An Verdoodt, Patrick M. Honore, Rita Jacobs, Elisabeth De Waele, Viola Van Gorp, Jouke De Regt and Herbert D. Spapen
the kidneys via cholesterol-related and -unrelated mechanisms, resulting in potential acute and long-term benefit on the renal function.[ 2 , 3 ]
We reviewed the literature on statin use for prevention and treatment of various acute or chronic kidney(-related) disorders. Statins are highlighted as a novel therapeutic approach with reference to potential beneficial or harmful effects.
Arguments in favor of statin use
Prevention of acute kidney injury (AKI) after cardiac surgery
AKI complicating cardiac surgery is often multifactorial, leaving the precise
Gabriel Ungureanu, Ioana-Dana Alexa and Maria-Christina Ungureanu
The authors discuss an important chapter of iatrogenic pathology – unneccessary medicine, by reviewing epidemiological aspects and financial impact and identifying such elements in no less than 10 areas: surgery, interventional medicine, diagnostic investigation, substitute procedures, preventive medicine, drug therapy, aesthetic shared medical appointments, surgery, unconventional medicine, medicine on political demand. We shall review the causes, motives and mechanisms of unnecessary medicine such as one’s hyperprudence to cover oneself with diagnosis arguments or to prevent potential complications through preventive therapies (defensive medicine), weak functionality of the institutionalized inspection bodies, onerous motivation. The respect for the fundamental principles of medical ethics (the primum non-nocere principle doubled by the principle of doing good), the use of practice guidelines, the proper functioning self-control mechanisms in exercising the medical profession, a different management of error and the existence of a consistent protective legislation for both the patient and doctor would be key-elements to avoiding unnecessary medicine.
Gaëlle Wilmet, Rolf Verlinde, Jan Vandevoorde, Laure Carnol and Dirk Devroey
Introduction. Traditionally, the body mass index (BMI) is used to describe anthropometric measurements and to assess weight-related health risks. However, the abdominal circumference (AC) might also be a valuable parameter to estimate this risk. This study aims to describe an association between the BMI and the AC.
Material and Methods. Participants were recruited during the Brussels Food Fair in 2014. They completed a questionnaire with their medical history, and health related parameters such as blood pressure, weight, height and AC were measured.
Results. In total, 705 participants were analyzed. Men had a mean BMI of 27.3 kg/m2 and a mean AC of 98.7 cm. Women had a mean BMI of 26.0 kg/m2 and a mean AC of 88.2 cm. The Pearson’s correlation coefficient between the BMI and the AC was 0.91 for men and 0.88 for women. There was a strong positive correlation between the BMI and the AC. In the identification of patients at high risk for weight-related diseases, the use of the AC identified more patients than the BMI. Especially more women were ranking in a higher risk class with the AC than with the BMI classification. Both the BMI as well as the AC identified most diseases with an increased relative risk.
Conclusion. There is a strong correlation between the BMI and the AC. There are too few arguments to prefer the use of AC above the BMI to detect people at high risk for weight-related diseases.
Inimioara Mihaela Cojocaru, V. Ştefănescu, Daniela Traşcă, Adelina Şerban-Pereţeanu, B. Chicoş and M. Cojocaru
A 78-year-old Caucasian man was admitted in the Department of Neurology for visual disturbances, started two days before. The next day the patient experienced headache, fever and gait disturbances. He had hypertension, diabetes mellitus, an ischemic stroke 13 years ago, longstanding seronegative rheumatoid arthritis (17 years), polynodular goiter, right ischio-pubian fracture and right femoral vein thrombosis a year ago due to a car accident, since he is treated with oral anticoagulants associated to antiaggregant, hypotensors, statin and oral antidiabetics. The neurologic examination had evidenced nuchal rigidity, left homonymous hemianopsia, left central facial palsy, ataxia of the inferior limbs with wide-based gait, achilean reflexes abolished bilaterally, bilaterally abolished plantar reflexes, ideomotor apraxia, dysarthria, hypoprosexia, and preserved consciousness patient. A non-contrast cerebral CT scan had shown right temporal and parieto-occipital intraparenchymatous hemorrhages, a right frontal sequelar lesion, multiple old lacunar infarcts, cortical atrophy. Laboratory findings included an inflammatory syndrome, absence of rheumatoid arthritis positive serology, normal coagulogram, an elevated proteinuria. The cerebral IRM performed on the seventh day of hospitalisation was suggestive for subacute right parietal hemorrhage, old cerebral infarction in the right anterior cerebral artery area, old lacunar infarcts and cerebral atrophy. The anticoagulant and antiaggregant treatment was stopped after a generalized tonic-clonic seizure occurred. Antiedematous, hypotensor, anticonvulsivant, beta-blocker, and symptomatic treatment was started, while the antidiabetic treatment was continued. All symptoms remitted. Arguments for amyloid angiopathy in our patient are previous non-cardioembolic ischemic stroke and a chronic inflammatory disease-rheumatoid arthritis in his personal medical history.
Elena Bălăşescu, Mirela Cioplea, Alice Brînzea, Roxana Nedelcu, Sabina Zurac and Daniela Adriana Ion
Introduction. Diabetes Mellitus causes ultrastructural changes triggered by partially clarified cellular mechanisms. Since cell death is an important mechanism in the appearance and progression of diabetic nephropathy, we studied alteration of several markers of apoptotic pathways signaling in renal tissue of diabetic or prediabetic patients.
Methods. We analyzed 48 human kidney tissue samples divided into two study groups: the research group (43 renal tissue samples from diabetic or prediabetic patients), and the control group (5 renal tissue samples from patients without diabetes). Immunohistochemistry revealed expression of Bcl-2, APAF-1, CD-95 and Caspase-9 in the renal cortical structures. Statistical analysis was also performed (significance level P<0.05).
Results. We found a variable expression of the antiapoptotic Bcl-2 with a decrease of Bcl-2 expression in diabetes. The control samples render evident intensely positive immunostaining for CD-95. In diabetes and diabetic nephropathy, there was positive immunostaining for APAF-1 at tubular cell level. Nuclear and cytoplasmic positivity for Caspase-9 was more frequently recorded as kidney damage progresses. APAF-1 and Caspase-9 positivity are arguments for an intrinsic apoptotic mechanism of cell death in diabetic nephropathy.
Conclusion. The mechanisms of apoptotic cell death identified in diabetic kidney samples prove that Bcl-2, CD-95, APAF-1 and Caspase-9 represent reliable markers of cell death in human renal tissue. Our results support the hypothesis that apoptosis is a pathogenic and initiator mechanism of renal remodeling in diabetic kidney disease.
Ciprian Blendea, István Kovács, Andreea Bărcan, Tiberiu Nyulas and Monica Chițu
1. Lee MS, Bokhoor P, Park SJ, et al. Unprotected left main coronary disease ant ST-segment elevation myocardial infarction: a contemporary review and argument for percutaneous coronary intervention. JACC Cardiovasc Interv. 2010;3:791-795.
2. Morice MC, Serruys PW, Kappetein AP, et al. Outcomes in Patients With De Novo Left Main Disease Treated With Either Percutaneous Coronary Intervention Using Paclitaxel-Eluting Stents or Coronary Artery Bypass Graft Treatment in the Synergy Between Percutaneous Coronary Intervention With TAXUS and
Sebastien Redant, Jacques Devriendt, Ilaria Botta, Rachid Attou, David De Bels, Patrick M. Honoré and Charalampos Pierrakos
] Another argument was that thermodilution did not allow the distinction between hydrostatic and inflammatory edema. [ 9 ] The study by Kushimoto refuted this last argument by introducing the PVPI. [ 11 ] Before the Berlin criteria were available, the definition of ARDS did include the PAOP value measured by pulmonary arterial catheters (Swan-Ganz catheter). This was even more invasive, expensive and methodologically limited than transpulmonary thermodilution. [ 9 ] Pulmonary edema now includes cardiogenic pulmonary edema, ARDS (at risk, moderate or severe), and a
the AAA between EPA and DHA groups. Similar arguments have been presented by Meital et al . [ 2 ] and suggested that inflammation plays a key role in the pathogenesis of AAA, and EPA and DHA are beneficial in the animal models of AAA in view of their anti-inflammatory actions. It was also suggested [ 2 ] that anti-inflammatory products of EPA and DHA, such as resolvins, protectins and maresins, may have a role in this beneficial action.
Pufas and their metabolites, angiotensin-II, AA and AAA
These results reported by Yoshihara et al . [ 1 ] and
. One could argue that the rates of recurrent disease, biochemical disease, metastasis, persistent disease, or death, which were reported as not statistically different, are an indication that both treatments are ineffective and that one should administer higher prescribed activities of I-131. To take this argument further, if one compares the administration of 30 mCi of I-131 to no treatment with I-131 and demonstrates that the outcomes are the same, would one conclude that they are equally effective or would one conclude that 30 mCi is not effective at all? Both are
not entirely clear based on information currently available; however, an article by Jasanoff et al . [ 3 ] posted on the US National Academy of Science’s website as part of the promotion for the recent NAS/ NAM International Summit meeting on gene editing contains arguments that support the US government’s position on the regulation of genome science research and the moratorium it proposes. The article was also published in the NAS’s Issues in Science and Technology publication, and even though gene editing is a controversial subject, the NAS did not post or