Jessenladefoged5297

SUMMARY Data on pharmacogenetics of anti-TNF therapy in severe sarcoidosis are scarce. Findings in other IMIDs indicate there may be a role for pharmacogenetics in predicting response and adverse events in anti-TNF therapy, also in sarcoidosis. Future studies are needed to evaluate pharmacogenetics as a predicting marker in anti-TNF therapy in sarcoidosis.PURPOSE OF REVIEW Despite improvements in acute kidney injury (AKI) detection, therapeutic options to halt the progression of AKI to chronic kidney disease (CKD) remain limited. In this review, we focus on recent discoveries related to the pathophysiology of the AKI to CKD continuum, particularly involving the renal tubular epithelial cells, and also discuss related ongoing clinical trials. While our focus is on injured renal tubular epithelial cells as initiators of the cascade of events resulting in paracrine effects on other cells of the kidney, the summation of maladaptive responses from various kidney cell types ultimately leads to fibrosis and dysfunction characteristic of CKD. RECENT FINDINGS Recent findings that we will focus on include, but are not limited to, characterizations of the association between cell cycle arrest and cellular senescence in renal tubular epithelial cells and its contribution to renal fibrosis, chronic inflammation with persistent cytokine production and lymphocyte infiltration among unrepaired renal tubules, mitochondrial dysfunction and a unique role of cytosolic mitochondria DNA in fibrogenesis, prolyl hydroxylase domain proteins as potential therapeutic targets, and novel mechanisms involving the Hippo/yes-associated protein/transcriptional coactivator with PDZ-binding pathway. SUMMARY Potential therapeutic options to address CKD progression will be informed by a better understanding of fibrogenic pathways. Recent advances suggest additional drug targets in the various pathways leading to fibrosis.PURPOSE OF REVIEW Although the concept of risk prediction in chronic kidney disease (CKD) is not new, how to integrate risk prediction models into CKD care remains largely unknown, particularly in the prevention and early management of CKD. The present review presents a timely overview of recent CKD risk prediction models and conceptualizes how these may be integrated into the care of patients with CKD. RECENT FINDINGS In recent literature, prediction of time-to-ESKD has been thoroughly validated in multiple international cohorts, new models focused on CKD incidence, morbidity, and mortality have been developed, and ongoing work will determine the impact of integrating risk prediction models into CKD care on patients, nephrologists, and health systems. SUMMARY With the availability of new models focused on CKD incidence, the United States Preventive Task Force should reconsider its determination of insufficient evidence for primary screening of CKD, which was due in part to the absence of validated risk models to guide CKD screening. Models predicting CKD morbidity and mortality present a new opportunity to standardize the intensity and frequency of care across nephrology practices.PURPOSE OF REVIEW Successful integration of artificial intelligence into extant clinical workflows is contingent upon a number of factors including clinician comprehension and interpretation of computer vision. This article discusses how image analysis and machine learning have enabled comprehensive characterization of kidney morphology for development of automated diagnostic and prognostic renal pathology applications. RECENT FINDINGS The primordial digital pathology informatics work employed classical image analysis and machine learning to prognosticate renal disease. Although this classical approach demonstrated tremendous potential, subsequent advancements in hardware technology rendered artificial neural networks '(ANNs) the method of choice for machine vision in computational pathology'. Offering rapid and reproducible detection, characterization and classification of kidney morphology, ANNs have facilitated the development of diagnostic and prognostic applications. In addition, modern machine learning with ANNs has revealed novel biomarkers in kidney disease, demonstrating the potential for machine vision to elucidate novel pathologic mechanisms beyond extant clinical knowledge. SUMMARY Despite the revolutionary developments potentiated by modern machine learning, several challenges remain, including data quality control and curation, image annotation and ontology, integration of multimodal data and interpretation of machine vision or 'opening the black box'. Resolution of these challenges will not only revolutionize diagnostic pathology but also pave the way for precision medicine and integration of artificial intelligence in the process of care.Removal of internal fixation implants previously placed to stabilize posterior pelvic ring injuries may be technically challenging. Described techniques for extraction require specialized equipment, extensile measures, or purchase of additional implants. We describe a technique for removal of large diameter cannulated screws and washers from the posterior pelvic ring which requires no additional equipment or implants beyond the instrumentation used for implant insertion, as well as a series of fifteen cases in which the technique was applied.OBJECTIVE Evaluate a combined technique for treating distal femoral bone defects following debridement of osteomyelitis, using an external fixator together with a short supracondylar nail. DESIGN Retrospective study. SETTING Single tertiary referral centre. METHODS Between 2003 and 2018, 23 patients with a mean age of 37.2 years (26 - 56) underwent surgery with the same technique to manage post-debridement defects in the distal femur due to osteomyelitis. This involved acute shortening and intramedullary fixation of the defect site, together with re-lengthening from a proximal osteotomy using simultaneous external fixation. Radiographic union, range of motion of the hip and knee, external fixation time (EFT) and index (EFI), and limb length discrepancy (LLD) were assessed. RESULTS The mean follow-up was 51 months (18 - 192). Union was achieved in all patients without recurrence of infection during this follow-up period. The mean knee flexion was 120° and the mean extension deficit was 5° at final follow-up. The mean LLD improved from 5.5 cm (3 to 7) to 0.5 cm (0 to 2). The mean EFI was 29.2 days/cm (20 - 50) and the mean EFT was 115 days (90-150). Radiographic scores were excellent in 15 cases, good in 6, and fair in 2. Functional scores were excellent in 14 cases, good in 7, and fair in 2. CONCLUSION This combined strategy was an effective method for treating distal femoral segmental bone defects after debridement of osteomyelitis, with a high rate of union and acceptable complication rates. LEVEL OF EVIDENCE Level IV.OBJECTIVE To compare union and complication rates in pediatric patients presenting with tibial shaft fractures treated with closed or open reduction prior to intramedullary stabilization. DESIGN Retrospective review. SETTING Multiple pediatric trauma centers. PATIENTS Pediatric patients presenting with tibial shaft fractures treated with intramedullary stabilization. INTERVENTION Intramedullary stabilization following closed or open reduction (percutaneous and open approach) MAIN OUTCOME MEASURES Union rates, infection rate (superficial and deep), unplanned return to the operating room. RESULTS 166 patients were included in this study. 136 patients presented with closed fractures and 30 patients presented with open tibial shaft fractures. 37/136 patients (27%) with closed fractures had their fracture specifically opened during surgical fixation. There was no statistical difference in radiographic union at 6 months between fractures electively opened versus those treated with closed reduction alone 97% vs. 97% (p=0.9). PD 0332991 order No patient who underwent an open reduction developed infection or wound healing concerns, while 2/99 (2%) patients treated closed had superficial surgical site infections requiring additional treatment (p = .999). There was no difference in unplanned return to OR between those that underwent open reduction at the time of intramedullary stabilization. (p = .568). CONCLUSION Performing an open reduction in a closed pediatric tibial shaft fracture prior to intramedullary fixation does not increase the risk of surgical site infection or wound issues, delayed union, or unplanned return to the operating room. An open reduction of a closed tibial shaft fracture for purposes of improving a reduction prior to intramedullary stabilization may be a safe and effective clinical practice. LEVEL OF EVIDENCE Therapeutic Level III.PURPOSE OF REVIEW To give an updated review on the underlying mechanisms and clinical effects of improved glucose control after bariatric surgery. RECENT FINDINGS The basic principles of the mechanism for the metabolic effects of bariatric surgery can be categorized into calorie restriction, deviation of nutrients, and reduced amounts of adipose tissue. Recent findings suggest the importance of early changes following deviation of nutrients to more distal parts of the small bowel resulting in altered release of gastrointestinal hormones, altered gut microbiota, and weight-reduction. In the long-term, loss of adipose tissue results in reduced inflammation and improved insulin sensitivity. From a clinical perspective these changes are associated with remission of diabetes in patients with morbid obesity and type 2 diabetes, prevention of diabetes in patients with insulin resistance without overt type 2 diabetes and prevention of both microvascular and macrovascular complications for all patients with morbid obesity. SUMMARY At present, bariatric surgery remains the most effective treatment option to improve glucose control and long-term complications associated with hyperglycemia in patients with obesity.Although the mechanisms behind these metabolic effects remain only partially understood, further knowledge on these complex mechanisms may help identifying durable treatment options for morbid obesity and important metabolic comorbidities.BACKGROUND Introduction of the GlideScope videolaryngoscope caused a change in use of other devices for difficult airway management. link2 OBJECTIVE The influence of the GlideScope videolaryngoscope on changes in the indications for and the frequency of use of flexible fibreoptic-assisted intubation and other difficult airway management techniques. link3 DESIGN Retrospective cohort study. SETTING Tertiary care referral centre. METHODS Two periods of equal length (647 days each) before and after introducing the GlideScope were compared. Information about patients who were intubated using nondirect laryngoscopic techniques were analysed. Data were retrieved from the anaesthesia and hospital information management systems. RESULTS Difficult airway management techniques were used in 235/8306 (2.8%) patients before and in 480/8517 (5.6%) (P  less then  0.0001) patients after the introduction of the GlideScope. There was an overall 44.4% reduction in use of flexible fibreoptic bronchoscopy after GlideScope introduction [beforethan the reduction in the use of flexible fibreoptic bronchoscopy and other difficult intubation techniques. This may be attributed to resident teaching and use in patients with low-to-moderate suspicion of difficult intubation.