Персонализированное прогнозирование острого повреждения почек у пациентов с панкреонекрозом

Relevance. The incidence of acute pancreatitis is growing worldwide, being one of the leading causes of hospitalization in urgent surgery. The most common complication of pancreatic necrosis (PN) in the aseptic phase is acute kidney injury (AKI), which is an independent risk factor for an unfavorable outcome.The objective was to develop a personalized risk model for AKI in the aseptic phase of pancreatic necrosis.Materials and methods. A comparative cohort study of the results of treatment of 502 patients with pancreatic necrosis was conducted. The primary endpoint was considered to be the development of AKI, for the development of a personalized model of the probability of its development in sterile pancreatic necrosis, binary logistic regression analysis was used.Results. A model of independent variables was developed that reliably (p < 0.001) determined that with an increase in age by 1 year, the probability of developing AKI increased by 2.3%, and with a history of chronic kidney disease in a patient – by 3.2 times.The same model demonstrates that the risk of AKI in patients with pancreatic necrosis with an increase in glomerular filtration rate by 1 ml·min–1·1.73 m2 and with the use of balanced crystalloid solutions decreased by 5.0% and 3.0 times, respectively.The specificity of the model was 79.8%, sensitivity – 79.1%.Conclusion. The proposed model makes it possible to reliably predict the individual risk of AKI on the first day of hospitalization.Актуальность. Заболеваемость острым панкреатитом растет во всем мире, являясь одной из ведущих причин госпитализации в ургентной хирургии. Наиболее частым осложнением панкреонекроза (ПН) в асептическую фазу является острое повреждение почек (ОПП), которое является независимым фактором риска неблагоприятного исхода.Цель – разработка персонализированной модели риска развития ОПП в асептической фазе панкреонекроза.Материалы и методы. Проведено сравнительное когортное исследование результатов лечения 502 пациентов с панкреонерозом. Первичной конечной точкой считали развитие ОПП, для разработки персонализированной модели вероятности развития которой при стерильном панкреонекрозе применяли бинарный логистический регрессионный анализ.Результаты. Разработана модель независимых переменных, достоверно (p < 0,001) определяющая, что при увеличении возраста на 1 год вероятность развития ОПП увеличивается на 2,3%, а при наличии хронической болезни почек у пациента в анамнезе – в 3,2 раза. Эта же модель демонстрирует, что риск развития ОПП у пациентов с панкреонекрозом при увеличении скорости клубочковой фильтрации на 1 мл∙мин–1/1,73м2 и при использовании сбалансированных кристаллоидных растворов снижался на 5,0% и в 3,0 раза соответственно. Специфичность модели составила 79,8%, чувствительность – 79,1%.Вывод. Предложенная модель позволяет достоверно прогнозировать индивидуальный риск ОПП в первые сутки госпитализации

Using radiocarbon to determine the mycorrhizal status of fungi

Measurements of C-13 in fungal sporocarps are useful in assessing mycorrhizal or saprotrophic status. Because C-14 measurements can indicate the age of fungal carbon (C) and mycorrhizal fungi depend closely on recent photosynthate, C-14 may provide additional insight into possible mycorrhizal status. Sporocarps, needles, and litter from Woods Creek, OR, USA together with archived sporocarps were measured for C-14 content by accelerator mass spectrometry. Known mycorrhizal fungi resembled current-year needles (Amanita, Cantharellus and Gomphidius) or atmospheric CO₂ (Tuber) in C-14 and indicated an average age of 0-2 yr for incorporated C, whereas saprotrophic genera (Pleurocybella , Lepiota and Hypholoma) were composed of C at least 10 yr old. Of genera tentatively considered mycorrhizal from previous work with C-13, only Otidia and Sowerbyella appeared mycorrhizal from C-14 measurements, whereas Aleuria, Clavulina, Paurocotylis and Ramaria (sensu lato) consisted of older carbon and were presumably saprotrophic. C-14 clearly separated known mycorrhizal or saprotrophic fungi and indicated C-13 measurements should be interpreted cautiously on species of unknown status. C-14 results for needles and mycorrhizal fungi suggested that C sources other than atmospheric CO₂ may contribute small amounts of C. Possible sources include storage of carbohydrates and amino acids, organic nitrogen uptake, and incorporation of soil-respired CO₂ by anaplerotic or photosynthetic pathways