Preoperative Renal Insufficiency: Underreporting and Association With Readmission and Major Postoperative Morbidity in an Academic Medical Center.

BACKGROUND: Making a formal diagnosis of chronic kidney disease (CKD) in the preoperative setting may be challenging because of lack of longitudinal data. We explored the predictive value of a single reduced preoperative estimated glomerular filtration rate (eGFR) value on adverse patient outcomes in the first 30 days after elective surgery. We compared the rate of major postoperative adverse events, including 30-day readmission rate, hospital length of stay, infection, acute kidney injury (AKI), and myocardial infarction across patients with declining preoperative eGFR values. We hypothesized that there is an association between decreasing preoperative eGFR values and major postoperative morbidity including readmission within 30 days of discharge and that the reasons for unplanned readmissions may be associated with poor preoperative renal function. METHODS: This was a retrospective analysis of the electronic health record of 39 989 adult patients who underwent elective surgery between June 2011 and July 2013 at our institution. Patients with reduced eGFR (<60 mL/min/1.73 m) were identified and categorized by the stages of CKD that correlated with the preoperative eGFR value. Odds of readmission to our hospital within 30 days, as well as new diagnosis of AKI, myocardial infarction, and infection, were determined with multivariate logistic regression. The subset of patients who were readmitted within 30 days also were subdivided further into patients who had an eGFR <60 mL/min/1.73 m and those with an eGFR ≥60 mL/min/1.73 m, as well as whether the readmission was planned or unplanned. RESULTS: Of the 4053 patients with eGFR <60 mL/min/1.73 m, 3290 (81.2%) did not carry a preoperative diagnosis of CKD. Adjusted odds ratios of being readmitted were 1.48 (99% confidence interval [CI], 1.18-1.87; P < .001) for eGFR 30 to 44 mL/min/1.73 m to 2.06 (99% CI, 1.32-3.23; P < .001) for eGFR <15 mL/min/1.73 m compared with patients with a preoperative eGFR value ≥60 mL/min/1.73 m. Patients with a lower eGFR also demonstrated increasing odds of AKI from 2.78 (99% CI, 1.86-4.17; P < .001) for eGFR 45 to 59 mL/min/1.73 m to 3.81 (99% CI, 1.68-8.16; P < .001) for eGFR <15 mL/min/1.73 m. CONCLUSIONS: This study highlights that preoperative renal insufficiency may be underreported and appears to be significantly associated with postoperative complications. It extends the association between a single low preoperative eGFR and postoperative morbidity to a broader range of surgical populations than previously described. Our results suggest that preoperative calculation of eGFR may be a relatively low-cost, readily available tool to identify patients who are at an increased risk of readmission within 30 days of surgery and postoperative morbidity in patients presenting for elective surgery.

Heuber Maneuver in Evaluation of Direct Carotid-Cavernous Fistula.

Carotid-cavernous fistulas are abnormal communications between the carotid system and the cavernous sinus. Elevated venous pressure produces congestion in the orbit with resultant transudation of fluid and increased intraocular pressure, thereby leading to secondary glaucoma which may result in visual loss. Immediate treatment is hence, warranted in these cases. The planning of endovascular management is dependent on many parameters, the most important of which are the size and location of the fistula. Since these are high-flow fistulas, assessment requires certain manoeuvers. Heuber manoeuver is one of the manoeuvers used to demonstrate the size of the fistula.

Exploring dielectric and AC conduction characteristics in elemental selenium glass modified with silver halides.

In this research work, we have examined the influence of silver halide doping on the dielectric dispersion and AC conduction of elemental selenium. The in-depth investigation shows that when the dopant silver halides are incorporated, there are noticeable changes in the parent selenium's dielectric constant (ε'), dielectric loss (ε''), and AC conductivity (σ ac). When we frame the discussion of the obtained results with the relevant transport models, we found that in pure selenium and Se95(AgI)5, conduction is primarily due to polaron hopping and follows the correlated barrier hopping (CBH) model. In contrast, Se95(AgBr)5 predominantly exhibits non-overlapping small polaron tunneling (NSPT). Interestingly, Se95(AgCl)5 demonstrates both NSPT and CBH conduction mechanisms, depending on the temperature range: NSPT is dominant between 303 K and 313 K, while CBH prevails from 318 K to 338 K. Additionally, our findings revealed the presence of both the Meyer-Neldel rule (MNR) and its reverse in the prepared silver halide chalcogenide alloys. The best optimization of dielectric constant and loss is observed for silver iodide as compared to silver chloride and silver bromide. Comparison with other silver-containing chalcogenide glasses indicates the better dielectric performance of the present silver halides containing selenium.

Correlation between the density of defect states (DDS) and cross-linking of corner/edge sharing GeSe4 tetrahedral structural units.

We have estimated the DDS in the STSG [Se78-xTe20Sn2Gex (x = 0, 2, 4, 6)] system by using the Correlated Barrier Hopping (CBH) model by performing A.C. conduction measurements in the frequency range (1 kHz-10 kHz) and temperature underneath the glass transition temperature (303-333) K. The detailed analysis reveals that bi-polaron hopping is a leading conduction mechanism over single-polaron hopping. Further, there is a noticeable reduction in DDS with increasing concentration of Ge beyond the composition x = 2. A close inspection indicates that cross-linking of Se with Ge has an important role in controlling the DDS in terms of the corner/edge sharing configurations in the structural unit of GeSe4 tetrahedral.

The small heat shock protein 27 is a key regulator of CD8+ CD57+ lymphocyte survival.

Differences in CD8(+)CD57(-) and CD8(+)CD57(+) lymphocyte lifespan have been documented. Lower numbers and shorter lifespan are characteristic of CD8(+)CD57(+) in normal individuals. However, CD8(+)CD57(+) are expanded in certain disease states including T cell large granular leukemia and other hematologic malignancies. The mechanisms responsible for the differences in CD8(+)CD57(-) and CD8(+)CD57(+) lifespan remain elusive. In this study, we demonstrate that the small heat shock protein (Hsp) 27 is a key regulator of CD8(+)CD57(+) lymphocyte lifespan. We found that Hsp27 expression is significantly lower in CD8(+)CD57(+) than in CD8(+)CD57(-) lymphocytes. In contrast, Hsp60 and Hsp70 are expressed at comparable levels. Unlike other antiapoptotic Bcl-2-like molecules, the expression of Hsp27 tightly correlates with CD8(+)CD57(+) and CD8(+)CD57(-) lifespan. We demonstrate that Hsp27 overexpression in CD8(+)CD57(+) lymphocytes to levels found normally in CD8(+)CD57(-) lymphocytes decreased apoptosis. Accordingly, silencing of Hsp27 in CD8(+)CD57(-) lymphocytes increased apoptosis. Collectively these results demonstrate that Hsp27 is a critical regulator of normal CD8(+)CD57(+) lifespan supporting its use as a marker of lifespan in this lineage, and suggest a mechanism responsible for the decreased apoptosis and clonal expansion characteristic of certain disease states.

Ground improvement using chemical methods: A review.

Ground improvement will be critically important in the present and future geotechnical practice for designing the structures in weak soil. This paper presents a review of the recent development in ground improvement techniques, especially chemical stabilisers. Various available chemical stabilisers are identified and compared with other available methods. Though the use of chemicals provides an excellent alternative to the traditional methods, they still lack proper understanding regarding their use, handling, application, and long-term effect on the environment. Various chemical stabilisers and their applicability conditions are summarised in the present paper. Insight of biochemical, electrochemical, inorganic, and organic stabilisers is presented with future scope of these methods along with the potential areas where a lot of efforts is needed to industrialise these methods are also discussed briefly. A need for developing a more environmentally friendly and safe method was felt while reviewing these methods. Lack of a large amount of data is a major concern for lesser use of these methods industrially. A lot of laboratory and field experiments should be conducted in different conditions to ensure safe results from chemical stabilisers.

Enhancement of polaron-hopping-based a.c. conduction in semiconducting STS (Se-Te-Sn) glass by silver incorporation.

In the present work, we have synthesized novel Se78-xAgxTe20Sn2 (0 ≤ x ≤ 6) semiconducting glasses for improving thermally activated a.c. conduction in STS glass (x = 0). The results of the experimental analysis of thermally activated a.c. conduction have been reported in terms of frequency and temperature of Se78-xAgxTe20Sn2 (0 ≤ x ≤ 6) glasses. The frequency dependent experimental data of a.c. conductivity σac show that σac follows the Jonscher universal power law. Variation of a.c. conductivity with temperature obeys the Arrhenius relation. Further analysis confirms that the density of defect states can be determined on the basis of a correlated barrier hopping model using the frequency/temperature dependence of a.c. conductivity σac (T,ω). The analysis of composition dependence of various electric parameters like potential barrier height Wm, hopping distances Rmin and Rω, dielectric constant (ε') and the density of defect states N shows that hopping conduction is improved after silver incorporation into the parent glass. This is explained in terms of a dipolar model by considering the dipoles of Ag+ ions with negatively charged defect states.

Comprehensive studies of temperature and frequency dependent dielectric and a.c. conducting parameters in third generation multi-component glasses.

The dielectric relaxation and thermally assisted a.c. conduction play an important role in understanding the conduction mechanism in chalcogenide glasses. These two phenomena are often the deciding factors of the suitability of chalcogenide materials for particular device applications. Dielectric relaxation studies are important to understand the nature and origin of dielectric losses, which, in effect, may be useful in the determination of structure and defects in solids. The study of thermally assisted a.c. conduction can be used as a tool to understand the nature of defect states and the estimation of their density of defect states. In this paper, therefore, we have studied the metal-induced effects of cadmium (Cd), indium (In) and antimony (Sb) on dielectric relaxation and thermally activated a.c. conduction in ternary Se80Te18Sn2 glass. The density of charged defect states in quaternary Se80Te8Sn2M10 alloys is found to vary with the electro-negativity difference (ξ M - ξ Te) of the foreign element M and Te. Further analysis shows that the increasing sequence of the density of charged defects is explained in terms of variation in the lone-pair electrons after the incorporation of Cd, In and Sb.

Regenerative efficacy of therapeutic quality platelet-rich plasma injections versus phonophoresis with kinesiotaping for the treatment of chronic plantar fasciitis: A prospective randomized pilot study.

BACKGROUND: Plantar fasciitis (PF) a common chronic musculoskeletal pain routinely diagnosed and treated in rehabilitation practices. When conservative management fails in this degenerative disease, local injections of corticosteroids, platelet rich plasma (PRP), botulinum toxin, extracorporeal shockwave therapy, surgical release are used. In our prospective randomized pilot study we compared the regenerative efficacy of Platelet Rich Plasma vs Kinesiotaping with phonophoresis who were resistant to conservative management of PF. MATERIALS AND METHODS: Sixty-four chronic plantar fasciitis patients nonresponding to conservative management were evaluated for two interventions.36 patients received ultrasound guided 2.5 ml autologous platelet rich plasma (PRP) injection and 28 participant received phonophoresis and total10 Kinesiotaping on alternate days. 54 participants 33 in PRP intervention group and 21 in KT group were analyzed, by Numerical Rating Scale (NRS), plantar fascia thickness (ultrasound guided) and disability and activity limitation measured by foot function index in every two weeks up to 6 months. RESULTS: Post intervention assessment at 2 weeks revealed improvement in pain relief was better in Kinesiotaping group (NRS-4.619) as compared to PRP group (NRS- 6.061). But evaluation at 12 and 24 weeks showed statistically significant improvement in NRS and Foot function index in PRP group than in Kinesiotaping. Similarly, at the end of 24-week improvement in foot function index (FFI) was more in PRP group (P<0.0001). At end of 12 and 24 weeks there was significant reduction in plantar fascia thickness in PRP group (p<0.0001) as compared to KT group (p<0.05). CONCLUSION: Our study concluded that therapeutic quality autologous PRP injection (1x106 platelets/µl) has regenerative effect with long and better efficacy in pain management of chronic recalcitrant plantar fasciitis than Phonophoresis and Kinesiotaping.

Iso-conversional kinetic analysis of quaternary glass re-crystallization.

Iso-conversional kinetic analysis is popular in scientific community for analyzing solid-state reactions (e.g., glass/amorphous and amorphous/crystal phase transformations, re-crystallization etc). It is a recognized significant tool to achieve useful outcomes for the solid state reaction under consideration. Present work is devoted to explore some insights of thermally activated crystallization using various heating rates (VHR) method. We have examined the correlation between iso-conversional activation energy and iso-conversional rate of crystal growth. In fact, we have observed the compensation law and iso-kinetic relationship using two different approaches for the study of crystallization phenomenon that drives thermally in an Arrhenian manner. Moreover, we found that the estimated intercepts and gradients (i.e., Meyer-Neldel energy and Meyer-Neldel pre-factor respectively) for both approaches also vary linearly and both sets are remarkably identical. These results approach to an inference for ensuring the equivalence of compensation law and iso-kinetic relationship and provide an understanding of various advanced materials in physical chemistry, materials sciences and solid-state physics.

A case of pulsatile scalp swelling in a child.

Arteriovenous fistulas (AVF) are an entity most commonly seen in the head and neck region. An AVF is a direct connection between the arterial feeders and the draining veins without intervening capillary beds (unlike an arteriovenous malformation in which a nidus intervenes between the arteries and veins). We describe a case of traumatic AVF in a child aged 9 years, who presented with a pulsatile scalp swelling following blunt trauma to the head. It turned out to be an AVF between the superficial temporal artery and vein. Correct diagnosis of an AVF involves Doppler examination with digital subtraction angiography providing a good roadmap for treatment, which can be either endovascular or surgical.

Ganglion impar block in patients with chronic coccydynia.

INTRODUCTION: Coccydynia refers to pain in the terminal segment of the spinecaused by abnormal sitting and standing posture. Coccydynia is usually managed conservatively, however in nonresponsive patients, ganglion impar block is used as a good alternate modality for pain relief. This article studies the effect of ganglion impar block in coccydynia patients who were not relieved by conservative management. MATERIALS AND METHODS: The study was carried out at the pain clinic in the departments of Physical Medicine and Rehabilitation and Radiology in a tertiary centre in India. It was a prospective hospital-based study, in which 35 patients with coccydynia were considered for fluoroscopy-guided trans-sacro-coccygeal ganglion impar block. The outcome assessment was done using Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI) scores for a follow-up period of 6 months. Of the 35 patients, 4 were lost to follow-up. Analysis was done usingthe data from the remaining 31 patients. RESULTS: The mean age of the patients suffering from chronic coccydynia was 42.9 ± 8.39 years, and patients' age range was 28-57 years. The mean score of NRS and ODI before the procedure was 7.90 ± 0.16 and 48.97 ± 1.05, respectively. The interquartile range (IQR) of NRS score remained almost unchanged during pre and postprocedure, however, IQR of ODI varied during the pre and post procedural events. The NRS and ODI scores immediately after the procedure decreased drastically showing significant pain relief in patients, and the difference of scores till the end of study was statistically significant. CONCLUSION: This study recommends the trans-sacro-coccygeal "needle inside needle" technique for local anesthetic block of the ganglion impar for pain relief in patients with coccydynia. This should be integrated with rehabilitative measures including ergonomical modification for prolonging pain free period.

Nonvisualization of the Internal Carotid Artery on Computed Tomography Angiography: Discussion of Two Cases with Review of Literature.

Nonvisualization of the internal carotid artery (ICA) on cross-sectional imaging studies can be due to congenital (dysgenesis of the ICA) or acquired (complete occlusion of ICA) causes. We report two cases, one with absent carotid canal on bone window setting of computed tomography (CT) suggestive of congenital cause and the other with normal carotid canal, suggesting acquired cause. Development of aortic arches with six pathways of collateral circulation in brain is also discussed.

Synthesis, antiproliferative activity, acute toxicity and assessment of the antiandrogenic activities of new androstane derivatives.

A number of 17-oxo-5-androsten-3ß-yl esters (9a-9f) and 3ß-alkoxy-5-androsten-17-ones (11a-11e) were synthesized from commercially available (25R)-5-spirosten-3ß-ol (Diosgenin) (4) as starting material. The synthesized compounds were evaluated for their antiproliferative activity against the prostate-specific cancer cell line DU-145, acute toxicity and effect on serum androgen levels, and compared with finasteride as positive control. Some of the compounds exhibited better cytotoxicity and antiandrogenic activity than the reference control. The detailed synthesis, spectroscopic data and biological activity of the synthesized compounds are reported.

Synthesis, antiproliferative, acute toxicity and assessment of antiandrogenic activities of some newly synthesized steroidal lactams.

The 17-oxo-17a-aza-d-homo-5-androsten-3beta-yl esters (13-22) were synthesized from commercially available (25R)-5-spirosten-3beta-ol (Diosgenin) (6) as starting material. The synthesized compounds were evaluated for their antiproliferative activity, acute toxicity and effect on serum androgen level and were compared with Finasteride as positive controls. Some of the compounds exhibited better cytotoxicity and antiandrogenic activity than the reference control. The detailed synthesis, spectroscopic data and pharmacological screening for the synthesized compounds were reported.