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https://www.readbyqxmd.com/read/27932204/total-renal-denervation-reduces-sympathoexcitation-to-different-target-organs-in-a-model-of-chronic-kidney-disease
#1
REVIEW
Glaucia L Veiga, Erika E Nishi, Heder F Estrela, Gisele S Lincevicius, Guiomar N Gomes, Alex Y Simões Sato, Ruy R Campos, Cássia T Bergamaschi
It is known that increased sympathetic nerve activity in chronic kidney disease (CKD) progressively worsens kidney function and hypertension. We tested the hypothesis that total renal denervation contributes to reduce sympathetic activation to different beds and improves renal function in 5/6 nephrectomy model of CKD in male Wistar rats. After eight weeks of 5/6 nephrectomy surgery there was an increase in mean arterial pressure (CKD 179±22mmHg, n=6 vs. control animals 108±9; p<0.05, n=6) with no changes in heart rate (HR)...
December 1, 2016: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/27932148/low-dose-spinal-block-with-continuous-epidural-infusion-for-renal-transplantation-in-a-patient-with-alport-syndrome-a-case-report
#2
F Gobbi, G Sales, P Bretto, P P Donadio, L Brazzi
OBJECTIVE: We aim to describe management of a patient receiving renal transplantation for chronic renal failure due to Alport syndrome with low dose of intrathecal bupivacaine and continuous epidural infusion of local anesthetic. CASE REPORT: A 38-years-old man with chronic renal failure secondary to Alport syndrome underwent kidney transplantation. Because of a high risk of respiratory and cardiovascular complications related to the patient's baseline lung disease and abnormalities in heart conduction, we selected combined spinal-epidural anesthesia...
November 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27925145/the-oldest-old-in-the-emergency-department-impact-of-renal-function
#3
T Brünnler, M Drey, G Dirrigl, C Weingart, F Rockmann, C Sieber, U Hoffmann
OBJECTIVES: The ageing population implicates an increasing numbers of older adults attending Emergency Departments (ED). We assessed the effect of estimated glomerular filtration rate as a predictor of clinical outcomes in oldest-old patients ≥ 85 years attending the ED in an university teaching hospital. DESIGN: Within three years, 81831 patient contacts were made in our ED. 7799 (9.5%) were older than 85 years, in whom we analyzed the impact of renal function on various outcome parameters...
2016: Journal of Nutrition, Health & Aging
https://www.readbyqxmd.com/read/27920365/maximizing-the-usefulness-of-statistical-classifiers-for-two-populations-with-illustrative-applications
#4
Daniel R Jeske, Steven Smith
The usefulness of two-class statistical classifiers is limited when one or both of the conditional misclassification rates is unacceptably high. Incorporating a neutral zone region into the classifier provides a mechanism to refer ambiguous cases to follow-up where additional information might be obtained to clarify the classification decision. Through the use of the neutral zone region, the conditional misclassification rates can be controlled and the classifier becomes useful. Three real-life examples, including applications to prostate cancer and kidney dysfunction following heart surgery, are used to illustrate how neutral zone regions can extract utility from disappointing classifiers that might otherwise be abandoned...
December 5, 2016: Statistical Methods in Medical Research
https://www.readbyqxmd.com/read/27891584/an-observational-study-of-the-macro-and-micro-haemodynamic-implications-of-epidural-anaesthesia-in-children
#5
L Triffterer, P Marhofer, G Lechner, T C Marksz, O Kimberger, W Schmid, D Marhofer
The haemodynamic implications of epidural anaesthesia in children are poorly documented. We report macro- and micro-haemodynamic data from an observational study of 25 children ranging from neonates to six-years old, who underwent surgery conducted with a specific combination of monitoring systems. We analysed 90 min of study-related monitoring after epidural catheterisation, with skin incision taking place after around 30 min. We recorded macrohaemodynamic parameters (monitored using LiDCOrapid) including heart rate, mean arterial pressure, cardiac output, stroke volume, systemic vascular resistance and stroke volume variation...
November 28, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27869053/incidence-risk-factors-and-outcomes-of-acute-kidney-injury-in-adults-undergoing-surgery-for-congenital-heart-disease
#6
David M Kwiatkowski, Elizabeth Price, David M Axelrod, Anitra W Romfh, Brian S Han, Scott M Sutherland, Catherine D Krawczeski
BACKGROUND: Acute kidney injury after cardiac surgery is a frequent and serious complication among children with congenital heart disease (CHD) and adults with acquired heart disease; however, the significance of kidney injury in adults after congenital heart surgery is unknown. The primary objective of this study was to determine the incidence of acute kidney injury after surgery for adult CHD. Secondary objectives included determination of risk factors and associations with clinical outcomes...
November 21, 2016: Cardiology in the Young
https://www.readbyqxmd.com/read/27868016/statins-barely-touch-the-heart-but-bite-the-kidneys-after-cardiac-surgery-coenzyme-q10-deficiency-in-the-dock
#7
COMMENT
Patrick M Honore, Rita Jacobs, Inne Hendrckx, Herbert D Spapen
No abstract text is available yet for this article.
October 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/27867655/veno-arterial-extracorporeal-membrane-oxygenation-va-ecmo-in-postcardiotomy-cardiogenic-shock-how-much-pump-flow-is-enough
#8
COMMENT
Federico Pappalardo, Andrea Montisci
Post-cardiotomy cardiogenic shock (PCCS) is a complication of heart surgery associated with a poor prognosis: veno-arterial extracorporeal membrane oxygenation (VA ECMO) ensures end-organ perfusion while fully replacing heart and lung function, though it is associated with unsatisfactory results. Few studies have identified reliable predictors of poor prognosis early in the course of extracorporeal support. A recent study showed the strong prognostic power of urine output in the first 24 hours of VA ECMO in predicting early and late mortality of PCCS...
October 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27865637/increased-risk-of-mortality-after-lower-extremity-bypass-in-individuals-with-acute-kidney-injury-in-the-vascular-quality-initiative
#9
Erica Flores, Juan Pablo Lewinger, Vincent L Rowe, Karen Woo, Fred A Weaver, David Shavelle, Leonardo Clavijo, Parveen K Garg
OBJECTIVE: The development of acute kidney injury (AKI) and its effect on prognosis after lower extremity bypass (LEB) surgery have not been well described. We determined risk factors associated with AKI in patients undergoing infrainguinal LEB surgery and whether individuals with AKI are at increased risk for cardiovascular events and mortality. METHODS: Data for 12,907 operations entered in the Vascular Quality Initiative (VQI) registry from January 2012 through April 2015 were retrospectively reviewed...
November 16, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27862029/creatinine-neutrophil-gelatinase-associated-lipocalin-and-cystatin-c-in-determining-acute-kidney-injury-after-heart-operations-using-cardiopulmonary-bypass
#10
Jurij Matija Kališnik, Eva Hrovat, Alenka Hrastovec, Janez Žibert, Aleš Jerin, Milan Skitek, Giuseppe Santarpino, Tomislav Klokocovnik
Acute kidney injury (AKI) represents frequent complication after cardiac surgery using cardiopulmonary bypass (CPB). In the hope to enhance earlier more reliable characterization of AKI, we tested the utility of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (CysC) in addition to standard creatinine for early determination of AKI after cardiac surgery using CPB. Forty-one patients met the inclusion criteria. Arterial blood samples collected after induction of general anesthesia were used as baseline, further sampling occurred at CPB termination, 2 h after CPB, on the first and second day after surgery...
November 8, 2016: Artificial Organs
https://www.readbyqxmd.com/read/27832187/risk-factors-for-acute-kidney-injury-after-congenital-cardiac-surgery-in-infants-and-children-a-retrospective-observational-study
#11
Sun-Kyung Park, Min Hur, Eunhee Kim, Won Ho Kim, Jung Bo Park, Youngwon Kim, Ji-Hyuk Yang, Tae-Gook Jun, Chung Su Kim
Acute kidney injury (AKI) after pediatric cardiac surgery is associated with high morbidity and mortality. Modifiable risk factors for postoperative AKI including perioperative anesthesia-related parameters were assessed. The authors conducted a single-center, retrospective cohort study of 220 patients (aged 10 days to 19 years) who underwent congenital cardiac surgery between January and December 2012. The incidence of AKI within 7 days postoperatively was determined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria...
2016: PloS One
https://www.readbyqxmd.com/read/27823895/impact-of-residual-mitral-regurgitation-after-mitraclip-implantation
#12
Hidehiro Kaneko, Michael Neuss, Jens Weissenborn, Christian Butter
BACKGROUND: MitraClip (MC) is an alternative treatment for mitral regurgitation (MR). Although residual MR is common after MC, little was known about the impact of residual MR after MC. METHODS: We examined 255 consecutive patients who underwent MC. The primary endpoint was the composite endpoint including all-cause death, left ventricular (LV) assist device, and mitral valve surgery. RESULTS: Procedure failure defined as unsuccessful MC implantation (n=6) and residual MR ≥3+ (n=19) was associated with worse outcomes including the primary endpoint and all-cause death than those with acute procedure success (APS) defined as residual MR 2+ (n=125) or 1+ (n=105)...
October 24, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27799177/non-invasive-measurement-of-renal-perfusion-and-oxygen-metabolism-to-predict-postoperative-acute-kidney-injury-in-neonates-and-infants-after-cardiopulmonary-bypass-surgery
#13
F Neunhoeffer, M Wiest, K Sandner, H Renk, E Heimberg, C Haller, M Kumpf, C Schlensak, M Hofbeck
BACKGROUND: The pathophysiology of acute kidney injury (AKI) after cardiopulmonary bypass surgery for congenital heart disease is not completely understood. The aim of this study was to carry out a prospective analysis of the diagnostic value of non-invasive monitoring of renal oxygenation and microcirculation by combining laser Doppler flowmetry and tissue spectrometry. METHODS: In 50 neonates and infants who underwent repair (n = 31) or neonatal palliation (n = 19) of congenital heart disease with cardiopulmonary bypass, renal oxygenation, and microcirculatory flow, the approximate renal metabolic rate of oxygen and Doppler-based renal resistive index were determined after surgery...
November 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27771699/cardiac-hepcidin-expression-associates-with-injury-independent-of-iron
#14
G Fenna van Breda, Lennart G Bongartz, Wenqing Zhuang, Rachel P L van Swelm, Jeanne Pertijs, Branko Braam, Maarten-Jan Cramer, Dorine W Swinkels, Pieter A Doevendans, Marianne C Verhaar, Roos Masereeuw, Jaap A Joles, Carlo A J M Gaillard
BACKGROUND: Hepcidin regulates systemic iron homeostasis by downregulating the iron exporter ferroportin. Circulating hepcidin is mainly derived from the liver but hepcidin is also produced in the heart. We studied the differential and local regulation of hepcidin gene expression in response to myocardial infarction (MI) and/or chronic kidney disease (CKD). We hypothesized that cardiac hepcidin gene expression is induced by and regulated to severity of cardiac injury, either through direct (MI) or remote (CKD) stimuli, as well as through increased local iron content...
2016: American Journal of Nephrology
https://www.readbyqxmd.com/read/27769089/-retrospective-analysis-of-diabetics-with-regard-to-treatment-duration-and-costs
#15
S Pscherer, A Nüssler, C Bahrs, M Reumann, C Ihle, U Stöckle, S Ehnert, T Freude, B G Ochs, I Flesch, P Ziegler
Background: The increasing incidence of diabetes mellitus is also reflected in the patient population of a trauma and orthopaedic centre. Diabetics also exhibit more comorbidities than non-diabetics. In addition to surgical problems in these patients, hospitalisation is often accompanied by complications, which can prolong treatment and increase costs. The aim of this retrospective study is to analyse hospitalisation of diabetics compared to non-diabetics, as well as differences in treatment costs, depending on associated age and comorbidities...
October 21, 2016: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/27767984/the-optimum-hematocrit
#16
Walter H Reinhart
The hematocrit (Hct) determines the oxygen carrying capacity of blood, but also increases blood viscosity and thus flow resistance. From this dual role the concept of an optimum Hct for tissue oxygenation has been derived. Viscometric studies using the ratio Hct/blood viscosity at high shear rate showed an optimum Hct of 50-60% for red blood cell (RBC) suspensions in plasma. For the perfusion of an artificial microvascular network with 5-70μm channels the optimum Hct was 60-70% for high driving pressures. With lower shear rates or driving pressures the optimum Hct shifted towards lower values...
October 21, 2016: Clinical Hemorheology and Microcirculation
https://www.readbyqxmd.com/read/27748669/congenital-heart-surgery-and-acute-kidney-injury
#17
Tennille N Webb, Stuart L Goldstein
PURPOSE OF REVIEW: The incidence of cardiac surgery-associated acute kidney injury (CS-AKI) continues to increase and is associated with significant morbidity and mortality. Early diagnosis and identification of patients at risk are extremely important. Therefore, identifying associated risk factors, biomarkers for earlier detection, prevention and therapeutic options for CS-AKI warrant special attention. RECENT FINDINGS: The current diagnosis of acute kidney injury (AKI) largely depends upon the functional biomarkers serum creatinine and oliguria leading to delays in diagnosis and worsening outcomes...
September 29, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27742806/renal-sympathetic-denervation-attenuates-hypertension-and-vascular-remodeling-in-renovascular-hypertensive-rats
#18
Peng Li, Pei-Pei Huang, Yun Yang, Chi Liu, Yan Lu, Fang Wang, Wei Sun, Xiang-Qing Kong
Sympathetic activity is enhanced in patients with essential or secondary hypertension, as well as in various hypertensive animal models. Therapeutic targeting of sympathetic activation is considered an effective antihypertensive strategy. We hypothesized that renal sympathetic denervation (RSD) attenuates hypertension and improves vascular remodeling and renal disease in the 2-kidney, 1-clip (2K1C) rat model. Rats underwent 2K1C modeling or sham surgery; then, rats underwent RSD or sham 4 weeks later, thus resulting in four groups (normotensive-sham, normotensive-RSD, 2K1C-sham, and 2K1C-RSD)...
October 14, 2016: Journal of Applied Physiology
https://www.readbyqxmd.com/read/27737408/mild-hypothermia-may-offer-some-improvement-to-patients-with-mods-after-cpb-surgery
#19
Xiaoqi Zhao, Tianxiang Gu, Zongyi Xiu, Enyi Shi, Lei Yu
Objective: To summarize the effect of mild hypothermia on function of the organs in patients with multiple organ dysfunction syndrome after cardiopulmonary bypass surgery. Methods: The patients were randomly divided into two groups, northermia group (n=71) and hypothermia group (n=89). We immediately began cooling the hypothermia group when test results showed multiple organ dysfunction syndrome, meanwhile all patients of two groups were drawn blood to test blood gas, liver and kidney function, blood coagulation function, and evaluated the cardiac function using echocardiography from 12 to 36 hours...
May 2016: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/27709094/goal-directed-perfusion-in-neonatal-aortic-arch-surgery
#20
Robert Anton Cesnjevar, Ariawan Purbojo, Frank Muench, Joerg Juengert, André Rueffer
Reduction of mortality and morbidity in congenital cardiac surgery has always been and remains a major target for the complete team involved. As operative techniques are more and more standardized and refined, surgical risk and associated complication rates have constantly been reduced to an acceptable level but are both still present. Aortic arch surgery in neonates seems to be of particular interest, because perfusion techniques differ widely among institutions and an ideal form of a so called "total body perfusion (TBP)" is somewhat difficult to achieve...
July 2016: Translational pediatrics
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