Ostry zespół sercowo−nerkowy: powrót funkcji nerek po leczeniu nerkozastępczym

Utilisation of invasive treatment in the form of elective dialysis end extracorporeal ultrafiltration as a method of complementaryto pharmacotherapy was presented by the example of the patient with acute decompensated heart failure with diagnosedcardiorenal syndrome type 1. Such procedure reduced symptoms of overhydration, restored sensitivity to oral diureticsand allow to obtain a partial return of renal function, improved prognosis and quality of life of the patient

Factors affecting change in renal function after contrast-enhanced computed tomography in cancer patients

Objectives. Contrast-enhanced computed tomography (CECT) is the most common form of assessing the effectiveness of cancer patient treatment. However, an injection of an iodine-based contrast agent can cause acute kidney damage (AKI). To determine the frequency and factors affecting post-contrast kidney function deterioration during oncological treatment.  Material and methods. Kidney function in cancer patients with solid tumors undergoing a total of 206 CECTs was retrospectively analyzed.  Results. Two hundred and six CECT procedures in 79 patients (age 68.4 ± 10.6 years) were included in the study. The median eGFR before CECT according to the MDRD was 81 mL/min/1.73m2 (IQR 26). The median time between CECT and kidney function examination was 8 (IQR 8) days. In the whole group, the median eGFR change defined as the difference between eGFR after and before CECT was 0.0 (9.0) mL/min/1.73m2 and was not significant. eGFR decreased in 100/206 (48.5%) CECT procedures with the median difference = –5.0 (6.0) mL/min/1.73m2. However, clinically significant deterioration of renal function (an increase in SCr of > 0.3 mg/dL) was found only in two cases (0.9%). The change in eGFR associated with CECT correlated significantly (p < 0.05) with initial creatinine (r = 0.117) and urea (r = 0.158), but not with age and comorbidities. After dividing the analyzed population according to the median GFR, it turned out that in the group of patients with eGFR < 81 mL/min/1.73m2, the median difference in GFR level was 1 (IQR 10), and in the group with a higher eGFR level the median was –1 (IQR 8.5), which was statistically significant (p = 0.03). The multivariate logistic regression analysis in subsequent reduced models confirmed that SCr, uric acid level, and the use of antimetabolites were the factors independently reducing the risk of deterioration of renal function after CECT.  Conclusions. CECT can be responsible for kidney function deterioration; however, it has no impact on oncological treatment

Evaluation of the usefulness of positron emission tomography with [18F]fluorodeoxylglucose performed to detect non-radioiodine avid recurrence and/or metastasis of differentiated thyroid cancer — a preliminary study

Background: About 30% of patients with disseminated differentiated thyroid cancer (DTC) may experience a loss of iodine uptake. It is associated with higher aggressiveness of the tumour and a reduced 10-year survival rate. The diagnosis of non-radioiodine avid DTC metastases remains a diagnostic challenge. A helpful technique for this diagnosis is positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose (PET/CT with [18F]FDG). On the other hand, there are still discussions about the clinical value of using exogenous thyroid-stimulating hormone (TSH) stimulation before PET/CT with [18F]FDG. The aim of the study was the assessment of the usefulness of PET/CT with [18F]FDG under TSH suppression and stimulation of TSH performed in the detection of non-radioiodine avid DTC metastases, as well as determination of the thyroglobulin concentration under suppression and stimulation of TSH, which influences the result of PET/CT with [18F]FDG in patients with non-radioiodine avid DTC. Material and methods: Retrospective analysis of 37 PET/CT with [18F]FDG performed in patients with DTC diagnosed and treated at the Department of Endocrinology and Isotope Therapy of the Military Institute of Medicine from January 2018 to July 2020. Of these, PET/CT with [18F]FDG under exogenous rhTSH stimulation was performed in 22 patients and PET/CT with [18F]FDG under TSH suppression in 15 was performed. In all analyzed patients, the result of diagnostic whole-body scintigraphy (WBS) using 80 MBq 131I under rhTSH stimulation was negative, and the concentration of thyroglobulin after stimulation (sTg) was greater than 1.0 ng/mL. Results: In the group of patients examined under TSH suppression, non-radioiodine avid in PET/CT with [18F]FDG were found in 6 out of 15 patients (40%) and in the group of patients examined under rhTSH stimulation in 10 out of 22 patients (45%). The differences between the groups were not statistically significant. The analysis of the receiver operating characteristic (ROC) curves allowed to determine the cut-off point for the positive result of PET/CT performed under TSH suppression with sTg concentration of 11.03 ng/mL. In the group of studies performed under rhTSH stimulation, the cut-off point for sTg was 6.3 ng/mL. There was no statistically significant difference between the baseline thyroglobulin (natTg) and sTg levels and the positive PET/CT result. The administration of rhTSH before the PET/CT examination also had no statistically significant effect on the maximum standard uptake value (SUVmax) of the dominant lesion identified in the PET/CT. Conclusions: 1) PET/CT with [18F]FDG is a useful tool for detection of non-radioiodine avid recurrence and/or metastases of DTC. 2) The concentration of natTg and sTg is highly correlated with a positive result of PET/CT with [18F]FDG. 3) The concentration of natTg is comparable with sTg in predicting a positive result of PET/CT with [18F]FDG. 4) The cut-off point for a positive result of PET/CT for natTg was 1.36 ng/mL and for sTg was 7.05 ng/mL

Material Model Effect for Simulating a Single-Lap Joint with a Blind Rivet

This paper concerns the influence of the material modeling method on the results of strength analyses. The research object was a single lap joint with a blind rivet (ISO 12996). The results of numerical strength analysis for various configurations of material models with material and contact nonlinearity were compared not only with the experimental results of such a connection but also with the values estimated using classical analytical tools (pressure stress and Hertz stress). The research aimed to determine how the results of numerical analyses (FEMs) were influenced by the method of modeling the material model and how it relates to the experimental results. As part of the analyses, a discrete riveted model and material models were constructed. The analyses took into account various load cases (from 10 to 90% of the connection capacity) to better illustrate the relationship between the numerical and experimental results. As a result of the conducted analyses, it was determined that the linear-elastic model was an acceptable and suggested solution (with a load of up to 90% of the load capacity of the joint connection) for further tests. The work was summarized with general and specific conclusions relating to all cases of numerical modeling. In addition, the summary includes suggestions for future works