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

Endoscopic placement of enteral feeding tubes

Malnutrition is common in patients with acute and chronic illness. Nutritional management of these malnourished patients is an essential part of healthcare. Enteral feeding is one component of nutritional support. It is the preferred method of nutritional support in patients that are not receiving adequate oral nutrition and have a functioning gastrointestinal tract (GIT). This method of nutritional support has undergone progression over recent times. The method of placement of enteral feeding tubes has evolved due to development of new feeding tubes and endoscopic technology. Enteral feeding can be divided into methods that provide short-term and long-term access to the GIT. This review article focuses on the current range of methods of gaining access to the GIT to provide enteral feed

Drug release from hydroxypropylcellulose gels cannot be statistically predicted from their viscometric and initial viscoelastic properties

This study questioned whether rheological properties can predict drug (metronidazole) release from Hydroxypropylcellulose (HPC) platforms. Viscometric and viscoelastic properties of aqueous, alcohols/diols and mixed solvent HPC solutions and gels were determined using viscometry and oscillatory analysis. Drug release was conducted at pH 7.4 under sink conditions. Relationships between rheological parameters and drug release were modelled using multiple linear stepwise regression. Viscometry identified ethanol and water as good solvents for HPC. Diol solvents were predicted to exhibit greater interactions with HPC (COSMO modelling) but possessed lowest intrinsic viscosities. Pentanediol or ethylene glycol prepared gels exhibited greatest elasticity. No relationships were observed between dilute solution properties and initial gel viscoelasticity. Drug release from HPC gels occurred via gel erosion and diffusion. No relationships were observed between initial gel viscoelasticity and drug release and thus, for gel platforms that undergo erosion in aqueous media, drug release cannot be predicted from initial gel viscoelasticity.</p