Outcomes of Albumin Use in the Treatment of Acute Hepatorenal Disorders: A Single Center Experience

Intravenous albumin is recommended for hepatorenal disorders (HRD), but individuals who do not recover renal function may be at a high risk for pulmonary edema. We reviewed outcomes by the amount of albumin infused in 93 patients not receiving dialysis at admission but being treated with intravenous albumin for acute HRD at our institution. Absence of renal recovery was defined as no decrease in serum creatinine and requirement of dialysis during hospitalization, and partial renal recovery was defined as a decrease in serum creatinine but not to prehospitalization levels. Associations of clinical factors including total albumin infused, presence of renal recovery, and oliguria with the development of pulmonary edema during hospitalization were determined using logistic regression. Of the 93 patients, 20 patients had complete renal recovery, 17 patients had partial renal recovery, and 56 patients showed no renal recovery. Most patients received 300–600 g of albumin. Overall, 47.3% of patients developed pulmonary edema (n=44), but the risk was 75% in patients with oliguria on presentation and no renal recovery versus 17% in those with no oliguria and complete renal recovery (P<0.001). In the logistic regression model, oliguria (3.32; 95% confidence interval [CI]: 1.12, 9.81) and no renal recovery (3.38; 95% CI: 1.24, 9.16) were each associated with higher odds of pulmonary edema after adjustment for covariates. No association was noted between total albumin infused and pulmonary edema. In summary, absence of renal recovery and oliguria in patients with HRD receiving intravenous albumin is associated with a higher risk of pulmonary edema

A BAC transgenic mouse model to analyze the function of astroglial SPARCL1 (SC1) in the central nervous system

Extracellular matrix associated Sparc-like 1 (SC1/SPARCL1) can influence the function of astroglial cells in the developing and mature central nervous system (CNS). To examine SC1’s significance in the CNS, we generated a BAC transgenic mouse model in which Sc1 is expressed in radial glia and their astrocyte derivatives using the astroglial-specific Blbp (Brain-lipid binding protein; [Feng et al., (1994) Neuron 12:895–908]) regulatory elements. Characterization of these Blbf-Sc1 transgenic mice show elevated Sc1 transcript and protein in an astroglial selective pattern throughout the CNS. This model provides a novel in vivo system for evaluating the role of SC1 in brain development and function, in general, and for understanding SC1’s significance in the fate and function of astroglial cells, in particular

Argentina 6–0 Perú: la victoria que no queremos tener

El Campeonato Mundial de Fútbol en la Argentina en 1978 se convirtió en una de las políticas centrales del último proceso cívico militar. Más allá que la designación de la sede se confirmó durante el gobierno dictatorial de Roberto Levingston (1970), y después de los acuerdos con la FIFA en 1966, la Junta Militar, conformada por el general Jorge Videla, el brigadier Orlando Ramón Agosti y el almirante Emilio Eduardo Massera, utilizó la competencia con el propósito de presentar una “imagen argentina ante el mundo”. Pero una de las huellas que dejó el primer trofeo mundial obtenido por la selección Nacional resultó el partido Argentina 6- Perú 0, disputado el 21 de junio de 1978, y correspondiente a la última fecha de la segunda fase. Aquel particular cotejo bisagra para la continuidad del equipo de Cesar Luis Menotti en el torneo y, en consecuencia, para los planes del gobierno militar quedó envuelto en un manto de sospechas. El partido Argentina 6- Perú 0 será el meollo de la cuestión en el presente trabajo debido que, a partir de ese momento clave para las aspiraciones del seleccionado albiceleste, se pusieron en escena los discursos oficiales del gobierno de facto, de los medios de comunicación afines al proceso y las maniobras de los principales actores sociales que utilizaron en un evento deportivo con la intención de manipular con el relato de la patria.Facultad de Periodismo y Comunicación Socia

Implementation of a pragmatic randomized trial of screening for chronic kidney disease to improve care among non-diabetic hypertensive veterans.

BackgroundWhether screening for chronic kidney disease (CKD) can improve the care of persons at high risk for complications remains uncertain. We describe the design and early implementation experience of a pilot, cluster-randomized pragmatic trial to evaluate the feasibility, implementation, and effectiveness of a "triple marker" CKD screening program (creatinine, cystatin C and albumin to creatinine ratio) for improving care among hypertensive veterans seen in primary care at one Veterans Administration Hospital.Methods/designNon-diabetic hypertensive veterans age 18-80 without known CKD were randomized in clusters determined by primary care provider (unit of randomization) into three arms. Usual care will be compared with two incrementally intensified treatment strategies: (1) screen for CKD followed by patient and provider education or (2) screen-educate plus a clinical pharmacist-led CKD and BP management program. The primary clinical outcome is systolic blood pressure (BP) change from baseline. Secondary clinical outcome is BP control. The primary process outcomes is triple marker screening (across three arms), and secondary process outcomes include use of inhibitors of the renin-angiotensin system (ACE/ARB) overall and in persons with albuminuria, CKD recognition by PCP, use of non-steroidal anti-inflammatory drugs (NSAIDs) and NSAID education by PCP. The design uses the Veterans Health Administration electronic health record (EHR) to identify participants, deliver the interventions and ascertain study outcomes. Assessment of the program implementation will use the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Study duration is 12&nbsp;months.ResultsA total of 1,819 patients have been randomized within 41 provider clusters. The median age (interquartile range) is 68&nbsp;years (61-72), and 99% of participants are male. Approximately 16% are Black, and 5% Hispanic. In the first 6&nbsp;months of the trial, 434 triple marker screening tests have been ordered, and 217(50%) have been tested. A total of 48 new CKD cases have been identified among those tested, for a preliminary yield of 22%.ConclusionWe have successfully implemented a pragmatic protocol that uses the EHR to identify and characterize eligible participants, deliver the intervention, and ascertain study outcomes with high rates of participation by providers and patients. Results from this study can guide design of pragmatic trials in the field of CKD.Trial registrationNCT01978951 ; Date or Registration: 1/17/2014

Additional file 1: of Implementation of a pragmatic randomized trial of screening for chronic kidney disease to improve care among non-diabetic hypertensive veterans

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