Chronic kidney disease (CKD) and chronic kidney insufficiency (CKI) diagnosing equation in cirrhotic patients.

Cirrhotic patients can develop acute kidney injury (AKI), and chronic kidney disease (CKD). Therefore, renal functional evaluation is crucial in cirrhotic patients. However, serum creatinine and urea levels, as well as measured or estimated glomerular filtration rate is not reliable renal functional markers in these patients compared to other patient groups. In the present study, four original equations are designed and tested for screening chronic kidney disease (CKD) and chronic kidney insufficiency (CKI) in stable cirrhotic patients. MATERIAL & METHOD: estimated GFR (CKD-EPI creatinine and cystatin equations) were recorded in 175 adult stable patients suffering from cirrhosis, and these patients were classified as presenting or not CKD and CKI after evaluation by two independent nephrologists. Based on these data, the variables with the significant discriminating capability to identify CKD and CKI (based on creatinine and cystatin) were detected by applying the Student's t-test for two independent groups, later confirmed by the lambda test of Wilks, in order to obtain the renal function equations. RESULTS: CKD equation (creatinine) = 7.094238-0.043104 × CKD-EPI creatinine - 0.057537 × haematocrit. CKD equation (cystatin) = 8.375074-0.117218 × CKD-EPI cystatin. CKI equation (creatinine) = 0.428389-0.043214 × CKD-EPI creatinine +0.183051 × Child-Pugh score + 0.050162 × age (in years). CKI equation (cystatin) = 9.169579-0.139319 × CKD-EPI cystatin. CONCLUSION: Simple and reliable equations have been obtained for screening chronic kidney disease and chronic kidney insufficiency in cirrhotic patients.

Evaluation of population pharmacokinetic models for amikacin dosage individualization in critically ill patients.

OBJECTIVES: The aim of this study was to evaluate the reliability for dosage individualization and Bayesian adaptive control of several literature-retrieved amikacin population pharmacokinetic models in patients who were critically ill. METHODS: Four population pharmacokinetic models, three of them customized for critically-ill patients, were applied using pharmacokinetic software to fifty-one adult patients on conventional amikacin therapy admitted to the intensive care unit. An estimation of patient-specific pharmacokinetic parameters for each model was obtained by retrospective analysis of the amikacin serum concentrations measured (n = 162) and different clinical covariates. The model performance for a priori estimation of the area under the serum concentration-time curve (AUC) and maximum serum drug concentration (C(max)) targets was obtained. KEY FINDINGS: Our results provided valuable confirmation of the clinical importance of the choice of population pharmacokinetic models when selecting amikacin dosages for patients who are critically ill. Significant differences in model performance were especially evident when only information concerning clinical covariates was used for dosage individualization and over the two most critical determinants of clinical efficacy of amikacin i.e. the AUC and C(max) values. CONCLUSIONS: Only a single amikacin serum level seemed necessary to diminish the influence of population model on dosage individualization.

Experiencia en el uso de colgajos locales para cobertura del pulgar / Local flaps utility for thumb coverage: our experience

Introducción y Objetivo. El pulgar asume el 40-50% de la funcionalidad de la mano, por lo que es fundamental su reconstrucción estable y funcional. Además de las opciones que nos ofrece la microcirugía, debemos manejar de manera eficaz los colgajos locales para cobertura del pulgar, ya que nos pueden aportar soluciones adecuadas a difíciles problemas reconstructivos, si se emplean correctamente. El objetivo de este trabajo es presentar nuestra sistemática en la reconstrucción con colgajos locales de defectos de pequeño y moderado tamaño del pulgar. Para ello, utilizamos el concepto de unidades estético-funcionales del pulgar y describimos los colgajos que consideramos como primera línea reconstructiva en cada tipo de defecto. Material y Método. Realizamos una revisión retrospectiva, descriptiva, de una serie de 56 casos de pérdidas de sustancia del pulgar con exposición ósea, tendinosa o ambas, susceptibles de cobertura con colgajos locales. Recogemos la edad, mano lesionada, tipo de accidente y mecanismo lesional, subunidad digital afectada y geometría de la lesión. Describimos la técnica reconstructiva indicada en cada caso. Resultados. De los 56 pacientes, el 95% (53 casos) correspondieron a defectos en subunidad distal del pulgar (distal a articulación interfalángica (IF)) que comprometían pulpejo y placa ungueal; 2 de ellos asociados a lesión en subunidad proximal volar y 8 a subunidad proximal dorsal. El otro 5% (3 casos) correspondieron a subunidad dorsal proximal exclusivamente. Para su cobertura, contabilizamos 17 colgajos basados en arteria dorso-cubital tipo Brunelli modificado (30%), 3 Brunelli clásicos (5%), 12 colgajos basados en primera arteria intermetacarpiana dorsal tipo Foucher (22%), 9 Elliot (16%), 4 Elliot asociados a colgajo eponiquial (7%), 6 colgajos heterodigitales de Littler (12%), 3 basados en arteria dorso-radial tipo Moschella (5%) y 2 colgajos heterodigitales tipo Buchler (3%). Conclusiones. Aplicando el concepto reconstructivo de unidades estético funcionales del pulgar, para defectos volares, nuestra primera línea reconstructiva son los colgajos de avance volar o los heterodigitales, por sus características mecánicas y posibilidad de neurotización. En algunos casos, asociamos el colgajo eponiquial de Backach que aporta una mejoría estética considerable. En defectos de predominio dorsal, nuestra preferencia son los colgajos dorso-cubitales o dorso-radiales, o bien al colgajo de primera arteria intermetacarpiana dorsal en defectos mayores. Estos colgajos no aportan apenas sensibilidad, pero presentan características similares a la piel dorsal en grosor y elasticidad (AU)

Background and Objective. The thumb represents 40-50%of hand function making its stability and functional reconstruction essential. Despite the development in microsurgery, the correct use of local flaps for thumb coverage can provide us appropriate solutions to difficult reconstructive problems. The aim of this paper is to present our systematic reconstruction treatment of small and moderate thumb defects using local flaps.We use the concept of functional aesthetic units of the thumb describing the flaps to be consider as first reconstructive line in each type of defect. Methods. We present a descriptive, retrospective review of 56 cases of loss of thumb substance that presented exposure of the bone, tendon or both, which could benefit from coverage by local flaps. We include age, injured hand, type of accident and injury mechanism, digital subunit affected and geometry of the lesion. We describe reconstructive technique indicated in each case. Results. 95% of the cases (53 cases) corresponded to defects in the thumb distal subunit (distal to the interphalangeal joint (IJ)) compromising the pulp and the nail plate; including 2 of them associated with proximal palmar subunit injury and 8 associated with a proximal dorsal subunit injury. The other 5% (3 cases) corresponded to the proximal dorsal subunit exclusively. We performed 17 dorsal ulnar artery modified Brunelli flaps (30%); 3 Brunelli classic (5%); 12 first dorsal metacarpal artery flap (Foucher's flap) (22%); 9 Elliot's flap (16%); 4 Elliot's flaps associated with eponychial flap (7%); 6 Littler's heterodigital flaps (12%); 3 dorsoradial collateral artery flap (Moschella's flap) (5%); and 2 Buchler's heterodigital flaps (3%). Conclusions. In application of the functional aesthetic units of the thumb reconstructive concepts for volar defects, our first reconstructive line are the palmar flaps or the heterodigital flaps due to their mechanical characteristics and the possibility of neurotization. In some cases, we would consider the Backach eponychial flap, which provides a considerable aesthetic improvement. On the other hand, in defects of dorsal preponderance, our preference are the dorsal ulnar and radial flaps and the first metacarpal artery flap for major defects cases. These types of flaps only contribute minimally for the sensitivity, but present similar characteristics with the dorsal skin in terms of thickness and elasticity (AU)

Modeling the Arabidopsis seed shape by a cardioid: efficacy of the adjustment with a scale change with factor equal to the Golden Ratio and analysis of seed shape in ethylene mutants.

A new model for the description of Arabidopsis seed shape based on the comparison of the outline of its longitudinal section with a transformed cardioid is presented. The transformation consists of scaling the horizontal axis by a factor equal to the Golden Ratio. The elongated cardioid approximates the shape of the Arabidopsis seed with more accuracy than other figures. The length to width ratio in wild-type Columbia Arabidopsis dry seeds is close to the Golden Ratio and decreases over the course of imbibition. Dry seeds of etr1-1 mutants presented a reduced length to width ratio. Application of the new model based on the cardioid allows for comparison of shape between wild-type and mutant genotypes, revealing other general alterations in the seeds in ethylene signaling pathway mutants (etr1-1).