR.19.
Jeffrey D. Lebensburger Prasannalaxmi Palabindela Thomas H. Howard Daniel I. Feig Inmaculada Aban David J. Askenazi 《Pediatric nephrology (Berlin, Germany)》2016,31(8):1363-1368
Background
Patients with sickle cell disease are at risk for developing chronic kidney disease (CKD). Acute kidney injury (AKI) has been linked to progression to CKD, but limited data exist to determine its role in acute complications of sickle cell disease. We hypothesized that AKI occurs in pediatric patients admitted for acute chest syndrome (ACS) and prolongs hospitalization.Methods
We conducted a 6-year retrospective review of pediatric patients with ACS admitted to a single medical institution.Results
Of the 149 pediatric patients admitted for ACS during the 6-year study period, 12 (8 %) developed AKI. Comparison of patients with and without AKI revealed a significant association between AKI and a larger drop in hemoglobin value from baseline (2.7 vs. 1.4 g/dL; p?=?0.003), a lower hemoglobin value at admission (6.4 vs. 7.5 g/dL; p?=?0.03), and an increased white blood cell count at admission (33.1 vs. 19.8?×?109/L; p?<?0.0001), respectively. AKI (p?<?0.0001) together with need for advanced respiratory support (biphasic positive airway pressure or mechanical ventilation) (p?<?0.0001) and need for exchange transfusion (p?<?0.0001) were associated with prolonged hospitalization.Conclusions
Clinicians should monitor pediatric patients hospitalized for ACS for the development of AKI as a potentially modifiable risk factor for prolonged hospitalization.20.
Kaijing Wang Xiaogang Zhou Giang Quach Jiajun Lu Wei Gao Anan Xu Jiangfan Zhu 《Obesity surgery》2016,26(4):797-804