bluuebunny/crossref_metadata_2025 huggingface dataset:
Intake of Vitamins B6 and C and the Risk of Kidney Stones in Women
Authors: CURHAN GARY C. , WILLETT WALTER C. , SPEIZER FRANK E. , STAMPFER MEIR J.
Published: April 2021

Urinary oxalate is an important determinant of calcium oxalate kidney stone formation. High doses of vitamin B6 may decrease oxalate production, whereas vitamin C can be metabolized to oxalate. This study was conducted to examine the association between the intakes of vitamins B6 and C and risk of kidney stone formation in women. The relation between the intake of vitamins B6 and C and the risk of symptomatic kidney stones were prospectively studied in a cohort of 85,557 women with no history of kidney stones. Semiquantitative food-frequency questionnaires were used to assess vitamin consumption from both foods and supplements. A total of 1078 incident cases of kidney stones was documented during the 14-yr follow-up period. A high intake of vitamin B6 was inversely associated with risk of stone formation. After adjusting for other dietary factors, the relative risk of incident stone formation for women in the highest category of B6 intake (≥40 mg/d) compared with the lowest category (<3 mg/d) was 0.66 (95% confidence interval, 0.44 to 0.98). In contrast, vitamin C intake was not associated with risk. The multivariate relative risk for women in the highest category of vitamin C intake (≥1500 mg/d) compared with the lowest category (<250 mg/d) was 1.06 (95% confidence interval, 0.69 to 1.64). Large doses of vitamin B6 may reduce the risk of kidney stone formation in women. Routine restriction of vitamin C to prevent stone formation appears unwarranted.
Cytokine Removal during Continuous Hemofiltration in Septic Patients
Authors: DE VRIESE AN S. , COLARDYN FRANCIS A. , PHILIPPÉ JAN J. , VANHOLDER RAYMOND C. , DE SUTTER JOHAN H. , LAMEIRE NORBERT H.
Published: April 2021

A potential application of the continuous renal replacement therapies is the extracorporeal removal of inflammatory mediators in septic patients. Cytokine elimination with continuous renal replacement therapies has been demonstrated in several clinical studies, but so far without important effects on their serum concentrations. Improved knowledge of the cytokine removal mechanisms could lead to the development of more efficient treatment strategies. In the present study, 15 patients with septic shock and acute renal failure were observed during the first 24 h of treatment with continuous venovenous hemofiltration (CVVH) with an AN69 membrane. After 12 h, the hemofilter was replaced and the blood flow rate (Q
B) was switched from 100 ml/min to 200 ml/min or vice versa. Pre- and postfilter plasma and ultrafiltrate concentrations of selected inflammatory and anti-inflammatory cytokines were measured at several time points allowing the calculation of a mass balance. Cytokine removal was highest 1 h after the start of CVVH and after the change of the membrane (ranging from 25 to 43% of the prefilter amount), corresponding with a significant fall in the serum concentration of all cytokines. The inhibitors of inflammation were removed to the same extent as the inflammatory cytokines. Adsorption to the AN69 membrane appeared to be the main clearance mechanism, being most pronounced immediately after installation of a new membrane and decreasing steadily thereafter, indicating rapid saturation of the membrane. A Q
B of 200 ml/min was associated with a 75% increase of the ultrafiltration rate and a significantly higher convective elimination and membrane adsorption than at a Q
B of 100 ml/min. The results indicate that optimal cytokine removal with CVVH with an AN69 membrane could be achieved with a combination of a high Q
B/ultrafiltration rate and frequent membrane changes.
Hemodynamic Effects of Endothelin-1 and Big Endothelin-1 in Chronic Hemodialysis Patients
Authors: OTTOSSON-SEEBERGER ASTRID , AHLBORG GUNVOR , HEMSÉN ANETTE , LUNDBERG JAN M. , ALVESTRAND ANDERS
Published: April 2021

Increased plasma concentrations of endothelin-1 (ET-1) and big endothelin-1 (big ET-1) have been reported in patients with end-stage renal failure (ESRD). In the present study, which included hemodialysis (HD) patients with (n = 21) and without (n = 32) ischemic heart disease, the putative association between plasma levels of ET-1 and big ET-1 and ischemic heart disease and the influence of the dialysis procedure on ET concentrations was investigated. This study also examined in an additional five HD patients without cardiac disease whether intravenously infused ET-1 and big ET-1 (0.2, 1, and 4 pmol/kg per min, each dose for 20 min) preserve their vasoactive potency and whether exogenous big ET-1, which in healthy humans is converted in the kidney, is still converted to ET-1 in ESRD. HD patients with ischemic heart disease demonstrated higher plasma levels of ET-1 and big ET-1 than HD patients without this disorder, and HD reduced plasma ET-1 and big ET-1 concentrations. In HD patients, the big ET-1 infusion, resulting in a 1.5-fold increase in plasma ET-1, caused a more marked and prolonged rise in mean arterial BP than ET-1 (20% versus 13%, P = 0.0001) and a slightly smaller but more prolonged decrease in estimated splanchnic blood flow than ET-1 (37% versus 44%, P = 0.02). Furthermore, big ET-1 lowered heart rate by 9% (P = 0.01) but ET-1 did not. Plasma half-lives of ET-1 and big ET-1 were longer in HD patients than in healthy humans. Thus, ET-1 and big ET-1 preserve their vasoactive potency, and circulating big ET-1 is still converted to active ET-1 in ESRD. Consequently, the increased plasma levels of ET-1 and big ET-1 noted in HD patients, especially in patients with ischemic heart disease, might play a role in the development of uremic cardiovascular complications.
Immunomodulatory Functions of Low-Molecular Weight Hyaluronate in an Acute Rat Renal Allograft Rejection Model
Authors: KNOFLACH ANDREAS , AZUMA HARUHITO , MAGEE COLM , DENTON MARK , MURPHY BARBARA , IYENGAR ANAND , BUELOW ROLAND , SAYEGH MOHAMED H.
Published: April 2021

Low molecular weight hyaluronate (LMW-HA) blocks interactions between T lymphocyte CD44 and hyaluronate (HA), a heteropolysaccharide that is expressed on the surface of endothelial cells and ubiquitously in the extracellular matrix. This study was undertaken to assess the ability of LMW-HA to modify the course of experimental acute renal allograft rejection. Lewis (LEW) rats were bilaterally nephrectomized and received an orthotopic, fully MHC-mismatched, Wistar-Furth (WF) kidney transplant. Animals received either no treatment, low doses of cyclosporin A (CsA) on days 0 to 5, LMW-HA on days 0 to 5, or CsA plus LMW-HA on days 0 to 5 after transplantation. With no treatment, CsA monotherapy, or HA monotherapy, animals rejected their allografts at a median of 15, 13, and 7.5 d, respectively (P = NS). In contrast, combined CsA plus LMW-HA therapy prevented acute rejection and significantly prolonged graft survival (P = 0.008) to a median of 49.0 d. CsA/LMW-HA-treated grafts also demonstrated better preservation of renal function at day 30 (serum creatinine level, 1.38 ± 0.8 mg/dl), compared with surviving animals treated with CsA alone (2.9 ± 0.55 mg/dl, P < 0.05). Histologic graft analysis of CsA/LMW-HA-treated animals at day 7 after transplantation showed minimal rejection and leukocyte infiltration, compared with all other groups. Intragraft gene expression analysis, using semiquantitative reverse transcription-PCR, at the same time point showed reductions of CD4, CD8, and interferon-γ transcript levels in the combined-treatment group. This is the first study demonstrating the immunomodulatory functions of LMW-HA in vivo in the setting of organ transplantation. Defining the exact mechanisms that underlie this immunomodulation may provide the rationale to develop novel strategies for use in clinical transplantation.
Lessons on Renal Physiology from Transgenic Mice Lacking Aquaporin Water Channels
Authors: VERKMAN A. S.
Published: April 2021

Several aquaporin-type water channels are expressed in kidney: AQP1 in the proximal tubule, thin descending limb of Henle, and vasa recta; AQP2, AQP3, and AQP4 in the collecting duct; AQP6 in the papilla; and AQP7 in the proximal tubule. AQP2 is the vasopressin-regulated water channel that is important in hereditary and acquired diseases affecting urine-concentrating ability. It has been difficult to establish the roles of the other aquaporins in renal physiology because suitable aquaporin inhibitors are not available. One approach to the problem has been to generate and analyze transgenic knockout mice in which individual aquaporins have been selectively deleted by targeted gene disruption. Phenotype analysis of kidney and extrarenal function in knockout mice has been very informative in defining the role of aquaporins in organ physiology and addressing basic questions regarding the route of transepithelial water transport and the mechanism of near isoosmolar fluid reabsorption. This article describes new renal physiologic insights revealed by phenotype analysis of aquaporin-knockout mice and the prospects for further basic and clinical developments.
Prevalence of and Factors Associated with Suboptimal Care before Initiation of Dialysis in the United States
Authors: OBRADOR GREGORIO T. , RUTHAZER ROBIN , ARORA PRADEEP , KAUSZ ANNAMARIA T. , PEREIRA BRIAN J. G.
Published: April 2021

Despite improvements in dialysis care, the mortality of patients with end-stage renal disease (ESRD) in the United States remains high. Factors that thus far have received scant attention, but could significantly affect morbidity and mortality in dialysis patients, are the timing and quality of care before the initiation of dialysis (pre-ESRD). Data from the new version of the Health Care Financing Administration (HCFA) 2728 Form were used to examine the prevalence of and factors associated with hypoalbuminemia, severe anemia, and erythropoietin (EPO) use among 155,076 incident chronic dialysis patients in the United States between April 1, 1995 and June 30, 1997. At initiation of dialysis, the median serum albumin and hematocrit were 3.3 g/dl and 28%, respectively. Sixty percent of patients had a serum albumin below the lower limit of normal and 51% had a hematocrit <28%. Overall, only 23% had received EPO pre-ESRD. Among patients with hematocrit <28%, only 20% were receiving EPO, compared to 27% among patients with hematocrit ≥28%. In a multivariate analysis that adjusted for diabetes, functional status, and demographic, socioeconomic, and geographic factors, the odds ratios for hypoalbuminemia, hematocrit <28%, and lack of EPO use were higher for African-Americans, patients with non-private insurance or no insurance, and patients who were started on hemodialysis. There were also significant differences in odds ratios for these outcomes between different geographic regions in the United States. The high prevalence of pre-ESRD hypoalbuminemia, hematocrit <28%, and lack of EPO use suggests that the quality of pre-ESRD care in the United States is suboptimal. Improvement in pre-ESRD care could potentially improve outcomes among ESRD patients.
Effect of MTHFR 1298A→C and MTHFR 677C→T Genotypes on Total Homocysteine, Folate, and Vitamin B12 Plasma Concentrations in Kdiney Graft Recipients
Authors: FO[Combining Diaeresis]DINGER MANUELA , BUCHMAYER HEIDI , HEINZ GOTFRIED , PAPAGIANNOPOULOS MENELAOS , KLETZMAYR JOSEF , RASOUL-ROCKENSCHAUB SUSANNE , HO[Combining Diaeresis]RL WALTER H. , SUNDER-PLASSMANN GERE
Published: April 2021

The effect of 5,10-methylenetetrahydrofolate reductase (MTHFR) 677C→T and 1298A→C on total homocysteine (tHcy), folate and vitamin B12 levels was investigated in 733 kidney graft recipients. The six major genotype combinations were used as grouping variables, and age, gender, BMI, serum creatinine, and creatinine clearance and ln-folate, ln-vitamin B12, or logarithmus naturalis tHcy (ln-tHcy) were used as covariates in three ANCOVA and multiple stepwise linear regression models. Hyperhomocysteinemia was present in 49.7% of the patients. The allele frequency of MTHFR 677T and 1298C was 0.319 and 0.326. MTHFR genotype and all other variables were significant predictors of ln-tHcy (higher tHcy plasma levels for MTHFR 677TT/1298AA versus all other five genotype groups: P < 0.05). BMI, creatinine clearance, ln-tHcy, and MTHFR genotype influenced ln-folate (lower folate levels for MTHFR 677TT/1298AA versus all other genotype groups: P < 0.05). Creatinine clearance and ln-tHcy were the only predictors of ln-vitamin B12 levels. In a prespecified subgroup analysis (n = 496), the MTHFR genotype also influenced tHcy levels and compound heterozygous patients had significantly lower folate levels as compared with MTHFR 677CC/1298AA and 677CC/1298CC. This study shows that the MTHFR 677TT/1298AA and 677CT/1298AC genotypes are significant predictors of tHcy and folate plasma levels.
Altered Expression of Type II Sodium/Phosphate Contransporter in Polycystic Kidney Disease
Authors: VOGEL MORITZ , KRA[Combining Diaeresis]NZLIN BETTINA , BIBER JO[Combining Diaeresis]RG , MURER HEINI , GRETZ NORBERT , BACHMANN SEBASTIAN
Published: April 2021

Renal phosphate (Pi) absorption is mediated via the type II sodium/Pi cotransporter (NaPi-2) in the brush border membrane (BBM) of proximal tubules. Simultaneous detection of NaPi-2 mRNA by in situ hybridization and of NaPi-2 immunoreactivity by immunohistochemistry was performed to investigate the distribution of the cotransporter in healthy control rats and during progression of autosomal dominant polycystic kidney disease (ADPKD). The purpose of the study was to disclose a relation between proximal tubular cell differentiation and NaPi-2 expression. In controls, NaPi-2 expression was present in the entire proximal tubule. In the Han:SPRD (cy/+) model for ADPKD, the proximal nephron is primarily affected by the cystic changes. Epithelial proliferation and impaired epithelial-matrix interaction result in a loss of cell differentiation that eventually leads to cystic enlargement of the nephron. Normal expression of NaPi-2 in this model was found only in tubules with intact BBM. Loss of BBM and cellular interdigitation were paralleled by the loss of NaPi-2 in situ hybridization and immunoreactive signals. These changes were moderate and focal in 2-mo-old rats and generalized all over the cortex after 8 mo. Advanced renal damage in the older PKD group was associated with mild phosphaturia, which suggests functional insufficiency of tubular NaPi-2 reabsorption. These data show how proliferative changes and loss of tubular epithelial differentiation in ADPKD may prevent functional expression of the NaPi-2 system in the proximal tubule in a rapidly progressive manner. NaPi-2 in proximal tubule BBM is suggested to play an important role in impaired tubular absorption of Pi in renal disease.
Éramos pocos y la abuela contrajo el coronavirus. Boceto sobre la coyuntura latinoamericana COVID-19
Authors: Ansaldi Waldo
Published: April 2021

El artículo es un esbozo de cuestiones a tener en cuenta para un posterior análisis pormenorizado, extenso y cuidadoso de la actual coyuntura política latinoamericana, caracterizada por un notable y agresivo avance de las posiciones de derecha en todos los ámbitos sociales. En términos de ejercicio del poder se aprecia la elección del formato de representación institucional capitalista, como en los inicios del ascenso de la burguesía como clase. Ese ejercicio del poder se realiza en un contexto planetario dominado por el patrón de acumulación del capital basado en la valorización financiera y el simultáneo desarrollo de la crisis-señal del ciclo sistémico de acumulación norteamericano. Y ha producido una formidable distribución desigual de la riqueza que, más que miedo y/u odio, muestra en el comportamiento de clase de la burguesía una formidable indiferencia por la vida de la mayoría de la población mundial. Ese comportamiento, cuya expresión más brutal es el deseo de la muerte de “los otros”, se expresa mayoritariamente de manera genérica, pero en ocasiones se refiere a individuos concretos. Significativamente, va acompañado del peso creciente de las iglesias evangélicas, particularmente entre las clases populares. La pandemia de la COVID-19 ha puesto de manifiesto los límites del modelo capitalista vigente y ha generado las primeras manifestaciones de lo que se supone vendrá una vez superada. El autor propone cautela y proseguir con los análisis antes de hacer pronósticos.
Preparation of acute midbrain slices for patch-clamp recordings v2
Authors: Pavón Arocas Oriol , Branco Tiago
Published: April 2021

Here we describe two different approaches to prepare acute midbrain slices from young adult mice for slice electrophysiology experiments. We also provide general advice for troubleshooting common issues leading to suboptimal slice quality, as well as some suggestions to ensure good maintenance of a patch-clamp rig.
Study on effect CO2 diluent on fuel cоmbustion in methane-oxygen combustion chambers
Authors: Komarov I.I. , Kharlamova D.M. , Vegera A.N. , Naumov V.Y.
Published: April 2021

Studying closed gas turbine cycles on supercritical carbon dioxide is currently a promising issue in the development of power energy sector in terms of increasing energy efficiency and minimizing greenhouse gas emissions into the atmosphere. Combustion of methane with oxygen in the combustion chamber occurs not in the nitrogen environment, but in the environment of carbon dioxide, that is the working fluid of the cycle, which is an inhibitor of chemical reactions. A large mass content of such a diluent of the reaction mixture in the volume of the chamber leads to the risks of significant chemical underburning, efficiency decrease of the combustion chamber and the cycle as a whole. The aim of the research is to study the kinetic parameters of the combustion of methane with oxygen in a supercritical CO2 diluent medium to ensure reliable and stable combustion of fuel by assessing the degree of the inhibitory effect of CO2 and determining its permissible amount in the active combustion zone of the combustion chamber. The research method is a numerical simulation of turbulent-kinetic processes of methane combustion in the combustion chamber using the reduced methane combustion mechanism. Ansys Fluent software package has been used. The authers have studied the impact of CO2 diluent on fuel cоmbustion in methane-oxygen combustion chambers. It is found that the combustor flame stabilization takes place if the content of СО2 diluent supplied to the mixture with oxidizer is 0,46–0,5 of mass fraction; additional СО2 diluent forms local low temperature zones which slow down the combustion process. When this happens, adding cooling СО2 into the flame stabilization zone should be eliminated. The study has found that no more than 20 % of the total carbon dioxide content should be supplied to the combustion chamber; to stabilize the flame and reduce its length, it is necessary to install blades to swirl the fuel and oxidizer mixed with CO2 at the inlet of the combustion chamber; CO2 supply for cooling should be carried out not less than 130 mm away from the burner mouth.
Cell model of transient heat processes in underground electric cable and surrounding ground
Authors: Kutumov Y.D. , Mizonov V.E. , Shadrikova T.Y. , Tikhonov A.I.
Published: April 2021

One of the most essential consequences of short circuits in underground cable networks of 6–10 kV is heating up the insulation with its possible inflammation and damage of adjacent objects of an electrical supply system that enlarge the concomitant damage many times as much. Various methods (including the methods, which are based on reference documents) to calculate the thermal state of underground cables are known. Despite the part of them are of extra complexity and require a lot of poorly identified parameters, the issue of the accuracy of forecasting calculations remains open. Hence, the issue of development of new approaches to model transient thermal processes in a cable, combining the simplicity, small computational time, and the reasonable accuracy of forecasting the process thermal parameters is an important one. The method of mathematical modeling is used to solve the problem. The model uses the mathematical tools of the Markov chains theory. It is adapted to the representation of ground as multilayer medium, and the non-stationary heat source may be placed in one of the layers. The heat transfer deep down into the ground is described by heat conduction, and the heat exchange with neighboring ground and environment is described by heat emission. The study of influence of the process parameters on the heat process behavior is carried out by numerical methods. The experimental validation of the model is not planned at the current stage of this investigation. The developed mathematical model allows predicting temperature in a cable and in surrounding ground depending on the heat capacity and depth of layout of the heat source, determined by the value of current in the cable. The results of numerical experiments come to agreement with the physical essence of the process. The obtained results have the scientific novelty as they are based on the universal algorithm of modeling and allow describing the transient processes in the object under consideration. The authors have proposed a mathematical tool to estimate the heat state of an underground electric cable depending on the heat capacity of the current, its depth of location in the ground and the thermo-physical properties of the ground. The model is simple to operate and takes exceedingly small computational time. It can be easily used in engineering practice.
Matrix method to solve the inverse problem of heat transfer in heat exchangers
Authors: Zhukov V.P. , Barochkin A.Ye. , Bobrova M.S. , Belyakov A.N. , Shuvalov S.I.
Published: April 2021

Along with verification calculations of known designs of heat exchangers, in design engineering and when we develop new technologies, design calculations are necessary to solve the inverse problems of choosing the optimal designs and operating modes of equipment. Previously, the formulation and solution of inverse problems of classification and unsteady heat conduction have been considered, while the inverse problems of heat transfer in the design of heat exchange equipment are poorly presented in the literature. The development of methods to solve inverse problems in the design of heat exchange equipment is an urgent task of power industry. Matrix models of heat transfer based on mass and energy balance equations are used to formulate and solve inverse problems of heat exchange systems. Methods of mathematical programming are applied to solve inverse and optimization problems. For design calculations, a matrix method to solve inverse problems for choosing the design of devices and parameters of heat carriers that ensure the effective operation of the system is proposed. The inverse problem is formulated for the case of the sliding boundary of the beginning of the phase transition with the countercurrent type of movement of heat carriers. The obtained results can be used in power energy, chemical and food industries to improve the efficiency of designing resource-and energy-saving technologies. The solutions obtained can be implemented when developing measures to improve resource and energy saving technologies.
QUALIDADE DE VIDA DE PRATICANTES DE DANÇA EM ACADEMIAS NO PERÍODO PANDÊMICO DA COVID-19
Authors: Brito Brenda Carvalho Silva , Rodrigues Neto Gabriel , Silva Júlio Cesar Gomes da
Published: April 2021

Mesmo com os benefícios, trazidos pela dança, em diversos aspectos relacionados à saúde e ao condicionamento físico de indivíduos, de diferentes faixas etárias, percebe-se que poucos estudos na literatura investigam a qualidade de vida de praticantes de dança em academias. Desta forma, o objetivo do presente estudo é analisar a percepção da qualidade de vida de praticantes de dança em academias na cidade de João Pessoa - PB. A amostra foi composta por 101 pessoas, entre homens e mulheres, praticantes de dança em academias da cidade de João Pessoa. A percepção da qualidade de vida foi verificada por meio do questionário WHOQOL-bref. Os dados foram analisados no pacote estatístico computadorizado Statistical Package for the social Science, versão 21.0. Inicialmente, foi realizado o teste de distribuição de frequência absoluta e relativa para análise dos dados referentes a prática da dança e aos domínios da qualidade de vida. Os principais achados deste estudo apontam que: a) a maioria dos praticantes de dança em academias é do sexo feminino (85,1%); b) apresentam uma qualidade de vida satisfatória, como também, uma melhor percepção de qualidade de vida no domínio relações sociais (77,2%). Conclui-se que as aulas de dança em academias são compostas, em sua grande maioria, pelo público feminino e, ainda, que a dança em academias, por seus escores satisfatórios, pode ser um instrumento para a melhoria/manutenção da qualidade de vida.
O USO DE METILFENIDATO ENTRE ESTUDANTES UNIVERSITÁRIOS NO BRASIL: UMA REVISÃO SISTEMÁTICA
Authors: Praxedes Milena De Souza , Figueirêdo de Sá Filho Geovan
Published: April 2021

O metilfenidato é um medicamento capaz de causar alterações comportamentais, de humor e, devido seus efeitos psicoestimulantes, vem sendo utilizado de forma indiscriminada entre os estudantes para melhorar o desempenho acadêmico. O estudo teve como objetivo avaliar a prevalência do uso de metilfenidato entre estudantes universitários, bem como, seus efeitos. A pesquisa é uma revisão sistemática de literatura, em que foram reunidos artigos de forma abrangente e não tendenciosa sobre o uso indiscriminado de metilfenidato entre estudantes universitários. Os artigos foram escolhidos a partir das bases eletrônicas SCIELO, Google Acadêmico e LILACS e selecionados 27, publicados entre os anos de 2008 e 2019. O Rio Grande do Sul apresentou a maior quantidade de artigos sobre o tema, entretanto, os estados do Rio de Janeiro e São Paulo manifestaram os maiores números para o uso indiscriminado do medicamento entre os estudantes, nos anos de 2013 e 2014. Registraram-se 17 efeitos negativos em relação ao consumo da droga. São eles: taquicardia/palpitação, boca seca, perda de apetite, ansiedade, cefaleia, insônia, cansaço após uso, náuseas, aumento do estresse, dose dependência, tremores, tremores nas mãos, arritmia, anorexia, declínio da sensação de bem-estar, visão turva e euforia. Nesse sentido, foi possível verificar um levantamento geral, do período de 2008 a 2019, sobre a prática do uso inadequado do metilfenidato pelos acadêmicos brasileiros, verificando os benefícios e os malefícios dessa prática inconsequente. Os dados compilados servirão como parâmetro para outras pesquisas, assim como para o desenvolvimento de medidas preventivas e de conscientização.
Dos pronunciamientos judiciales relacionados y decisivos para el avance del reconocimiento mutuo del Reglamento 805/2004: La sentencia del TC 26/2020, de 24 de febrero y el auto de la AP de Girona 243/2020, de 10 de junio
Authors: Echezarreta Ferrer Mayte , Rodríguez Vázquez Mª Ángeles
Published: April 2021

En este trabajo se analizan dos pronunciamientos judiciales, la STC 26/2020, de 24 de febrero y el Auto de la AP Girona 243/2020, de 10 de junio, que vienen a confirmar que solo puede certificarse como Título ejecutivo europeo una resolución dictada en rebeldía si, en el proceso de origen, se han cumplido las normas mínimas establecidas en el capítulo III del Reglamento 805/2004. La supresión de los controles de la resolución en el Estado miembro de ejecución debe estar inseparablemente vinculada a la existencia de una garantía suficiente de que se observen los derechos de la defensa. El órgano de la ejecución solo puede suspender la ejecución mientras se resuelve la impugnación en origen, como sucede en las resoluciones comentadas.
Crónica de Jurisprudencia del Tribunal de Justicia de la Unión Europea, septiembre-diciembre 2020
Authors: Castillo de la Torre Fernando , Nemeckova Petra
Published: April 2021

Crónica de jurisprudencia del Tribunal de Justicia de la Union Europea, septiembre-diciembre 2020
De la doble a la triple prejudicialidad: ¿Es posible ordenar lo complejo?
Authors: Matia Portilla Francisco Javier
Published: April 2021

El debate existente sobre la doble prejudicialidad se ve transformado y enriquecido con el nuevo procedimiento de opinión consultiva que puede plantearse en relación con el Tribunal de Estrasburgo si el Reino de España firma el protocolo correspondiente. En el presente estudio se muestran las posibles ordenaciones de estos procesos asumidas por algunos Estados de nuestro entorno (Francia e Italia) y defendidas por la doctrina y se propone un modelo coherente que permita ordenar las vías incidentales europeas (cuestión prejudicial, opinión consultiva) con la cuestión de inconstitucionalidad.
Coronavirus y derecho constitucional. Crónica política y legislativa del año 2020
Authors: Azpitarte Sánchez Miguel
Published: April 2021

La crónica de este año se centra en la crisis sanitaria. Repasa primero los instrumentos que se han utilizado para contener el virus, prestando especial atención a la justificación del estado de alarma en sede parlamentaria. Posteriormente muestra la incidencia de estas medidas sobre la organización territorial del Estado, que ha dado lugar a la dinámica de la cogobernanza. Asimismo, se exponen las limitaciones de derechos que ha implicado el estado de alarma y la manera en que la nueva normalidad también ha restringido las libertades. Finalmente se describen las particularidades que durante este tiempo han experimentado el control político y el control jurídico.
Assessment of management approach for myocardial infarction by family physicians in central India: a cross sectional survey
Authors: Vishandasani Jogesh Kumar , Choudhary Animesh , Chouhan Jitendra , Gulati Sanjeev
Published: April 2021

Background: Myocardial infarction (MI) is the most common cause of mortality globally. Patients generally consult their family physicians first and hence the role of these physicians in management of is very important. it is thus pertinent to assess the approach to management of MI patients by the primary health care physicians.Methods: A cross-sectional survey was conducted with a validated questionnaire among 232 family physicians in central India.Results: Combination of aspirin, clopidogrel and statins was the treatment of choice by 69.82% of physicians. Use of morphine was not preferred by 87.93% of physicians due to non-availability. Tramadol, diclofenac and pethidine were the analgesics preferred. Use of aspirin was stressed by 91.37% of physicians, of these 56.89% preferred the use of soluble aspirin and 43.10% enteric coated. 91.37% were familiar with ECG findings of MI. As latest treatment of choice 41.37% thought of immediate thrombolysis with tenecteplase whereas 47.41% considered coronary angiogram followed by angioplasty in a nearby cardiac center and 29.74% immediate thrombolysis with streptokinase. Regarding referral to hospital with catheterization laboratory facility, 65.94% opined 3 hours as maximum time period of referral from onset of attack of MI and 43.96% opined it to be 6 hours.Conclusions: Family practitioners play a key role in timely management of acute MI. Hence updating them on the management of acute MI through various continuing medical education programs is considered mandatory so that timely management can help significantly reduce mortality rates in our country.
Utilization of fresh frozen plasma in a tertiary care hospital in central Kerala
Authors: Sreelekshmi S. N. , . Lekshmidevi , Rajan G. , Suma M. S.
Published: April 2021

Background: The demand for blood and its components always exceeds the supply in our health care setting. Hence there is a need to prioritize the usage of these components. An audit makes this possible. The present study is conducted on utilization of Fresh frozen plasma which is one of the most requested blood components.Methods: The study was conducted on the first 241 FFP transfusions during the study period of 1 year. Requisition forms for issuing FFP from various departments were reviewed and relevant data collected. Patients’ case record was also retrieved to collect data related to the transfusion episodes. The data collected were compiled, coded and expressed using descriptive statistical tools like mean, mode, percentage and ratio using Microsoft Excel 2010.Results: Most of the patients who underwent FFP transfusion were males and in the age group 60-70. Most of the requests for FFP issue came from Cardiothoracic department. Most common indication for FFP transfusion was raised PT INR. FFP units remained unutilized in CTVS, General surgery and general medicine. 20% of the received request forms were incompletely filled with the Clinical diagnosis and Indication for FFP being most frequently omitted information.Conclusions: Various departments at Government Medical College, Kottayam are efficiently utilizing FFP. But more intervention is needed in addressing issues related to the sending of requisition forms and ensuring adequate usage of FFP to prevent its wastage.
Study on acute transfusion related adverse reactions in surgery department
Authors: Rahim Rejla , Varghese Sheela , Thambi Renu , Suma M. S.
Published: April 2021

Background: Blood transfusion is a routine life- saving medical intervention which is generally regarded as safe when done appropriately. Without blood transfusion, many medical and surgical conditions like anemia, road traffic accidents, obstetric hemorrhage, cardiothoracic surgeries are nearly impossible to manage. However, this life-saving procedure is often associated with adverse effects ranging from minor chills and rigors to life-threatening anaphylaxis. Incidence of transfusion reactions is estimated at 0.001% -10%. The knowledge about the adverse transfusion reaction (ATRs) will help in early identification, management, and prevention of adverse transfusion reactions.Methods: Descriptive cross-sectional study done in 1047 patients, admitted and received at least one unit of whole blood and blood components in the surgery department, Government Medical College, Kottayam during the study period. Information regarding the issue of blood component collected from the transfusion medicine department and the details of the reactions were collected from the patients, and the transfusion reaction workups were done in the transfusion medicine department. The collected data was analysed using Microsoft Excel sheets.Results: The frequency of acute transfusion reaction in this study is 1%. The majority of the reactions were seen with a packed PRBC transfusion. Febrile non-hemolytic transfusion accounted for 54.64% followed by allergic reactions (36.36%) and Transfusion associated cardiac overload (9%).Conclusions: The frequency of ATR in our study was 1%. Febrile non-hemolytic transfusion (FNHTR) and allergic reactions were common patterns followed by transfusion associated cardiac overload (TACO) seen.
The role of thoracodorsal artery perforator flap after breast conserving surgery
Authors: El-Gapaty Fatemah , Skaker Shawky , Sabry Ahmed , Taalab Ahmed
Published: April 2021

Background: The emergence of thoracodorsal artery perforator flap combined with radiotherapy as new techniques in breast reconstruction has resulted in greater focus on oncoplastic breast surgery. In this study, were to study the role of thoracodorsal artery perforator flap after breast conserving surgery.Methods: This study included 40 patients of stage I and II breast cancer at Menoufia University hospital from July 2018 to February 2019. Every patient accepted to be enrolled in thus study with curative intent by having breast conservative surgery and immediate reconstruction by TDAP flap.Results: The mean operative time was 145 min. Seroma is the commonest complication following TDAP flap reconstruction and occurred in four cases (20%) and was treated by repeated aspiration. The cosmetic outcome was acceptable with 90% of patients rating their outcome as either pleased or satisfied. The subjectively assessed functional outcome showed a mean time of 10 days postoperative for patients to regain their full range of shoulder movements.Conclusions: Thoracodorsal artery perforator flap can play a significant role in oncoplastic surgery and breast reconstruction with acceptable cosmetic and functional outcome.
Procalcitonin: the ideal predictor of anastomotic leakage. But, when?
Authors: Çaparlar Mehmet Ali , Uçar Yasin , Dokcu Şeref , Hasırcı İsmail , Ulutaş Mehmet Eşref , Erşen Ogün
Published: April 2021

Background: Rectal cancer ranks 3rd among the most common malignancies in both sexes. Abdominal infections that can be seen after rectal cancer surgery are the most feared postoperative complications, as they can also be the harbinger of anastomotic leakage. According to its localization, the rate of anastomotic leak varies between 4% and 29.5%. Procalcitonin (PCT) is an increasing parameter in bacterial infections and sepsis. Therefore, it is used to monitor the infection and the effectiveness of the treatment. Our study we aimed to evaluate the effect of PCT on early diagnosis of anastomotic leakage in rectal surgery and the correlation between PCT and CRP and WBC levels.Methods: File records of 50 patients who were operated on for rectal cancer and had anastomosis between 2016 and 2019 were retrospectively analyzed. Demographic features, operation information, preoperative and postoperative clinical features of the patients were recorded. The WBC, CRP and procalcitonin values of the patients were measured on the preoperative and postoperative 1st and 5th days. Patients were divided into two groups as PC values<2 ng/ml and ≥2 ng/ml. Patients with surgical site infections were found. The relationship between hospital stay and PCT levels and those with surgical incision site infection and those with intra-abdominal infection was examined. The correlation between PCT values and CRP and WBC values of the patients was evaluated.Results: There was no significant difference in PCT values in infections at the surgical incision site. However, it was observed that the PCT values of patients with surgical infection in the abdomen were significantly higher than those without (p=0.005). It was observed that the PCT level was high and the duration of hospital stay was observed to be prolonged in patients with infections in the surgical incision area and in the abdomen.Conclusions: PCT can be used as a biochemical parameter in terms of abdominal infection and anastomotic leaks. It is recommended to be checked especially on the fifth postoperative day and to investigate for anastomotic leakage if it is seen to reach the highest value.
Analysing prognostic factors among patients with perforative peritonitis
Authors: Wagh Pradeep M. , Patil Samadhan
Published: April 2021

Background: The mortality of perforation peritonitis is highly dependent on early approach to the hospital, quick diagnosis and prompt surgical treatment as it correlates with the duration and degree of peritoneal contamination, the patient's age, the general health of the patient and the nature of the underlying aetiology. The present study was done to assess the role of various prognostic factors which have a bearing on the final outcome of the patients.Methods: This prospective observational cross-sectional study was conducted in the at a tertiary level hospital in Maharashtra, in which 47 patients who presented a surgical emergency of perforation peritonitis and underwent an exploratory laparotomy were included. We compared different variables between patients who survived and those who died. Results: High mortality was also found in patients who presented after 24 hours of developing symptoms. Ileal perforation was significantly more common among dead patients (50%) as compared to patients who survived (20%), p-value<0.05. There were significantly higher proportion of patients who had shock on day 1 who died (67%) as compared to those who survived (12%), p-value<0.05. Also, the group of patients who died, had significantly higher MPI (p-value<0.01), higher proportion of patients with multiple perforations (p-value<0.05), larger perforations (p-value<0.01) and contamination more than 1000 ml (p-value<0.05).  Conclusions: High mortality was observed in patients who presented late, had ileal perforations, multiple and large perforation and developed shock on day one.
Effectiveness of Mannheim peritonitis index scoring system in predicting the morbidity and mortality in peritonitis due to hollow viscous perforation
Authors: Basavaraju Sachin Murukanahalli , Srinivas Akshatha Hebbale , Janardan Rakshitha
Published: April 2021

Background: To study the spectrum and prognostic factor in perforation peritonitis. To evaluate the outcome of patients and identification of high risk patients using Mannheim peritonitis index.Methods: 80 patients with hollow viscous perforation admitted in the Dept. of Surgery Adhichuchanagiri Institute of Medical sciences from January 2019 to June 30 2020 were included in the study. Necessary data was collected; MPI score was calculated for each patient and analysis done.Results: The number of post-operative complications, hospital stay and mortality proportionately increased with the MPI score. In our study Age >50 years, Organ failure at admission pre operatively and MPI scoring found to be statistically significant. Out of the 8 variables used in this scoring system, age more than 50 years and organ failure on admission carried more significance in predicting the morbidity and mortality in the post operative period than the other variables.Conclusions: Mannheim peritonitis index is a simple and effective method in predicting the mortality and morbidity of patients with hollow viscous perforation.
Comparison between scalpel incision and electrocautery incision in midline abdominal surgery: a comparative study
Authors: Yadav Amit , Agarwal Lakshman , Jain Sumit A. , Kumawat Sanjay , Sharma Sandeep
Published: April 2021

Background: Fear of poor wound healing have curtailed the use of diathermy for making skin incision. Scalpel produces little damage to surrounding tissue but causing more blood loss. Our aim of study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection.Methods: Total of 104 patients were included in the study undergoing midline abdominal surgery. Patients were randomized into electrocautery (group A) and scalpel (group B). The incision dimension, incision time and blood loss were noted intraoperatively. Postoperative pain was noted on postoperative day 2 using visual analog scale. Wound complications were recorded on every postoperative day till the patient was discharged.Results: 52 patients in each of the two groups were analyzed. There was significant difference found between group A and group B in terms of mean incision time per unit wound area, 8.16±1.59 s\cm2 and 11.02±1.72 s\cm2 respectively (p value=0.0001). The mean blood loss per unit wound area was found to be significantly lower in group A (0.31±0.04 ml\cm2) as compared to group B (1.21±0.21), p value=0.0001. There was no significant difference noted in terms of postoperative pain and wound infection between both groups.Conclusions: Electrocautery can be considered safe in making skin incision in midline laparotomy compared to scalpel incision with comparable postoperative pain and wound infection with less intraoperative blood loss and less time consuming.
A prospective comparative study on the use of nanocrystalline silver ion dressing with normal saline dressing in diabetic foot ulcers
Authors: Malligurki Vamsi K. , Fatima Samar , Anmol Ruhee , Thimmegowda Prashanth Annayyanapalya
Published: April 2021

Background: A diabetic foot is any pathology that results directly from peripheral arterial disease and/or sensory neuropathy affecting the feet in diabetes mellitus. Proper assessment of the wound followed by an aggressive multidisciplinary approach can reduce the risk of amputation, thereby greatly increasing the patient’s quality of life. Wound dressings play a vital role in diabetic foot care management. Nanocrystalline silver ion dressing is a newer modality that has been in consideration for the treatment of diabetic wounds.Methods: This was a prospective comparative study conducted in the department of general surgery, Sagar hospital-DSI, Bangalore from December 2020 to March 2021. A total of 50 diabetic patients were included in the study and were randomised into the study group and control group. The study group received nanocrystalline silver ion dressings while the control group received dressings with normal saline. Patients were observed for 8 weeks. Data regarding the presence of wound discharge, type of discharge, granulation tissue, presence of slough and changes in the size of the wound was recorded and analysed.Results: Study group showed statistically significant better outcomes (p<0.05) in terms of reduced wound discharge, early granulation tissue, rapid reduction of slough from wounds and reduction in the wound size when compared with the control group. 17 patients responded completely in the study group when compared with the control group, where 8 patients have got a complete response (p<0.05).Conclusions: Wound dressings with nanocrystalline silver ion helps in the early healing of diabetic foot ulcers when compared to normal saline dressings.
Laparoscopic resection of small bowel gist: a case report
Authors: Mark Satkunan , Wai Lai Weng , Supramaniam Navien , Wai Yan Yang
Published: April 2021

Small bowel bleed accounts for approximately 5% of all gastrointestinal bleeding. While arteriovenous malformation is the commonest cause of small bowel bleeding, other causes include inflammatory bowel disease, small bowel tumours, ulcers and polyps make up the rest. Tumours range from benign adenomas, hamartomas and leiomyomas to malignant GISTs, adenocarcinomas or lymphomas. We reported a case of a jejunal GIST causing intermittent bleeding. Upper and lower GI endoscopy did not find any abnormality and the diagnosis was made through computerized tomography. It showed a mid-jejunal tumour that was in close proximity to the distal duodenum. The rest of the hollow and solid organs were normal. The patient was prepared and underwent laparoscopic assessment. The tumour was mobile, arising from proximal jejunum and did not show infiltration or adhesions to nearby viscera. A segmental resection with adequate margin was performed laparoscopically and extracted through the umbilical port wound. The pathology report revealed an intermediate GIST with clear margins. Laparoscopic assessment should ideally be carried prior to any resection of small bowel tumours. Uncomplicated small bowel resections can safely be done laparoscopically with good oncological outcome and faster patient recovery.
Spontaneous bilateral chylothorax in both vena cava thrombosis; cisterna chyli ligation
Authors: Bayrakci Onur , Borazan Ersin , Şanli Maruf , Yagci Sevinç , Kusdogan Nurevşan
Published: April 2021

Chilothorax, a rare clinical condition characterized by high triglyceride white fluid in the thoracic cavity; when the literature is examined, it is seen because of trauma, malignancy, complication of surgery, and rarely central catheter-related thromboplasty. In the treatment, diet change, nutrition, drainage with tube thoracostomy, conservative method, surgical procedure with thoracotomy are applied.In our case there was no response to nutritional changes, drainage, thoracotomy and somatostatin treatments. Cisterna chyli ligation was performed with laparotomy. We present a case of spontaneous bilateral chylothorax associated with superior and inferior vena cava thrombosis (without central catheter relationship).