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

Transversus abdominis plane block with liposomal bupivacaine for pain control after cesarean delivery: a retrospective chart review

B Wycke Baker,1&ndash;4 Lea G Villadiego,1,2 Y Natasha Lake,1,2 Yazan Amin,3 Audra E Timmins,3 Laurie S Swaim,3 David W Ashton3 1Department of Obstetrical and Gynecological Anesthesiology, Texas Children&rsquo;s Hospital Pavilion for Women, Houston, TX, USA; 2US Anesthesia Partners, Houston, TX, USA; 3Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA; 4Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA Background: Adverse effects of opioid analgesics and potential for chronic use are limitations in the cesarean setting. Regional anesthesia using transversus abdominis plane (TAP) block post-cesarean delivery may improve analgesia and reduce opioid consumption. Effectiveness of TAP block using liposomal bupivacaine (LB) to reduce post-cesarean pain is unknown.Methods: We performed a single-center retrospective chart review of patients aged &ge;18 years who underwent cesarean delivery with a multimodal pain management protocol with or without TAP block with LB 266 mg. Assessments included postsurgical opioid consumption; area under the curve (AUC) of numeric rating scale pain scores from 0 to 3 days; proportion of opioid-free patients; discharge- and post-anesthesia care unit (PACU)-ready time; times to ambulation, solid food, and bowel movement; hospital length of stay (LOS); and adverse events (AEs). Data were analyzed in the total population and in first- and repeat-cesarean subgroups using Wilcoxon, chi-squared, and Student&rsquo;s t-tests.Results: Of 201 patients, 101 were treated with LB TAP block (LB-TAPB) and 100 without LB-TAPB. Treatment with LB-TAPB vs without LB-TAPB significantly reduced mean postsurgical opioid consumption (total, 47%; first-cesarean, 54%; repeat-cesarean, 42%; P&lt;0.001 each) and mean AUC of pain scores (total, 46%; first-cesarean, 57%; repeat-cesarean, 40%; P&lt;0.001 each). Patients treated with LB-TAPB had significantly shorter mean discharge-ready times (2.9 vs 3.6 days; P=0.006), PACU-ready times (138 vs 163 minutes; P=0.028), and LOS (2.9 vs 3.9 days; P&lt;0.001). LB-TAPB significantly decreased mean times to ambulation and solid food by 39% and 31% (P&lt;0.01 each), respectively, and numerically reduced mean time to bowel movement (26%; P=0.05). Fewer patients treated with LB-TAPB vs without LB-TAPB reported an AE (34% vs 50%; P=0.026).Conclusion: These results suggest multimodal pain management incorporating TAP block with LB 266 mg is an effective approach to reducing opioid requirements and improving analgesia post-cesarean delivery. Keywords: transversus abdominis plane block, liposomal bupivacaine, cesarean section, postoperative pain managemen

Sorption of heavy metal ions by glass beads-immobilized calix[4]arenes derivative

Glass beads (GB) immobilized, 5,11,17,23-tetra-tert-butyl-25,27-diethoxycarbonylmethoxy-26,28-dihydroxycalix[4]arene (CA) are prepared and used as a new sorbent in sorption study of removal heavy metal ions. A calixarene derivative bonded to amino-functionalized glass beads sorbent was synthesized via a self assembly technique for sorbent of selected heavy metal ions in aqueous. In order to absorb selected heavy metal ions in aqueous, a calixarene derivative bonded to amino-functionalized glass beads sorbent was synthesized via a self assembly technique. The sorbent which is named GB-APTS-CA was characterized using infrared (FTIR) spectroscopy, scanning electron microscopy (SEM), elemental analysis and thermal analysis (TGA/DTG). The influences of some experimental parameters including pH of the sample solution, weight of sorbent, concentration and temperature have been investigated. The sorption data were evaluated using the Langmuir, Freundlich and Dubinin Radushkevich (D-R) isotherm. The obtained maximum sorption capacity for Cu(II), and Pb(II) is 0.06 mmol g−1 and 0.02 mmol g−1, respectively. Thermodynamic parameters such as the standard free energy change (ΔG○), enthalpy change (ΔH○) and entropy change (ΔS○) were calculated to determine the nature of sorption process. Thus, GB-APTS-CA is favorable and useful for the removal of Cu(II) and Pb(II) metal ions

BACS: The Brussels Artificial Character Sets for studies in cognitive psychology and neuroscience

Written symbols such as letters have been used extensively in cognitive psychology, whether to understand their contributions to written word recognition or to examine the processes involved in other mental functions. Sometimes, however, researchers want to manipulate letters while removing their associated characteristics. A powerful solution to do so is to use new characters, devised to be highly similar to letters, but without the associated sound or name. Given the growing use of artificial characters in experimental paradigms, the aim of the present study was to make available the Brussels Artificial Character Sets (BACS): two full, strictly controlled, and portable sets of artificial characters for a broad range of experimental situations.SCOPUS: ar.jinfo:eu-repo/semantics/publishe