Chronic inflammation and calciphylaxis.

Calciphylaxis also known as calcific uraemic arteriolopathy is a rare condition mostly seen in patients with end-stage kidney disease. We report a case of a simultaneous-kidney-pancreas transplant patient with functioning grafts developing biopsy-proven calciphylaxis in the setting of chronic inflammation. Despite several modalities of management, the patient developed progression of her disease leading to multiple amputations. This case illustrates chronic inflammation driven by persistent infection as a probable contributing factor to the development and progression of calciphylaxis in a simultaneous kidney-pancreas recipient. Calciphylaxis should be considered in the differential for a painful, non-healing ulcer even in the absence of common risk factors.

Posttransplant proteinuria due to Apolipoprotein E2 deposition in a kidney allograft.

Lipoprotein deposition disorders limited to the kidney and causing proteinuria are rare. We present a case of nephrotic range proteinuria presenting within 4 months after deceased donor renal transplantation in a patient with end-stage kidney disease presumed secondary to hypertension. Two transplant kidney biopsies were performed sixteen weeks after transplantation, and one year after the first biopsy, both showing lipoprotein deposits in the glomeruli, progressive focal segmental glomerulosclerosis, and effacement of visceral foot processes. The patient had a normal lipid profile. Based on previous case reports of Apolipoprotein E variants causing proteinuria in native kidneys, Apolipoprotein E genotyping was performed. Genotyping showed Apolipoprotein E2 homozygosity. This Apolipoprotein E variant has been associated with lipoprotein deposition, proteinuria, and progressive kidney disease in the native kidneys. However, this is the first case of Apolipoprotein E2 homozygosity-related kidney disease in a transplant recipient. The patient was treated with fenofibrate, angiotensin enzyme inhibition, and angiotensin receptor blockade with reduction in proteinuria, and he kept good stable kidney function.

Simulations of breakthrough curves for fixed-bed column adsorption of cobalt (II) ions on spent tealeaves.

The objective of this study is to model the breakthrough adsorption curves of Co (II) ions using spent tealeaves in fixed-bed column experiments. Spent leaves of green tea (GT), peppermint tea (PM) and chamomile (CM) were packed in glass columns with a diameter of 2 cm and height of 15 cm, and used as filters for the removal of the pollutant. Aqueous solutions of cobalt (II) ions (100 mg/L) at pH 6 were prepared and pumped against gravity through the columns at a uniform flow rate of 5 mL/min. Breakthrough curves were fitted for the residual concentration data using the Thomas, Yoon-Nelson, and Clark models, with added empirical terms to delineate the lower tail of the breakthrough curve. These mathematical models were successfully linearized using the natural logarithm for parameter estimation. The results reveal that the Co (II) adsorption fits all three models for all the adsorbents. The Thomas model indicated that the calculated adsorption capacities followed the trend: PM > GT > CM with values of 59.7, 25.2, and 24.9 mg/g respectively. Moreover, CM showed the highest adsorption rates with all the mathematical models, whereas Yoon-Nelson theory provided evidence that PM has the longest 50% adsorption breakthrough among the adsorbents. Lastly, morphological and textural studies indicate that all spent leaves are good candidates as adsorbents due to their high surface heterogeneity. This study proposes the use of spent tealeaves as Co (II) adsorbents because they are inexpensive and environmentally beneficial.

Hematopoietic stem cell transplantation and acute kidney injury in children: A comprehensive review.

AKI in the setting of HSCT is commonly investigated among adult patients. In the same way, malignancies requiring treatment with HSCT are not limited to the adult patient population, AKI following HSCT is frequently encountered within pediatric patient populations. However, inadequate information regarding epidemiology and pathophysiology specific to pediatric patients prevents development of appropriate and successful therapeutic strategies for those afflicted. Addressing AKI in the context of sinusoidal obstruction syndrome, chemotherapy, thrombotic microangiopathy and hypertension post chemotherapy, glomerulonephritis, and graft versus host disease provides greater insight into renal impairment associated with these HSCT-related ailments. To obtain a better understanding of AKI among pediatric patients receiving HSCT, we investigated the current literature specifically addressing these areas of concern.

Risk factors for infection after operative fixation of Tibial plateau fractures.

INTRODUCTION: Tibial plateau fractures are challenging to treat due to the high incidence of postoperative infections. Treating physicians should be aware of risk factors for postoperative infection in patients who undergo operative fixation. PATIENTS AND METHODS: A retrospective review was undertaken to identify all patients with tibial plateau fractures over a 10 year period (2003-2012) who underwent open reduction internal fixation. A total of 532 patients were identified who met the inclusion criteria. Several patient and clinical characteristics were recorded, and those variables with a significant association (p<0.05) with postoperative infection after a univariate analysis were further analyzed using a multivariate analysis. RESULTS: Fifty-nine (11.1%) of the 532 patients developed a deep infection. The average length of follow-up for patients was 19.5 months. Methicillin-resistant Staphylococcus aureus was the most common species, and it was isolated in 26 (44.1%) patients. Open fractures, the presence of compartment syndrome, and a Schatzker type IV-VI were found to be independent risk factors for deep infection. CONCLUSIONS: The rate of deep infection remains high after operative fixation of tibial plateau fractures. Patients with risk factors for infection should be counseled on the possibility of reoperation, and surgeons should consider MRSA prophylaxis in those patients who are at higher risk.

Beliefs about birth rank and their reflection in reality.

Beliefs about birth rank reflect what the society regards as social reality, and they may also influence that reality. Three studies found that people believe those with different birth ranks differ in their personalities, that higher birth ranks are likely to attain higher occupational prestige, and that the personality characteristics attributed to the various birth ranks favor the actual attainment of higher occupational prestige. In one example of such beliefs, firstborns were rated as most intelligent but least creative whereas the opposite was true of last-borns. The 4th study found that those with higher birth ranks in fact attain more prestigious occupations and actually do complete more years of schooling.