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Acute Kidney Injury (AKI) is a common complication after liver transplantation (LT) but the specific impact of rapidly resolving AKI is not elucidated. This study investigates the factors associated with early recovery from AKI and its association with post-LT outcomes.
Retrospective analysis of 441 liver transplant recipients with end-stage liver disease without pretransplant renal impairment. AKI was defined according to KDIGO criteria and early renal recovery by its disappearance within 7 days post-LT.
146 patients (32%) developed a post-LT AKI, of whom 99 (69%) recovered early and 45 (31%) did not. Factors associated with early recovery were KDIGO stage 1 (OR14.11; 95%CI5.59-40.22; P<0.0001), minimum prothrombin time >50 % (OR4.50; 95%CI1.67-13.46; P=0.003) and AST peak value <1000 U/L (OR4.07; 95%CI1.64-10.75; P=0.002) within 48h post-LT. Patients with early recovery had a renal prognosis similar to that of patients without AKI with no difference in estimated glomerular filtration rate betg the adverse effects of CNI.
Normothermic machine perfusion (NMP) provides a promising strategy for preservation and conditioning of marginal organ grafts. However, at present high logistic effort limits normothermic renal perfusion to a short, postponed machine perfusion at site of the recipient transplant center. Thus, organ preservation during transportation still takes place under hypothermic conditions, leading to significantly reduced efficacy of NMP. Recently it was shown that gentle and controlled warming up of cold stored kidneys compensates for hypothermic induced damage in comparison to end ischemic NMP. This study aims to compare controlled oxygenated rewarming (COR) with continuous up- front normothermic perfusion in a porcine model of transplantation.
Following exposure to 30 minutes of warm ischemia kidneys (n=6/group) were removed and either cold stored for 8 hours (CS), cold stored for 6 hours with subsequent controlled rewarming up to 35 °C for 2 hours (COR) or directly subjected to 8 hours of continuous normothermic machine perfusion (NMP). Kidney function was evaluated using a preclinical autotransplant model with follow up for 7 days.
NMP and COR both improved renal function in comparison to CS and displayed similar serum creatinine and urea levels during follow up. COR resulted in less tenascin C expression in the tissue compared to CS, indicating reduced proinflammatory upregulation in the graft by gentle rewarming.
COR seems to be a potential alternative in clinical application of NMP, thereby providing logistic ease and usability.
COR seems to be a potential alternative in clinical application of NMP, thereby providing logistic ease and usability.Targeted blood pressure (BP) control is a goal of left ventricular assist device medical management, but the interpretation of values obtained from noninvasive instruments is challenging. In the MOMENTUM 3 Continued Access Protocol, paired BP values in HeartMate 3 (HM3) patients were compared from arterial (A)-line and Doppler opening pressure (DOP) (319 readings in 261 patients) and A-line and automated cuff (281 readings in 247 patients). Pearson (R) correlations between A-line mean arterial (MAP) and systolic blood pressures (SBP) were compared with DOP and cuff measures according to the presence (>1 pulse in 5 seconds) or absence of a palpable radial pulse. There were only moderate correlations between A-line and noninvasive measurements of SBP (DOP R = 0.58; cuff R = 0.47) and MAP (DOP R = 0.48; cuff R = 0.37). DOP accuracy for MAP estimation, defined as the % of readings within ± 10 mmHg of A-line MAP, decreased from 80% to 33% for DOP ≤ 90 vs. >90 mmHg, and precision also diminished (mean absolute difference [MAD] increased from 6.3 ± 5.6 to 16.1 ± 11.4 mmHg). Across pulse pressures, cuff MAPs were within ±10 mmHg of A-line 62.9%-68.8% of measures and MADs were negligible. The presence of a palpable pulse reduced the accuracy and precision of the DOP-MAP estimation but did not impact cuff-MAP accuracy or precision. In summary, DOP may overestimate MAP in some patients on HM3 support. Simultaneous use of DOP and automated cuff and radial pulse may be needed to guide antihypertensive medication titration in outpatients on HM3 support.We compared the effects on the nutritional condition and health-related quality of life (HR-QoL) of the treatment of patients with on-line hemodiafiltration (OL-HDF) and conventional hemodialysis (CHD) using a superflux dialyzer. In total, 47 maintenance (M) HD patients were treated by CHD with a high-flux dialyzer for the first 4 months (1st CHD) and were then switched to predilution OL-HDF for the next 4 months (OL-HDF), after which CHD was resumed for the last 4 months (2nd CHD). We assessed the clinical parameters, fat mass value, muscle mass value, and HR-QoL. In patients with low serum albumin levels, these levels significantly (p less then 0.05) increased in the OL-HDF period. Moreover, the fat mass values significantly (p less then 0.05) increased in patients with decreased fat mass values in the OL-HDF period. Although there was no significant difference in the patients with higher scores of physical functioning, role physical, vitality, and social functioning, patients with lower scores in the 1st CHD period had significantly increased (p less then 0.05) in the OL-HDF period. In this crossover study, we revealed that OL-HDF treatment significantly improved the nutritional conditions and HR-QoL scores compared with the improvement observed after CHD with a superflux dialyzer, especially for maintenance hemodialysis patients with malnutrition and a low QoL.There is little research on factors that influence the choice of dialyzer in patients undergoing hemodialysis. In patients at risk for poorer outcomes, including those with hypoalbuminemia, understanding how this choice impacts clinical parameters could inform patient management. The objective of this real-world analysis was to evaluate the use and performance of four single-use (i.e., nonreuse [NR]), high-flux Optiflux dialyzers with varying surface areas (F160NR [1.5 m2], F180NR [1.7 m2], F200NR [1.9 m2], and F250NR [2.5 m2]) in patients (N = 271) with baseline hypoalbuminemia (≤3.5 g/dl) receiving hemodialysis at a medium-sized dialysis organization. Thrice weekly, in-center dialysis was delivered for 6 months without adjustments to the hemodialysis prescription. Larger dialyzers were more frequently used in men, patients with higher body mass indices, and those with diabetes. Increases in serum albumin from baseline (month 1) to month 6 (p less then 0.05) were observed with all dialyzer sizes. A mean increase in hemoglobin of 0.31 g/dl was also observed (p less then 0.001). Among patients exhibiting increased serum albumin levels (n = 177), reductions in the neutrophil-to-lymphocyte ratio, a marker of inflammation, were observed (mean 0.90; p less then 0.001). These results support the use of high-flux dialyzers in patients with hypoalbuminemia.
Hibbert, JE, Klawiter, DP, Schubert, MM, Nessler, JA, and Asakawa, DS. Strength, cardiovascular fitness, and blood lipid measures in law enforcement personnel after a 12-week health promotion program. J Strength Cond Res XX(X) 000-000, 2021-Law enforcement personnel often have high rates of cardiovascular disease and injury. Health promotion programs have been found to successfully encourage behavior change among law enforcement personnel, but these programs can often be intensive and expensive. Thus, the purpose of this study was to examine the efficacy of a health promotion program on body composition, metabolic health, muscle strength, and cardiovascular endurance in law enforcement personnel. Active duty officers from a local law enforcement agency were invited to participate in a 12-week health promotion program that included activity tracking and exercise and nutrition education. Eighteen subjects underwent measurements of body composition, V[Combining Dot Above]O2max through treadmill test, knee extejects improved blood lipid levels evidenced by movement of mean values toward established healthy ranges. Although 8 subjects improved their V[Combining Dot Above]O2max (range 1.3-30% change), there was large variability and no statistically significant differences in measures of V[Combining Dot Above]O2max (pre 38.48 ± 5.86 ml·kg·min-1; post 39.27 ± 5.26 ml·kg·min-1), body composition (pre 26.52 ± 8.02% body fat; post 26.44 ± 7.45% body fat), and strength normalized to body mass (isometric pre 1.45 ± 0.45; post 1.08 ± 0.36). Although no significant changes were noted, promising trends in these data suggest that health promotion programs with a modified focus may lead to positive changes in overall health.
Nuzzo, JL. Inconsistent use of resistance exercise names in research articles a brief note. J Strength Cond Res XX(X) 000-000, 2021-Academic fields require standard nomenclature to communicate concepts effectively. Empesertib MPS1 inhibitor Previous research has documented resistance training exercises are named inconsistently. This inconsistent use has been observed among fitness professionals and within resistance training textbooks. The purpose of the current note was to explore inconsistent use of resistance training exercise names in scientific articles. Keyword searches were performed in PubMed to identify articles that referred to 4 different resistance training exercises. The search was limited to titles and abstracts of articles published between 1960 and 2020. For exercise 1, "shoulder press," "overhead press," and "military press" were searched. For exercise 2, "arm curl," "bicep curl," and "biceps curl" were searched. For exercise 3, "hamstring curl," "leg curl," and "knee curl" were searched. For exercise 4, "calf raise press," and 45 articles included "military press." For exercise 2, 244 articles included "arm curl," 37 articles included "bicep curl," and 177 articles included "biceps curl." For exercise 3, 24 articles included "hamstring curl," 159 articles included "leg curl," and 7 articles included "knee curl." For exercise 4, 68 articles included "calf raise" and 154 articles included "heel raise." The results are evidence of inconsistent use of resistance training exercise names in scientific articles. A possible solution to inconsistent use of exercise names in research articles, educational texts, and clinical practice is a system that includes a standard exercise naming pattern and guidelines for communicating exercise names.
Rodriguez, C, Harty, PS, Stratton, MT, Siedler, MR, Smith, RW, Johnson, BA, Dellinger, JR, Williams, AD, White, SJ, Benavides, ML, and Tinsley, GM. Comparison of indirect calorimetry and common prediction equations for evaluating changes in resting metabolic rate induced by resistance training and a hypercaloric diet. J Strength Cond Res XX(X) 000-000, 2021-The ability to accurately identify resting metabolic rate (RMR) changes over time allows practitioners to prescribe appropriate adjustments to nutritional intake. However, there is a lack of data concerning the longitudinal utility of commonly used RMR prediction equations. The purpose of this study was to evaluate the validity of several commonly used prediction equations to track RMR changes during a hypercaloric nutritional intervention and supervised resistance exercise training program. Twenty resistance-trained men completed the study. The protocol lasted 6 weeks, and subjects underwent RMR assessments by indirect calorimetry (IC) preintervention and postintervention to obtain reference values.
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