Раннее выявление изменений почечной гемодинамики у больных с циррозом печени

Catedra de Medicină internă nr. 5, USMF „Nicolae Testemiţanu”, Conferinţa Ştiinţifico-Practică „Medicina modernă, actualităţi şi perspective”, consacrată aniversării de 40 de ani ai Spitalului Clinic al Ministerului Sănătăţii, 27-28 mai, 2010, Chişinău, Republica MoldovaThe study included 114 patients with cirrhosis of diverse etiology. It was established that aggressive diuretic medication, upper GI bleeding and paracentesis drainage often cause renal complications in patients with liver cirrhosis. In patients with cirrhosis Child-Pugh class C, a decrease of the minimum diastolic velocity in renal arteries was determined, confirming an increased vascular renal resistance during the progression of cirrhosis. A significant increase in renal and portal insufficiencies values is present in patients with liver cirrhosis Child-Pugh class C, which compromises the inner-kidney vascular irrigation. Dopplerography of renal artery is an effective and noninvasive method for determining renal hemodynamics disturbances in patients with viral and alcoholic cirrhosis.В исследование были включены 114 пациентов с циррозом печени различной этиологии. Установлено, что агрессивное лечение мочегонными лекарствами, кровотечения из верхних отделов ЖКТ и дренаж после парацентеза часто вызывают почечные осложнения. У больных с циррозом печени класса С по Child-Pugh, уменьшается минимальная диастолическая скорость в почечных артериях, подтверждающая увеличение артериального давления с прогрессированием цирроза печени, прогрессируют почечная и портальная недостаточности, что ставит под угрозу почечную ирригацию. Допплерометрия почечных артерий является эффективным и неинвазивным методом определения почечных нарушений гемодинамики у пациентов с вирусным и алкогольным циррозом печени

Оценка патогенетических факторов, влияющих на почечные осложнения у больных циррозом печени

Catedra de Medicină Internă nr. 5, USMF „Nicolae Testemiţanu”, Conferinţa Ştiinţifico-Practică „Medicina modernă, actualităţi şi perspective”, consacrată aniversării de 40 de ani ai Spitalului Clinic al Ministerului Sănătăţii, 27-28 mai, 2010, Chişinău, Republica MoldovaThe study involved 82 patients - 40 women and 42 men. Early detection of renal function impairment is a major predictive importance in managing patients with liver cirrhosis. In liver cirrhosis Child-Pugh class C, the renal hemodynamics is already compromised and is characterized by growth of vasoconstrictor factors. Azotemia in acute renal failure in hepato-renal syndrome does not reach very high values and is not associated with severe hyperpotassemia. PGE2 synthesis in the kidney is progressively inhibited by renal hemodynamic disturbances with advancing liver cirrhosis, which translates into decreasing PGE-1 levels in the serum. E1 is the vasoconstrictor with the most increased levels in patients with liver cirrhosis Child-Pugh class C and particularly in patients with hepato-renal syndrome. The decreased glomerular filtration rate is associated with an increased amount of ET-1, low sodium in the blood and edema in patients with refractory ascites. В исследовании включены 82 больных - 40 женщин и 42 мужчины. Раннее обнаружение почечной недостаточности является одним из основных прогностических факторов в менеджменте больных циррозом печени. При циррозе печени класса C по ChildPugh почечная гемодинамика уже скомпрометирована и характеризуется ростом сосудосуживающих факторов при отсутствии роста показателей эндогенных креатинина и мочевины в сыворотке крови. Азотемия в острой почечной недостаточности при печеночнопочечном синдроме не достигает больших значений и не связана с выраженной гиперкалиемией. Синтез PGE2 в почках постепенно замедляется из-за нарушения почечной гемодинамики при прогрессировании цирроза печени. У больных циррозом печени класса С по Child-Pugh, особенно при наличии печеночно-почечного синдрома, выявляется повышенная концентрация сосудосуживающего фактора Е1. Снижение скорости клубочковой фильтрации ассоциируется с повышенным содержанием ЕТ-1, низким содержанием натрия крови и с отеками

Highlights from the Pierre Auger Observatory

The Pierre Auger Observatory is the world's largest cosmic ray observatory. Our current exposure reaches nearly 40,000 km$^2$ str and provides us with an unprecedented quality data set. The performance and stability of the detectors and their enhancements are described. Data analyses have led to a number of major breakthroughs. Among these we discuss the energy spectrum and the searches for large-scale anisotropies. We present analyses of our X$_{max}$ data and show how it can be interpreted in terms of mass composition. We also describe some new analyses that extract mass sensitive parameters from the 100% duty cycle SD data. A coherent interpretation of all these recent results opens new directions. The consequences regarding the cosmic ray composition and the properties of UHECR sources are briefly discussed.Comment: 9 pages, 12 figures, talk given at the 33rd International Cosmic Ray Conference, Rio de Janeiro 201

The Pierre Auger Observatory III: Other Astrophysical Observations

Astrophysical observations of ultra-high-energy cosmic rays with the Pierre Auger ObservatoryComment: Contributions to the 32nd International Cosmic Ray Conference, Beijing, China, August 201

Measurement of the Depth of Maximum of Extensive Air Showers above 10^18 eV

We describe the measurement of the depth of maximum, Xmax, of the longitudinal development of air showers induced by cosmic rays. Almost four thousand events above 10^18 eV observed by the fluorescence detector of the Pierre Auger Observatory in coincidence with at least one surface detector station are selected for the analysis. The average shower maximum was found to evolve with energy at a rate of (106 +35/-21) g/cm^2/decade below 10^(18.24 +/- 0.05) eV and (24 +/- 3) g/cm^2/decade above this energy. The measured shower-to-shower fluctuations decrease from about 55 to 26 g/cm^2. The interpretation of these results in terms of the cosmic ray mass composition is briefly discussed.Comment: Accepted for publication by PR

Operations of and Future Plans for the Pierre Auger Observatory

Technical reports on operations and features of the Pierre Auger Observatory, including ongoing and planned enhancements and the status of the future northern hemisphere portion of the Observatory. Contributions to the 31st International Cosmic Ray Conference, Lodz, Poland, July 2009.Comment: Contributions to the 31st ICRC, Lodz, Poland, July 200

An Integrated TCGA Pan-Cancer Clinical Data Resource to Drive High-Quality Survival Outcome Analytics

For a decade, The Cancer Genome Atlas (TCGA) program collected clinicopathologic annotation data along with multi-platform molecular profiles of more than 11,000 human tumors across 33 different cancer types. TCGA clinical data contain key features representing the democratized nature of the data collection process. To ensure proper use of this large clinical dataset associated with genomic features, we developed a standardized dataset named the TCGA Pan-Cancer Clinical Data Resource (TCGA-CDR), which includes four major clinical outcome endpoints. In addition to detailing major challenges and statistical limitations encountered during the effort of integrating the acquired clinical data, we present a summary that includes endpoint usage recommendations for each cancer type. These TCGA-CDR findings appear to be consistent with cancer genomics studies independent of the TCGA effort and provide opportunities for investigating cancer biology using clinical correlates at an unprecedented scale. Analysis of clinicopathologic annotations for over 11,000 cancer patients in the TCGA program leads to the generation of TCGA Clinical Data Resource, which provides recommendations of clinical outcome endpoint usage for 33 cancer types

Anisotropy and chemical composition of ultra-high energy cosmic rays using arrival directions measured by the Pierre Auger Observatory

The Pierre Auger Collaboration has reported evidence for anisotropy in the distribution of arrival directions of the cosmic rays with energies $E>E_{th}=5.5\times 10^{19}$ eV. These show a correlation with the distribution of nearby extragalactic objects, including an apparent excess around the direction of Centaurus A. If the particles responsible for these excesses at $E>E_{th}$ are heavy nuclei with charge $Z$, the proton component of the sources should lead to excesses in the same regions at energies $E/Z$. We here report the lack of anisotropies in these directions at energies above $E_{th}/Z$ (for illustrative values of $Z=6,\ 13,\ 26$). If the anisotropies above $E_{th}$ are due to nuclei with charge $Z$, and under reasonable assumptions about the acceleration process, these observations imply stringent constraints on the allowed proton fraction at the lower energies

Atmospheric effects on extensive air showers observed with the Surface Detector of the Pierre Auger Observatory

Atmospheric parameters, such as pressure (P), temperature (T) and density, affect the development of extensive air showers initiated by energetic cosmic rays. We have studied the impact of atmospheric variations on extensive air showers by means of the surface detector of the Pierre Auger Observatory. The rate of events shows a ~10% seasonal modulation and ~2% diurnal one. We find that the observed behaviour is explained by a model including the effects associated with the variations of pressure and density. The former affects the longitudinal development of air showers while the latter influences the Moliere radius and hence the lateral distribution of the shower particles. The model is validated with full simulations of extensive air showers using atmospheric profiles measured at the site of the Pierre Auger Observatory.Comment: 24 pages, 9 figures, accepted for publication in Astroparticle Physic