Urinary Trace Elements Are Biomarkers for Early Detection of Acute Kidney Injury

IntroductionAcute kidney injury (AKI) is common in hospitalized patients and associated with poor outcomes. Current methods for identifying AKI (rise in serum creatinine [sCr] or fall in urine output [UO]) are inadequate and delay detection. Early detection of AKI with easily measurable biomarkers might improve outcomes by facilitating early implementation of AKI care pathways.MethodsFrom a porcine model of AKI, we identified trace elements (TEs) in urine that were associated with subsequent development of AKI. We tested these putative biomarkers in 2 observational cohort studies of patients at high risk of AKI: 151 patients undergoing cardiac surgery and 150 patients admitted to a general adult intensive care unit (ICU).ResultsIn humans, urinary zinc (Zn) was associated with AKI. In adults admitted to the ICU, urinary cadmium (Cd) (adjusted for urinary creatinine) had area under the receiver operating characteristic curve (AUROC) 0.70 and negative predictive value (NPV) 89%; copper (Cu) had AUROC 0.76 and NPV 91%; and Zn had AUROC 0.67 and NPV 80%. In patients undergoing cardiac surgery, Zn had AUROC 0.77 and NPV 91% and urinary Cd and Cu had poor AUROC but NPV of 93% and 95%, respectively. In control studies, we found that the urinary biomarkers are stable at room temperature for at least 14 days and are not affected by other confounding factors, such as chronic kidney disease (CKD).ConclusionUrinary Cd, Cu, and Zn are novel biomarkers for early detection of AKI. Urinary trace metals have advantages over proteins as AKI biomarkers because they are stable at room temperature and have potential for cheap point-of-care testing using electrochemistry

Pełna biologiczna proteza aorty wstępującej z zastawką (shelhigh stentless composite valve) - Pierwsze doświadczenia

Background: Currently, Shelhigh Stentless Composite Valve (SSCV) is the only complete biological conduit available on the market for this purpose. SSCV has been used to avoid anticoagulation with the advantage of established haemodynamic benefits of stentless valves as well as for its surgeon-friendly surgical implantation.Methods: Between August 1999 and January 2001, 11 patients (8 women, 3 men, mean age 71.5±9.3 years) underwent first time aortic root and ascending aorta replacement with SSCV in Leicester. Aortic regurgitation was found in seven patients and aortic stenosis was predominant in three. Mean preoperative NYHA functional class was 24±0.7 and mean Parsonnet score was 25.1±1.1. Mean preoperative aortic root diameter was 5.34±1.2 cm, left ventricular (LV) end-systolic diameter was 4.3±0.5, and end-diastolic diameter was 6.5±0.6 cm. Preoperative LV ejection fraction was less than 30% in 6 (55%) patients. One patient had additional aortic arch replacement and three patients had concomitant myocardial revascularisation. Seven patients received size 25 mm SSVC, and four patients received size 27 mm SSCV. All patients had Doppler echocardiographic studies before discharge from the hospital and current follow-up data are available for all patients.Results: All patients survived the early postoperative period, however, one patient developed transient stroke. While no biological glue or teflon were used during surgery, no patient required re-operation for bleeding and there was no significant blood loss recorded postoperatively. Mean postoperative intensive care stay was 1.5±0.7 and hospital stay was 11.3±4.9 days. Postoperative mean gradients were 9.7±3.05 mmHg for 25 mm grafts, and 8.6±4.3 mmHg for 27 mm composite grafts.Conclusions: Early experience with the SSCV used for the replacement of ascending aorta is encouraging. Practical benefits include improved haemostatic suture line, established haemodynamic advantages of a stentless valve and surgeon-friendly implantation while avoiding long-term anticoagulation

Leczenie ropnego zapalenia śródpiersia z niestabilnością mostka - Opis przypadku

Abstract: The authors report the case of 70-year-old female who underwent urgent CABG for unstable angina. The post-operative course was complicated by Staphyloccoccal mediastinitis, which was treated with chest irrigation system and antibiotics. Because of extensive tissue destruction caused by the infection, the steel sternal wires were not placed. Interestingly, one year after surgery the sternal wound was completely healed and there were no paradoxical respiratory movements

Case reportsMitral annuloplasty ring dehiscence after blunt chest trauma

A case of recurrent severe mitral regurgitation following blunt chest trauma with deceleration injury in a 61-year-old woman is presented. The patient had undergone previous CABG and mitral annuloplasty with the use of a flexible (Duran) ring. At reoperation, partial dehiscence of the annuloplasty ring, which had become rigid, was found. This was successfully repaired

Changes in the Substrate Source Reveal Novel Interactions in the Sediment-Derived Methanogenic Microbial Community

Methanogenesis occurs in many natural environments and is used in biotechnology for biogas production. The efficiency of methane production depends on the microbiome structure that determines interspecies electron transfer. In this research, the microbial community retrieved from mining subsidence reservoir sediment was used to establish enrichment cultures on media containing different carbon sources (tryptone, yeast extract, acetate, CO2/H2). The microbiome composition and methane production rate of the cultures were screened as a function of the substrate and transition stage. The relationships between the microorganisms involved in methane formation were the major focus of this study. Methanogenic consortia were identified by next generation sequencing (NGS) and functional genes connected with organic matter transformation were predicted using the PICRUSt approach and annotated in the KEGG. The methane production rate (exceeding 12.8 mg CH4 L−1 d−1) was highest in the culture grown with tryptone, yeast extract, and CO2/H2. The analysis of communities that developed on various carbon sources casts new light on the ecophysiology of the recently described bacterial phylum Caldiserica and methanogenic Archaea representing the genera Methanomassiliicoccus and Methanothrix. Furthermore, it is hypothesized that representatives of Caldiserica may support hydrogenotrophic methanogenesis