RATIONALE: Acute kidney injury (AKI) is a frequent complication in critically ill cancer patients. OBJECTIVES: To assess plasma neutrophil gelatinase-associated lipocalin (NGAL) levels and risks factors associated with AKI and mortality. METHODS: We recruited 96 critically ill cancer patients and followed them prospectively. Plasma NGAL levels were determined at intensive care unit (ICU) admission and at 48 hours. We generated receiver operating characteristic curves to assess the ability of NGAL to predict AKI. Logistic regression analysis was performed to determine risks factors associated with AKI. Cox-regression analysis was performed to evaluate 6-month mortality. MEASUREMENTS AND MAIN RESULTS: From 96 patients, 60 (63%) developed AKI and 33 (55%) were classified as stages 2 and 3. In patients without AKI at admission, plasma NGAL levels revealed an area under the curve (AUC) = 0.522 for all AKI stages and an AUC = 0.573 for stages 2 and 3 AKI (85% sensitivity and 67% specificity for a 50.66 ng/mL cutoff). We identified sequential organ failure assessment (SOFA) score (without renal parameters) at admission as an independent factor for developing stages 2 and 3 AKI, and haemoglobin as a protective factor. We observed that metastatic disease, dobutamine use and stage 3 AKI were independent factors associated with 6-month mortality. CONCLUSIONS: In our cohort of critically ill cancer patients, NGAL did not predict AKI. SOFA score was a risk factor for developing AKI, and haemoglobin level was a protective factor for developing AKI. The independent factors associated with 6-month mortality included metastatic disease, dobutamine use, lactate and stage 3 AKI.
Inherited mutations in the RET proto-oncogene, which encodes a receptor tyrosine kinase, predispose individuals to the multiple endocrine neoplasia type 2 (MEN 2) cancer syndromes. The major component tumor of these syndromes is medullary thyroid carcinoma (MTC). To date, somatic mutations in RET have been identified in tumors from individuals with MEN 2 finding. RET M918T mutation is present in 95% of the MEN2B cases, and approximately 50% of sporadic MTCs harbor this mutation. We performed a mutational analysis in 17 cases of Medullary thyroid carcinoma, the somatic missense mutation at codon 918 of RET was found in 2 of the 17 MTCs, and one case presented MEN2 phenotype including MTC. The percentage of RET M918T mutation is similar in Mexican MTC patients to other series, although other mutations could be implicated in our population.
Carcinoma, Neuroendocrine/genetics , Mutation, Missense , Proto-Oncogene Proteins c-ret/genetics , Thyroid Neoplasms/genetics , Adolescent , Adult , Amino Acid Substitution , Carcinoma, Neuroendocrine/epidemiology , DNA Mutational Analysis , Female , Gene Frequency , Humans , Male , Methionine/genetics , Mexico/epidemiology , Middle Aged , Proto-Oncogene Mas , Threonine/genetics , Thyroid Neoplasms/epidemiology , Young Adult
Process windows in injection molding are habitually built with only one performance measure in mind. In reality, a more realistic picture can be obtained when considering multiple performance measures at a time, especially in the presence of conflict. In this work, the construction of process windows for injection molding (IM) is undertaken considering two and three performance measures in conflict simultaneously. The best compromises between the criteria involved are identified through the direct application of the concept of Pareto-dominance in multiple criteria optimization. The aim is to provide a formal and realistic strategy to set processing conditions in IM operations. The resulting optimization approach is easily implementable in MS Excel. The solutions are presented graphically to facilitate their use in manufacturing plants.
Se presentan dos casos de enfermedad de Kawasaki con aneurismas coronarios diagnosticados por ecocardiografía. El primer paciente de un año de edad, con afección del tronco de la coronaria izquierda, desarrolló infarto del miocardio y falleció tres semanas después de la detección de los aneurismas. El segundo de 2 meses, con afección de la coronaria derecha, se encuentra asintomático a tres meses del diagnóstico. Se hace énfasis en la utilidad de la ecocardiografía para el diagnóstico de las complicaciones cardíacas
Infant, Newborn , Infant , Humans , Male , Coronary Aneurysm/diagnosis , Coronary Aneurysm/etiology , Echocardiography, Doppler/statistics & numerical data , Mucocutaneous Lymph Node Syndrome/diagnosis
