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81.
Lakhmir S. Chawla Richard L. Amdur Andrew D. Shaw Charles Faselis Carlos E. Palant Paul L. Kimmel 《Clinical journal of the American Society of Nephrology》2014,9(3):448-456
Background and objectives
AKI is associated with major adverse kidney events (MAKE): death, new dialysis, and worsened renal function. CKD (arising from worsened renal function) is associated with a higher risk of major adverse cardiac events (MACE): myocardial infarction (MI), stroke, and heart failure. Therefore, the study hypothesis was that veterans who develop AKI during hospitalization for an MI would be at higher risk of subsequent MACE and MAKE.Design, setting, participants, & measurements
Patients in the Veterans Affairs (VA) database who had a discharge diagnosis with International Classification of Diseases, Ninth Revision, code of 584.xx (AKI) or 410.xx (MI) and were admitted to a VA facility from October 1999 through December 2005 were selected for analysis. Three groups of patients were created on the basis of the index admission diagnosis and serum creatinine values: AKI, MI, or MI with AKI. Patients with mean baseline estimated GFR<45 ml/min per 1.73 m2 were excluded. The primary outcomes assessed were mortality, MAKE, and MACE during the study period (maximum of 6 years). The combination of MAKE and MACE—major adverse renocardiovascular events (MARCE)—was also assessed.Results
A total of 36,980 patients were available for analysis. Mean age±SD was 66.8±11.4 years. The most deaths occurred in the MI+AKI group (57.5%), and the fewest (32.3%) occurred in patients with an uncomplicated MI admission. In both the unadjusted and adjusted time-to-event analyses, patients with AKI and AKI+MI had worse MARCE outcomes than those who had MI alone (adjusted hazard ratios, 1.37 [95% confidence interval, 1.32 to 1.42] and 1.92 [1.86 to 1.99], respectively).Conclusions
Veterans who develop AKI in the setting of MI have worse long-term outcomes than those with AKI or MI alone. Veterans with AKI alone have worse outcomes than those diagnosed with an MI in the absence of AKI. 相似文献82.
Rajit K. Basu Yu Wang Hector R. Wong Lakhmir S. Chawla Derek S. Wheeler Stuart L. Goldstein 《Clinical journal of the American Society of Nephrology》2014,9(4):654-662
Background and objectives
Novel AKI biomarkers carry variable performance for prediction of AKI in patients with heterogeneous illness. Until utility is demonstrated in critically ill patients outside of the cardiopulmonary bypass population, AKI biomarkers are unlikely to gain widespread implementation. Operationalization of an AKI risk stratification methodology, termed renal angina, was recently reported to enhance prediction at the time of intensive care unit admission for persistent severe AKI. The renal angina index (RAI) was developed to provide the clinical context to direct AKI biomarker testing. This study tested the hypothesis that incorporation of AKI biomarkers in patients fulfilling renal angina improves the prediction of persistent severe AKI.Design, setting, participants, & measurements
In a multicenter study of 214 patients admitted to the pediatric intensive care unit with sepsis, the discrimination of plasma neutrophil gelatinase–associated lipocalin (NGAL), matrix metalloproteinase-8 (MMP-8), and neutrophil elastase-2 (Ela-2) were determined individually and in combination with the RAI for severe AKI. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated.Results
Individual biomarkers demonstrated marginal discrimination for severe AKI (area under curve [AUC]: NGAL, 0.72; MMP-8, 0.68; Ela-2, 0.72), inferior to prediction by the clinical model of the RAI (AUC=0.80). Incorporation of each biomarker significantly added to the renal angina model AKI prediction (AUC=0.80, increased to 0.84–0.88; P<0.05 for each). The inclusion of each biomarker with the RAI demonstrated NRI (0.512, 0.428, and 0.545 for NGAL, MMP-8, and Ela-2, respectively; all P<0.03) and IDI (0.075 for Ela-2). The inclusion of both Ela-2 and NGAL with RAI demonstrated an NRI of 0.871 (P<0.001) and an IDI of 0.1 (P=0.01).Conclusions
This study shows that incorporation of AKI biomarkers into the RAI improves discrimination for severe AKI. The RAI optimizes the utility of AKI biomarkers in a heterogeneous, critically ill patient population. 相似文献83.
Kunal Chawla Richa Gupta Harsimran Jit Singh Tulika Gupta Anjali Aggarwal Daisy Sahni 《Surgical and radiologic anatomy : SRA》2014,36(4):393-396
During routine dissection of 82-year-old female cadaver with no known unfavorable medical history, we observed bilateral bifid ureter and variation in arterial supply of left kidney only. Careful examination revealed that there were bifid ureters on both sides enclosed in single facial sheath. It was also observed that both the ureter have different pattern of origin. On the right side, both the ureters were seen to be emerging from the hilum, one below another and joined together at the brim of the lesser pelvis just before crossing the right external iliac artery. Right kidney was supplied by single renal artery lying anterior to both the ureters. On the left side one ureter emerged from the hilum while the second one exited the kidney from a prominent lobule present below the inferior pole. 相似文献
84.
Chandrakant Mukesh Jitkumar Bhatt Kamlesh Prasad 《Macromolecular chemistry and physics.》2014,215(15):1498-1504
Nanogels (NGs) are considered as one of the most suitable nanocarrier matrices for drug, gene and protein delivery. There are many methods of synthesis of NGs but polymerizable bioionic liquids are not being applied so far for the synthesis of such nanocarriers. The synthesis of a stimuli‐responsive NG system having average hydrodynamic size of 41 ± 15 nm is reported here, obtained by the simultaneous polymerization and crosslinking of a polymerizable biobased ionic liquid. The NG thus obtained shows prolonged drug delivery for 5‐fluorouracil, an anticancer drug, at pH 1.2 (stomach pH) for 10 days at physiological human body temperature (37 °C). However, no substantial drug delivery is observed at pH 5 and 7.4. Such a prolonged drug release profilemakes the reported NG system a potential candidate in the formulation of a pH‐sensitive drug nanocarrier vehicle for in vivo delivery of stomach‐specific therapeutic agents.
85.
Singh M Shah T Adigopula S Molnar J Ahmed A Khosla S Arora R 《Indian heart journal》2012,64(4):341-352
BackgroundStudies evaluating CYP2C19*2 and ABCB1-C3435T polymorphisms have shown conflicting results. We performed this meta-analysis to evaluate role of clinical testing for these polymorphisms in CAD patients on clopidogrel.Methods19,601 patients from 14 trials were analyzed. The endpoints were major adverse cardiovascular events (MACE), cardiovascular (CV) death, stent thrombosis (ST), myocardial infarction (MI), stroke and major bleeding. Combined relative risks (RR) with 95% confidence intervals (CI) were computed for each outcome by using standard methods of meta-analysis and test parameters were computed.ResultsCYP2C19*2 polymorphism was associated with higher risk of MACE [RR: 1.28, CI: 1.06–1.54; p = 0.009], CV death [RR: 3.21, CI: 1.65–6.23; p = 0.001], MI [RR: 1.36, CI: 1.12–1.65; p = 0.002], ST [RR: 2.41, CI: 1.69–3.41; p < 0.001]. No difference was seen in major bleeding events [RR: 1.02, CI: 0.86–1.20; p = 0.83]. Subgroup analysis showed similar results for elective PCI [RR: 1.34, CI: 1.01–1.76; p = 0.03], and PCI with DES [RR: 1.53, CI: 1.029–1.269; p = 0.03]. CYP2C19*2 polymorphism has very low sensitivity (28–58%), specificity (71–73%), positive predictive value (3–10%) but good negative predictive value (92–99%). ABCB1-C3435T polymorphism analysis revealed similar MACE [RR: 1.13, CI: 0.99–1.29; p = 0.06], ST [RR: 0.88, CI: 0.52–1.47; p = 0.63] and major bleeding [RR: 1.04, CI: 0.87–1.25; p = 0.62] in both groups.ConclusionIn CAD patients on clopidogrel therapy, CYP2C19*2 polymorphism is associated with significantly increased adverse cardiovascular events. However, due to the low positive predictive value, routine genetic testing cannot be recommended at present. 相似文献
86.
87.
Chronic intussusception is defined as intussusception with a history of more than 14 days and is generally associated with a predisposing factor. We are reporting a rare case of chronic intussusception due to Non Hodgkin lymphoma of ileum, appendix, caecum and ascending colon presented as acute intestinal obstruction in emergency. Chronic Intussusception is rare in childhood due to Non Hodgkin lymphoma. A five year male child presented with fever, pain abdomen, vomiting, diarrhoea and mass in right flank. Ultrasonography of the abdomen revealed a mass in ileao-caecal region with chronic intussusception which was confirmed on surgery. X ray of the abdomen showed dilated bowel loops. It is very difficult to make diagnosis of intestinal lymphoma on pre-operative investigations. Patient presented with obstruction should be explored as surgery is the treatment of the choice. Diagnosis can be confirmed by histopathologically. In conclusion, a high index of suspicion and appropriate investigations (USS, Barium enema and CT scan) can result in prompt diagnosis. In majority of children the diagnosis is made at laparotomy and surgery plays a pivotal role in the management. 相似文献
88.
Nakhleh N Francis R Giese RA Tian X Li Y Zariwala MA Yagi H Khalifa O Kureshi S Chatterjee B Sabol SL Swisher M Connelly PS Daniels MP Srinivasan A Kuehl K Kravitz N Burns K Sami I Omran H Barmada M Olivier K Chawla KK Leigh M Jonas R Knowles M Leatherbury L Lo CW 《Circulation》2012,125(18):2232-2242
89.
M Gupta AK Lamba M Verma F Faraz S Tandon K Chawla DK Koli 《Australian dental journal》2013,58(1):41-49
Background
Traditional periodontal open flap debridement (OFD) results in reduced pocket depth (PD), clinical attachment loss (CAL), gingival recession (GR) and postoperative pain and discomfort. The quest to overcome these shortcomings has led to research into Er,Cr:YSGG laser assisted pocket therapy (ELAPT). This study was designed to compare the clinical outcomes of ELAPT versus OFD.Methods
Fifteen patients with a PD of ≥5 mm and ≤8 mm at two sites were selected. Test sites (Group 1) were treated by ELAPT and the control (Group 2) by OFD. Clinical parameters were recorded at baseline, 3 and 6 months and included Plaque Index (PI), Gingival Index (GI), modified Sulcular Bleeding Index (mSBI), PD, CAL and GR.Results
Both treatments produced a reduction in PI, GI, mSBI and PD, an increase in GR, and a gain in CAL at 3 and 6 months. The mean gain of CAL in Group 1 at 3 and 6 months (1.60 ± 0.78 and 1.80 ± 0.63) was similar (p > 0.05) to the value of Group 2 (1.93 ± 0.88 and 2.00 ± 0.54). GR increased significantly (p < 0.05) only in Group 2 at 3 and 6 months (1.80 ± 0.56 and 1.87 ± 0.64) compared to Group 1 (0.50 ± 0.68 and 0.60 ± 0.74).Conclusions
ELAPT compared with OFD results in similar CAL gains with less GR and significant reductions in PD, GI and mSBI, and may be considered as an alternative to surgical therapy. 相似文献90.
The present case report highlights that a tense mega-sized aortic root and ascending aorta can mechanically resist the passage of fully inflated (1.5 ml air) balloon to wedge-trace position in the pulmonary artery. Any attempt to push the catheter rather predisposed its recoiling and rebutting into the right ventricle and the cardiac arrhythmia. Inflating continuous cardiac output catheter balloon with lesser volume of air (1 ml) is suggested to overcome this problem. 相似文献