Short Communication Nutritional Status and Immune Functions in Maintenance Hemodialysis Patients

Epidemiological studies suggest various kinds of immune dysregulation in hemodialysis (HD) patients. The aim of this study was to investigate the relationship between immune functions and nutritional status of HD patients. We studied 54 patients with ESRD on chronic HD, included 34 females and 20 males with mean age 46.6 ± 16.3 (18-77) years. We measured the height and dry weight of all patients. The BMI was calculated by dividing weight (kg) by height squared (m 2 ). In all patients serum urea, creatinine, albumin, iron, cholesterol, triglyceride, CRP, IgG, IgM, IgA, CD4, CD8, CD19, CD16-56 lymphocytes were measured. Kt/V values were calculated according to DOQI guideline. In this study, a positive correlation between albumin, cholesterol, and triglyceride levels as nutritional parameters and immune functions in terms of total and subtype lymphocyte counts was observed. Further prospective studies are needed to determine the clinical importance of this finding and the appropriate means of measurement and effects of nutrition on immune function in hemodialysis patients

The interrelations of radiologic findings and mechanical ventilation in community acquired pneumonia patients admitted to the intensive care unit: a multicentre retrospective study

BACKGROUND: We evaluated patients admitted to the intensive care units with the diagnosis of community acquired pneumonia (CAP) regarding initial radiographic findings. METHODS: A multicenter retrospective study was held. Chest x ray (CXR) and computerized tomography (CT) findings and also their associations with the need of ventilator support were evaluated. RESULTS: A total of 388 patients were enrolled. Consolidation was the main finding on CXR (89%) and CT (80%) examinations. Of all, 45% had multi-lobar involvement. Bilateral involvement was found in 40% and 44% on CXR and CT respectively. Abscesses and cavitations were rarely found. The highest correlation between CT and CXR findings was observed for interstitial involvement. More than 80% of patients needed ventilator support. Noninvasive mechanical ventilation (NIV) requirement was seen to be more common in those with multi-lobar involvement on CXR as 2.4-fold and consolidation on CT as 47-fold compared with those who do not have these findings. Invasive mechanical ventilation (IMV) need increased 8-fold in patients with multi-lobar involvement on CT. CONCLUSION: CXR and CT findings correlate up to a limit in terms of interstitial involvement but not in high percentages in other findings. CAP patients who are admitted to the ICU are severe cases frequently requiring ventilator support. Initial CT and CXR findings may indicate the need for ventilator support, but the assumed ongoing real practice is important and the value of radiologic evaluation beyond clinical findings to predict the mechanical ventilation need is subject for further evaluation with large patient series

Volume CXIV, Number 4, November 7, 1996

Objective: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population.Methods: Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014.Results: The most common karyotype was 45,X (50.7%), followed by 45,X/46,XX (10.8%), 46,X,i(Xq) (10.1%) and 45,X/46,X,i(Xq) (9.5%). Mean age at diagnosis was 10.2±4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45,X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosis) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto's thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%.Conclusion: This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespa

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

The challenge of concept of origin in international and European law

L'élaboration et l'application de règles d'origine sont devenues plus problématiques face aux réalités de la mondialisation, car les matières premières ou les composantes peuvent venir d'un certain nombre de pays, mais les douaniers doivent déterminer l'origine du produit aux fins de traitement, parmi lesquelles le droit de douane à appliquer, à partir du moment où le produit entre dans sa juridiction. Traditionnellement, l'origine des marchandises faisant l'objet d'échanges internationaux a été considéré comme l'un des instruments de l'administration des douanes, mais l'évolution du commerce international a montré que la détermination de l'origine pouvait avoir des conséquences sur un très grand nombre d'aspects régis par différents Accords de l'OMC. Actuellement, les règles d'origine constituent un instrument secondaire de politique commerciale important et elles sont utilisées pour déterminer la nationalité d'un produit en vue d'une application correcte des mesures de politique commerciale discriminatoire. Mais l'absence d'un ensemble de règles d'origine unifiées et harmonisées offre à certains pays l'opportunité et les incitent à utiliser ces règles pour appliquer une politique protectionniste et discriminatoire entre les différents pays. En raison de la manière dont elles sont appliquées dans un grand nombre de cas, il semble que ces règles soient de plus en plus considérées comme des instruments de politique commerciale en soi, et non comme un dispositif de soutien aux dits instruments. Il est reconnu par tous les pays que l'harmonisation faciliterait les échanges internationaux. Mais compte tenu de la diversité des règles d'origine, cette harmonisation est un exercice complexe en fonction des divergences des intérêts nationaux, couvrant le spectre entier du commerce global, s'étendant de la libéralisation et de l'accès aux marchés à la protection. Cette thèse n'a pas l'ambition de trouver une solution à cette problématique, car les solutions dépendent de l'intérêt privilégié, mais de fournir quelques pistes de réflexion.The elaboration and application of rules of origin have become more problematic when faced with the realities of globalization, because raw materials or components may come from a number of countries, but Customs must determine the origin of the product for processing, including the tariff to be applied from the time the product enters its jurisdiction Traditionally, rules of origin have been considered a rather technical customs issue, with little bearing on trade and economic policy, but the evolution of international trade has shown that the determination of origin could affect a large number of matters covered by various WTO agreements. Actually, the rules of origin constitute a secondary instrument of trade policy important and they are used to determine the nationality of a product for the correct application of discriminatory trade policy measures. But the lack of unified and harmonized set of rules of origin provides countries with the opportunity and incentive to use these rules as a protectionist policy device that discriminates between countries. The manner of application of these rules in a large number of cases conveys the impression that these rules are increasingly being viewed as trade policy instruments per se, instead of as a device to support trade policy instruments It is accepted by all countries that harmonization of rules of origin would facilitate the flow of international trade, but such harmonization is a complex exercise because of divergences of national trade interests, covering the full spectrum of global trade, stretching from liberalization and market access, to protection. This thesis has no ambition to find a solution of this question, because the solutions depend on the privileged interest, but to supply some tracks of reflection

Les enjeux du concept d'origine en droit international et communautaire.

The elaboration and application of rules of origin have become more problematic when faced with the realities of globalization, because raw materials or components may come from a number of countries, but Customs must determine the origin of the product for processing, including the tariff to be applied from the time the product enters its jurisdiction Traditionally, rules of origin have been considered a rather technical customs issue, with little bearing on trade and economic policy, but the evolution of international trade has shown that the determination of origin could affect a large number of matters covered by various WTO agreements. Actually, the rules of origin constitute a secondary instrument of trade policy important and they are used to determine the nationality of a product for the correct application of discriminatory trade policy measures. But the lack of unified and harmonized set of rules of origin provides countries with the opportunity and incentive to use these rules as a protectionist policy device that discriminates between countries. The manner of application of these rules in a large number of cases conveys the impression that these rules are increasingly being viewed as trade policy instruments per se, instead of as a device to support trade policy instruments It is accepted by all countries that harmonization of rules of origin would facilitate the flow of international trade, but such harmonization is a complex exercise because of divergences of national trade interests, covering the full spectrum of global trade, stretching from liberalization and market access, to protection. This thesis has no ambition to find a solution of this question, because the solutions depend on the privileged interest, but to supply some tracks of reflection.L'élaboration et l'application de règles d'origine sont devenues plus problématiques face aux réalités de la mondialisation, car les matières premières ou les composantes peuvent venir d'un certain nombre de pays, mais les douaniers doivent déterminer l'origine du produit aux fins de traitement, parmi lesquelles le droit de douane à appliquer, à partir du moment où le produit entre dans sa juridiction. Traditionnellement, l'origine des marchandises faisant l'objet d'échanges internationaux a été considéré comme l'un des instruments de l'administration des douanes, mais l'évolution du commerce international a montré que la détermination de l'origine pouvait avoir des conséquences sur un très grand nombre d'aspects régis par différents Accords de l'OMC. Actuellement, les règles d'origine constituent un instrument secondaire de politique commerciale important et elles sont utilisées pour déterminer la nationalité d'un produit en vue d'une application correcte des mesures de politique commerciale discriminatoire. Mais l'absence d'un ensemble de règles d'origine unifiées et harmonisées offre à certains pays l'opportunité et les incitent à utiliser ces règles pour appliquer une politique protectionniste et discriminatoire entre les différents pays. En raison de la manière dont elles sont appliquées dans un grand nombre de cas, il semble que ces règles soient de plus en plus considérées comme des instruments de politique commerciale en soi, et non comme un dispositif de soutien aux dits instruments. Il est reconnu par tous les pays que l'harmonisation faciliterait les échanges internationaux. Mais compte tenu de la diversité des règles d'origine, cette harmonisation est un exercice complexe en fonction des divergences des intérêts nationaux, couvrant le spectre entier du commerce global, s'étendant de la libéralisation et de l'accès aux marchés à la protection. Cette thèse n'a pas l'ambition de trouver une solution à cette problématique, car les solutions dépendent de l'intérêt privilégié, mais de fournir quelques pistes de réflexion

In silico identification of putative roles of food-derived xeno-mirs on diet-associated cancer

Aim: Dietary miRNAs in foods were recently suggested to be absorbed into the human circulation and engage in human gene regulation. This started a debate on their possible impacts on human diseases which need further investigation. In this study, we aimed to identify the putative functions and possible implications of selected Xeno-miRs in human diseases by using bioinformatic tools. Methods: Seventy-five human absorbable Xeno-miR candidates were selected from literature and narrowed down the list to miRNAs that share sequence homologies with human miRNAs. Sixteen distinct Xeno-miRs of animal species (cow, pig, chicken) were identified to have homologs in human and they were subsequently analyzed with target prediction, functional and pathway analysis tools. Results and Conclusion: Thirteen human genes were common targets of the miRNA sets grouped by species and shown evidence of associations with various cancer categories, specifically in large intestine adenocarcinoma by Ingenuity Pathway Analysis. miRNA functional enrichment analyses also highlighted the putative involvements of the dietary miRNAs in cancer pathways. Our effort provides ?in silico? evidence for implications of animal-derived dietary miRNAs in cancer-associated pathways, and this shed on light the necessities of future translational research design to investigate the roles of dietary Xeno-miRs in cancer pathophysiology and nutrition-based interventions towards cancer management

Can Capillary Suction Time be an Indicator for Sludge Disintegration?

Sludge disintegration is a tool for sludge minimization goal. Sludge disintegration (or sludge pretreatment) principally converts the waste activated sludge into a more bioavailable form prior to anaerobic digestion and contributes to the enhancement of anaerobic digestion. The indicator of success for sludge disintegration is generally taken as the concentration of released organics to the liquid phase. There are different examples of expressing the success of disintegration; such as degree of disintegration, soluble COD release, ratio of soluble to total COD, the released sCOD per unit amount of solids present or constituents of released sCOD. Capillary suction time (CST) is a simple method used to measure dewaterability of sludge samples. Relationship between dewaterability measured by CST and a number of sludge properties such particle size, bound water content, etc. has been shown in the past. Therefore, this study investigates whether CST can be used to express the effectiveness of sludge disintegration. For this purpose a number of sludge pretreatment techniques were tested and correlations between CST and sCOD were analyzed. Results show that CST can act as a good indicator of disintegration for some pretreatment methods but is not useful for indicating the disintegration levels if any of the pretreatment method involves some sort of conditioning