Neutrophil gelatinase-associated lipocalin and acute kidney injury in endovascular aneurysm repair or open aortic repair: a pilot study

Introduction: Acute kidney injury (AKI) occurs frequently after abdominal aortic surgery and there is currently no effective marker able to detect early onset. The aim of this study is to evaluate the ability of neutrophil gelatinase-associated lipocalin (NGAL) to early identify the development of acute renal damage in patients undergoing endovascular aneurysm repair (EVAR) or open aortic repair (OAR). Materials and methods: Serial samples of blood and urine were obtained from 25 patients undergoing both EVAR and OAR. Seven male subjects with AKI and 18 subjects with no-AKI (17 males, 1 female) were included in the study. We determined concentrations of serum creatinine (sCr) and urinary, serum and whole blood NGAL (uNGAL, sNGAL, bNGAL) collected at baseline, and after 4 and 18 hours. AKI was defined according to the RIFLE criteria (risk, injury, failure, loss of kidney function, and end-stage kidney disease): increase by 50% in sCr or reduction of at least 25% of estimated glomerular filtration rate (eGFR) from baseline. Results: Seven patients developed AKI in the stage Risk. There was no significant difference in sNGAL concentrations in the AKI group as compared to no-AKI group. However, the uNGAL/uCreatinine ratio and bNGAL concentrations were significantly higher after 18 hours in the AKI group (no-AKI 1.69 (0.91 - 2.47) vs AKI 3.2 (2.08 - 5.92) ng/mg for uNGAL/uCreatinine ratio, P = 0.036; and no-AKI 83 (59 - 131) vs AKI 164 (126 – 263) ng/mL for bNGAL, P = 0.029). Conclusions: Our results suggest that uNGAL, sNGAL and bNGAL, after abdominal aortic surgery, are not suitable as early biomarkers of AKI

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services

Shear response, deformations, and subgrade stiffness of a dowel bar embedded in concrete

The design of shear-carrying structures very often profits by the dowel action developed by reinforcing bars or shear connectors, since dowel action is, in principle, a very efficient shear-transfer mechanism. Within the same element, the reinforcing bars may act as dowels as soon as stress-induced interfaces form (cracks in the ultimate load situation), while shear connectors between side-by-side elements (studs, pins, dowels) develop a dowel action from the very beginning of the loading process, including the service load situation. Within this framework an experimental program has been carried out to investigate the dowel action in 27 reinforced concrete specimens fitted up with a single deformed bar of 14, 18, and 24-mm diameter (No. 5, 6, and 8). The shear response of the dowel bar, the displacements and curvatures up to failure, and the subgrade stiffness of the concrete embedment were measured or evaluated. The tests give new evidence on the behavior of dowel action and allow further checks of the models available in literature for predicing dowel strength and stiffness. Furthermore, suitable formulations are proposed for the subgrade stiffness of the concrete embedment to allow the professional engineer to design a dowel bar or introduce dowel action in a safer and more consistent way

Cover and stirrup effects on the shear response of Dowel bar embedded in concrete

The efficiency of dowel action in shear transfer in cracked reinforced concrete structures depends strongly n the confinement exerted by the surrounding concrete, as well as on the hoop action of the stirrups. In spite of the many test data obtained to date in this field, several aspects of dowel behavior are still open to further investigation, since dowel/cover/stirrup interaction is a manifold problem, especially when the dowel bar pushes against a thin concrete cover. Within this framework, 28 reinforced concrete specimens reinforced with a single deformed bar 14, 18, and 24 mm in diameter (#5,6, and 8) were tested as a part of a major research program on dowel action. Block-type specimens were loaded according to a displacement-controlled procedure