Acute kidney injury is common, parallels organ dysfunction or failure, and carries appreciable mortality in patients with major burns: a prospective exploratory cohort study

Introduction: The purpose of this study was to determine the incidence, time course, and outcome of acute kidney injury after major burns and to evaluate the impact of possible predisposing factors ( age, gender, and depth and extent of injury) and the relation to other dysfunctioning organs and sepsis. Method: We performed an explorative cohort study on patients with a TBSA% (percentage burned of total body surface area) of 20% or more who were admitted to a national burn centre. Acute kidney injury was classified according to the international consensus classification of RIFLE ( Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease). Prospectively collected clinical and laboratory data were used for assessing organ dysfunction, systemic inflammatory response, and sepsis. Results: The incidence of acute kidney injury among major burns was 0.11 per 100,000 people per year. Of 127 patients, 31 (24%) developed acute kidney injury (12% Risk, 8% Injury, and 5% Failure). Mean age was 40.6 years (95% confidence interval [CI] 36.7 to 44.5), TBSA% was 38.6% (95% CI 35.5% to 41.6%), and 25% were women. Mortality was 14% and increased with increasing RIFLE class (7% normal, 13% Risk, 40% Injury, and 83% Failure). Renal dysfunction occurred within 7 days in 55% of the patients and recovered among all survivors. Age, TBSA%, and extent of full thickness burns were higher among the patients who developed acute kidney injury. Pulmonary dysfunction and systemic inflammatory response syndrome were present in all of the patients with acute kidney injury and developed before the acute kidney injury. Sepsis was a possible aggravating factor in acute kidney injury in 48%. Extensive deep burns (25% or more full thickness burn) increased the risk for developing acute kidney injury early (risk ratio 2.25). Conclusions: Acute kidney injury is common, develops soon after the burn, and parallels other dysfunctioning organs. Although acute kidney injury recovered in all survivors, in higher acute kidney injury groups, together with cardiovascular dysfunction, it correlated with mortality

A Preparatory Study for a Randomized Controlled Trial of Dietary Fiber Intake During Adult Pelvic Radiotherapy

Background: Patients undergoing pelvic radiotherapy are often advised to omit fiber-rich foods from their diet to reduce the adverse effects of treatment. Scientific evidence supporting this recommendation is lacking, and recent studies on animals and humans have suggested that there is a beneficial effect of dietary fiber for the alleviation of symptoms. Randomized controlled studies on dietary fiber intake during pelvic radiotherapy of sufficient size and duration are needed. As preparation for such a large-scale study, we evaluated the feasibility, compliance, participation rate, and logistics and report our findings here in this preparatory study. Methods: In this preparatory study of a fiber intervention trial, Swedish gynecological cancer patients scheduled for radiotherapy were recruited between January 2019 and August 2020. During the intervention, the participants filled out questionnaires and used an application. They also consumed a fiber supplement at first in powder form, later in capsules. Blood- and fecal samples were collected. The study is registered in clinicaltrials.gov (https://clinicaltrials.gov/ct2/show/NCT04534075?cond=fidura&draw=2&rank=1). Results: Among 136 approached patients, 57 started the study and the participation rate for primary outcomes was 63% (third blood sample) and 65% (third questionnaire). Barely half of the participants provided fecal samples. Providing concise and relevant information to the patients at the right time was crucial in getting them to participate and stay in the study. The most common reasons for declining participation or dropping out were the expected burden of radiotherapy or acute side effects. Tailoring the ambition level to each patient concerning the collection of data beyond the primary endpoints was an important strategy to keep the dropout rate at an acceptable level. Using capsules rather than psyllium in powder form made it much easier to document intake and to create a control group. During the course of the preparatory study, we improved the logistics and for the last 12 participants included, the participation rate was 100% for the earliest primary outcome. Conclusion: A variety of adjustments in this preparatory study resulted in an improved participation rate, which allowed us to set a final protocol and proceed with the main study

Fecal short chain fatty acids in children living on farms and a link between valeric acid and protection from eczema

Children growing up on farms have low rates of allergy, but the mechanism for this protective effect has not been fully elucidated. Short chain fatty acids (SCFAs) produced by the gut microbiota may play a role in protection from allergy. We measured fecal SCFA levels in samples collected from 28 farming and 37 control children over the first 3\ua0years of life using gas chromatography. Data on diet and other host factors were recorded and allergy was diagnosed at 8\ua0years of age. Among all children, median propionic and butyric acid concentration increased over the first 3\ua0years, and longer SCFAs typically appeared by 1\ua0year of age. Farm children had higher levels of iso-butyric, iso-valeric and valeric acid at 3\ua0years of age than rural controls. In addition, children with elder siblings had higher levels of valeric acid at 3\ua0years of age, and dietary factors also affected SCFA pattern. High levels of valeric acid at 3\ua0years of age were associated with low rate of eczema at 8\ua0years of age. The fecal SCFA pattern in farm children suggests a more rapid maturation of the gut microbiota. Valeric acid or associated microbes may have protective potential against eczema

Long-Term Survival Rates after Resection for Locally Advanced Kidney Cancer: Memorial Sloan Kettering Cancer Center 1989 to 2012 Experience

Purpose: We analyzed the 23-year Memorial Sloan Kettering Cancer Center experience with surgical resection, and concurrent adrenalectomy and lymphadenectomy for locally advanced nonmetastatic renal cell carcinoma. Materials and Methods: We retrospectively reviewed the records of 802 patients who underwent nephrectomy with or without concurrent adrenalectomy or lymphadenectomy for locally advanced renal cell carcinoma, defined as stage T3 or greater and M0. Patients who received adjuvant treatment within 3 months of surgery or had fewer than 3 months of followup or bilateral renal masses at presentation were excluded from analysis. Five and 10-year progression-free and overall survival was estimated by the Kaplan-Meier method. Differences between groups were analyzed by the log rank test. Results: A total of 596 (74%) and 206 patients (26%) underwent radical and partial nephrectomy, respectively. Renal cell carcinoma progressed in 189 patients and 104 died of the disease. Median followup in patients without progression was 4.6 years. Symptoms at presentation, ASA (R) classification, tumor stage, histological subtype, grade and lymph node status were significantly associated with progression-free and overall survival. On multivariate analysis adrenalectomy use decreased with time but lymphadenectomy use increased (OR 0.82 vs 1.16 per year). Larger tumors were associated with a higher likelihood of concurrent adrenalectomy and lymphadenectomy. Conclusions: In our series of patients with locally advanced nonmetastatic renal cell carcinoma survival was favorable in those in good health who were asymptomatic at presentation with T3 tumors and negative lymph nodes. Further, there has been a trend toward more selective use of adrenalectomy and increased use of lymphadenectomy

The agency of liminality: army wives in the DR Congo and the tactical reversal of militarization

The inherently unstable boundaries between military and civilian worlds have emerged as a main object of study within the field of critical military studies. This article sheds light on the (re)production of these boundaries by attending to a group that rarely features in the debates on the military/civilian divide: army wives in a ‘non-Northern’ context, more specifically the Democratic Republic of the Congo (DRC). Drawing upon the ‘analytical toolbox’ of governmentality, we explore how civilian and military positionalities are called upon, articulated and subverted in the governing and self-governing of Congolese army wives. We show the decisive importance of these wives’ civilian-military ‘in betweenness’ both in efforts to govern them and in their exercise of agency, in particular The inherently unstable boundaries between military and civilian worlds have emerged as a main object of study within the field of critical military studies. This article sheds light on the (re)production of these boundaries by attending to a group that rarely features in the debates on the military/civilian divide: army wives in a ‘non-Northern’ context, more specifically the Democratic Republic of the Congo (DRC). Drawing upon the ‘analytical toolbox’ of governmentality, we explore how civilian and military positionalities are called upon, articulated, and subverted in the governing and self-governing of Congolese army wives. We show the decisive importance of these wives’ civilian–military ‘in-betweenness’ both in efforts to govern them and in their exercise of agency, in particular the ways in which they ‘tactically reverse’ militarization. The article also demonstrates the dispersed nature of the governing arrangements surrounding army wives, highlighting the vital role of ‘the civilian’ as well as the ‘agency of those being militarized’ within processes of militarization. By foregrounding the relevance of studying Congolese army wives and their militarization with an analytical toolbox often reserved for so called ‘advanced militaries/societies’, and by revealing numerous similarities between the Congolese and ‘Northern’ contexts, the article also sets out to counter the Euro/US-centrism and ‘theoretical discrimination’ that mark present-day (critical) military studies

Interleukin-4 activated macrophages mediate immunity to filarial helminth infection by sustaining CCR3-dependent eosinophilia

Eosinophils are effectors in immunity to tissue helminths but also induce allergic immunopathology. Mechanisms of eosinophilia in non-mucosal tissues during infection remain unresolved. Here we identify a pivotal function of tissue macrophages (Mϕ) in eosinophil anti-helminth immunity using a BALB/c mouse intra-peritoneal Brugia malayi filarial infection model. Eosinophilia, via C-C motif chemokine receptor (CCR)3, was necessary for immunity as CCR3 and eosinophil impairments rendered mice susceptible to chronic filarial infection. Post-infection, peritoneal Mϕ populations proliferated and became alternatively-activated (AAMϕ). Filarial AAMϕ development required adaptive immunity and interleukin-4 receptor-alpha. Depletion of Mϕ prior to infection suppressed eosinophilia and facilitated worm survival. Add back of filarial AAMϕ in Mϕ-depleted mice recapitulated a vigorous eosinophilia. Transfer of filarial AAMϕ into Severe-Combined Immune Deficient mice mediated immunological resistance in an eosinophil-dependent manner. Exogenous IL-4 delivery recapitulated tissue AAMϕ expansions, sustained eosinophilia and mediated immunological resistance in Mϕ-intact SCID mice. Co-culturing Brugia with filarial AAMϕ and/or filarial-recruited eosinophils confirmed eosinophils as the larvicidal cell type. Our data demonstrates that IL-4/IL-4Rα activated AAMϕ orchestrate eosinophil immunity to filarial tissue helminth infection

The disappearance and reappearance of optical emission lines and the drop in a Swift/XRT count rate during the recent rebrightening of TCP J21040470+4631129

We report the results of our continuing optical and X-ray monitoring of the bright WZ Sge-type dwarf nova TCP J21040470+4631129 (hereafter TCP2104) discovered on July 12, 2019 (for previous reports, see ATel #12947, #13009). Our optical photometric observations are mostly performed using 30-cm class telescopes, while spectroscopic data are obtained with the 2.1-m telescope at the OAN-SPM, the 2.5-m Isaac Newton Telescope on La Palma, and other smaller telescopes.peer-reviewe

How do you know if you are any good? A surgeon performance feedback system for the outcomes of radical prostatectomy

Surgery remains a mainstay of initial treatment for prostate cancer, with an estimated 85,000 operations per year in the US. Radical prostatectomy is associated with important risks of erectile dysfunction, urinary incontinence and, naturally, cancer recurrence. Given the possible consequences, it would be reassuring were it known that urologic surgeons offer uniformly high-quality care. Unfortunately, the data suggest that this is far from the case. There is copious evidence that surgeons with greater case volume or total lifetime experience have better outcomes. For example, low volume surgeons have complication rates 6 to 8% greater than their higher volume counterparts; in studies on the learning curve, the risk of recurrence is about 7% higher for a typical patient treated by an inexperienced surgeon than if treated by a more experienced surgeon There are also data that differences in outcome go over and above characteristics such as volume or experience, with large variations between surgeons even within volume categories, with one study reporting a five-fold variation in potency rates between surgeons at a single institution