Serum cystatin C as an early predictor of acute kidney injury in preterm neonates with respiratory distress syndrome

Abstract

Preterm neonates with respiratory distress syndrome (RDS) are at increased risk of acute kidney injury (AKI). Our study aimed at determining whether serum cystatin C (sCysC) on day 3 of life (D3) can early predict AKI in preterm neonates with RDS. This prospective study was conducted on 75 preterm neonates; 50 with RDS and 25 without RDS. On D3, sCysC, serum creatinine (sCr) and blood urea nitrogen (BUN) were measured and estimated glomerular filtration rate (eGFR) was calculated. sCr and BUN levels were measured again on days 5 and 7. Neonates were evaluated for development of AKI during first week of life according to the modified pediatric RIFLE (pRIFLE) criteria. Thirteen neonates with RDS developed AKI (26%).There was no significant difference between RDS and control groups with respect to sCysC. RDS neonates with AKI had significantly higher sCysC than those without AKI (1.62?±?0.12 versus 1.16?±?0.09?mg/l; p?<?.001). RDS grade III–IV neonates had significantly higher sCysC than RDS grade I–II. There was a significant positive correlation between D3 sCysC and (D5 and D7 sCr and BUN). Receiver operating characteristic (ROC) curve showed that D3 sCysC can predict AKI in preterm neonates with RDS at a cutoff point of >1.3?mg/l with sensitivity of 92.30% and specificity of 96%. We conclude that neonates with RDS are at increased risk of AKI. sCysC on day 3 of life can predict AKI earlier than Cr and eGFR.     

The involvement of KATP channels in morphine‐induced antinociception and hepatic oxidative stress in acute and inflammatory pain in rats

This study investigated the role of K_ATP channels in morphine‐induced antinociception and hepatic oxidative stress in acute and inflammatory pain. The K_ATP channel modulators (K_ATP channel opener, diazoxide 100 mg/kg, p.o, and K_ATP channel blocker, glibenclamide, 3 mg/kg i.p.) were administered with morphine (80 mg/kg, i.p.). Antinociception was assessed by the tail‐flick and formalin tests in rats and measured by the area under the curve values and the maximum percent effect for 3 h. The indices of hepatic oxidative stress: glutathione, glutathione peroxidase, and malondialdehyde were then determined in the liver homogenates obtained from the treated animals. In both tests, glibenclamide antagonized morphine‐induced antinociception, whereas diazoxide augmented it in the tail‐flick test only. In the formalin test, glibenclamide alone has a significant hyperalgesic effect, whereas diazoxide decreased the number of flinches. Coadministration of glibenclamide with morphine antagonized the hepatotoxic effect of morphine in both animal models. In the tail‐flick test, glibenclamide administered alone significantly increased malondialdehyde's level. Coadministration of diazoxide with morphine increased glutathione level in the formalin test. Diazoxide administered alone exacerbated the hepatic oxidative stress in both animal models. These findings suggest a role of K_ATP channel modulators on morphine‐induced antinociception and hepatic oxidative stress. The administration of glibenclamide may prevent morphine‐induced hepatotoxicity. The effectiveness of diazoxide in the management of pain is limited due to its deleterious effect on the liver. However, the interaction of the K_ATP channel modulators with morphine depends on the differential sensitivity to the pain stimulus.     

Comparative study between atorvastatin and losartan on high fat diet‐induced type 2 diabetes mellitus in rats

Obesity is often associated with chronic inflammatory state which contributes to the development of insulin resistance (IR) and type 2 diabetes mellitus (T2DM). This study investigated the effects of single and combined administration of atorvastatin (ATOR, lipid‐lowering drug) and losartan (LOS, angiotensin receptor antagonist) on metabolic disorders and inflammatory status that are implicated in the development of T2DM with the use of pioglitazone (PIO) as a standard antidiabetic drug. T2DM was induced in male rats by high‐fat diet (HFD) feeding for 16 weeks. Oral administrations of ATOR (10 mg/kg), LOS (20 mg/kg), PIO (3 mg/kg), their binary combinations, or vehicle were started in the last 4 weeks. Fasting serum glucose, oral glucose tolerance, fasting serum insulin, IR, serum lipid profile, serum TNF‐α and body composition index were determined. Results showed that all drugs and their combinations had positive impact effect on all measured parameters, and better results were achieved from binary drug combinations than administration of each drug alone. Combination of PIO with either ATOR or LOS provided better improvements on T2DM‐associated metabolic abnormalities and inflammatory status with respect to each drug alone. However, the most pronounced effects of drugs and their combinations regarding the above parameters were attributed to LOS + PIO combination. In conclusion, this study indicates that combination of ATOR + PIO and, in particular, LOS + PIO can be used as promising effective therapies in the management of HFD‐induced T2DM. This concept may be attributed to the combined effects of the respective monotherapies to improve lipid profile, insulin sensitivity, and TNF‐α level.     

Potential impact of PET/CT on the initial staging of lymphoma

Purpose

The aim of this study was to investigate the potential impact of PET/CT on the initial staging of lymphoma with comparison to each of the PET and CT components alone.

Materials and methods

PET/CTs from 37 patients with lymphoma undergoing initial staging were studied. Review of PET, CT and PET/CT images were done and staging of each patient by each modality was assigned and compared together. Clinical follow-up, additional imaging and histology served as the standard of reference.

Results

PET/CT correctly diagnosed 83 nodal regions as positive for lymphomatous involvement versus 61 and 57 detected by PET and CT respectively. The respective sensitivities, specificities, and accuracies for the detection of nodal involvement were: PET: 88.4%, 65%, 94%, CT 89.1%, 60.1%, 96.1%, PET/CT 96.3%, 88.3%, 98.2%. PET/CT also correctly identified more extra-nodal lesions (n = 24) than CT (n = 16) and PET (n = 15). Correct staging was more accurate at PET/CT (n = 31) in comparison to PET alone (n = 23) and CT alone (n = 21).

Conclusions

PET/CT was superior to PET and CT in the initial staging of lymphoma with significant better performance compared to PET and CT to clarify nodal and extra-nodal involved sites. The application of PET/CT rather than CT or PET is likely to be more beneficial.     

Multidetector CT in pre- and post-operative evaluation of living-related liver transplantation

Objective

To assess the role of multi-detector CT (MDCT) in the pre and post operative evaluation of both potential donors and recipients for living related liver transplantation (LRLT).

Material and Methods

This prospective study included 26 patients for LRLT and their corresponding donors. For preoperative assessment, all subjects were evaluated by triphasic CT abdomen. CT angiography (CTA) with 3D reconstruction and CT volumetry was additionally done for donors. CT findings were compared to surgical results as gold standard reference. In post-operative evaluation, CT abdomen was performed at least once after transplantation for all recipients and for indicated donors. CTA was done for indicated recipients when US findings were inconclusive.

Results

No statistically significant difference was found between CT volumetry and intraoperative findings. Compared to surgical findings, MDCT identified hepatic arterial and portal venous anatomy with 100% sensitivity and specificity, while for hepatic venous anatomy; it showed sensitivity and specificity of 85.7% and 84.2%. Biliary complications and fluid collections were the commonest in recipients and donors respectively.

Conclusion

MDCT is a single comprehensive non-invasive and accurate imaging modality for preoperative evaluation of liver parenchyma, hepatic vascular anatomy and graft volume and postoperative complications in donors and recipients of LRLT.     

MRI as complementary tool added to ultrasound in the diagnosis of fetal renal abnormalities – any added value?

Purpose

To assess the potential role of magnetic resonance imaging (MRI) as a complementary diagnostic tool to ultrasonography (US) in the diagnosis of fetal renal anomalies in pregnant women with oligohydramnios in the absence of amniotic membrane rupture.

Methods

Ninety pregnant women, with oligohydramnios were prospectively evaluated using both US and MRI. Prenatal findings were correlated with the babies’ outcome.

Results

MRI studies of diagnostic quality were obtained in all fetuses. The US and MRI findings were concordant in 79 (87.8%) of the fetuses. MRI modified and changed the diagnosis in 11 fetuses (12.2%), these were five fetuses in which US diagnosis was inconclusive, five cases in which the diagnosis changed from bilateral renal agenesis to unilateral agenesis with the other kidney multicystic dysplastic kidney (MCDK), and in the remaining fetuses the modification was from bilateral renal agenesis to unilateral agenesis with the other kidney structurally normal.Concordant findings for the prenatal US and MRI scans were seen in 100% of the autosomal recessive polycystic kidney disease (APCKD), 96% of MCDK, and 92.9% of bilateral normal kidneys.

Conclusion

MRI is of value in cases of oligohydramnios in limited circumstance when US findings were inconclusive.     

Intratumoral Gas in Hepatocellular Carcinoma following Transarterial Chemoembolization: Associated Factors and Clinical Impact

PurposeTo determine the frequency and factors associated with the presence of intratumoral gas-containing areas in hepatocellular carcinoma (HCC) on computed tomography (CT) scans obtained 4–6 weeks after transarterial chemoembolization.Materials and MethodsFrom June 2010 to December 2011, 201 patients underwent 286 chemoembolization procedures for HCC (n = 497 tumors) and were retrospectively included. The presence of intratumoral gas was assessed on CT 4–6 weeks after chemoembolization. Clinical and biologic data and tumoral and chemoembolization procedure characteristics were noted. Factors associated with the presence of intratumoral gas were evaluated. Tumor response was assessed by using European Society for the Study of the Liver criteria. Tumors containing gas or not containing gas were compared by univariate and multivariate analysis.ResultsIntratumoral gas was found in 26 tumors (5%) after 26 chemoembolization procedures (9.1%) in 26 patients (13%). Gas was related to abscess formation in three patients (11.5%). On multivariate analysis, a large mean tumor diameter at baseline (72.4 mm vs 40.2 mm; P = .003), chemoembolization with drug-eluting beads (P = .033), and superselective approach (P = .024) were independently associated with the presence of gas. Tumors that exhibited gas-containing areas at 1 month had a significantly higher objective response rate than those that did not (P < .0001).ConclusionsIntratumoral gas-containing areas after chemoembolization are rarely related to the formation of abscesses. The presence of intratumoral gas on CT 4–6 weeks after chemoembolization could be a surrogate marker for marked tumor necrosis.     

Patient-specific predictors of image noise in coronary CT angiography

BackgroundCoronary computed tomography (CT) angiography can be associated with high radiation exposure. Reduction of tube voltage from 120 kV to 100 kV can reduce the dose by up to 40%, but it also increases image noise.ObjectiveWe aimed to find a patient-specific predictor of image noise to determine the use of reduced tube voltage.MethodsContrast-enhanced coronary dual-source CT angiography data sets [prospectively electrocardiogram (ECG)–triggered axial and retrospectively ECG-gated spiral acquisition, rotation of 280 milliseconds, 2 × 128 × 0.6 mm collimation, 100 kV, 320 mAs] of 165 patients (age, 54 ± 13 years) for the detection of coronary artery stenoses were analyzed. Image noise was measured in the aortic root. Influence of body weight, height, body mass index, thoracic cross sectional area, as well as the area of the thoracic solid tissue were analyzed.ResultsMean image noise in the aorta was 35.1 ± 8.9 HU. Mean dose length product was 207 ± 184 cm · cGy with an average effective dose of 2.9 ± 2.6 mSv. The patient cohort was divided into tertiles according to image noise. Numerous parameters, including BMI and body weight, were significantly different between the highest and lowest tertiles. In multivariable regression analysis, the area of the thoracic solid tissue was the only independent predictor of image noise (P < 0.0001).ConclusionsThe area of the thoracic solid tissue at the level of the aortic root predicts image noise and may hence be used for the decision to reduce tube voltage from 120 kV to 100 kV.     

Iatrogenic iliac artery rupture and type a dissection after endovascular repair of type B aortic dissection

We report a case of two iatrogenic complications after endovascular repair of a type B aortic dissection treated for abdominal aortic branch ischemia. A rupture of the common iliac artery occurred first during the procedure. A type A dissection occurred 12 days later. The proximal part of the aortic endovascular graft had created a tear in the aortic wall resulting in a retrograde type A dissection. Although aortic endovascular grafting is apparently associated with less morbidity and mortality, potentially lethal complications, both acute and delayed, may arise.