Uric acid and acute kidney injury in high-risk patients for developing acute kidney injury undergoing cardiac surgery: A prospective multicenter study.

PURPOSE: It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI. DESIGN: Multicenter prospective international cohort study. SETTING: Fourteen university hospitals in Spain and the United Kingdom. PARTICIPANTS: We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥ 4 points, from July to December 2017. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7 mg/dL) and AKI. Elevated preoperative AUS (≥7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; P = .17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93-1.19, P = .37). CONCLUSIONS: Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.

Erratum: Ratchet universality in the bidirectional escape from a symmetric potential well [Phys. Rev. E 103, 022203 (2021)].

This corrects the article DOI: 10.1103/PhysRevE.103.022203.

Spreading fronts of wetting liquid droplets: Microscopic simulations and universal fluctuations.

We have used kinetic Monte Carlo (kMC) simulations of a lattice gas to study front fluctuations in the spreading of a nonvolatile liquid droplet onto a solid substrate. Our results are consistent with a diffusive growth law for the radius of the precursor layer, R∼t^{δ}, with δ≈1/2 in all the conditions considered for temperature and substrate wettability, in good agreement with previous studies. The fluctuations of the front exhibit kinetic roughening properties with exponent values which depend on temperature T, but become T independent for sufficiently high T. Moreover, strong evidence of intrinsic anomalous scaling has been found, characterized by different values of the roughness exponent at short and large length scales. Although such a behavior differs from the scaling properties of the one-dimensional Kardar-Parisi-Zhang (KPZ) universality class, the front covariance and the probability distribution function of front fluctuations found in our kMC simulations do display KPZ behavior, agreeing with simulations of a continuum height equation proposed in this context. However, this equation does not feature intrinsic anomalous scaling, at variance with the discrete model.

Two new species of geckos of the genus Phyllopezus Peters, 1878 (Squamata: Gekkota: Phyllodactylidae) from northeastern Brazil.

We describe two new species of Brazilian geckos of the genus Phyllopezus based on morphological and molecular data. The first species is currently known from a relictual Cerrado enclavecampos rupestres, in the mountains of the Serra do Espinhao in the state of Bahia. The second species is known from northeastern Atlantic Forest and transitional areas with Caatinga biome in the state of Alagoas. The two new species are sister taxa and together are the sister clade to the remaining species in the Phyllopezus pollicaris species complex. These new species can be morphologically distinguished from their congeners by meristic and morphometric characters, in addition to color pattern and genetic differentiation.

Ratchet universality in the bidirectional escape from a symmetric potential well.

The present work discusses symmetry-breaking-induced bidirectional escape from a symmetric metastable potential well by the application of zero-average periodic forces in the presence of dissipation. We characterized the interplay between heteroclinic instabilities leading to chaotic escape and breaking of a generalized parity symmetry leading to directed ratchet escape to an attractor either at ∞ or at -∞. Optimal enhancement of directed ratchet escape is found to occur when the wave form of the zero-average periodic force acting on the damped driven oscillator matches as closely as possible to a universal wave form, as predicted by the theory of ratchet universality. Specifically, the optimal approximation to the universal force triggers the almost complete destruction of the nonescaping basin for driving amplitudes which are systematically lower than those corresponding to a symmetric periodic force having the same period. We expect that this work could be potentially useful in the control of elementary dynamic processes characterized by multidirectional escape from a potential well, such as forced chaotic scattering and laser-induced dissociation of molecular systems, among others.

Redescription of the tadpole of Leptodactylus natalensis Lutz (Anura: Leptodactylidae), an inhabitant of the Brazilian Atlantic Forest.

The Neotropical foam-nesting genus Leptodactylus Fitzinger is currently composed of 75 species (Frost 2019) divided into four monophyletic species groups (De Sá et al. 2014). The L. melanonotus species group includes 17 species delimited by five adult osteological character-states (De Sá et al. 2014). Leptodactylus natalensis Lutz is the only species of the L. melanonotus species group that occurs in north of the Brazilian Atlantic Rain Forest (De Sá et al. 2014; Almeida et al. 2016) and whose type locality is the municipality of Natal, state of Rio Grande do Norte, Brazil (Lutz 1930). The tadpole of this species was briefly described by Oliveira Lírio-Júnior (2000) based on a single individual from the municipality of Aracaju, state of Sergipe, Brazil. Herein, we present a complete redescription of the tadpole of this species, including morphometric data and interpopulational variation. Besides, we provide comparisons with all members of the L. melanonotus group.

Helpers at the nest compensate for reduced maternal investment in egg size in carrion crows.

Life history theory predicts that mothers should trade off current and future reproductive attempts to maximize lifetime fitness. When breeding conditions are favourable, mothers may either increase investment in the eggs to improve the quality of the offspring or save resources for future reproduction as the good raising environment is likely to compensate for a 'bad start'. In cooperatively breeding birds, the presence of helpers improves breeding conditions so that mothers may vary the number, size and quality of the eggs in response to the composition of the group. Here, we show that in cooperatively breeding carrion crows Corvus corone corone, where nonbreeding males are more philopatric and more helpful at the nest than females, breeding females decreased egg size as the number of subordinate males in the group increased. However, despite the smaller investment in egg size, fledglings' weight increased in groups with more male subordinates, improving post-fledging survival and indicating that helpers fully compensated for the initial 'bad start'. These results highlight a 'hidden effect' of helpers that bears profound implications for understanding the ultimate function of helping.

[Chlamydia trachomatis infection in the first year of life]. / Infección por Chlamydia trachomatis en el primer año de vida.

BACKGROUND: Chlamydia trachomatis (C. trachomatis) is the most frequent bacterial sexual infection in women. Pregnant women screening is controversial, with asymptomatic colonization occurring in 2-20%, and 40-70% newborns can be infected. OBJECTIVES: The aim of this work is to characterise C. trachomatis infections in children under 12 months. MATERIAL AND METHODS: Retrospective study was carried out from January 1997 to December 2009 (13 years), on Chlamydia infections, diagnosed by immunofluorescence of ocular scraping or serum immunoglobulin M (IgM). Demographic, clinical features, imaging findings, and outcomes were analysed. RESULTS: A total of 46 children were identified, with an overall incidence of 0.7/1,000 deliveries. Mean age was 2 months (range from 7 days to 11 months). Seven mothers had co-infections: Human Immunodeficiency Virus (HIV) (1), HBs antigen (HBsAg) (1) and group B Streptococcus (5). Most (81.4%) children had a vaginal delivery, with membrane rupture over 12 hours in 13.0%. Respiratory infection occurred in 41 (89.1%) cases and conjunctivitis in 17 (36.9%). Conjunctivitis manifested in the first 30 days of life (range from 7 days to 52 days). Respiratory symptoms occurred at age 45 days (range from 8 days to 11 months). Ten (29.4%) children had complications: hypoxemia (9), acute medial otitis (2), apnoea (3) and atelectasis (1). Chest X-ray revealed interstitial infiltrate in 25 (65.8%), and was normal in 4 children. Most children (80.5%) had a good outcome. CONCLUSIONS: C. trachomatis should be considered as an aetiologic agent of conjunctivitis and respiratory infections in the first year of life. The prevalence of C. trachomatis infection in Portugal is unknown, and is probably an underdiagnosed disease.

[Management of COPD according to severity by respiratory specialists in France]. / Prise en charge de la BPCO en pneumologie selon le stade de sévérité.

INTRODUCTION: The diagnosis and treatment of chronic obstructive pulmonary disease (COPD) is suboptimal in many patients, which may impact on morbidity, mortality, use of healthcare resources and patients' overall quality of life. OBJECTIVES: To describe the management of COPD by respiratory physicians from the French mainland according to severity. METHODS: Observational cross-sectional survey performed in France in 2006-2007. 515 pulmonologists located throughout the national territory were involved and each of them had to recruit 5 patients with stable COPD. RESULTS: The study included 2494 patients (mean age 67 years, 78% males), of whom nearly 50% had severe to very severe COPD (GOLD stage III-IV). At inclusion, 93.2% of patients were receiving pharmacological treatment, most often non-nebulised bronchodilators (91.2%) and/or inhaled corticosteroids (73.7%). Pulmonary rehabilitation was scheduled or had been performed within the last 2 years in 26.9% of patients. Investigations and treatments were more frequent when the disease was more severe, but there was considerable overlap between severity grades. CONCLUSIONS: Differences in decisions about the investigation and treatment of COPD by pulmonologists can not be explained only by the severity of disease. Efforts must be made to identify other patient characteristics associated with these decisions, in order to help developing future recommendations.

Vascular endothelial growth factor serum concentrations in hypercholesterolemic patients.

OBJECTIVE: Vascular endothelial growth factor (VEGF) promotes normal and pathological angiogenesis. VEGF is a chemotactic factor for macrophages and vascular smooth muscle cells, and induces synthesis of metalloproteinases and adhesion molecules. VEGF expression is regulated by hypoxia, cytokines, oncogenes, and oxidized low-density lipoprotein (LDL). The purpose of this study was to determine the relationship between levels of lipid parameters and VEGF, to investigate whether pravastatin treatment influences VEGF serum concentrations, and to examine the relationship between VEGF and the variations in post-treatment lipid and inflammatory parameters. MATERIAL AND METHODS: Eighteen patients aged 48+/-6.8 years with total cholesterol (TC) >6.1 mmol/L comprised the hypercholesterolemic group. The controls included 12 individuals aged 50+/-7.4 years with TC <5.1 mmol/L. TC, high-density lipoprotein cholesterol (HDLC), triglycerides, LDLC, C-reactive protein (CRP), and VEGF were determined in both groups at baseline, and in the hypercholesterolemic group after 4 months of treatment with 20 mg/day pravastatin. RESULTS: A significant correlation was observed between concentrations of VEGF and TC, LDLC and TG, and a significant difference in VEGF concentration was observed between the control group (mean 142 ng/L) and the hypercholesterolemic group (mean 272.9 ng/L). A significant decrease was observed in TC (14.7 %), LDLC (21.5 %), CRP (22.7 %), and VEGF (14.8 %) after 4 months of treatment with pravastatin. CONCLUSIONS: A relationship was found between serum levels of VEGF and most atherogenic lipoproteins. In patients with hypercholesterolemia treated with pravastatin, a reduction in VEGF and CRP was seen in addition to lipid decreases.

Right renal vein elongation with the inferior vena cava for cadaveric kidney transplants: an old neglected surgical approach

INTRODUCTION: Short right renal vein is a frequent and well-known technical inconvenience that is commonly observed during transplantation of the right kidney. We present our experience with the elongation of short cadaveric right renal veins using the contiguous vena cava during cadaveric renal transplants. METHODS: We performed 34 kidney transplantations with a short right renal vein requiring elongation using the inferior vena cava, to make the venous anastomosis technically feasible. The elongated right renal vein was anastomosed end to side to the external iliac vein in 24 patients, to the common iliac vein in 8 patients and to the inferior vena cava in 2 patients. The right renal artery with an aortic patch was implanted end to side in 33 patients, and end to end without aortic patch to the internal iliac artery in one patient. RESULTS: In all cases, the vascular anastomoses were easily performed in the recipient and no thrombosis was observed. CONCLUSION: Elongation of a short right renal vein with the inferior vena cava is a feasible mean to overcome technical problems that may compromise the results of cadaveric renal transplantation.

Right renal vein elongation with the inferior vena cava for cadaveric kidney transplants. An old neglected surgical approach.

INTRODUCTION: Short right renal vein is a frequent and well-known technical inconvenience that is commonly observed during transplantation of the right kidney. We present our experience with the elongation of short cadaveric right renal veins using the contiguous vena cava during cadaveric renal transplants. METHODS: We performed 34 kidney transplantations with a short right renal vein requiring elongation using the inferior vena cava, to make the venous anastomosis technically feasible. The elongated right renal vein was anastomosed end to side to the external iliac vein in 24 patients, to the common iliac vein in 8 patients and to the inferior vena cava in 2 patients. The right renal artery with an aortic patch was implanted end to side in 33 patients, and end to end without aortic patch to the internal iliac artery in one patient. RESULTS: In all cases, the vascular anastomoses were easily performed in the recipient and no thrombosis was observed. CONCLUSION: Elongation of a short right renal vein with the inferior vena cava is a feasible mean to overcome technical problems that may compromise the results of cadaveric renal transplantation.

[Effects of muscle training on breathing pattern in patients with severe chronic obstructive pulmonary disease]. / Efectos del entrenamiento muscular sobre el patrón ventilatorio en pacientes con enfermedad pulmonar obstuctiva crónica grave.

OBJECTIVE: During physical exertion, the ventilatory response of patients with severe chronic obstructive pulmonary disease (COPD) is more rapid and shallow than that of healthy subjects. There is evidence that exercise training can alter breathing pattern in COPD patients. The purpose of the present study was to observe the effects of physical training on patients with severe COPD and to determine whether or not any possible changes were maintained over time. MATERIAL AND METHODS: Patients with severe COPD without bronchial reversibility were enrolled in a randomized controlled trial of a peripheral muscle training program carried out in a hospital setting. All enrolled patients were clinically stable, without exacerbation, and were randomly assigned to a training program of high (group A) or low (group B) intensity. RESULTS: Thirty-five men with severe COPD in stable condition (mean [SD] forced expiratory volume in 1 second at 41%[7%]) were enrolled in the study. The mean age was 64(5) years. Group A underwent training at 70(22) W and group B at 35(10) W, such that the estimated total work was 8050(2882) kJ in group A and 4044(1205) kJ in group B. Breathing pattern changes were detected in exercise tests only for group A patients, but the changes were not maintained 12 months after the end of the program. CONCLUSIONS: Intense training produces changes in the breathing pattern of patients with severe COPD. The changes are not specific to the task performed, not dependent on lactate production, and not maintained over the long term.

[Analysis of withdrawal from noninvasive mechanical ventilation in patients with obesity-hypoventilation syndrome. Medium term results]. / Análisis de la retirada de la ventilación mecánica no invasiva en pacientes con síndrome de hipoventilación-obesidad. Resultados a medio plazo.

OBJECTIVE: To evaluate the possibility of cessation of noninvasive mechanical ventilation or noninvasive positive pressure ventilation (NPPV) treatment in patients with obesity-hypoventilation syndrome (OHS). MATERIAL AND METHODS: A study was carried out on 22 OHS patients who had received NPPV for a minimum of 1 year. Prior to evaluation of the cessation of ventilatory support, all patients underwent the following tests: diurnal and nocturnal arterial blood gases, nocturnal oximetry, nocturnal cardiorespiratory polygraphy, and lung function tests. Based on the results obtained, 12 patients who met the NPPV cessation criteria were selected. This group was liberated from ventilatory support for 3 months. At the end of this period, all of the tests initially carried out were repeated on all patients and the results were compared with those obtained at the time of NPPV cessation. RESULTS: Three months after liberation from NPPV, no significant variations were observed in arterial blood gases or in lung function tests in comparison with the values found at the time of cessation. In terms of individual development, only 1 patient showed blood gas deterioration requiring a return to NPPV. In 7 cases, a polygraph showed obstructive sleep apnea syndrome (OSAS), 4 at the time of cessation and 3 at the follow-up examination carried out at the end of the 3 months. Finally, in 4 patients the respiratory situation remained stable, with no significant variations in the tests done before or after cessation of NPPV. CONCLUSIONS: The majority of the OHS patients who receive prolonged treatment with NPPV continue to be stable 3 months after liberation from ventilatory support. A high percentage of these patients can be seen to have OSAS once the hypercapnia situation is corrected.

[A comparison of several measurement scales for assessing dyspnea in their daily activities in patients with chronic obstructive lung disease]. / Comparación de varias escalas de medición para valorar la disnea en las actividades diarias en los pacientes con enfermedad pulmonar obstructiva crónica.

The objective of this study was to compare two instruments for measuring dyspnea to functional capacity, defined as maximal oxygen uptake in a stress test limited by symptoms. We carried out a descriptive study to determine correlation between the methods. Subjects with severe chronic obstructive pulmonary disease were enrolled and dyspnea during daily activities was evaluated using the Medical Research Council (MRC) scale and the chronic respiratory disease health perception questionnaire (CRQ). Dyspnea was also assessed on a visual analog scale (VAS) and the Borg scale. Patients performed a progressive treadmill test limited by symptoms to measure peak VO2 and VE. Correlation analysis of the two measures of dyspnea and the objective measures of functional capacity (peak VO2 and VE) showed that the clinical dyspnea measures (CRQ and MRC) correlated well with peak aerobic capacity and with maximal ventilation, whereas the VAS and Borg scale were not significantly related to the aforementioned variables. We also observed that the clinical scales for dyspnea correlated with each other, as did the VAS and Borg scale, but that there was no correlation between the two types of measurement. We conclude that clinical dyspnea indexes (CRQ and MRC) correlate well with maximal aerobic capacity and with each other. However, the VAS and Borg scale do not correlate with functional capacity measured by peak VO2 and VE.

[Current status of home mechanical ventilation in Spain: results of a national survey]. / Estado actual de la ventilación mecánica domiciliaria en España: resultados de una encuesta de ámbito nacional.

Home mechanical ventilation (HMV) is used to treat chronic respiratory insufficiency in patients who are clinically stable and require partial or total support ventilation. To determine how HMV is being used in Spain, we mailed a questionnaire to the respiratory medicine departments of all hospitals in the public health system. The closing date for receipt of responses was April 1999. Forty-three hospitals in 14 autonomous communities of Spain responded. At the time of the survey, 1,821 patients were using HMV, which had been introduced in 1987. Volumetric respirations were being used by 856 patients and various models for delivering support pressure were being used by 965. Nasal masks connected to respirators were being used by 90%, while 6% were ventilated through a tracheotomy, 2% through face masks and fewer than 1% trough mouth devices. In conclusion, HMV has been widely applied in Spain and non invasive ventilation is usually provided through a face mask. HMV is prescribed for the usual reasons (chest and neuromuscular diseases) and for such conditions as hypoventilation due to obesity and chronic obstructive pulmonary disease.

Intra-muscular vidarabine therapy for polyomavirus-associated hemorrhagic cystitis following allogeneic hemopoietic stem cell transplantation.

Hemorrhagic cystitis (HC) is a common complication following hemopoietic stem cell transplantation (HSCT), its incidence ranging from 7 to 52% of all patients. Late occurring HC frequently results from viral infections. We describe a patient who developed severe polyomavirus-associated HC, which responded dramatically to a single dose of intra-muscular vidarabine. Previous studies show an improvement in HC with vidarabine therapy, but to date only the intravenous route of administration has been described and responses described take from several days to weeks. This report confirms the safety and efficacy of vidarabine administered intramuscularly when used in patients with an adequate platelet count, thereby making its use feasible when intravenous vidarabine is not available.

[Training of inspiratory muscles in chronic obstructive lung disease. Its impact on functional changes and exercise tolerance]. / Entrenamiento de los músculos inspiratorios en la enfermedad pulmonar obstructiva crónica. Su impacto sobre las alteraciones funcionales y sobre la tolerancia al ejercicio.

The aim of this study was to evaluate the impact of inspiratory muscle training on lung function and exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). Thirty-five patients with stable COPD were enrolled. We measured lung function variables and peak inspiratory and expiratory pressures (PImax and PEmax). Tests of progressive maximal exercise tolerance and stable submaximal exercise tolerance were administered. Two study groups were formed. Group A patients (n = 20) were enrolled in a respiratory muscle training program lasting four months. Group B (n = 15) was the control group. At the end of the study period the patients underwent testing similar to the first battery of tests. All showed moderate to severe obstruction with no significant differences between groups (FEV1: group A 37.6 +/- 13%, group B 36.6 +/- 12%; FVC: group A 80.4 +/- 15%, group B 80 +/- 12%). Nor were there any significant differences between the two groups in initial results of either maximal respiratory pressures or exercise tolerance. No lung function changes were observed in either group. PImax in group A increased significantly at the end of the study (from 54 +/- 9 to 78 +/- 16 cmH2O; p < 0.001); there were no changes in group B. No changes were seen in VO2max or ventilatory response and/or gasometry during exercise in any of the groups. The trained group, on the other hand, experienced a significant decrease in dyspnea evaluated on the Borg scale exercise in maximal (5.7 +/- 1.1 versus 4.7 +/- 1.2, p < 0.005) and submaximal (5.9 +/- 0.9 versus 4.9 +/- 1.3, p < 0.005) and an increase in time of submaximal exercise tolerance (5.5 +/- 2 versus 7 +/- 3 min, p < 0.05), changes that were not observed in the control group. Based on these results, and although specific training of inspiratory muscles does not appear to improve lung function in patients with COPD, it is accompanied by a decreased sense of dyspnea during exercise and greater tolerance.

Riboflavin requirements of Filipino children and non-pregnant, pregnant and lactating women: Studied by the erthrocyte glutathione reductase activation test.

Riboflavin requirements were studied in six non-pregnant, 12 pregnant, 11 lactating women, 20 children aged 4-6 years and 14 children aged 10-12 years. All subjects initially were riboflavin-deficient with erythrocyte glutathione reductase activation coefficient (EGR-AC) of >=1.3, confined in a metabolic ward and repleted with increasing doses of riboflavin during four 10 or 8 day feeding periods. The repletion diet simulated the usual basal diet of the subjects but were modified to contain adequate energy and protein in the pregnant group. Minimum riboflavin requirements determined by regression analysis as intakes required to obtain an EGR-AC value of < 1.3 were: 0.72 ± 0.09 (non-pregnant); 1.36 ± 0.37 (pregnant); 1.31 ± 0.16 (lactating); 0.58 ± 0.10 (children 4-6 years), and 0.70 ± 0.18 mg/d (children 10-12 years). Riboflavin requirements in mg/d, mg/1000 kcal, mg/g protein or mg/kg metabolic body size for the groups varied. Because of the large variability, the use of a single value relating riboflavin requirement to either energy,protein requirements or metabolic body size to calculate requirements for different age groups or gender is deemed inappropriate. It is recommended that riboflavin requirements be expressed in mg/d as determined experimentally for different population groups. Estimated recommended dietary allowances for the groups studied, obtained by adding 30% to the mean minimum riboflavin requirement, are presented.