EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Case report: Cerebral arterial thrombosis in a child with nephrotic syndrome

Nephrotic syndrome (NS) in childhood may be associated with thromboembolic complications, mainly in venous origin. However, arterial thrombosis may also be seen as a very rare and life‑threatening complication. Herein, we described a case of steroid‑resistant NS who did not respond to full‑dose steroid treatment for 8 weeks and was complicated by neurological findings. The renal biopsy was consistent with focal segmental glomerulosclerosis. His cerebral magnetic resonance angiography showed the sudden termination of M3 branch of the left middle cerebral artery which corresponded with subacute infarction in the left frontoparietotemporal area. Thrombosis panel yielded the results of hyperhomocysteinemia (46.1 µmol/L, range: 5–15 µmol/L) and heterozygous methylene tetrahydrofolate reductase mutation (C677T, A1298C). After that, the patient was given medical therapy including anticoagulant treatment. Improvement in the neurological outcome was determined on the 1st month of follow‑up examinations.Keywords: Arterial thrombosis, cerebral infarction, children, nephrotic syndrome, treatmen

Use of cyclic strain bioreactor for the upregulation of key tenocyte gene expression on Poly(glycerol-sebacate) (PGS) sheets

The inadequate donor source and the difficulty of using natural grafts in tendon repair and regeneration has led researchers to develop biodegradable and biocompatible synthetic based tissue equivalents. Poly(glycerol sebacate) (PGS) is a surface-erodible bioelastomer and has been increasingly investigated in a variety of biomedical applications. In this study, PGS elastomeric sheets were prepared by using a facile microwave method and used as elastomeric platform for the first time under mechanical stimulation to induct the tenocyte gene expression. It is revealed that elastomeric PGS sheets promote progenitor tendon cell structure by increasing proliferation and gene expression with regard to tendon extracellular matrix components. Human tenocytes were seeded onto poly(glycerol-sebacate) sheets and were cultured two days prior to transfer to dynamic culture in a bioreactor system. Cell culture studies were carried out for 12 days under 0%, 3% and 6% strain at 0.33 Hz. The PGS-cell constructs were examined by using Scanning Electron Microscopy (SEM), cell viability via live/dead staining using confocal microscopy, and GAG/DNA analysis. In addition, gene expression was examined using real-time polymerase chain reaction (RT-PCR). Tenocytes cultured upon PGS scaffolds under 6% cyclic strain exhibited tendon-like gene expression profile compared to 3% and 0% strain groups. The results of this study show that PGS is a suitable material in promoting tendon tissue formation under dynamic conditions. © 2019 Elsevier B.V

Investigation of the properties of the nuclei used on the new generation reactor technology systems (Conference Paper)

13th International Conference on Emerging Nuclear Energy Systems 2007, ICENES 2007 -- 3 June 2007 through 8 June 2007 -- Istanbul -- 85239The application fields of the fast neutron are Accelerator-Driven subcritical Systems (ADS) for fission energy production and hybrid reactor systems. The technical design hybrid reactor and ADS systems potentialities require the knowledge of a wide range of better data and much effort. Thorium (Th) and Uranium (U) are nuclear fuels in these reactor systems. Lead (Pb), Bismuth (Bi) and Tungsten (IT) are the target nuclei in the ADS reactor systems. The Hartree-Fock (H-F) method with an effective interaction with Skyrme forces is widely used for studying the properties of nuclei such as binding energy, Root Mean Square (RMS) charge radii, mass radii, neutron density, proton density, electromagnetic multipole moments, etc. In this study, by using H-F method with interaction Skyrme RMS charge radii, RMS mass radii, neutron density and proton density were calculated for the 232Th, 238U, 207Pb, 209Bi and 184W isotopes used on the new generation reactor systems. The calculation results of charge radii have been compared with experimental data and obtained other results have been discussed for hybrid and ADS reactor systems.120470, DPT-2006KThis work has been supported by State Planning Organization of Turkey project DPT-2006K, # 120470

The effect of radiotherapy on cardiac function

BACKGROUND: Radiation-induced heart disease is a complication that may be encountered after radiotherapy (RT) of tumors in the vicinity of the heart. In this study, we aimed to evaluate the effect of RT on the heart, by comparing conventional and tissue Doppler echocardiography parameters obtained before and after RT. METHODS: Forty patients who had undergone RT for either lung or left breast cancer were included in the study. ECG, conventional, and tissue Doppler echocardiography were performed before and 4-6 weeks after RT. RESULTS: The mean value of the radiation dose applied to all regions of the heart was calculated as 13.1±2.2 Gy (maximum 41.7 Gy). The value for the left ventricle was 10.2±2.0 Gy (maximum 43.6 Gy). A decrease in early transmitral diastolic velocity (E), E/A ratio, EF, Em, and Em/Am, and an increase in E-wave deceleration time, isovolumic relaxation time, isovolumic contraction time, ejection time, and QTc were found after RT. CONCLUSION: We found detrimental effects of RT on systolic and diastolic cardiac functions and the electrical conduction system of the heart. Maximal prevention should be provided for the patients during RT. © 2012 Lippincott Williams & Wilkins, Inc

Vertical bone augmentation using bone marrow-derived stem cells: An in vivo study in the rabbit calvaria

PubMedID: 26397478Purpose: To evaluate the bone regeneration capacity of bone marrow-derived stem cells (BMSCs) in vertical guided augmentation of bone tissue. Material and Methods: The calvaria of 20 rabbits were vertically augmented with autogenous bone graft (ABG); collagen/beta-tricalcium phosphate (ß-TCP) linked scaffold transplanted with 15 × 10 4 BMSCs; or scaffold alone (control). The augmentation materials were covered with stainless steel domes. BMSCs were isolated with Ficoll-Paque technique and applied directly without in vitro expansion. The newly formed bone was evaluated using radiodensitometric, histomorphometric, histological, and micro-computed tomographic (micro-CT) analyses after a 12-week healing period. The data excluding micro-CT assessments were compared statistically. Results: Radiodensitometric and bone volume parameters demonstrated increased bone formation in both BMSC group and ABG group compared with control group (P 0.05). The mean histological scores for the BMSC, ABG, and control groups were 7.44 ± 1.03, 8.44 ± 0.81, and 6.00 ± 1.10, respectively, indicating significant difference among the groups (P < 0.05). Conclusion: BMSCs delivered with a collagen/ß-TCP linked scaffold can provide improved new bone formation that is comparable with autogenous bone block graft through vertical guided bone regeneration technique. © 2015 Wolters Kluwer Health, Inc