Mediation of serum albumin in the association of serum potassium with mortality in Chinese dialysis patients: a prospective cohort study / 中华医学杂志(英文版)

BACKGROUND@#The clinical importance of hypokalemia is likely underrecognized in Chinese dialysis patients, and whether its clinical effect was mediated by serum albumin is not fully elucidated. This study aimed to explore the association between serum potassium and mortality in dialysis patients of a Chinese nationwide multicenter cohort, taking albumin as a consideration.@*METHODS@#This was a prospective nation-wide multicenter cohort study. Restricted cubic splines were used to test the linearity of serum potassium and relationships with all-cause (AC) and cardiovascular (CV) mortality and a subsequent two-line piecewise linear model was fitted to approach the nadir. A mediation analysis was performed to examine relations of albumin to potassium and mortalities.@*RESULTS@#A total of 10,027 patients were included, of whom 6605 were peritoneal dialysis and 3422 were hemodialysis patients. In the overall population, the mean age was 51.7 ± 14.8 years, 55.3%(5546/10,027) were male, and the median dialysis vintage was 13.60 (4.70, 39.70) months. Baseline serum potassium was 4.30 ± 0.88 mmol/L. After a median follow-up period of 26.87 (14.77, 41.50) months, a U-shape was found between potassium and mortality, and a marked increase in risk at lower potassium but a moderate elevation in risk at higher potassium were observed. The nadir for AC mortality risk was estimated from piecewise linear models to be a potassium concentration of 4.0 mmol/L. Interestingly, the significance of the association between potassium and mortality was attenuated when albumin was introduced into the extended adjusted model. A subsequent significant mediation by albumin for potassium and AC and CV mortalities were found ( P < 0.001 for both), indicating that hypokalemia led to higher mortality mediated by low serum albumin, which was a surrogate of poor nutritional status and inflammation.@*CONCLUSIONS@#Associations between potassium and mortalities were U-shaped in the overall population. The nadir for AC mortality risk was at a potassium of 4.0 mmol/L. Serum albumin mediated the association between potassium and AC and CV mortalities.

Nutritional response and clinical complications in patients with post-pyloric and gastric enteral tubes / Resposta nutricional e complicações clínicas em pacientes com uso de sonda gástrica ou pós-pilórica

ABSTRACT Objective The present study assessed the differences in nutritional markers (albumin, transferrin, total body fat, and body mass index) and clinical complications (diarrhea, vomiting, and diet interruptions) associated with enteral nutrition. Methods This is an open-label, randomized, two-arm parallel-group controlled clinical trial. Out of 105 patients assessed for eligibility, 35 adult patients were randomly divided into two groups and followed for 28 days. The sample comprised a heterogeneous group of severely ill individuals initially treated in the intensive care units. Neurological conditions (i.e., strokes and brain tumours) were the most common reasons for hospitalization. Patients had one singularity: the clinical need for exclusive enteral nutrition therapy. One group received the diet via gastric tube and the other via a post-pyloric tube. Results The groups presented increases in the calories prescribed and administered, as well as reduced diet discontinuation. Although similar values were observed up to day 21, the post-pyloric group showed increased albumin levels compared to the gastric group on Day 28. Transferrin levels increased over time in both groups. Conclusion There were no differences in the complications recorded between groups, albeit serum albumin significantly increased in the post-pyloric group.

RESUMO Objetivo Avaliar diferenças tanto nos marcadores nutricionais (albumina, transferrina, gordura corporal e índice de massa corporal) quanto nas complicações clínicas (diarreia, vômitos e interrupções na dieta) associadas à nutrição enteral administrada através de duas vias tradicionais. Métodos Este é um ensaio clínico de tratamento, paralelo de dois braços, aberto e randomizado controlado. Dos 105 participantes avaliados para elegibilidade, 35 pacientes adultos foram divididos aleatoriamente em dois grupos e seguidos por 28 dias. A amostra foi formada por um grupo heterogêneo e gravemente enfermo, tratados inicialmente em unidades de terapia intensiva. Condições neurológicas, como acidente vascular e tumores cerebrais foram as razões principais para hospitalização. Os pacientes tinham em comum um aspecto, a saber, a necessidade clínica exclusiva de receber nutrição enteral. Um grupo recebeu a dieta via sonda gástrica e o outro através de sonda pós-pilórica. Resultados Os grupos apresentaram aumento de calorias prescritas e administradas, bem como redução da descontinuação da dieta. Embora valores semelhantes tenham sido observados até o 21° dia, o grupo pós-pilórico apresentou aumento dos níveis de albumina em relação ao grupo gástrico no dia 28. Os níveis de transferrina aumentaram ao longo do tempo em ambos os grupos. Conclusão Não houve diferenças nas complicações registradas entre os grupos, embora níveis séricos de albumina aumentaram significativamente no grupo pós-pilórico.

Asociación de factores de riesgo independientes con fracaso posextubación en pacientes desconectados de la ventilación mecánica / Association of independent risk factors with post-extubation failure in patients undergoing mechanical ventilation weaning

Resumen Introducción: Aun con adecuado protocolo de desconexión de la ventilación mecánica (DVM), el procedimiento falla en 15 a 30 % de los casos. Objetivo: Evaluar la asociación entre factores de riesgo independientes y fracaso posextubación en pacientes con DVM en una unidad de cuidados intensivos. Método: Estudio de cohorte, longitudinal, prospectivo, analítico, que incluyó pacientes sometidos a ventilación mecánica por más de 24 horas y que fueron extubados. Se obtuvieron reportes preextubación de hemoglobina, albúmina, fósforo, índice cintura-cadera y puntuación SOFA. Se definió como fracaso de extubación al reinicio de la ventilación mecánica en 48 horas o menos. Resultados: Se extubaron 123 pacientes, 74 hombres (60 %); la edad promedio fue de 50 ± 18 años. Ocurrió fracaso de extubación en 37 (30 %). Como factores de riesgo independentes se asoció hipoalbuminemia en 29 (23.8 %, RR = 1.43, IC 95 % = 1.11-1.85) e hipofosfatemia en 18 (14.6 %, RR = 2.98, IC 95 % = 1.66-5.35); se observaron dos o más factores de riesgo independientes en 22.7 % (RR = 1.51, IC 95 % = 1.14-2.00). Conclusiones: Identificar los factores de riesgo independentes antes de la DVM puede ayudar a reducir el fracaso de la extubación y la morbimortalidad asociada.

Abstract Introduction: Even with an adequate mechanical ventilation weaning (MVW) protocol, the procedure fails in 15 to 30 % of cases. Objective: To assess the association between independent risk factors (IRFs) and post-extubation failure in patients undergoing MVW in an intensive care unit. Method: Longitudinal, prospective, analytical cohort study in patients on mechanical ventilation for more than 24 hours and who were extubated. Pre-extubation reports of hemoglobin, albumin, phosphorus, waist-hip ratio and SOFA score were obtained. Extubation failure was defined as resumption of mechanical ventilation within 48 hours or less. Results: 123 patients were extubated, out of whom 74 were males (60 %); average age was 50 ± 18 years. Extubation failure occurred in 37 (30 %). Hypoalbuminemia was associated as an independent risk factor in 29 (23.8 %, RR = 1.43, 95 % CI = 1.11-1.85) and hypophosphatemia was in 18 (14.6 %, RR = 2.98, 95 % CI = 1.66-5.35); two or more IRFs were observed in 22.7 % (RR = 1.51, 95 % CI = 1.14-2.00). Conclusions: Identifying independent risk factors prior to MVW can help reduce the risk of extubation failure and associated morbidity and mortality.

Is the C-reactive protein/albumin ratio a prognostic and predictive factor in sudden hearing loss? / A relação proteína C-reativa/albumina é um fator prognóstico e preditivo na surdez súbita?

Abstract Introduction: Sudden hearing loss is a significant otologic emergency. Previous studies have revealed a coexistence of sudden hearing loss with chronic inflammation. The predictive importance of C-reactive protein/albumin values as a prognostic factor has been shown in various inflammatory and tumoral conditions. Objectives: The aim of this study was to determine whether the C-reactive protein/albumin ratio in sudden hearing loss can be used for prognostic purposes and whether there is a relationship between the neutrophil/lymphocyte ratio and the C-reactive protein/albumin ratio. Methods: A retrospective examination was made of 40 patients diagnosed with idiopathic sudden hearing loss and a control group of 45 healthy subjects. The pure tone averages of all the patients were determined on first presentation and repeated at 3 months after the treatment. The patients were separated into 2 groups according to the response to treatment. The neutrophil/lynphocyte ratio and the C-reactive protein/albumin ratios were calculated from the laboratory tests. Results: The patients included 16 females and 24 males with a mean age of 44.1 ± 14.2 years and the control group was composed of 23 females and 22 males with a mean age of 42.2 ± 13.8 years. The mean C-reactive protein/albumin ratio was 0.95 ± 0.47 in the patient group and 0.74 ± 0.13 in the control group. The difference was statistically significant (p = 0.009). The mean C-reactive protein/albumin ratio was 0.79 ± 0.12 in the response to treatment group and 1.27 ± 0.72 in the non-response group, with no significant difference determined between the groups (p = 0.418). The mean neutrophil/lymphocyte ratio was 3.52 ± 3.00 in the response to treatment group and 4.90 ± 4.60 in the non-response group, with no statistically significant difference determined between the groups (p = 0.261). Conclusion: C-reactive/albumin ratio was significantly higher in patients with sudden hearing loss than in the control group. Although C-reactive protein/albumin ratio was found to be lower in sudden hearing loss patients who responded to treatment compared to those who did not, the difference between two groups was not statistically significant.

Resumo Introdução: A perda auditiva neurossensorial súbita ou surdez súbita é uma emergência otológica significativa. Estudos anteriores revelaram uma coexistência dessa condição com inflamação crônica. A importância preditiva dos valores da relação proteína C-reativa/albumina como fator prognóstico tem sido demonstrada em várias condições inflamatórias e tumorais. Objetivos: O objetivo deste estudo foi determinar se a relação proteína C-reativa/albumina na perda auditiva neurossensorial súbita pode ser usada para fins prognósticos e se existe uma associação entre as relações neutrófilo/linfócito e proteína C-reativa/albumina. Método: Foram avaliados retrospectivamente 40 pacientes com diagnóstico de perda auditiva neurossensorial súbita idiopática e um grupo controle de 45 indivíduos saudáveis. As médias de tons puros de todos os pacientes foram determinadas na primeira consulta e repetidas 3 meses após o tratamento. Os pacientes foram separados em 2 grupos de acordo com a resposta ao tratamento. As relações neutrófilo/linfócito e proteína C-reativa/albumina foram calculadas a partir de testes laboratoriais. Resultados: Os pacientes incluíam 16 mulheres e 24 homens, com média de 44,1 ± 14,2 anos, e o grupo controle por 23 mulheres e 22 homens, com média de 42,2 ± 13,8 anos. A média da relação proteína C-reativa/albumina foi de 0,95 ± 0,47 no grupo de pacientes e de 0,74 ± 0,13 no grupo controle e a diferença foi estatisticamente significante (p = 0,009). A média da relação proteína C-reativa/albumina foi de 0,79 ± 0,12 do grupo com resposta ao tratamento e de 1,27 ± 0,72 no grupo sem resposta, sem diferença significante entre os grupos (p = 0,418). A média da relação neutrófilo/linfócito foi de 3,52 ± 3,00 no grupo com resposta ao tratamento e de 4,90 ± 4,60 no grupo sem resposta, sem diferença estatisticamente significativa entre os grupos (p = 0,261). Conclusão: A relação proteína C-reativa/albumina foi significantemente maior nos pacientes com perda auditiva neurossensorial súbita do que no grupo controle. No entanto, embora a relação proteína C-reativa/albumina tenha sido menor nos pacientes com perda auditiva neurossensorial súbita que responderam ao tratamento em comparação a aqueles que não apresentaram resposta, a diferença entre os dois grupos não foi estatisticamente significante.

Mast cells in the kidney biopsies of pediatric patients with lupus nephritis / Mastócitos em biópsias renais de pacientes pediátricos com nefrite lúpica

ABSTRACT Introduction: Mast cells may be involved in inflammation and contribute to the onset of fibrosis in lupus nephritis (LN). Objective: This study aimed to correlate the presence of mast cells in kidney biopsy specimens of pediatric patients with LN with activity (AI) and chronicity (CI) indices and assess how effectively mast cells may be used as a prognostic factor. Method: The study included 40 patients aged 6-18 years diagnosed with LN at the Renal Disease Service of the Federal University of Triângulo Mineiro between 1996 and 2015. Workup and epidemiological data were evaluated vis-à-vis AI, CI, and mast cell counts (MCC). Results: Significant positive correlations were found between mast cell counts (MCC) and AI (p = 0.003; r: 0.66) and MCC and CI (p = 0.048; r: 0.48). The ROC curve showed that mast cells were highly sensitive and specific in the differentiation of patients with an AI > 12 from individuals with an AI ≤ 12. Serum creatinine levels were higher in individuals with class IV LN than in patients with class V disease [1.50 (0.40-20.90) vs. 0.70 (0.62-0.90), p = 0.04]. Blood urea nitrogen had a positive significant correlation with MCC (p = 0.002; r: 0.75). A trend toward a negative correlation was observed between MCC and serum albumin (p = 0.06; r: -0.5459). Kidney biopsies of patients with nephrotic syndrome had higher MCC [2.12 (0.41-5.140) vs. 0.53 (0.0-3.94), p = 0.07]. Conclusion: Inflammatory cell infiltration and morphological differences between cell types in the inflammatory infiltrate are relevant factors in the assessment of the LN. Mast cell analysis and AI/CI assessment may be relevant prognostic indicators for pediatric patients with LN.

RESUMO Introdução: Mastócitos podem participar da inflamação e contribuir para fibrose na nefrite lúpica (NL). Objetivo: Correlacionar mastócitos em biópsias renais (BR) de pacientes pediátricos com NL com índices de atividade (IA) e cronicidade (IC), avaliando sua efetividade como fator prognóstico. Metodologia: Foram estudados 40 pacientes, entre 6 e 18 anos, diagnosticados com NL pelo Serviço de Nefropatologia da UFTM entre 1996 e 2015. Dados laboratoriais e epidemiológicos foram correlacionados com IA, IC e contagem de mastócitos (CM). Resultados: Encontramos correlação positiva e significativa entre contagem de mastócitos (CM) e IA (p = 0,003; r: 0,66) e entre CM e IC (p = 0,048; r: 0,48). Conforme a curva Roc, os mastócitos têm alta sensibilidade e especificidade na diferenciação de pacientes com IA menor ou maior do que 12. A creatinina sérica foi mais elevada na classe IV em relação à classe V [1,50 (0,40 - 20,90) versus 0,70 (0,62 - 0,90), p = 0,04]. Ureia sérica apresentou correlação positiva e significativa com CM (p = 0,002; r: 0,75). Observou-se tendência à correlação negativa entre CM e albumina sérica (p = 0,06; r: -0,5459). BR de pacientes com síndrome nefrótica apresentaram maior CM [2,12 (0,41 - 5,140) versus 0,53 (0,0 - 3,94), p = 0,07]. Conclusão: Não apenas o infiltrado inflamatório como também a diferenciação morfológica dos tipos celulares que o constituem são importantes para a avaliação da NL. Isso indica que a análise dos mastócitos, juntamente com a dos IA e IC, pode ajudar os nefrologistas a definirem o prognóstico de pacientes pediátricos.

Longitudinal changes in nutritional parameters and resting energy expenditure in end-stage renal disease / Alterações longitudinais nos parâmetros nutricionais e gasto energético de repouso na doença renal em estágio terminal

Abstract Aims: To evaluate the nutritional status, resting energy expenditure, caloric and protein intake, and evolution of biochemical parameters in three stages of chronic kidney disease: pre-dialytic, at the beginning of the dialysis treatment, and 30 days after starting treatment. Methods: The chi-square and Student's t tests were used to compare the variables, and analysis of repeated measurements was used to compare the data obtained in the three moments evaluated. The results were discussed at the 5% level of significance. Results: We evaluated 35 patients, 60% female and 60% with diabetes mellitus. There was a decrease in midarm circumference and serum albumin. Inflammatory state and caloric and protein intake increased. There was no significant difference in resting energy expenditure in the three moments. The serum urea and serum albumin, handgrip strength, and protein consumption after 30 days from the start of dialysis were greater in the peritoneal dialysis patients, when compared to the hemodialysis population. Conclusion: there was a decrease in midarm circumference and serum albumin and an increase in protein intake after dialysis. The peritoneal dialysis patients had higher muscle strength, even with lower protein intake. Resting energy expenditure was not different between dialysis methods and the moments evaluated.

Resumo Objetivos: Avaliar o estado nutricional, o gasto energético em repouso, o gasto calórico e proteico e a evolução dos parâmetros bioquímicos em três estágios da doença renal crônica: pré-dialítico, no início do tratamento dialítico e 30 dias após o início do tratamento. Métodos: O teste do qui-quadrado e o teste t de Student foram utilizados para comparar as variáveis, e a análise das medidas repetidas foi utilizada para comparar os dados obtidos nos três momentos avaliados. Os resultados foram discutidos ao nível de significância de 5%. Resultados: Foram avaliados 35 pacientes, 60% mulheres e 60% com diabetes mellitus. Houve uma diminuição na circunferência do terço médio do braço (CMB) e na albumina sérica. O estado inflamatório e a ingestão calórica e protéica aumentaram. Não houve diferença significativa no gasto energético em repouso nos três momentos. A ureia sérica e a albumina sérica, a força de preensão manual e o consumo de proteínas após 30 dias do início da diálise foram maiores nos pacientes em diálise peritoneal, quando comparados com a população em hemodiálise. Conclusão: houve diminuição da circunferência do terço médio do braço e na albumina sérica, e aumento da ingestão protéica após a diálise. Os pacientes em diálise peritoneal apresentaram maior força muscular, mesmo com menor consumo proteico. O gasto energético em repouso não foi diferente entre os métodos de diálise e os momentos avaliados.

Fatores de risco relacionados à mortalidade em pacientes internados por Doença Arterial Periférica / Risk Factors related to patients hospitalized for Peripheral Arterial Disease

Introdução: Pacientes portadores de vasculopatia periférica internam recorrentemente para procedimentos cirúrgicos ou tratamento clínico devido a complicações da doença de base. O real impacto da desnutrição nesses pacientes durante a internação ainda é pouco compreendido. Objetivo: Investigar os fatores de risco associados à mortalidade em pacientes internados com doença vascular periférica devido a complicação da doença vascular. Métodos: Estudo observacional retrospectivo avaliou cento e dezessete pacientes acima de 18 anos admitidos no serviço de cirurgia vascular de hospital terciário no período de junho de 2013 a agosto de 2014 por complicação da doença vascular. Avaliados parâmetros clínicos, comorbidades, dados demográficos, complicações durante a internação e estado nutricional. Dados coletados por meio de entrevista, aplicação do questionário Avaliação Global Subjetiva (AGS), exame físico e laboratoriais e dados de prontuário. Resultados: Cento e dezessete pacientes com doença vascular periférica avaliados em relação a complicações vasculares durante internação. Mortalidade geral de 7,7% e pacientes desnutridos ou com suspeita de desnutrição eram 39% da amostra Através da análise multivariada, tanto a classificação AGS (OR 6,15 CI 1,092-34,74 P = 0,039) quanto a presença de doença cardíaca (OR 8,51 CI 1,56-47,44 P = 0,015) foram fatores preditores independentes para mortalidade. Pacientes com doença vascular classificados em suspeita de estarem desnutridos ou desnutridos apresentaram chance de ir a óbito durante a internação aumentada em 6,15 vezes, enquanto a cardiopatia elevou essa chance 8,51 vezes. Conclusão: Pacientes internados por complicação de doença vascular periférica apresentam como fatores de risco para mortalidade a desnutrição e a presença de doença cardíaca.(AU)

Patients with peripheral vasculopathy are routinely hospitalized for surgical procedures or clinical treatment due to complications of the underlying disease. The real impact of malnutrition in these patients during hospitalization is still poorly understood. Aim: This study aimed to assess mortality predictors in patients with peripheral vascular disease during hospitalization. Methods: This retrospective observational study evaluate one hundred and seventeen patients over 18 years admitted to the vascular surgery service of a tertiary hospital in the period of June 2013 and August 2014 due to complications of vascular disease. They were assessed for clinical parameters, comorbidities, demographics, complications during hospitalization and nutritional status. Data were collected through interviews, the questionnaire Subjective Global Nutritional Assessment (SGA), laboratory exam and physical examination. Results: One hundred and seventeen patients with peripheral vascular disease were followed during admission due to vascular complications. Overall mortality was 7.7%, and malnourished patients or patients at nutritional risk were 39,0% of the sampled population By multivariate analysis both rating by SGA (OR 6.15, CI 1.092 to 34.74, P = 0.039), the presence of heart disease (OR 8.51 CI 1,56 to 47.44 P = 0.015) were independent predictors of mortality. When the patient was classified as malnourished or suspected of being malnourished by SGA it increased 6.15 times the odds of death during hospitalization, while the presence of heart disease increased by 8.51 times. Conclusion: Patients hospitalized for complications of peripheral vascular disease present as risk factors for mortality: malnutrition and the presence of heart disease. (AU)

Utilización práctica del laboratorio en las enfermedades hepáticas / Practical use of the laboratory in hepatic diseases

RESUMEN El médico asistencial debe evaluar a diario las pruebas hepáticas en personas con afecciones del hígado, o en los llamados controles a personas supuestamente normales. El objetivo fue facilitar la reflexión práctica en la interpretación de las pruebas hepáticas. Se realizó una revisión de las publicaciones más importantes en base de datos como MEDLINE, EMBASE y Scielo en los últimos años para facilitar la interpretación de las pruebas de laboratorio en el estudio de las lesiones del hígado. En la práctica diaria la elevación de las aminotransferasas, ha sido asociada con un incremento en la mortalidad total y está relacionada con disfunción hepática. Los estudios imagenológicos al igual que la biopsia hepática pueden ser considerados cuando las pruebas hepáticas no definen el diagnóstico, para estudiar al enfermo o cuando los posibles diagnósticos sean múltiples, por lo que definir el valor de la elevación de los niveles de alanino aminotransferasas, aspartato aminotransferasas, junto a la los niveles de fosfatasa alcalina y bilirrubina en la lesión colestática, unidas al uso de pruebas que miden el metabolismo celular en la enfermedad hepatocelular o la colestasis son de vital importancia la práctica médica diaria (AU).

SUMMARY The physician providing health care should daily evaluate hepatic testes in persons with liver diseases, or in the so-called controls to persons supposedly healthy. The aim of this work was facilitating practical reflection in the interpretation of hepatic testes. The most important works published in MEDLINE, EMBASE and Scielo during the last years were reviewed for understanding laboratory tests in the study of hepatic lesions. In the regular practice the increase of aminotransferases has been associated to a growth of total mortality, and this one related to hepatic dysfunction. The imaging studies and also hepatic biopsy should be taking into consideration when hepatic testes do not define the diagnosis, to study the patient, or when there are many possible diagnoses; therefore defining the growth of the alaninotransferase and aspartate aminotransferase levels together with the levels of alkaline phosphatase and bilirubin in the cholestasis lesion and the use of testes measuring the cell metabolism in the hepatocellular disease or cholestasis are very important in the day-to-day medical practice (AU).

Survey on the perception of health professionals on the use of intradialytic oral nutrition in patients under hemodialysis

Abstract Background Intradialytic oral nutrition (ION) has been shown to improve many clinical outcomes, including lowering mortality, in hemodialysis (HD) patients. Despite the benefits, ION is underused in many countries. Objective The objective of our study was to determine the perception of health-care professionals (HCP) in our environment of the use of ION in patients undergoing HD. Methods Survey applied to HCP in Mexico who worked or had worked in an HD unit in their locality. Results From 272 HCP who answered the survey, 74.3% believed that the use of ION has at least one beneficial effect; of these, the most frequently mentioned were an improvement in quality of life (QoL) (54.7%) followed by an improvement in serum albumin (37.9%) and muscle anabolism (31.6%). However, 49% consider that its use involves some risks. Of the respondents, 22% reported that their HD units allowed patients to consume food or supplements during HD sessions; the main reason given to forbid the introduction of food or supplements was the clinic’s policy (41%). Conclusions The personnel surveyed heterogeneous opinions regarding ION, but most believe that it may improve the QoL or the nutritional status of the patients. Nevertheless, the use of ION is uncommon in our country as it is against the internal regulations of most HD units.

The effect of continuous ventilation on thiol-disulphide homeostasis and albumin-adjusted ischemia-modified albumin during cardiopulmonary bypass

Abstract Objective: To investigate the effect of continuous lung ventilation with low tidal volume on oxidation parameters, such as thiol/disulphide homeostasis and albumin-adjusted ischemia-modified albumin (AAIMA), during cardiopulmonary bypass (CBP) in coronary artery bypass grafting (CABG). Methods: Seventy-four patients who underwent elective CABG with CPB were included in the study. Blood samples were taken in the preoperative period, 10 minutes after CPB, and six and 24 hours postoperatively. Patients were assigned to the continuous ventilation group (Group 1, n=37) and the non-ventilated group (Group 2, n=37). The clinical characteristics, thiol/disulphide homeostasis, ischemia-modified albumin (IMA), and AAIMA levels of the patients were compared. Results: A significant difference was found between the groups regarding native thiol, total thiol, and IMA levels at the postoperative 24th hour (P=0.030, P=0.031, and P=0.004, respectively). There was no difference between the groups in terms of AAIMA. AAIMA levels returned to preoperative levels in Groups 1 and 2, at the 6th and 24th postoperative hours, respectively. Length of hospital stay was significantly shorter in Group 1 (P<0.001) than in Group 2. Conclusion: Continuous ventilation during CPB caused an increase in native and total thiol levels, an earlier return of AAIMA levels, and shorter hospital stay. Continuous ventilation may reduce the negative effects of CPB on myocardium (Table 2, Figure 1, and Reference 31).

Prognostic significance of inflammation-based prognostic scoring in patients with upper urinary tract urothelial carcinoma

ABSTRACT Objectives: To investigate whether Glasgow Prognostic Score has prognostic significance in patients with upper urinary urothelial carcinoma. Patients and methods: We retrospectively reviewed the clinical records of 74 patients with upper urinary urothelial carcinoma. We set the cut-off value for C-reactive protein as 1.0mg/dL, and 3.5mg/dL for albumin as Glasgow Prognostic Score. Their blood data including albumin and C-reactive protein for Glasgow Prognostic Score and cytokeratin 19 fragment 21-1 as a tumor marker were measured before starting treatment. The patients were stratified into three groups with Glasgow Prognostic Score: The Group-1, albumin ≥3.5g/dL and C-reactive protein < 1.0mg/dL; Group-2, albumin < 3.5g/dL or C-reactive protein ≥1.0mg/dL; Group-3, albumin < 3.5g/dL and C-reactive protein ≥1.0mg/dL. Results: The median follow-up for all patients was 26.9 months (range: 10.9-91.1 months), during which 37 (50%) patients died. There was a significant difference in the estimated survival rate among the 3 groups stratified by Glasgow Prognostic Score. The estimated survival rate in the Group-1 was significantly higher than those in Groups 2 and 3. In the univariate analysis C-reactive protein, serum cytokeratin 19 fragment 21-1 and Glasgow Prognostic Score were significant predictors of overall survival. On the multivariate analysis, serum cytokeratin 19 fragment 21-1 and Glasgow Prognostic Score were independently associated with shorter overall survival. Conclusion: Our review suggests Glasgow Prognostic Score may play as a prognostic predictor for upper urinary urothelial carcinoma.

Evaluation of the use of tacrolimus ointment for the prevention of hypertrophic scars in experimental model

Abstract BACKGROUND: Tacrolimus, for its activity on modulation of collagen production and fibroblast activity, may have a role in the prevention of hypertrophic scars. OBJECTIVES: Evaluate macroscopic, microscopic, metabolic, laboratory effects and side effects of the use of topical tacrolimus ointment, in different concentrations, in the prevention of hypertrophic scars. METHODS: Twenty-two rabbits were submitted to the excision of 2 fragments of 1 cm of each ear, 4 cm apart, down to cartilage. The left ear of the animals was standardized as control and Vaseline applied twice a day. The right ear received tacrolimus ointment, at concentrations of 0.1% on the upper wound and 0.03% on the lower wound, also applied twice a day. Macroscopic, microscopic, laboratory criteria and the animals' weight were evaluated after 30 days of the experiment. RESULTS: Wounds treated with tacrolimus, at concentrations of 0.1% and 0.03%, when compared to control, showed a lower average degree of thickening (p = 0.048 and p <0.001, respectively). The average of scar thickness and lymphocyte, neutrophil and eosinophil concentrations are lower in the treated wounds compared to the control (p <0.001, p=0.022, p=0.007, p=0.044, respectively). The mean concentration of lymphocytes is lower in wounds treated with a higher concentration of the drug (p=0.01). STUDY LIMITATIONS: experiment lasted only 30 days. CONCLUSIONS: Tacrolimus at the 2 concentrations evaluated reduced the severity of inflammatory changes and positively altered the macroscopic aspect of the scar in the short term. Its use was shown to be safe, with no evidence of systemic or local adverse effects.

Estado nutricional de portadores de doença renal crônica em hemodiálise no Sistema Único de Saúde / Nutritional status of individuals with chronic renal failure in hemodialysis in the Unified Health System

Resumo A desnutrição é um fator relevante na evolução dos pacientes com doença renal crônica (DRC) em hemodiálise (HD), estando associada a maior frequência e duração de internações hospitalares. Objetivou-se avaliar o estado nutricional de pacientes com DRC em HD em unidades públicas ou privadas vinculadas ao SUS no Distrito Federal. Dados sociodemográficos, bioquímicos e antropométricos foram obtidos de 96 participantes, sendo 35,5% provenientes de hospitais públicos. Os critérios utilizados para avaliação de desnutrição na DRC foram Índice de Massa Corpórea (IMC) < 23 kg/m2, circunferência muscular do braço (CMB) reduzida e albumina sérica < 3,8 g/dl. Do total de avaliados, 14,6% apresentou desnutrição (60 ± 12 anos; 57% masculino; 69% clínicas privadas); 33,3% apresentou estado nutricional adequado (55 ± 14 anos; 53% masculino; 57% clínicas privadas); 52,1% tinha ao menos uma variável relacionada à desnutrição, onde o IMC abaixo do recomendado foi o mais prevalente (42,7%), seguido da CMB reduzida (41,7%) e da albumina sérica (33,3%). Com base nos resultados conclui-se que ao menos uma variável relacionada ao estado nutricional esteve alterada em metade da amostra estudada, o que reforça a importância da avaliação nutricional no contexto do tratamento da DRC.

Abstract Malnutrition is a major factor in the evolution of patients with chronic kidney disease (CKD) on hemodialysis (HD). It is associated with increased frequency and the duration of hospitalizations. The scope of this study was to evaluate the nutritional status of patients with CKD on HD in public or private clinics of the Unified Health System in the Federal District. Sociodemographic, biochemical and anthropometric data were obtained from 96 participants, 35.5% of which were from public clinics. Parameters for evaluation of malnutrition in CKD included Body Mass Index (BMI) < 23 kg/m2, reduced arm muscle circumference (AMC) and serum albumin < 3.8 g/dL. From all participants, 14.6% were classified as malnourished (60 ± 12 years; 57% male; 69% private clinics); 33.3% presented adequate nutritional status (55 ± 14 years; 53% male; 57% private clinics); 52.1% had at least one parameter related to malnutrition. BMI below the recommended parameter was the most prevalent variable (42.7%), followed by reduced AMC (41.7%) and serum albumin (33.3%). Based on these results, it may be concluded that at least one positive variable was related to malnutrition in half of the sample, which reinforces the importance of nutritional assessment in the context of the treatment of CKD.

The application of Compont gel in chronic obstructive jaundice rats model

Abstract Purpose: To establish a new rat model, the pathogenesis of which is closer to the clinical occurrence of chronic obstructive jaundice with liver fibrosis. Methods: 90 SD rats were randomly divided into 3 groups. Group A common bile duct ligation, group B common bile duct injection compont and group C injection saline. The serum of three groups was extracted, and the liver function was detected by ELISA. HE staining, Masson staining and immunohistochemistry were used to detect liver pathology. Results: Group B showed a fluctuant development of jaundice, obstructive degree reached a peak at 2 weeks, and decreased from 3 weeks. HA, LA and PCIII were significantly higher than control group. 3 weeks after surgery, liver tissue fibrosis occurred in group B, and a wide range of fiber spacing was formed at 5 weeks. Immunohistochemistry showed that hepatic stellate cells were more active than the control group. Conclusion: Intra-biliary injection of Compont gel is different from the classic obstructive jaundice animal model caused by classic bile duct ligation, which can provide an ideal rat model of chronic obstructive jaundice with liver fibrosis.

Valoración e intervenciones nutricionales en pacientes en hemodiálisis / Assesment and nutrition intervention in hemodialysis patients

INTRODUCCIÓN: La desnutrición en pacientes dializados es altamente frecuente siendo de etiología multifactorial. OBJETIVO: Realizar diagnóstico de situación y evolución de Parámetros luego de la intervención nutricional. Metas esperadas a los 6 meses: evaluación nutricional en 100% de pacientes; 70% con valoración global subjetiva (VGS) tipo A; 80% con albúmina ≥3.5 g/dl; 70% con ingesta proteica (nPNA) >0.8 g/kg/día. MATERIAL Y MÉTODOS: Se evaluaron pacientes en diálisis con más de 90 días de tratamiento durante marzo y abril (etapa diagnóstica) y noviembre y diciembre de 2016 (evolución de parámetros); registrando datos personales, antropométricos y de laboratorio, anamnesis alimentaria y VGS. Las acciones nutricionales fueron entrevistas a pacientes y familiares, educación a través de charlas grupales e indicación de suplementos hiperproteicos a pacientes seleccionados según apetito, pérdida de peso y albúmina. RESULTADOS: En etapa diagnóstica se evaluaron 35 pacientes; 18 (51%) tenían IMC >23 y <35, 9 (26%) con nPNA >0.8 g/kg/día. Albúmina ≥3.5 g/dl 24 pacientes (69%). VGS tipo A 16 pacientes (46%), tipo B 12 (34%) y tipo C 7 (20%). Se suplementaron 5 pacientes (14%). En etapa posterior se valoraron 28 pacientes; 11 (39%) IMC >23 y <35. nPNA >0.8 g/kg/día 27 pacientes (96%). Albúmina ≥3.5 g/dl 23 pacientes (82%). VGS tipo A 18 (64%), tipo B 9 (32%) y tipo C 1 (4%). 100% de los suplementados lograron las metas esperadas. CONCLUSIÓN: La valoración nutricional periódica, las intervenciones y la suplementación mejoran los objetivos nutricionales a corto plazo de la población en diálisis

INTRODUCTION: Malnutrition, being a condition with a multifactorial etiology, is very frequent in dialysis patients. OBJECTIVE: TO make a diagnosis of the situation and the evolution of parameters following nutrition intervention. Expected goals after six months: nutritional assessment of 100% of patients; 70% with type A subjective global assessment (SGA); 80% with ≥3.5 g/dL albumin levels, and 70% with >0.8 g/kg/day protein intake (nPNA). METHODS: Patients undergoing dialysis for more than 90 days were evaluated during March and April (diagnostic stage) and November and December 2016 (evolution of parameters), recording personal, anthropometric and laboratory data, food history and SGA. The nutritional actions were: interviews to patients and relatives, education through group talks and indication of hyperproteic supplements to patients selected according to appetite, weight loss and albumin. RESULTS: In the diagnostic stage, 35 patients were evaluated; 18 (51%) had BMI > 23 and < 35; 9 (26%) with nPNA > 0.8 g/kg/day. Albumin was ≥3.5 g/dL in 24 patients (69%). Type A SGA in 16 patients(46%); type B in 12 of them (34%) and type C in 7 (20%). Five patients received supplements (14%). In a later stage, 28 patients were evaluated; 11 (39%) with BMI > 23 and < 35. nPNA; > 0.8 g/kg/day in 27 patients (96%). Albumin was ≥3.5 g/dL in 23 patients (82%). Type A SGA in 18 patients (64%); type B in 9 of them (32%) and type C in 1 (4%). 100% of the supplemented subjects achieved the expected goals. CONCLUSION: Periodic nutritional assessment, interventions and supplementation improve the short-term nutritional goals of the dialysis population

Prevention of rocuronium induced mast cell activation with prophylactic oleuropein rich diet in anesthetized rabbits

Abstract Purpose: The effect of a prophylactic oleuropein-rich diet before anesthesia accompanied by the widely-used steroid-based neuromuscular drug rocuronium on mast cell activation was investigated in the study. Methods: 14 rabbits used in the study. The rabbits in the oleuropein group were given oleuropein-rich extract added to the animals' water at doses of 20 mg/kg oleuropein for 15 days orally. After 15 days, all rabbits in the two groups were given general anesthesia with rocuronium of 1 mg/kg. After 1 day, animals were sacrificed and the liver tissue sections stained with H&E, toluidine blue and tryptase for immunohistochemical study. Results: There was no statistically significant difference between ALT, AST and albumin averages of the oleuropein and control groups (p> 0.05). The tryptase average of the control group was higher than the tryptase average of the oleuropein group and this difference was statistically significant (p=0.003). The T. blue average in the oleuropein group was higher than the control group. However, there was no statistically significant difference between groups (p=0.482). Conclusions: Rocuronium adverse effects, like hypersensitivity and anaphylaxis, may limit routine use of this substance. The use of oleuropein reduced the number of inflammatory cells and prevented degranulation.

Effects of different periods of gastric ischemia on liver as a remote organ

Abstract Purpose: To evaluate the hepatic changes associated with gastric ischemia. Methods: Thirty male rabbits were studied, distributed in 3 groups (n=10). Group 1: ligature and section of the gastric vasculature and removal of the liver after three hours; Group 2: ligature and section of the gastric vasculature and removal of the liver after 6 hours; Group 3: ligature and section of the gastric vasculature and removal of the liver after 12 hours. Blood samples were collected immediately before surgery and after the determined time of ischemia in each group to evaluate the hepatic function. After the death of the rabbits, the liver was removed for macro and microscopic study. Results: An increase in aminotransferases and bilirubin occurred in groups 2 and 3. Total protein and albumin diminished in all of the animals. All of the rabbits from groups 2 and 3 presented hepatocellular necrosis. Conclusion: The devascularization of the stomach for a period of above three hours is associated with hepatic morphological and functional disorders.

Prognostic role of preoperative albumin to globulin ratio in predicting survival of clear cell renal cell carcinoma

ABSTRACT Purpose: To investigate the prognostic role of preoperative albumin/globulin ratio (AGR) in predicting disease-free survival (DFS) and overall survival (OS) in localized and locally advanced clear cell renal cell carcinoma (RCC) patients. Patients and Methods: 162 patients who met the criteria specified were included in the study. The DFS and OS ratios were determined using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the prognostic factors affecting DFS and OS. Results: Median follow-up period was 27.5 (6-89) months. There was a statistically significant relationship between low AGR and high pathological tumor (pT) stage, presence of collecting system invasion, presence of tumor necrosis, and a high platelet count (p = 0.012, p = 0.01, p = 0.001, and p = 0.004, respectively). According to the Kaplan-Meier survival analysis, both OS and DFS were found to be significantly lower in the low AGR group (p = 0.006 and p = 0.012). In the multivariate Cox regression analysis, collecting system invasion and tumor necrosis were found to be independent prognostic factors in predicting OS and pT stage was found to be an independent prognostic factor in predicting DFS (HR: 4.08, p = 0.043; HR: 8.64, p = 0.003 and HR: 7.78, p = 0.041, respectively). Conclusion: In our study, low AGR was found to be associated with increased mortality and disease recurrence in localized and locally advanced RCC.

Malnutrition associated with inflammation in the chronic renal patient on hemodialysis

SUMMARY INTRODUCTION Malnutrition-Inflammation-Atherosclerosis Syndrome is very frequent in patients with chronic kidney disease on haemodialysis. In these patients, the inflammation associated with malnutrition is observed by the Malnutrition-Inflammation Score. OBJECTIVE To analyse the relationship between malnutrition-inflammation-atherosclerosis syndrome and anthropometric and biochemical parameters of patients on haemodialysis. METHODS A cross - sectional study was performed at the Haemodialysis Clinic of the Barão de Lucena Hospital, Recife, Brazil, between July and August 2016, with patients cared at the clinic for at least six months. Patients with amputees, hospitalized, visually impaired, HIV positive, with catheters in the neck, ascites and/or oedema, and those who were unable to provide information at the time of the interview were excluded. The patients were submitted to anthropometric evaluation for the classification of the nutritional status by waist circumference, neck circumference, body mass index, waist-to-hip ratio and waist-to-height ratio. Nutritional status related to inflammation was measured by the Malnutrition-Inflammation Score and nutritional status assessment using biochemical indicators that used urea, creatinine and albumin. RESULTS Twenty-seven individuals of both genders, adults and elderly, aged 51.3 ± 13.3 years old participated in the study. The anthropometric evaluation showed that most of the population presented cardiovascular risk. The biochemical evaluation reported low frequencies of malnutrition. Malnutrition-Inflammation-Atherosclerosis syndrome was evidenced in 3.7% of the patients. The Malnutrition-Inflammation Score had a moderate negative correlation with body mass index, waist circumference, neck circumference, waist-to-height ratio and creatinine. CONCLUSION The correlation seen among the parameters suggests that most of the parameters evaluated can be used as an indirect indicator of malnutrition-inflammation-atherosclerosis syndrome.

RESUMO INTRODUÇÃO A síndrome Desnutrição-Inflamação-Aterosclerose é frequente nos pacientes com doença renal crônica em hemodiálise, acarretando perda de proteínas corporais e produção de citocinas pró-inflamatórias. OBJETIVO Verificar, entre os indicadores nutricionais estudados, aqueles que melhor se correlacionam com a síndrome Desnutrição-Inflamação-Aterosclerose em pacientes submetidos à hemodiálise. MÉTODOS O estudo foi transversal, realizado na Clínica de Hemodiálise do Hospital Barão de Lucena, no Recife (PE), entre julho e agosto de 2016, com pacientes atendidos há pelo menos seis meses. Foram excluídos pacientes amputados, internados, com deficiência visual, cateter no pescoço, HIV positivo, ascite e/ou edema e aqueles incapazes de prestar informações no momento da entrevista. Os pacientes foram submetidos à avaliação antropométrica para a classificação do estado nutricional pela circunferência da cintura, perímetro do pescoço, índice de massa corporal, relação cintura-quadril e relação cintura-estatura. O estado nutricional relacionado à inflamação foi mensurado pelo escore Desnutrição-Inflamação e a avaliação do estado nutricional pelos indicadores bioquímicos: ureia, creatinina e albumina. RESULTADOS Participaram do estudo 27 indivíduos de ambos os sexos, adultos e idosos, com idade de 51,3 ± 13,3 anos. A avaliação antropométrica mostrou que a maior parte da população apresentava risco cardiovascular. A avaliação bioquímica relatou baixas frequências de desnutrição. Foi evidenciada síndrome Desnutrição-Inflamação-Aterosclerose em 3,7% dos pacientes. O escore Desnutrição-Inflamação apresentou correlação moderada negativa com o índice de massa corporal, circunferência da cintura, perímetro do pescoço, relação cintura-estatura e creatinina. CONCLUSÃO A correlação observada entre os parâmetros sugere que a maioria dos parâmetros avaliados pode ser utilizada como indicador indireto da síndrome Desnutrição-Inflamação-Aterosclerose.