Risk Stratification to Predict Renal Survival in Anti-Glomerular Basement Membrane Disease.

SIGNIFICANCE STATEMENT: Most patients with anti-glomerular basement membrane (GBM) disease present with rapidly progressive glomerulonephritis, and more than half develop ESKD. Currently, no tools are available to aid in the prognostication or management of this rare disease. In one of the largest assembled cohorts of patients with anti-GBM disease (with 174 patients included in the final analysis), the authors demonstrated that the renal risk score for ANCA-associated vasculitis is transferable to anti-GBM disease and the renal histology is strongly predictive of renal survival and recovery. Stratifying patients according to the percentage of normal glomeruli in the kidney biopsy and the need for RRT at the time of diagnosis improves outcome prediction. Such stratification may assist in the management of anti-GBM disease. BACKGROUND: Prospective randomized trials investigating treatments and outcomes in anti-glomerular basement membrane (anti-GBM) disease are sparse, and validated tools to aid prognostication or management are lacking. METHODS: In a retrospective, multicenter, international cohort study, we investigated clinical and histologic parameters predicting kidney outcome and sought to identify patients who benefit from rescue immunosuppressive therapy. We also explored applying the concept of the renal risk score (RRS), currently used to predict renal outcomes in ANCA-associated vasculitis, to anti-GBM disease. RESULTS: The final analysis included 174 patients (out of a total of 191). Using Cox and Kaplan-Meier methods, we found that the RRS was a strong predictor for ESKD. The 36-month renal survival was 100%, 62.4%, and 20.7% in the low-risk, moderate-risk, and high-risk groups, respectively. The need for renal replacement therapy (RRT) at diagnosis and the percentage of normal glomeruli in the biopsy were independent predictors of ESKD. The best predictor for renal recovery was the percentage of normal glomeruli, with a cut point of 10% normal glomeruli providing good stratification. A model with the predictors RRT and normal glomeruli ( N ) achieved superior discrimination for significant differences in renal survival. Dividing patients into four risk groups led to a 36-month renal survival of 96.4% (no RRT, N ≥10%), 74.0% (no RRT, N <10%), 42.3% (RRT, N ≥10%), and 14.1% (RRT, N <10%), respectively. CONCLUSIONS: These findings demonstrate that the RRS concept is transferrable to anti-GBM disease. Stratifying patients according to the need for RRT at diagnosis and renal histology improves prediction, highlighting the importance of normal glomeruli. Such stratification may assist in the management of anti-GBM disease. PODCAST: This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/JASN/2023_02_27_JASN0000000000000060.mp3.

A hybridization of evolution strategies with iterated greedy algorithm for no-wait flow shop scheduling problems.

This study investigates the no-wait flow shop scheduling problem and proposes a hybrid (HES-IG) algorithm that utilizes makespan as the objective function. To address the complexity of this NP-hard problem, the HES-IG algorithm combines evolution strategies (ES) and iterated greedy (IG) algorithm, as hybridizing algorithms helps different algorithms mitigate their weaknesses and leverage their respective strengths. The ES algorithm begins with a random initial solution and uses an insertion mutation to optimize the solution. Reproduction is carried out using (1 + 5)-ES, generating five offspring from one parent randomly. The selection process employs (µ + λ)-ES, allowing excellent parent solutions to survive multiple generations until a better offspring surpasses them. The IG algorithm's straightforward search mechanism aids in further improving the solution and avoiding local minima. The destruction operator randomly removes d-jobs, which are then inserted one by one using a construction operator. The local search operator employs a single insertion approach, while the acceptance-rejection criteria are based on a constant temperature. Parameters of both ES and IG algorithms are calibrated using the Multifactor analysis of variance technique. The performance of the HES-IG algorithm is calibrated with other algorithms using the Wilcoxon signed test. The HES-IG algorithm is tested on 21 Nos. Reeves and 30 Nos. Taillard benchmark problems. The HES-IG algorithm has found 15 lower bound values for Reeves benchmark problems. Similarly, the HES-IG algorithm has found 30 lower bound values for the Taillard benchmark problems. Computational results indicate that the HES-IG algorithm outperforms other available techniques in the literature for all problem sizes.

Heterotopic Ossification after Trauma.

Heterotopic ossification (HO) refers to benign ectopic bone formation in soft tissue and is common following trauma surgery. HO bone can restrict movement and progress into ankylosis that may necessitate surgical intervention. This article discusses the current literature on the pathophysiology, prophylaxis, treatment, and epidemiology of postoperative HO following orthopedic trauma.

Sweeper's lung disease: a cross-sectional study of an overlooked illness among sweepers of Pakistan.

BACKGROUND: Sweepers are prone to develop chronic obstructive pulmonary disease even without tobacco smoking. PURPOSE: To investigate roadside dust as a cause of air flow obstruction among sweepers, and the role of spirometry in its preclinical diagnosis. MATERIAL AND METHODS: One-hundred nonsmoking sweepers (aged 30-60 years) of both sexes sweeping on roads for 8-12 hours a day for the Capital Development Authority of Islamabad, Pakistan were used as study participants (Group A). One-hundred healthy nonsmokers (aged 30-60 years) in the same socioeconomic group and living in the same environment represented the nonsweeper group (Group B). After proper clinical evaluation and chest X-rays, spirometric evaluation was carried out in both groups. Comparisons were drawn between various spirometric parameters. RESULTS: Pulmonary function tests showed that the mean forced vital capacity was 78 ± 1.40 in the sweeper group (Group A) and 83 ± 0.86 in the nonsweeper group (Group B). Mean forced expiratory volume in 1 second was 66 ± 1.67 in Group A and 85 ± 0.85 in Group B (P < 0.05), a difference of 19%. The forced midexpiratory flow was 41% lower in Group A than in Group B (P < 0.0001). The pattern of pulmonary function obstruction was shown to be proportional to the duration of exposure to dust caused by sweeping. CONCLUSION: Occupational exposure to dust leads to an obstructive pattern among sweepers. Spirometry is the simplest, noninvasive technique to detect preclinical disease.