Relação entre a Razão Nitrogênio Ureico/Creatinina e Prognóstico de Insuficiência Cardíaca em Todo o Espectro da Fração de Ejeção / Relationship between BUN/Cr and Prognosis of HF Across the Full Spectrum of Ejection Fraction

Resumo Fundamento Em pacientes com insuficiência cardíaca (IC), devido à relativa deficiência do volume sanguíneo, a ativação do sistema neuro-hormonal leva à vasoconstrição renal, que afeta o teor de nitrogênio ureico (NU) e creatinina (C) no organismo, sendo que NU e C são facilmente afetados por outros fatores. Portanto, a razão NU/C pode ser utilizada como mais um marcador para o prognóstico da IC. Objetivo Explorar o prognóstico do desfecho adverso da IC no grupo NU/C alta em comparação com o grupo NU/C baixa em todo o espectro da fração de ejeção. Métodos De 2014 a 2016, pacientes sintomáticos hospitalizados com IC foram recrutados e acompanhados para observar desfechos cardiovasculares adversos. Foram realizadas análise logística e a análise COX para determinar a significância. Valores de p<0,05 foram considerados estatisticamente significativos. Resultados Na análise de regressão logística univariada, o grupo NU/C alta apresentou maior risco de desfecho adverso na insuficiência cardíaca com fração de ejeção reduzida (ICFEr) e insuficiência cardíaca com fração de ejeção preservada (ICFEp). A análise de regressão logística multivariada mostrou que o risco de morte cardíaca no grupo ICFEr foi maior do que no grupo NU/C baixa, enquanto o risco de morte por todas as causas foi significativo apenas em 3 meses (p<0,05) (Ilustração Central). O risco de morte por todas as causas no grupo NU/C alta no grupo ICFEP foi significativamente maior do que no grupo NU/C baixa em dois anos. Conclusão O grupo NU/C alta está relacionado ao risco de mau prognóstico da ICFEP, não sendo inferior ao valor preditivo da fração de ejeção do ventrículo esquerdo (FEVE).

Abstract Background In patients with heart failure (HF), due to the relative deficiency of blood volume, neurohormone system activation leads to renal vasoconstriction, which affects the content of blood urea nitrogen (BUN) and creatinine (Cr) in the body, while BUN and Cr are easily affected by other factors. Therefore, BUN/Cr can be used as another marker for the prognosis of HF. Objective Explore the prognosis of adverse outcome of HF in the high BUN/Cr group compared with the low BUN/Cr group across the full spectrum of ejection fraction. Methods From 2014 to 2016, symptomatic hospitalized HF patients were recruited and followed up to observe adverse cardiovascular outcomes. Logistic analysis and COX analysis were performed to determine significance. p-values <0.05 were considered statistically significant. Results In the univariate logistic regression analysis, the high BUN/Cr group had a higher risk of adverse outcome in heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Multivariate logistic regression analysis showed that the risk of cardiac death in the HFrEF group was higher than that in the low BUN/Cr group, while the risk of all-cause death was significant only in 3 months (p<0.05) (Central Illustration). The risk of all-cause death in the high BUN/Cr in the HFpEF group was significantly higher than that in the low BUN/Cr group at two years. Conclusion The high BUN/Cr group is related to the risk of poor prognosis of HFpEF, and is not lower than the predictive value of left ventricular ejection fraction (LVEF).

Natural exosome-like nanovesicles from edible tea flowers suppress metastatic breast cancer via ROS generation and microbiota modulation

Although several artificial nanotherapeutics have been approved for practical treatment of metastatic breast cancer, their inefficient therapeutic outcomes, serious adverse effects, and high cost of mass production remain crucial challenges. Herein, we developed an alternative strategy to specifically trigger apoptosis of breast tumors and inhibit their lung metastasis by using natural nanovehicles from tea flowers (TFENs). These nanovehicles had desirable particle sizes (131 nm), exosome-like morphology, and negative zeta potentials. Furthermore, TFENs were found to contain large amounts of polyphenols, flavonoids, functional proteins, and lipids. Cell experiments revealed that TFENs showed strong cytotoxicities against cancer cells due to the stimulation of reactive oxygen species (ROS) amplification. The increased intracellular ROS amounts could not only trigger mitochondrial damage, but also arrest cell cycle, resulting in the in vitro anti-proliferation, anti-migration, and anti-invasion activities against breast cancer cells. Further mice investigations demonstrated that TFENs after intravenous (i.v.) injection or oral administration could accumulate in breast tumors and lung metastatic sites, inhibit the growth and metastasis of breast cancer, and modulate gut microbiota. This study brings new insights to the green production of natural exosome-like nanoplatform for the inhibition of breast cancer and its lung metastasis via i.v. and oral routes.

Synergetic delivery of triptolide and Ce6 with light-activatable liposomes for efficient hepatocellular carcinoma therapy

Hepatocellular carcinoma (HCC) has been known as the second common leading cancer worldwide, as it responds poorly to both chemotherapy and medication. Triptolide (TP), a diterpenoid triepoxide, is a promising treatment agent for its effective anticancer effect on multiple cancers including HCC. However, its clinical application has been limited owing to its severe systemic toxicities, low solubility, and fast elimination in the body. Therefore, to overcome the above obstacles, photo-activatable liposomes (LP) integrated with both photosensitizer Ce6 and chemotherapeutic drug TP (TP/Ce6-LP) was designed in the pursuit of controlled drug release and synergetic photodynamic therapy in HCC therapy. The TP encapsulated in liposomes accumulated to the tumor site due to the enhanced permeability and retention (EPR) effect. Under laser irradiation, the photosensitizer Ce6 generated reactive oxygen species (ROS) and further oxidized the unsaturated phospholipids. In this way, the liposomes were destroyed to release TP. TP/Ce6-LP with NIR laser irradiation (TP/Ce6-LP+L) showed the best anti-tumor effect both

Self-assembled FeS-based cascade bioreactor with enhanced tumor penetration and synergistic treatments to trigger robust cancer immunotherapy

Major challenges for cancer treatment are how to effectively eliminate primary tumor and sufficiently induce immunogenic cell death (ICD) to provoke a robust immune response for metastasis control. Here, a self-assembled cascade bioreactor was developed to improve cancer treatment with enhanced tumor penetration and synergistic therapy of starvation, chemodynamic (CDT) and photothermal therapy. Ultrasmall FeS-GOx nanodots were synthesized with glucose oxidase (GOx) as template and induced by paclitaxel (PTX) to form self-assembling FeS-GOx@PTX (FGP)

Pure photosensitizer-driven nanoassembly with core-matched PEGylation for imaging-guided photodynamic therapy

Pure drug-assembled nanomedicines (PDANs) are currently under intensive investigation as promising nanoplatforms for cancer therapy. However, poor colloidal stability and less tumor-homing ability remain critical unresolved problems that impede their clinical translation. Herein, we report a core-matched nanoassembly of pyropheophorbide a (PPa) for photodynamic therapy (PDT). Pure PPa molecules are found to self-assemble into nanoparticles (NPs), and an amphiphilic PEG polymer (PPa-PEG

Precise delivery of obeticholic acid

Primary bile acids were reported to augment secretion of chemokine (C‒X‒C motif) ligand 16 (CXCL16) from liver sinusoidal endothelial cells (LSECs) and trigger natural killer T (NKT) cell-based immunotherapy for liver cancer. However, abundant expression of receptors for primary bile acids across the gastrointestinal tract overwhelms the possibility of using agonists against these receptors for liver cancer control. Taking advantage of the intrinsic property of LSECs in capturing circulating nanoparticles in the circulation, we proposed a strategy using nanoemulsion-loaded obeticholic acid (OCA), a clinically approved selective farnesoid X receptor (FXR) agonist, for precisely manipulating LSECs for triggering NKT cell-mediated liver cancer immunotherapy. The OCA-nanoemulsion (OCA-NE) was prepared

Inhibition of Total Flavonids from Cudrania tricuspidata Bun on Lewis Lung Cancer and the Effect of Its Component Compatibility on Autophagy of LLC Cells / 中国药学杂志

OBJECTIVE: To explorethe effect of total flavonoids from Cudrania tricuspidata Bun on Lewis lung cancer mice and its new component compatibility on the autophagy of LLC cells. METHODS: A mouse model of Lewis lung cancer xenografts was constructed. The body weight, tumor weight, tumor volume and organ index were measured before and after taking total flavonoids of Cudrania tricuspidata Bun. The HE staining of the xenograft pathological sections were also observed. The TNF-α, IL-2, IL-6 and IL-12 levels in the serum were calculated by ELISA. The content of the main active ingredient and its ratio in the flavonoid extract were measured by UPLC. Western blot was used to detect the effect of the new component compatibility on the expression of autophagy protein in LLC cells, and the ultra structural changes of LLC cells were observed by transmission electron microscopy. Flow cytometry was used to detect the effect of the new component compatibility on autophagy of LLC cells. RESULTS: The high-dose group of total flavonoids from Cudrania tricuspidata Bun can significantly inhibit the growth of tumor in mice and enhance the organ index of tumor-bearing mice, and the survival rate of mice could be improved in all groups of total flavonoids from Cudrania tricuspidata Bun. The serum levels of TNF-α, IL-2, IL-6 and IL-12 in the tumor-bearing mice of each group were higher than those in the model group, and there was significant difference in the high dose group of total flavonoids (P<0.01). The main active ingredients were taxifolin, kaempferol and naringenin by UPLC. The ratio of taxifolin to kaempferol was 60:1. Western blot assay showed that its new component compatibility significantly increased the expression of autophagic protein in LLC cells (P<0.01). The autophagosomes in the cytoplasm were observed by transmission electron microscopy. The results of flow experiments showed that the average fluorescence intensity of its new component compatibility was significantly higher than that of the control group. CONCLUSION: Total flavonoids of Cudrania tricuspidata Bun can effectively inhibit tumor growth and have less harm to immune organs. Its mechanism may be related to up-regulation of cytokines TNF-α, IL-2, IL-6 and IL-12 levels and improve immune function in the body. Moreover, its main active ingredient promotes the increase of autophagy protein expression in LLC cells and induces autophagy in LLC cells.

Redox-sensitive prodrug nanoassemblies based on linoleic acid-modified docetaxel to resist breast cancers

Prodrug nanoassemblies, which can refrain from large excipients, achieve higher drug loading and control drug release, have been placed as the priority in drug delivery system. Reasoning that glutathione (GSH) and reactive oxygen species (ROS) are highly upgraded in tumor tissues which makes them attractive targets for drug delivery system, we designed and synthetized a novel prodrug which utilized mono thioether bond as a linker to bridge linoleic acid (LA) and docetaxel (DTX). This mono thioether-linked conjugates (DTX-S-LA) could self-assemble into nanoparticles without the aid of much excipients. The mono thioether endowed the nanoparticles redox sensitivity resulting in specific release at the tumor tissue. Our studies demonstrated that the nanoassemblies had uniform particle size, high stability and fast release behavior. DTX-S-LA nanoassemblies outperformed DTX solution in pharmacokinetic profiles for it had longer circulation time and higher area under curve (AUC). Compared with DTX solution, the redox dual-responsive nanoassemblies had comparable cytotoxic activity. Besides, the antitumor efficacy was evaluated in mice bearing 4T1 xenograft. It turned out this nanoassemblies could enhance anticancer efficacy by increasing the dose because of higher tolerance. Overall, these results indicated that the redox sensitivity nanoassemblies may have a great potential to cancer therapy.

Inactivation of TFEB and NF-B by marchantin M alleviates the chemotherapy-driven pro-tumorigenic senescent secretion

It is critical to regulate the senescence-associated secretory phenotype (SASP) due to its effect on promoting malignant phenotypes and limiting the efficiency of cancer therapy. In this study, we demonstrated that marchantin M (Mar-M, a naturally occurring bisbibenzyl) suppressed pro-inflammatory SASP components which were elevated in chemotherapy-resistant cells. Mar-M treatment attenuated the pro-tumorigenic effects of SASP and enhanced survival in drug-resistant mouse models. No toxicity was detected on normal fibroblast cells or in animals following this treatment. Inactivation of transcription factor EB (TFEB) and nuclear factor-B (NF-B) by Mar-M significantly accounted for its suppression on the components of SASP. Furthermore, inhibition of SASP by Mar-M contributed to a synergistic effect during co-treatment with doxorubicin to lower toxicity and enhance antitumor efficacy. Thus, chemotherapy-driven pro-inflammatory activity, seen to contribute to drug-resistance, is an important target for Mar-M. By decreasing SASP, Mar-M may be a potential approach to overcome tumor malignancy.

Cilastatin protects against imipenem-induced nephrotoxicity inhibition of renal organic anion transporters (OATs)

Imipenem is a carbapenem antibiotic. However, Imipenem could not be marketed owing to its instability and nephrotoxicity until cilastatin, an inhibitor of renal dehydropeptidase-I (DHP-I), was developed. In present study, the potential roles of renal organic anion transporters (OATs) in alleviating the nephrotoxicity of imipenem by cilastatin were investigated and in rabbits. Our results indicated that imipenem and cilastatin were substrates of hOAT1 and hOAT3. Cilastatin inhibited hOAT1/3-mediated transport of imipenem with IC values comparable to the clinical concentration, suggesting the potential to cause a clinical drug-drug interaction (DDI). Moreover, imipenem exhibited hOAT1/3-dependent cytotoxicity, which was alleviated by cilastatin and probenecid. Furthermore, cilastatin and probenecid ameliorated imipenem-induced rabbit acute kidney injury, and reduced the renal secretion of imipenem. Cilastatin and probenecid inhibited intracellular accumulation of imipenem and sequentially decreased the nephrocyte toxicity in rabbit primary proximal tubule cells. Renal OATs, besides DHP-I, was also the target of interaction between imipenem and cilastatin, and contributed to the nephrotoxicity of imipenem. This therefore gives in part the explanation about the mechanism by which cilastatin protected against imipenem-induced nephrotoxicity. Thus, OATs can potentially be used as a therapeutic target to avoid the renal adverse reaction of imipenem in clinic.

Anti-diabetic effects of blue honeyberry on high-fed-diet-induced type II diabetic mouse

BACKGROUND/OBJECTIVE: The blue honeysuckle berry (Lonicera caerulea var. edulis L.) is a small deciduous shrub belonging to the Caprifoliaceae family that is native to Russia, China, Japan, and Korea. The berry of this shrub is edible, sweet and juicy and is commonly known as the blue honeyberry (BHB). This study examined the anti-diabetic potential of BHB on high-fat-diet-induced mild diabetic mice. The hypoglycemic, and nephroprotective effects of the 12-week oral administration of blue honeyberry extract were analyzed. MATERIALS/METHODS: The hypoglycemic effects were based on the observed changes in insulin, blood glucose, and glycated hemoglobin (HbA1c). Furthermore, the changes in the weight of the pancreas, including its histopathology and immunohistochemical investigation were also performed. Moreover, the nephroprotective effects were analyzed by observing the changes in kidney weight, its histopathology, blood urea nitrogen (BUN), and serum creatinine levels. RESULTS: The results showed that the high-fat diet (HFD)-induced control mice showed a noticeable increase in blood glucose, insulin, HbA1c, BUN, and creatinine levels. Furthermore, growth was observed in lipid droplet deposition related to the degenerative lesions in the vacuolated renal tubules with the evident enlargement and hyperplasia of the pancreatic islets. In addition, in the endocrine pancreas, there was an increase in the insulin-and glucagon-producing cells, as well as in the insulin/glucagon cell ratios. On the other hand, compared to the HFD-treated mice group, all these diabetic and related complications were ameliorated significantly in a dose-dependent manner after 84 days of the continuous oral administration of BHBe at 400, 200 and 100 mg/kg, and a dramatic resettlement in the hepatic glucose-regulating enzyme activities was observed. CONCLUSIONS: By assessing the key parameters for T2DM, the present study showed that the BHBe could act as a potential herbal agent to cure diabetes (type II) and associated ailments in HFD-induced mice.

Efecto de los procesos de congelación y descongelación sobre los almidones en un alimento a base de maíz / Effect of the freezing and thawing processes on starches in a corn-based food

RESUMEN Se decidió estudiar el efecto que la cocción y el congelamiento sucesivos tiene sobre contenido de almidones y el índice glicémico (IG) de un alimento a base de harina de maíz (bollo). Se elaboró el alimento y se sometió congelamiento y cocción un par de veces. El contenido de almidones se comparó con el de la harina de maíz pre-cocida y se encontraron diferencias significativas (F = 5,84; p = 0,005), con un incremento importante del contenido de almidón resistente debido a los tratamientos térmicos. Se elaboraron curvas de glicemia a una muestra de individuos sanos, a los que se dio a consumir el alimento sometido a los diferentes tratamientos y pan integral. Se encontraron diferencias significativas (F= 4,21; p= 0,034) y un IG de 67,9 para el bollo sometido a tres procesos de cocción y dos congelamientos. Indicativo de que los procesos térmicos provocaron la aparición de una proporción de almidón retrogradado equivalente a fibra dietética que puede ser beneficioso para el organismo.

ABSTRACT We studied the effect that subsequent cooking and freezing has on the starch content and the glycemic index (GI) of a corn flour-based food (bun). The food was made and exposed to cooking and freezing a couple of times. The starch content was compared with that of precooked corn flour and significant differences were found (F = 5.84; p = 0.005), with an important increase in the retrograded starch content due to thermic treatments. Glycemic response curves were conducted for a sample of healthy individuals, who consumed the food submitted to the treatments and wholegrain bread. Significant differences were found (F = 4.21; p= 0.034) and a GI of 67.9 for the bun submitted to three cooking and two freezing processes. Results suggest that the thermic treatments induced the appearance of a retrograded starch proportion equivalent to dietary fiber which could be beneficial for the body.

Clinical Observation of Febuxostat in the Treatment of Type 2 Diabetic Nephropathy Complicated with Hyperuricemia / 中国药房

OBJECTIVE: To observe clinical efficacy and safety of febuxostat in the treatment of type 2 diabetic nephropathy complicated with hyperuricemia. METHODS: A total of 137 patients with type 2 diabetic nephropathy complicated with hyperuricemia selected from our hospital during Jan. 2014-Jun. 2016 were divided into group A (46 cases), B (47 cases), C (44 cases) according to random number table. On the basis of routine treatment, group A was given Allopurinol tablets orally with initial dose of 0. 05 g, bid; increasing to 0. 10 g, bid, 2 weeks later. Group B was given Benzbromarone tablets 50 mg orally, qd. Group C was given Febuxostat tablets orally with initial dose of 40 mg, qd; increasing to 80 mg, qd, 2 weeks later. All patients received treatment for consecutive 12 weeks. Clinical efficacies of 2 groups were observed, and the levels of serum uric acid (SUA), Scr and BUN were also observed before and after treatment. The occurrence of ADR was recorded. RESULTS: Four, six, three patients withdrew from the study in group A, B, C, respectively. The total response rates of group B, C (87. 8％, 85. 4％) were significantly higher than that of group A (76. 2％), with statistical significance (P＜0. 05); there was no statistical significance between group B and C (P＞0. 05). Before treatment, there was no statistical significance in the levels of SUA, Scr or BUN among 3 groups (P＞0. 05). Four weeks after treatment, the levels of SUA in 3 groups were decreased significantly compared to before treatment, with statistical significance (P＜0. 05); there was no statistical significance in other indexes among 3 groups or between before and after treatment (P＞0. 05). Twelve weeks after treatment, the levels of SUA in 3 groups were decreased significantly compared to before treatment and 4 weeks after treatment, and group B and C were significantly lower than group A; the levels of Scr in group A and C were decreased significantly compared to before treatment, while that of group B was increased significantly compared to before treatment and group B was significantly higher than group A and C, with statistical significance (P＜0. 05). There was no statistical significance in the levels of Scr or BUN among 3 groups compared to 4 weeks after treatment; there was also no statistical significance in the levels of SUA between group B and C, the levels of Scr between group A and C (P＞0. 05). Total incidence of ADR in group C (12. 20％) was significantly lower than group A and B (25. 58％, 24. 39％), with statistical significance (P＜0. 05); there was no statistical significance between group A and B (P＞0. 05). CONCLUSIONS: Febuxostat is better than allopurinol in reducing the level of SUA in type 2 diabetic nephropathy patients with hyperuricemia. It shows small effect on renal function with better safety.

Study on Effect of TLR4/MyD8 8 Protein on Chronic Renal Failure / 现代检验医学杂志

Objective To explore the expression of TLR4 and MyD88 in chronic renal failure and its role in the development of chronic renal failure.Methods 40 cases of patients diagnosed chronic renal failure during 2011.07~2014.05 were select-ed as observation subjects,and renal tissues without invasion of 40 cases patients with renal carcinoma resection were chosen as control.The expression of TLR4 and MyD88 in chronic renal failure was detected by IMH.The mice model was stabled establish through gavage of adenine (200 mg/kg).And the TLR4 and MyD88 expression was detected by RT-PCR and Western blot.The models was divided into three groups:TLR4 blocking group,TLR4 non-blocking and control group.And the BUN and CRE were detected by biochemical analyzer in three groups.Results The expression of TLR4 and MyD88 were higher in chronic renal failure than in normals.The TLR4 and MyD88 were also higher in chronic renal failure model mice.The levels of BUN (15.65±3.97 mmol/L)in TLR4 blocking group were lower than which in TLR4 non-blocking group (23.33±7.62 mmol/L)and which in IgG group (26.33±6.77mmol/L)(t=2.887,P=0.045).The CRE levels were the lowest in TLR4-blocking group (523.89 ± 52.67μmol/L)compared with the TLR4 non-blocking group (789.51 ± 98.17μmol/L)and the IgG group (809.51±94.19μmol/L)(t=4.125,P=0.015).Conclusion The increased expression of TLR4 and MyD88 in chronic renal failure significantly would promote the development of chronic renal failure.

Toxicity of nano-TiO2 in rat kidney under oxidative stress / 西安交通大学学报(医学版)

Objective To investigate the adverse effects of nano-titanium dioxide (TiO2 )on kidney tissues in healthy rats and rats with oxidative stress (OS).Methods Thirty-six healthy male SD rats were randomly divided into control group, alloxan-treated group, nano-TiO2 treated (NM) group, and alloxan and nano-TiO2 dual treatment (OS-NM)group.Nano-TiO2 of three concentrations (0.5,5 and 50 mg/kg body weight)was injected intraperitoneally.The level of OS biochemical factors and blood urea nitrogen (BUN)and pathological changes of kidney were determined.Results Compared with those in NM and OS groups,the levels of O2 -· and superoxide dismutase (SOD)in OS-NM group were significantly increased after exposure to nano-TiO2 of 5 mg/kg body weight (P <0.05).Nano-TiO2 of 50 mg/kg body weight led to significant changes of O2 -·,SOD,and glutathione (GSH) levels in OS-NM group in comparison with OS and NM groups (P <0.01).The levels of O2 -· and GSH between OS group and NM group changed significantly (P < 0.05 ).Compared with healthy rats,OS rats showed significant increased BUN level (P <0.01),cell number and edema of renal tubular epithelial cells after nano-TiO2 exposure.A synergic effect between OS condition and nano-TiO2 level was shown on the increased level of O2 -·.Conclusion Nano-TiO2 induced more adverse effects on the kidney in OS rats,suggesting a synergistic effect between nano-TiO2 and OS.This result provides experimental evidence for patients’safe use of nano-TiO2 .

Limitations of Conventional Parameters and Role of Urinary Protein Biomarkers in the Determination of Drug Induced Acute Kidney Injury in Very Early Stage.

Drug-induced Acute Kidney Injury (AKI) constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. Drug-induced acute renal failure (ARF) accounted for 20% of all ARF in an Indian study. The incidence and prevalence of chronic kidney disease (CKD) has dramatically increasing worldwide. Progression of AKI from mild or moderate to end stage may be prevented by selecting potentially effective therapies, if it is detected in very early stage. But early detection of AKI is often difficult due to paucity of early predictive noninvasive biomarkers. Development of omics technology has led to the identification of several urinary protein biomarkers and transcriptional biomarkers, which enable earlier detection of kidney injury. Urinary protein biomarkers have great benefit due to the easy or non-invasive availability of urine and many showing good predictive power. Several urinary protein biomarkers have been identified and have demonstrated superiority in detecting kidney injury in comparison to conventional parameters like serum creatinine (SCr), blood urea nitrogen (BUN) etc. These promising experimental biomarker of kidney damage require further confirmation of its use in routine clinical use.

Identification of predictive marker of prerenal damage in pregnant women with Preeclampsia and women at high risk- A Prospective study conducted in Riyadh,Saudi Arabia.

Background: Preeclampsia is characterized by development of high blood pressure and proteinuria. It affects 5–8% of all pregnancies and is a major contributor to maternal and fetal morbidity and mortality. There is no single test that fulfils all the criteria for a good predictor of preeclampsia and associated renal damage. Aims & Objectives: To evaluate the role of serum and urine biochemical parameters as early predictors of preeclampsia. To investigate the role of BUN: Creatinine ratio in diagnosing preeclampsia and evaluating prognosis of the disease. Material and Methods: In the present prospective study, one hundred and twenty pregnant women divided into three groups: normotensive (control), women at high risk and with preeclampsia were included. Analyses of different biochemical parameters including BUN: Creatinine were carried out. Results: There was significant difference in the mean value of serum uric acid, blood urea nitrogen, creatinine, urinary protein and BUN: Creatinine ratio in preeclampsia group compared to control group (p < 0.001). There was significant difference (p < 0.05) in serum uric acid between control and preeclampsia group. However, there was no significant change in haematocrit, serum creatinine and urine protein between control and high risk group. Conclusion: BUN: Creatinine ratio in pregnant women with preeclampsia and also in high risk group was significantly increased (t = 15.55, p < 0.001 and t = 8.66, p < 0.001 respectively) in comparison to the control group. This index could be useful in evaluating the severity of preeclampsia and could be used as a predictor in prognosis of preeclampsia and subsequent early renal disease.

Comparison of hepatic and renal function between inhalation anesthesia with sevoflurane and remifentanil and total intravenous anesthesia with propofol and remifentanil for thyroidectomy / 대한마취과학회지

BACKGROUND: Inhalation anesthetics are an important factor for postoperative hepatic and renal dysfunction. In this regard, TIVA can reduce the risk of hepatic and renal dysfunction inherited to inhalation anesthetics. The present study was conducted to determine whether hepatic and renal functions differ after anesthesia with sevoflurane and propofol. METHODS: Two hundred patients, ASA physical status class I, II, scheduled for an elective thyroidectomy were randomly divided into two groups. Anesthesia was maintained with sevoflurane 1-2% and remifentanil in the sevoflurane group (Group S) and propofol 2-5 ug/ml and remifentanil 2-5 ng/ml at the effect site, using a target controlled infusion (TCI) pump in the TIVA group (Group T) to maintain BIS of 40-60. To evaluate the hepatic and renal function, aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN) and creatinine were tested at preoperation (baseline), postoperative 1 day and 3 days. RESULTS: AST was increased at postoperative 1 day and 3 days, compared with that of the preoperation in Group S, and postoperative 1 day in Group T, but the values were within its normal limit. ALT was not changed after anesthesia in both groups. BUN was increased at postoperative 1 day, compared with that of the preoperation in Group S, but the value was within its normal limit. Creatinine was not changed after anesthesia in both groups. CONCLUSIONS: The changes of hepatic and renal function after inhalation anesthesia with sevoflurane and TIVA with propofol and remifentanil for thyroidectomy were clinically insignificant, and there was no difference between the two methods.

Serum Creatinine and Blood Urea Nitrogen Levels in Patients with Coronary Artery Disease.

Background: Few studies have assessed the relation of Serum creatinine and serum blood urea nitrogen (BUN) level with the severity of coronary artery disease (CAD). This study investigated the association between high uric acid BUN levels with the presence of Coronary artery disease. Materials and Methods: This study was designed as an observational cohort study. The study was composed of 170 patients admitted at our institution due to symptoms related to CAD. Patients having angiographic evidence of stenosis in coronary artery were as case group and without stenosis control group. Patients with high serum creatinine were defined as serum creatinine concentration with in 80-105 μmol/L and BUN level with in 10-20 μmol/L. The presence of CAD has been defined as the Gensini score being >1. Results: Patients with or without CAD were similar in terms of age (45.22±6.80 years vs. 52.87±9.31 years, p<0.01) and significant age difference was found between patients. Male gender (p<0.001) and smoking habit (p=0.003) were more frequent and statistically significant in patients with CAD. There was a statistically significant difference between the mean serum creatinine levels (92.89±20.82 μmol/L vs 108.68±23.62 μmol/L respectively, p<0.05) and serum blood urea nitrogen level (10.59±6.15 μmol/L vs. 20.37±6.73 μmol/L respectively, p<0.01) of patients with or without CAD. While looking at the correlation coefficient of Gensini score with different factors; S. creatinine, ejection fraction and BUN were significantly correlated at<0.001 and <0.04 and <0.01 level respectively. Increased serum creatinine levels were found to be independent risk factors for the presence of CAD (for serum cretinine hazard ration 3.9, p<0.001 and in case BUN hazard ration 2.08, p<0.001). Conclusion: In conclusion, a significant association has been found between serum creatinine & BUN level and the presence of CAD. In addition to the evaluation of conventional risk factors in daily clinical practice, the measurement of serum creatinine and BUN level might provide significant prognostic benefits in terms of global cardiovascular risk and management of the patients.

Experience without using venoveno bypass in adult orthotopic liver transplantation / 대한마취과학회지

BACKGROUND: Venoveno bypass (VVB) has been used to achieve hemodynamic stability and decrease the incidence of renal dysfunction. However, VVB has many complications. The purpose of this study is to verify the safety of total clamping of the suprahepatic inferior vena cava (IVC) without VVB during orthotropic liver transplantation (OLT) in terms of anesthetic management. METHODS: Twenty-five patients without preoperative renal dysfunction who underwent primary OLT were enrolled in this study. Hemodynamic data and blood gas measurements were collected 1 hour after incision, 30 minutes after IVC total clamping and 30 minutes after reperfusion. Postoperative laboratory data, including blood urea nitrogen (BUN), creatinine (Cr) and glomerular filtration rate (GFR), were assessed at postoperative day (POD) 0-7, 30, 90, 180 and 1 year. RESULTS: Mean blood pressure was well maintained during IVC total clamping with infusion of inotropics. There was no case of severe acidosis (pH < 7.2) during the anhepatic period. The immediate postoperative Cr and GFR were not significantly different from those of the preoperative values. BUN increased from POD 1 and decreased after POD 6, while Cr increased at POD 90 only. CONCLUSIONS: In patients without preoperative renal dysfunction, when IVC was totally clamped, VVB does not need to be routinely performed to maintain hemodynamics during the anhepatic phase and renal function after OLT.