Clinical presentation and outcome of pediatric ANCA-associated glomerulonephritis

Background Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a small- and medium-sized vasculitis classically seen in adult patients, with peak onset near the fifth to seventh decade of life. There is little data on ANCA-associated vasculitis in pediatric patients, and most studies have limited follow-up. Methods This is a retrospective chart review of 22 patients with ANCA-positive glomerulonephritis in a single institution from 1991 to 2013. Results Of the 22 patients, eight (36 %) required renal replacement therapy (RRT) at diagnosis; four of these patients recovered sufficient renal function to initially discontinue dialysis. Five patients (23 %) were treated with plasmapheresis at presentation. The median time from presentation until first clinical or serologic relapse was 1.7 ± 1.2 years. After a median follow-up of 5.8 years, just over half of our patients had chronic kidney disease (CKD) stages 1–3 (55 %). Seven (32 %) patients progressed to end-stage renal disease (ESRD) and eventually required kidney transplant. Conclusion ANCA-associated glomerulonephritis is a rare disorder in children. Presentation and outcomes vary significantly among patients. More research is required to follow these patients who are diagnosed in childhood to further characterize the long-term outcome of the disease

Ecumenical modal logic

The discussion about how to put together Gentzen's systems for classical and intuitionistic logic in a single unified system is back in fashion. Indeed, recently Prawitz and others have been discussing the so called Ecumenical Systems, where connectives from these logics can co-exist in peace. In Prawitz' system, the classical logician and the intuitionistic logician would share the universal quantifier, conjunction, negation, and the constant for the absurd, but they would each have their own existential quantifier, disjunction, and implication, with different meanings. Prawitz' main idea is that these different meanings are given by a semantical framework that can be accepted by both parties. In a recent work, Ecumenical sequent calculi and a nested system were presented, and some very interesting proof theoretical properties of the systems were established. In this work we extend Prawitz' Ecumenical idea to alethic K-modalities

Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome

Hemolytic uremic syndrome (HUS) is the most common cause of acute renal failure in childhood and the reason for chronic renal replacement therapy. It leads to significant morbidity and mortality during the acute phase. In addition to acute morbidity and mortality, long-term renal and extrarenal complications can occur in a substantial number of children years after the acute episode of HUS. The most common infectious agents causing HUS are enterohemorrhagic Escherichia coli (EHEC)-producing Shiga toxin (and belonging to the serotype O157:H7) and several non-O157:H7 serotypes. D+ HUS is an acute disease characterized by prodromal diarrhea followed by acute renal failure. The classic clinical features of HUS include the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. HUS mortality is reported to be between 3% and 5%, and death due to HUS is nearly always associated with severe extrarenal disease, including severe central nervous system (CNS) involvement. Approximately two thirds of children with HUS require dialysis therapy, and about one third have milder renal involvement without the need for dialysis therapy. General management of acute renal failure includes appropriate fluid and electrolyte management, antihypertensive therapy if necessary, and initiation of renal replacement therapy when appropriate. The prognosis of HUS depends on several contributing factors. In general “classic” HUS, induced by EHEC, has an overall better outcome. Totally different is the prognosis in patients with atypical and particularly recurrent HUS. However, patients with severe disease should be screened for genetic disorders of the complement system or other underlying diseases

Monitoraggio ambientale e biologico dell’esposizione ad idrocarburi mono-aromatici ed a metil tert-butil etere in un gruppo di lavoratori addetti all’erogazione di carburanti

Lo studio è stato condotto per valutare gli indicatori biologici di esposizione a vapori di benzina in lavoratori addetti all’erogazione di carburante tramite un approccio combinato di monitoraggio ambientale e biologico. L’esposizione personale a benzene, toluene, etilbenzene e xilene (BTEX) e l’escrezione urinaria di BTEX, metil tert-butil etere (MTBE-U), degli acidi trans,transmuconico (t,t-MA) ed S-fenilmercapturico (S-PMA) e della cotinina sono stati valutati con tecniche cromatografiche accoppiate alla spettrometria di massa. I livelli di MTBE-U erano influenzati dalla sola esposizione professionale a vapori di benzina, mentre quelli di B-U ed S-PMA dipendevano da abitudine tabagica ed esposizione professionale

Focusing in Asynchronous Games

Game semantics provides an interactive point of view on proofs, which enables one to describe precisely their dynamical behavior during cut elimination, by considering formulas as games on which proofs induce strategies. We are specifically interested here in relating two such semantics of linear logic, of very different flavor, which both take in account concurrent features of the proofs: asynchronous games and concurrent games. Interestingly, we show that associating a concurrent strategy to an asynchronous strategy can be seen as a semantical counterpart of the focusing property of linear logic

Shintaido in the elderly: the new way for physical and psychological health

The research aims to investigate the effects of a Shintaido practice in terms of physical and psychological functioning in a group of elderly. Forty seniors, of both gender, with a mean age of (69 ± 6) years, self-sufficient and without highly invalidating diseases participated in the study. The experimental group (EG) attended the Shintaido physical training of 20 weeks (1 hour per session, twice a week), while the control group (CG) maintained his usual routine. The exercise protocol included specific activities of joint mobility, balance and breathing. At the begin and at the end of intervention were administered to both groups the following validated instruments: 1) One-leg Stance test for the measure of monopodalic static balance; 2) 6-Minutes Walking test for the endurance assessment; 3) Self-Efficacy Perception in Physical Activity (APEF) questionnaire for the selfefficacy evaluation. Data were treated with the not-parametric test for paired and unpaired samples, the Spearman correlation and the linear regression. The results show that: 1) the EG improves the endurance in walking and the monopodalic balance as well as his self-efficacy after the Shintaido program; 2) there are strong associations among Shintaido physical activity and physical/psychological variables; 3) there is a mediating effect of walking endurance between the participation to Shintaido training and the self-efficacy. The results suggest that a well structured Shintaido training can help to maintain a good level of physical and psychological functioning in old people

Cefepime Neurotoxicity in an Adolescent Cystic Fibrosis Patient with Aminoglycoside-Induced Acute Kidney Injury

Objective: To describe a case of cefepime neurotoxicity in an adolescent with cystic fibrosis and aminoglycoside-associated acute kidney injury (AKI). Case Summary: A 15-year-old, 46-kg male with cystic fibrosis (CF) and chronic sinusitis was admitted to the hospital for CF exacerbation. The patient was subsequently discharged to complete home antibiotic therapy with intravenous gentamicin and cefepime. Thirteen days after discharge, while still receiving intravenous antibiotics, the patient presented to an outside hospital complaining of vomiting, fatigue, decreased appetite, and decreased urine output. The patient was diagnosed with AKI and was transferred to our institution, where he displayed signs and symptoms consistent with encephalopathy. Encephalopathy was thought to be consistent with cefepime-associated neurotoxicity. After 2 hemodialysis sessions, the encephalopathy resolved. Over the course of admission, the patient\u27s renal function improved. Discussion: This patient experienced neurotoxicity thought to be secondary to cefepime in the setting of AKI. Aminoglycoside therapy most likely led to the AKI. We believe that our patient represents the fourth pediatric patient with cefepime-associated encephalopathy described in the literature and the second without chronic renal dysfunction. Conclusions: Children receiving cefepime should be monitored for AKI. In the presence of AKI, cefepime doses may need to be adjusted and the patient should be monitored for signs and symptoms of neurotoxicity

Reactive oxygen molecule-mediated injury in endothelial and renal tubular epithelial cells in vitro

Reactive oxygen molecule-mediated injury in endothelial and renal tubular epithelial cells in vitro. To investigate renal tubular epithelial cell injury mediated by reactive oxygen molecules and to explore the relative susceptibility of epithelial cells and endothelial cells to oxidant injury, we determined cell injury in human umbilical vein endothelial cells and in four renal tubular epithelial cell lines including LLC-PK1, MDCK, OK and normal human kidney Cortical epithelial cells (NHK-C). Cells were exposed to reactive oxygen molecules including superoxide anion, hydrogen peroxide and hydroxy 1 radical generated by xanthine oxidase and hypoxanthine. We determined early sublethal injury with efflux of 3H-adenine metabolites and a decline in ATP levels, while late lytic injury and cell detachment were determined by release of51 chromium. When the cells were exposed to 25, 50, and 100 mU/ml xanthine oxidase with 5.0mM hypoxanthine, ATP levels were significantly lower (P < 0.001) in LLC-PK1, NHK-C and OK cells compared to MDCK cells while ATP levels were significantly lower (P < 0.01) in endothelial cells compared to all tubular cell lines. A similar pattern of injury was seen with efflux of 3H-adenine metabolites. When the cells were exposed to 50 mU/ml xanthine oxidase with 5.0mM hypoxanthine for five hours, total 51chromium release was significantly (P < 0.001) greater in LLC-PK1, NHK-C and OK cells compared to MDCK cells, while total 51chromium release was significantly (P < 0.001) greater in endothelial cells compared to all tubular cells. However, lytic injury was the greatest in LLC-PK1 cells and NHK-C cells while cell detachment was the greatest in endothelial cells. MDCK cells were remarkably resistant to oxidant-mediated cell detachment and cell lysis. In addition, we determined ATP levels, 3H-adenine release and 51chromium release in LLC-PK1, NHK-C and endothelial cells in the presence of superoxide dismutase to dismute superoxide anion, catalase to metabolize hydrogen peroxide, DMPO to trap hydroxyl radical and DMTU to scavenge hydrogen peroxide and hydroxyl radical. We found that catalase and DMTU (scavengers of hydrogen peroxide) provided significant protection from ATP depletion, prevented efflux of 3H-adenine metabolites and cell detachment while DMPO (scavenger of hydroxyl radical) prevented lytic injury. In addition, we found that the membrane-permeable iron chelator, phenanthroline, and preincubation with deferoxamine prevented cell detachment and cell lysis, confirming the role of hydroxyl radical in cell injury. We conclude that among tubular epithelial cells, cells with proximal tubular characteristics including LLC-PK1, NHK-C and OK cells were more susceptible to oxidant injury than MDCK cells which originate from distal tubules. Endothelial cells responded to oxidant injury with a greater fall in ATP levels, efflux of 3H-adenine metabolites and cell detachment, while tubular epithelial cells demonstrated greater cell lysis. Finally, it appears that hydrogen peroxide mediates ATP depletion and efflux of 3H-adenine metabolites while hydrogen peroxide and hydroxyl radical mediate cell detachment and cell lysis