Comparison of continuous and intermittent renal replacement therapy for acute renal failure

Background. Mortality rates of critically ill patients with acute renal failure (ARF) requiring renal replacement therapy (RRT) are high. Intermittent and continuous RRT are available for these patients on the intensive care units (ICUs). It is unknown which technique is superior with respect to patient outcome. Methods. We randomized 125 patients to treatment with either continuous venovenous haemodiafiltration (CVVHDF) or intermittent haemodialysis (IHD) from a total of 191 patients with ARF in a tertiary-care university hospital ICU. The primary end-point was ICU and in-hospital mortality, while recovery of renal function and hospital length of stay were secondary end-points. Results. During 30 months, no patient escaped randomization for medical reasons. Sixty-six patients were not randomized for non-medical reasons. Of the 125 randomized patients, 70 were treated with CVVHDF and 55 with IHD. The two groups were comparable at the start of RRT with respect to age (62±15 vs 62±15 years, CVVHDF vs IHD), gender (66 vs 73% male sex), number of failed organ systems (2.4±1.5 vs 2.5±1.6), Simplified Acute Physiology Scores (57±17 vs 58±23), septicaemia (43 vs 51%), shock (59 vs 58%) or previous surgery (53 vs 45%). Mortality rates in the hospital (47 vs 51%, CVVHDF vs IHD, P = 0.72) or in the ICU (34 vs 38%, P = 0.71) were independent of the technique of RRT applied. Hospital length of stay in the survivors was comparable in patients on CVVHDF [median (range) 20 (6-71) days, n = 36] and in those on IHD [30 (2-89) days, n = 27, P = 0.25]. The duration of RRT required was the same in both groups. Conclusion. The present investigation provides no evidence for a survival benefit of continuous vs intermittent RRT in ICU patients with AR

Maximum tumor diameter is not an independent prognostic factor in high-risk localized prostate cancer

Contains fulltext : 69173.pdf (publisher's version ) (Closed access)OBJECTIVES: Previous studies suggest that maximum tumor diameter (MTD) is a predictor of recurrence in prostate cancer (PC). This study investigates the prognostic value of MTD for biochemical recurrence (BCR) in patients with PC, after radical prostatectomy (RP), with emphasis on high-risk localized prostate cancer. METHODS: RP specimens of 542 patients were evaluated with a median follow-up of 39.5 months (range 0.6-150 months). MTD was defined as the largest diameter of the largest tumor; high-risk as >or=T2c or PSA level>20 ng/ml or Gleason score>or=8 and BCR as two consecutive PSA levels>0.10 ng/ml. Proportional hazards multivariable regression models were composed to determine prognostic factors for BCR. RESULTS: Overall, 114 patients developed BCR after RP. The overall 5-year risk of BCR was 25% (95% CI=20.4-29.6), and median MTD was 24 mm (range 1-65). MTD in the total and high-risk group was associated with total tumor volume, volume of the largest tumor, pre-operative PSA levels, and Gleason score. In a univariable analyses, MTD was weakly associated with risk of BCR (HR=1.02 per mm increase, 95% CI=1.002-1.035, P=0.024) in the total group; in the high-risk group this association was lost (HR=1.01, 95%CI=0.99-1.03, P=0.18). Multivariable analyses indicated that positive surgical margins, higher Gleason score, advanced pathological stage, and multiple tumors were the main prognostic factors for BCR irrespective of the risk profile. MTD did not provide additional information. CONCLUSIONS: MTD is not an independent prognostic factor for BCR in patients treated with RP, irrespective of the risk profile

Ray paths of VLF/LF transmitter radio signals in the seismic Adriatic regions

We analyze the radio wave propagations of VLF/LF transmitter signals along subionospheric paths using two different reception systems localized in the Graz seismo-electromagnetic facility (15.43E,47.06N). Those systems allow the simultaneous detection of more than fifteen transmitter signals emitting in the northern (i.e. France, Germany and United Kingdom) and southern (i.e. Italy and Turkey) parts of Europe. In this work, we investigate the transmitter radio wave propagations associated with two earthquakes (EQs) which occurred, at two occasions, in nearly the same Croatian regions (Geo. Long.=16°E; Geo. Lat.=45°N). The first and second EQs happened, respectively, on March 22 and December 29, 2020, with magnitudes Mw equal to 5.4 and 6.4. The use of two complementary reception systems, i.e. INFREP (Biagi et al., Open Journal of Earthquake Research, 8, 2019) and UltraMSK (Schwingenschuh et al., Nat. Hazards Earth Syst. Sci., 11, 2011), and the proximity to the epicenters lead us to characterize the behavior of the transmitter signal amplitudes particularly above the Croatian seismic regions. We analyze the amplitude variation for a given transmitter frequency starting few weeks before the earthquakes occurrences. We discuss the observed anomalies in the transmitter signals which may be considered as precursors due to the ionospheric disturbances of the transmitter ray paths above the earthquakes preparation zones