32 research outputs found

    EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI): study protocol for a multicentre, observational trial

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    IntroductionMore than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI.Methods and analysisEPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI.Ethics and disseminationEPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University MĂŒnster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials.Trial registration numberNCT04165369

    Experimental and Theoretical Study of Phase Equilibria in Aqueous Mixtures of Lactic Acid with Benzyl Alcohol and p-Xylene at Various Temperatures

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    Liquid-liquid equilibria for the (water + lactic acid + benzyl alcohol or p-xylene) ternary systems were investigated at atmospheric pressure and in the temperature range from 298.15-318.15 K. The studied systems exhibit two types of liquid-liquid equilibrium (LLE) behavior. The system consisting of benzyl alcohol displays type-1 LLE behavior, while a type-2 behavior is exhibited by the other system. The quality of the experimental tie line data was determined using the Othmer-Tobias and Hand equations. Distribution coefficients and separation factors were calculated over the biphasic region. The experimental tie line data were regressed using the UNIQUAC and NRTL models and the binary interaction parameters were obtained

    EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI): Study protocol for a multicentre, observational trial

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    Introduction More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. Methods and analysis EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. Ethics and dissemination EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University MĂŒnster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

    Unus pro omnibus, omnes pro uno: A novel, evidence-based, unifying theory for the pathogenesis of endometriosis

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    The theory of retrograde menstruation as aetiopathogenesis of endometriosis formulated by John Sampson in 1927 shows clear shortcomings: this does not explain why retrograde menstruation is a physiological process that affects 90% of women, while endometriosis occurs in only 10% of cases; it also does not explain the endometriotic foci distant from the pelvis, nor explains the cases of endometriosis in male patients. The immunological alterations of the peritoneal fluid explains the effects of disease, such as the inhibition of the physiological processes of cytolysis, but does not explain the cause. There is evidence to support the hypothesis that ectopic müllerian remnants of the endometrium, endocervix and endosalpinx are items from the genital ridge leaked during organogenesis. It is known that tissues derived from coelomatic epithelial and mesenchymal cells have the potential to metaplastically differentiate into epithelium and stroma. In addition, the phenotype of the ectopic endometrial cells is significantly different from those ectopic. There is scientific evidence that, during organogenesis, the genes of the Homeobox and Wingless family play a fundamental role in the differentiation of the ducts of Muller and development of the anatomical structure of the urogenital tract. We present here a hypothesis that deregulation of genes and the Wnt signaling pathway Wnt/ÎČ-catenin leads to aberrations and deregulation within the mesoderm, thus, may cause aberrant placement of stem cells. In addition, immune cells, adhesion molecules, extracellular matrix metalloproteinase and pro-inflammatory cytokines activate/alter peritoneal microenvironment, creating the conditions for differentiation, adhesion, proliferation and survival of ectopic endometrial cells

    EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

    Get PDF
    More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University MĂŒnster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

    Bedeutung opioiderger Signalwege fĂŒr die Modulation viszeraler Afferenzen bei funktionellen Magendarmerkrankungen

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    Funktionelle Erkrankungen des Magendarmtrakts sind ĂŒberaus hĂ€ufig. Sie sind charakterisiert durch Symptome wie Oberbauchschmerzen, VöllegefĂŒhl etc. sowie durch das Fehlen struktureller LĂ€sionen oder biochemischer AbnormalitĂ€ten, die diese Symptome erklĂ€ren. Die funktionelle Dyspepsie mit auf den Oberbauch bezogenen chronischen oder chronisch rezidivierenden Symptomen ist dabei eine der wichtigsten Erkrankungen, die in der Klinik Anlass gibt fĂŒr endoskopische Untersuchungen. Hinsichtlich der Pathogenese der Symptome wird heute angenommen, dass neben MotilitĂ€tsstörungen vor allem VerĂ€nderungen der gastrointestinalen Sensorik eine zentrale Rolle einnehmen. So sind bei Patienten im Vergleich zu gesunden Probanden die Schwellen fĂŒr die Wahrnehmung und das Auftreten von Beschwerden bei mechanischer Distension des Magens signifikant niedriger als bei gesunden Probanden . Neben Unterschieden hinsichtlich der Wahrnehmungsschwellen sind Patienten gekennzeichnet durch gestörte adaptive VerĂ€nderungen der Wahrnehmungsschwellen nach repetitiver mechanischer Stimulation oder einer mukosalen SchleimhautschĂ€digung durch nicht-steroidale Antirheumatika (NSAR). Ziel der vorliegenden Untersuchung war es, den Einfluss opioiderger Bahnen fĂŒr die Modulation viszeraler Wahrnehmungsschwellen zu erfassen und die Effekte bei Patienten mit funktioneller Dyspepsie und gesunden Probanden zu vergleichen. In Übereinstimmung mit anderen frĂŒheren Arbeiten findet sich bei Gesunden ein Anstieg viszeraler Wahrnehmungsschwellen nach repetitiver mechanischer Stimulation und Behandlung mit NSAR, wĂ€hrend die Schwellen bei Patienten mit funktioneller Dyspepsie abnehmen. Die Gabe von Naloxon, einem unspezifischen Opioidantagonisten, bewirkt bei Gesunden einen signifikant stĂ€rker ausgeprĂ€gten Abfall viszeraler Wahrnehmungsschwellen als bei Patienten. Die Daten lassen insofern den Schluss zu, dass a) bei Patienten offensichtlich antinozizeptive Bahnen nur eingeschrĂ€nkt funktionstĂŒchtig sind; b) b) dies auf eine Störung opioiderg vermittelter antinozizeptiver Effekte zurĂŒckzufĂŒhren ist, was die verminderte Antwort auf intravenös appliziertes Naloxon bei Patienten nahe legt

    Gallbladder endometriosis as a cause of occult bleeding

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    Revisiting Renal Protection: Assessment and Preservation of Kidney Function

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    In Response

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