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https://www.readbyqxmd.com/read/28208200/massive-pulmonary-embolism-extracorporeal-membrane-oxygenation-and-surgical-pulmonary-embolectomy
#1
Aaron Weinberg, Victor F Tapson, Danny Ramzy
Massive pulmonary embolism (PE) refers to large emboli that cause hemodynamic instability, right ventricular failure, and circulatory collapse. According to the 2016 ACCP Antithrombotic Guidelines, therapy for massive PE should include systemic thrombolytic therapy in conjunction with anticoagulation and supportive care. However, in patients with a contraindication to systemic thrombolytics or in those who fail the above interventions, extracorporeal membrane oxygenation (ECMO) and/or surgical embolectomy may be used to improve oxygenation, achieve hemodynamic stability, and successfully treat massive PE...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28183805/klotho-expression-in-long-bones-regulates-fgf23-production-during-renal-failure
#2
Jovana Kaludjerovic, Hirotaka Komaba, Tadatoshi Sato, Reinhold G Erben, Roland Baron, Hannes Olauson, Tobias E Larsson, Beate Lanske
Circulating levels of bone-derived fibroblast growth factor 23 (FGF23) increase early during acute and chronic kidney disease and are associated with adverse outcomes. Membrane-bound Klotho acts as a permissive coreceptor for FGF23, and its expression was recently found in osteoblasts/osteocytes. We hypothesized that Klotho in bone cells is part of an autocrine feedback loop that regulates FGF23 expression during renal failure. Thus, we induced renal failure in mice with targeted deletion of Klotho in long bones...
February 9, 2017: FASEB Journal: Official Publication of the Federation of American Societies for Experimental Biology
https://www.readbyqxmd.com/read/28155015/nitrofurantoin-safety-and-effectiveness-in-treating-acute-uncomplicated-cystitis-auc-in-hospitalized-adults-with-renal-insufficiency-antibiotic-stewardship-implications
#3
B A Cunha, C B Cunha, B Lam, J Giuga, J Chin, V F Zafonte, S Gerson
Nitrofurantoin remains a key oral antibiotic stewardship program (ASP) option in the treatment of acute uncomplicated cystitis (AUC) due to multi-drug resistant (MDR) Gram negative bacilli (GNB). However, there have been concerns regarding decreased nitrofurantoin efficacy with renal insufficiency. In our experience over the past three decades, nitrofurantoin has been safe and effective in treating AUC in hospitalized adults with renal insufficiency. Accordingly, we retrospectively reviewed our recent experience treating AUC in hospitalized adults with decreased renal function (CrCl < 60 ml/min) with nitrofurantoin...
February 2, 2017: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/28129461/bullous-pemphigoid-associated-with-nivolumab-a-programmed-cell-death-1-protein-inhibitor
#4
Chase W Kwon, Anna S Land, Bruce R Smoller, Glynis Scott, Lisa A Beck, Mary Gail Mercurio
Checkpoint inhibitors, such as nivolumab, are revolutionary new drugs in cancer therapy. Mild dermatologic toxicities are commonly reported adverse events. Herein, we highlight the development of the autoimmune blistering condition, bullous pemphigoid (BP) in a patient undergoing treatment with nivolumab. A 60-year-old man, who was being treated with nivolumab (3mg/kg intravenously every 2 weeks) after failing chemotherapy for metastatic renal cell carcinoma, presented acutely with a blistering rash. This article is protected by copyright...
January 27, 2017: Journal of the European Academy of Dermatology and Venereology: JEADV
https://www.readbyqxmd.com/read/28119255/limitations-of-current-liver-transplant-immunosuppressive-regimens-renal-considerations
#5
Wei Zhang, John Fung
BACKGROUND: The use of calcineurin inhibitor (CNI)-based immunosuppressive regimens following liver transplantation (LTx) has improved the outcomes of the recipients. However, CNI has nephrotoxicity and causes short- and long-term renal complications. The progressive structural changes can be irreversible in the long-term, leading to chronic kidney dysfunction. The present review was to evaluate the different strategies of CNI application to renal function in liver recipients. DATA SOURCES: PubMed database was searched for relevant articles in English on the issue of immunosuppressive regimen and kidney injury that related to early minimization of CNI after LTx...
February 2017: Hepatobiliary & Pancreatic Diseases International: HBPD INT
https://www.readbyqxmd.com/read/28054732/liver-transplantation-is-associated-with-good-clinical-outcome-in-patients-with-active-tuberculosis-and-acute-liver-failure-due-to-anti-tubercular-treatment
#6
REVIEW
Michele Bartoletti, Giulia Martelli, Sara Tedeschi, Mariacristina Morelli, Valentine Bertuzzo, Marina Tadolini, Paolo Pianta, Francesco Cristini, Maddalena Giannella, Russell E Lewis, Antonio D Pinna, Pierluigi Viale
BACKGROUND: Active tuberculosis (TB) is commonly considered a contraindication for liver transplantation (LT). However, in patients with TB who develop acute liver failure (ALF) due to toxicity induced by anti-tubercular treatment (ATT), LT could be the only opportunity. The aim of this study was to evaluate the feasibility of LT in this scenario. METHODS: We described 2 cases and comprehensively reviewed the literature finding 26 cases of LT performed in patients having a concomitant active TB and liver failure secondary to ATT toxicity...
January 5, 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/28033261/elevated-thrombopoietin-and-platelet-indices-confirm-active-thrombopoiesis-but-fail-to-predict-clinical-severity-of-puumala-hantavirus-infection
#7
Outi Laine, Lotta Joutsi-Korhonen, Riitta Lassila, Heini Huhtala, Antti Vaheri, Satu Mäkelä, Jukka Mustonen
We evaluated the mechanisms of thrombocytopenia and procoagulant changes in relation with clinical variables in a cohort of patients with acute hantavirus disease.Blood samples of 33 prospectively recruited, consecutive, hospitalized patients with acute Puumala virus-induced hemorrhagic fever with renal syndrome (HFRS) were collected acutely and at the recovery visit (control). Serum thrombopoietin (TPO) and activity of plasma microparticles (MPs) from various cell sources were measured with enzyme-linked immunosorbent assay-based methods...
December 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27959707/epidemiology-of-acute-kidney-injury-in-critically-ill-children-and-young-adults
#8
MULTICENTER STUDY
Ahmad Kaddourah, Rajit K Basu, Sean M Bagshaw, Stuart L Goldstein
Background The epidemiologic characteristics of children and young adults with acute kidney injury have been described in single-center and retrospective studies. We conducted a multinational, prospective study involving patients admitted to pediatric intensive care units to define the incremental risk of death and complications associated with severe acute kidney injury. Methods We used the Kidney Disease: Improving Global Outcomes criteria to define acute kidney injury. Severe acute kidney injury was defined as stage 2 or 3 acute kidney injury (plasma creatinine level ≥2 times the baseline level or urine output <0...
5, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/27942395/current-outcomes-of-off-pump-coronary-artery-bypass-grafting-evidence-from-real-world-practice
#9
REVIEW
Piroze M Davierwala
Coronary artery bypass grafting (CABG) can be performed conventionally using cardiopulmonary bypass (CPB) and aortic clamping or on a beating heart (BH) without the use of CPB, the so-called off-pump CABG. Some surgeons, who are proponents of off-pump CABG, preferentially use this technique for the majority of operations, whereas others use it only in certain situations which warrant avoidance of CPB. Ever since the conception of off-pump CABG, the never-ending debate about which technique of CABG is safe and efficacious continues to date...
November 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27927599/angiotensin-converting-enzyme-2-amplification-limited-to-the-circulation-does-not-protect-mice-from-development-of-diabetic-nephropathy
#10
Jan Wysocki, Minghao Ye, Ahmed M Khattab, Agnes Fogo, Aline Martin, Nicolae Valentin David, Yashpal Kanwar, Mark Osborn, Daniel Batlle
Blockers of the renin-angiotensin system are effective in the treatment of experimental and clinical diabetic nephropathy. An approach different from blocking the formation or action of angiotensin II (1-8) that could also be effective involves fostering its degradation. Angiotensin-converting enzyme 2 (ACE2) is a monocarboxypeptidase that cleaves angiotensin II (1-8) to form angiotensin (1-7). Therefore, we examined the renal effects of murine recombinant ACE2 in mice with streptozotocin-induced diabetic nephropathy as well as that of amplification of circulating ACE2 using minicircle DNA delivery prior to induction of experimental diabetes...
December 4, 2016: Kidney International
https://www.readbyqxmd.com/read/27888551/selective-targeting-of-high-affinity-lfa-1-does-not-augment-costimulation-blockade-in-a-nonhuman-primate-renal-transplantation-model
#11
K P Samy, D A Anderson, D J Lo, M S Mulvihill, M Song, A B Farris, B S Parker, A L MacDonald, C Lu, T A Springer, S C Kachlany, K A Reimann, T How, F V Leopardi, K S Franke, K D Williams, B H Collins, A D Kirk
Costimulation blockade (CoB) via belatacept is a lower morbidity alternative to calcineurin inhibitor (CNI)-based immunosuppression. However, it has higher rates of early acute rejection. These early rejections are mediated in part by memory T cells, which have reduced dependence on the pathway targeted by belatacept, and increased adhesion molecule expression. One such molecule is Leukocyte Function Associated Antigen (LFA)-1. LFA-1 exists in two forms, a commonly expressed, low-affinity form, and a transient, high-affinity form, expressed only during activation...
November 26, 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27869328/real-life-efficacy-and-safety-of-paritaprevir-ritonavir-ombitasvir-and-dasabuvir-in-chronic-hepatitis-c-patients-in-hong-kong
#12
Henry Lik-Yuen Chan, Owen Tak-Yin Tsang, Yee-Tak Hui, James Fung, Grace Chung-Yan Lui, Ching-Lung Lai, Grace Lai-Hung Wong, Kam-Hon Chan, David Yiu-Kuen But, Moon-Sing Lai, Wai-Cheung Lao, Carmen Ka-Man Chan, Yip-Shun Lam, Wai-Kay Seto, Carlton Li, Man-Fung Yuen, Vincent Wai-Sun Wong
BACKGROUND AND AIM: In registration studies, combination therapy of paritaprevir/ritonavir, ombitasvir and dasabuvir (PrOD) with and without ribavirin for 12-24 weeks can achieve >90% sustained virological response (SVR) for genotype 1 hepatitis C virus (HCV) infection. However, data in Asia is scanty. We aimed to study the efficacy and safety of this combination therapy in chronic hepatitis C patients in Hong Kong. METHODS: We retrospectively analyzed data from 6 local hospitals which have prescribed PrOD with and without ribavirin to patients with genotype 1 chronic HCV infection as part of a global compassionate program...
November 21, 2016: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/27867530/continuous-renal-replacement-therapy-for-haemodynamic-collapse-and-rhabdomyolysis-induced-by-pheochromocytoma-crisis
#13
Xi Zhou, Chuhuan Zhao, Xiafei Feng, Anweshan Samanta, Yi Nuo Lin, Jun Chen, Xiaochun Dai, Xia Hong, Qiangli Xie, Weijian Huang
Pheochromocytoma associated with pregnancy is not common. Caesarean section may induce pheochromocytoma crisis, resulting in a lethal condition. The clinical picture of pheochromocytoma crisis is extremely variable. In this report, we describe a case of severe pheochromocytoma crisis induced by caesarean section presenting with hyperpyrexia, haemodynamic collapse, muscle weakness, heart failure, and acute kidney injury. Furthermore, we report that the muscle weakness was a manifestation of rhabdomyolysis, resulting from the pheochromocytoma crisis...
December 2016: ESC Heart Failure
https://www.readbyqxmd.com/read/27783835/percutaneous-acetabuloplasty-for-metastatic-lesions-to-the-pelvis
#14
Ryan A Durfee, Scott A Sabo, G Douglas Letson, Odion Binitie, David Cheong
Metastatic lesions of the acetabulum can be painful and debilitating. First-line treatment is multimodal and consists of disease-specific chemotherapy, osteoclastic inhibitors, analgesics, and radiation therapy. When these therapies fail, surgical intervention usually is indicated and varies from regional defect stabilization to large periacetabular reconstructions that are demanding procedures with high rates of complications. Percutaneous cement augmentation (acetabuloplasty) of lesions in selected patients has been explored as a less invasive method of lesional control...
October 25, 2016: Orthopedics
https://www.readbyqxmd.com/read/27742385/costimulatory-blockade-and-use-of-mtor-inhibitors-avoiding-injury-part-2
#15
REVIEW
David Wojciechowski, Flavio Vincenti
Kidney transplantation immunosuppression relies on a calcineurin inhibitor backbone. Calcineurin inhibitors have reduced early-acute rejection rates but failed to improve long-term allograft survival. Their nephrotoxicity has shifted the focus of investigation to calcineurin inhibitor-free regimens. Costimulation blockade with belatacept, a second generation, higher avidity variant of CTLA4-Ig, has emerged as part of a calcineurin inhibitor-free regimen. Belatacept has demonstrated superior glomerular filtration rate compared with calcineurin inhibitors albeit with an increased risk of early and histologically severe rejection...
September 2016: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/27742346/a-single-center-experience-of-allograft-nephrectomies-following-kidney-transplantation
#16
F Toth, G Zadori, R Fedor, L Illesy, M Szabo-Pap, Z Kanyari, D A Kovacs, L Asztalos, B Nemes
INTRODUCTION: Approximately 10% of renal allografts fail during the first year after kidney transplantation (KT) and 3%-5% thereafter yearly. The indication and timing of allograft nephrectomy (AN) is still uncertain in some cases. The aim of this study was to reveal the ratio, etiology, and complications of AN at our center. MATERIAL AND METHODS: This is a retrospective study of all patients who underwent KT at our center between January 1, 2004 and December 31, 2014...
September 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27727514/serelaxin-in-acute-heart-failure-most-recent-update-on-clinical-and-preclinical-evidence
#17
REVIEW
Raktim Kumar Ghosh, Kinjal Banerjee, Ramyashree Tummala, Somedeb Ball, Keyvan Ravakhah, Anjan Gupta
Heart failure continues to be a widely prevalent disease across the world, affecting millions of Americans annually. Acute heart failure (AHF) has a substantial effect on rising healthcare costs and is one of the major causes of morbidity and mortality. The search for new drugs for symptom relief and to improve long-term outcomes in heart failure has led to development of serelaxin, a recombinant human relaxin-2 hormone. Relaxin was discovered in pregnancy, but eventually found to have a number of other physiological actions, not only in pregnancy, but also in nonpregnant women and men...
February 2017: Cardiovascular Therapeutics
https://www.readbyqxmd.com/read/27685848/fluid-composition-and-acute-kidney-injury
#18
Fernando G Zampieri, Alexandre B Libório, Alexandre B Cavalcanti
PURPOSE OF REVIEW: To describe recent advances in the understanding of the role of fluid composition in renal outcomes in critically ill patients. RECENT FINDINGS: The debate on fluid composition is now focused in a pragmatic discussion on fluid electrolyte composition. The resurgence of this debate was propelled by several observational studies that suggested that balanced (i.e., low chloride) solutions were associated with less acute kidney injury in critically ill patients...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27669547/role-of-isolated-ultrafiltration-in-the-management-of-chronic-refractory-and-acute-decompensated-heart-failure
#19
Mayank K Mittal, Natraj Katta, Martin A Alpert
Chronic congestive heart failure (CHF) and acute decompensated heart failure (ADHF) refractory to medical therapy represent therapeutic challenges. In such patients, attempts to reduce pulmonary and systemic congestion frequently produce deterioration of renal function. In studies of patients with chronic severe CHF refractory to medical therapy (including loop diuretics), isolated ultrafiltration was frequently able to relieve congestive symptoms by precise removal of extracellular water and sodium, and in some cases was able to restore responsiveness to loop diuretics...
October 2016: Hemodialysis International
https://www.readbyqxmd.com/read/27647685/acute-west-nile-virus-meningoencephalitis-diagnosed-via-metagenomic-deep-sequencing-of-cerebrospinal-fluid-in-a-renal-transplant-patient
#20
M R Wilson, L L Zimmermann, E D Crawford, H A Sample, P R Soni, A N Baker, L M Khan, J L DeRisi
Solid organ transplant patients are vulnerable to suffering neurologic complications from a wide array of viral infections and can be sentinels in the population who are first to get serious complications from emerging infections like the recent waves of arboviruses, including West Nile virus, Chikungunya virus, Zika virus, and Dengue virus. The diverse and rapidly changing landscape of possible causes of viral encephalitis poses great challenges for traditional candidate-based infectious disease diagnostics that already fail to identify a causative pathogen in approximately 50% of encephalitis cases...
September 20, 2016: American Journal of Transplantation
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