Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Of No One Born: Queering Motherhood in Marivaux’s <i>La Vie de Marianne</i>

Abstract This article proposes that, rather than a sentimental love story, Pierre de Marivaux’s unfinished novel, La Vie de Marianne ou les aventures de Mme la Comtesse de *** (1731–41), presents a form of queer motherhood that provides a counterpoint to the form of Republican motherhood and the ‘cult of domesticity’ championed by Jean-Jacques Rousseau (among others) and critiqued by feminists such as Adrienne Rich and Élisabeth Badinter. Grounding the maternal experience in discourses of traumatic memory, it argues that, contrary to Sigmund Freud’s assertion that repeating is an act of repression (rather than working through), in this novel we see the opposite. The article demonstrates how trauma brings women together into polymaternal communities based on mutual affection that bypass the patriarchal structure that tends to shape eighteenth-century sentimental novels. For Marianne, re-enacting childhood trauma with others allows her to share the burden of pain and strengthen intimate bonds between women. More than being just a unique literary experiment, the queer articulation of family throughout this novel might help us to imagine an ontology of motherhood that is unencumbered by patriarchy.</jats:p

Prosthetic Matters: On Blindness, Machines, and Knowledge in Diderot’s Letter on the Blind

Denis Diderot’s 1749 essay La Lettre sur les aveugles à l’usage de ceux qui voient (Letter on the Blind for the Use of Those Who Can See) examines three blind figures, in the process laying the foundation for his materialist hermeneutic. Although many academic works of recent decades have focused on skepticism and materialism in Diderot’s oeuvre broadly–and in the Lettre specifically–to date, few have reckoned with the materiality of machines and their role in the production of this new form of knowledge. The Lettre examines not only the ways in which language expresses itself through the human body but also the ways in which the body engages with tools and machines in order to liberate expression and knowledge from the body itself. These machines exist in prosthetic relation to the body, and this intracorporeal relation posits a view of disability that is enabling. In this essay, I examine Lettre sur les aveugles, arguing that in form and in content, Diderot proposes a prosthetic ethos that breaks down distinctions between organic and inorganic matter. Placing Diderot into dialogue with Bernard Stiegler, particularly regarding the latter\u27s work on mnemotechnics, I demonstrate how in Diderot’s Lettre, materialist knowledge emanates from a delicate and intense relation between disabled bodies and machines

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

Abstract Background This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. Methods This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. Results A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). Conclusion There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT. </jats:sec