Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Study on the Organoleptic Intensity Scale for Measuring Oral Malodor

The 0–5 organoleptic scale is used widely in breath research and in trials to measure the efficacy of anti-odor agents. However, the precise relationship between odor scores and gas concentrations of target odorants is unknown. The purpose of this study was to relate mean organoleptic scores from odor judges (n = 7) for pure odorants (n = 8) representative of those found in oral malodor. Judges used a common 0–5 scale to report the odor intensity of sample sets in random order of concentration. Regression analysis of data showed that odor score was proportional to the log concentration of odorant, and comparison of slopes showed H2S to be the most significant in terms of odor power. Detection thresholds (mol.dm−3) were: Skatole (7.2 × 10−13) < methylmercaptan (1.0 × 10−11) < trimethylamine (1.8 × 10−11) < isovalerate (1.8 × 10−11) < butyrate (2.3 × 10−10) < hydrogen sulphide (6.4 × 10−10) < putrescine (9.1 × 10−10) < dimethyl disulphide (5.9 × 10−8). The study demonstrates the exponential nature of the olfactory response and shows that any single compound’s contribution to malodor depends on odor power and threshold in addition to concentration.

Valuation of national park system visitation: the efficient use of count data models, meta-analysis, and secondary visitor survey data

The National Park Service (NPS) currently manages a large and diverse system of park units nationwide which received an estimated 279 million recreational visits in 2011. This article uses park visitor data collected by the NPS Visitor Services Project to estimate a consistent set of count data travel cost models of park visitor willingness to pay (WTP). Models were estimated using 58 different park unit survey datasets. WTP estimates for these 58 park surveys were used within a meta-regression analysis model to predict average and total WTP for NPS recreational visitation system-wide. Estimated WTP per NPS visit in 2011 averaged $102 system-wide, and ranged across park units from $67 to $288. Total 2011 visitor WTP for the NPS system is estimated at $28.5 billion with a 95% confidence interval of $19.7-$43.1 billion. The estimation of a meta-regression model using consistently collected data and identical specification of visitor WTP models greatly reduces problems common to meta-regression models, including sample selection bias, primary data heterogeneity, and heteroskedasticity, as well as some aspects of panel effects. The article provides the first estimate of total annual NPS visitor WTP within the literature directly based on NPS visitor survey data.

In vitro models for oral malodor

A model is a representation of some real phenomena and contains aspects or elements of the real system to be modeled. The model reflects (or duplicates) the type of behavior (or mechanisms) seen in the real system. The main characteristic of any model is the mapping of elements or parameters found in the system being studied (e.g. tongue dorsum biofilm in situ) on to the model being devised (e.g. laboratory perfusion biofilm). Such parameters include correct physico-chemical (abiotic) conditions as well as biotic conditions that occur in both model and reality. The main purpose of a model is to provide information that better explains the processes observed or thought to occur in the real system. Such models can be abstract (mental, conceptual, theoretical, mathematical or computational) or 'physical', e.g. in the form of a real disaggregated in vitro system or laboratory model. A wide range of different model systems have been used in oral biofilm research. These will be briefly reviewed with special emphasis on those models that have contributed most to knowledge in breath odor research. The different model systems used in breath odor research are compared. Finally, the requirements for developing an overall 'bad breath model' from considering the processes as a whole (real oral cavity, substrates in saliva, biotransformation by tongue microflora, odor gases in the breath) and extending this to the detection of malodor by the human nose will be outlined and discussed.

Actinide speciation in relation to biological processes

In case of accidental release of radionuclides into the environment, actinides represent a severe health risk to human beings following internal contamination (inhalation, ingestion or wound). For a better understanding of the actinide behaviour in man (in term of metabolism, retention, excretion) and in specific biological systems (organs, cells or biochemical pathways), it is of prime importance to have a good knowledge of the relevant actinide solution chemistry and biochemistry, in particular of the thermodynamic constants needed for computing actinide speciation. To a large extent, speciation governs bioavailability and toxicity of elements and has a significant impact on the mechanisms by which toxics accumulate in cell compartments and organs and by which elements are transferred and transported from cell to cell. From another viewpoint, speciation is the prerequisite for the design and success of potential decorporation therapies. The purpose of this review is to present the state of the art of actinide knowledge within biological media. It is also to discuss how actinide speciation can be determined or predicted and to highlight the areas where information is lacking with the aim to encourage new research efforts.

Regulation of leptin synthesis and secretion before birth: implications for the early programming of adult obesity

A series of epidemiological, clinical and experimental studies have shown that there are associations between the fetal and neonatal nutritional environment and the amount and distribution of adipose tissue in adult life. This review considers the evidence for these relationships and discusses the potential impact of the prenatal nutritional experience on the development of the endocrine and neuroendocrine systems that regulate energy balance, with a particular emphasis on the role of the adipocyte-derived hormone, leptin. In the rodent, leptin derived from the mother may exert an important influence on the development of the appetite regulatory neural network and on the subsequent regulation of leptin synthesis and the risk for obesity in the offspring. In species such as the human and sheep, there is also recent evidence that the synthesis and secretion of adipocyte-derived hormones, such as leptin, are regulated in fetal life. Furthermore, the hypothalamic neuropeptides that regulate energy intake and expenditure in adult life are also present within the fetal brain and may be regulated by the prevailing level of maternal and hence fetal nutrient and hormonal signals, including leptin. This work is important in determining those initiating mechanisms within the 'fat-brain' axis in early life that precede the development of adult obesity.

Assessing the relationship between concentrations of malodor compounds and odor scores from judges

BACKGROUND

The purpose of this review was to assess the relationship between mean organoleptic scores (using a 0-to-5 scale) and concentrations of putative odorants representative of those thought to be important in oral malodor, as well as to propose a simple model that explains the dose-response curves obtained from a group of odor judges.

METHODS

The model assumes that the scale is rooted at the detection threshold (0), the maximum score (5) is fully saturating and the brain and olfactory nervous system can act as a faithful transducer of the state of binding (occupancy) of the smell receptors in the nose. The authors predicted that the response would be exponential or sigmoidal in nature. They tested this using published empirical data based on seven odor judges and eight odor compounds.

RESULTS

Analysis of the data by different plotting methods showed the odorants to be significantly different from each other (P < .01 by regression analysis) with regard to thresholds and slopes. The lower the threshold, the stronger the inherent odor of the compound. The greater the slope, the greater the odor power. Volatile sulfur compounds had low smell thresholds and high odor power and were highly volatile, while indole was less volatile but had a very low threshold. Both compounds may be significant in human oral malodor.

CONCLUSIONS

The authors found that the organoleptic scale was exponential in practice. These findings imply that when inhibitory agents are tested against odor-generating bacteria, a given percentage inhibition of the volatile compound production rate by a treatment (such as an antimicrobial mouthwash) will result in an equal incremental reduction on the scale, regardless of the starting position on the scale. Understanding the scale enables dental professionals to develop better ways of training, calibrating and standardizing odor judges, along with better ways of designing clinical trials and interpreting data regarding the efficacy of antiodor treatments.

Use of n-butanol as an odorant to standardize the organoleptic scale of breath odour judges

OBJECTIVE

The alcohol n-butanol has been recommended for use as a standard odorant by various groups for the training or standardization of breath odour judges and sensory evaluation panels. The objective of this study is to assess the use of n-butanol as a suitable odorant for organoleptic training of breath judges.

METHODS

One judge with full smell acuity was trained in the method of organoleptic assessment using odorant solutions of main chemical classes (acids, amines, indole and sulphides) with the exception of alcohols. The subject was proficient in scoring odorant solutions, standard gas mixtures and human breath using the Rosenberg 0-5 organoleptic scale. A wide range of n-butanol solutions were prepared from 0 to 90 000 ppm and dispensed as replicate 12-ml volumes in Universal bottles (24 ml) leaving a headspace of 12 ml. Sets of odorants were prepared, labelled by code, randomized and presented to the judge in a completely blind fashion. The judge scored each concentration. This process was repeated on 32 occasions over a period of 12 weeks. Mean values of data for each determination for each concentration series were plotted against the log concentrations of odorant. Linear regression slope analysis was used to measure slope, the 95% CI of slope and the scatter of points (R2 value). Headspace concentrations of odorant were determined using gas chromatography (GC) analysis.

RESULTS

The n-butanol regression slope gave a high R(2) value (0.971) and low scatter. However, the data did not correspond to other published work using an ASTM method where the range of recommended butanol concentrations was insufficient at both the high and low ends to determine the top and threshold. Moreover, headspace analysis using GC confirmed the published gas concentrations to be in error by a factor of 100. It was also observed that high concentrations of odorants were irritant causing desensitization if used for prolonged periods.

CONCLUSION

The published method had erroneous headspace calculations listed and n-butanol could not be recommended as a training odorant because of its irritancy.

Matrix metalloproteinase inhibitors cause cell cycle arrest and apoptosis in glomerular mesangial cells

Inflammation is characterized by an excess of cell proliferation often leading to fibrosis and sclerosis with subsequent loss of organ function. We hypothesized that these features may be ameliorated by induction of cell cycle arrest and apoptosis as result of therapy with matrix metalloproteinase (MMP) inhibitors. In our study, mesangial cells and experimental mesangial proliferative glomerulonephritis provided the model of inflammation. First, we investigated the effect of the MMP inhibitor BB-1101 in anti-Thy1.1 nephritis. The numbers of apoptotic glomerular cells in nephritic rats increased about 4 and 6 times as a result of BB-1101 therapy, observed 11 and 14 days after induction of disease, respectively. Subsequently, rat mesangial cells were exposed to an MMP inhibitor in vitro. Fluorescence-activated cell sorter analyses of cells exposed to RO111-3456 demonstrated a dose-dependent cell cycle arrest in the G(0)/G(1) phase associated with increased expression of statin. The cell cycle arrest was followed by apoptosis as investigated by terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate (dUTP) biotin nick-end labeling (TUNEL) and acridine orange/ethidium bromide stainings, as well as by annexin V binding. The induction of p53, p21, and bax, but not the Fas/FasL pathway appeared to play an important pathogenetic role. In summary, MMP inhibitors induce cell cycle arrest followed by apoptosis in mesangial cells. These features help to explain the anti-inflammatory effects of these compounds, such as reduction of mesangial cell proliferation and attenuation of extracellular matrix accumulation. In conclusion, induction of cell cycle arrest with subsequent apoptosis may offer new perspectives in the therapy of inflammation even beyond kidney diseases.

Dangerous chemicals: EDEXIM: The European database on export and import of certain dangerous chemicals

Council Regulation (EEC) No 2455/92 has been adopted by the Council of the European Communities, in 1992, to improve information exchange on certain dangerous chemicals with third countries, particularly developing countries. To implement the notification procedure in accordance with the Regulation, a database has been developed to manage and simplify the procedure. The software exists in three versions; one adapted for use by the Designated Authorities of the Member States, another for the European Chemicals Bureau (ECB) and the third one is an information version aimed at Designated National Authorities outside the European Union and Industry. The database "EDEXIM" is currently working in a PC environment and is being developed as an on-line system with a stand-alone client/server architecture.

Factors influencing the uptake of iron and plutonium into cells

Uptake of 59Fe as well as 125I-labelled Fe-transferrin into HeLa cells points to the existence of a limited number of specific binding sites. This is in contrast to hepatocytes and hepatoma cells (Hep G2) where metal uptake from transferrin is very low, not saturable and cannot be prevented by an excess of the protein. Iron uptake into these cells is much higher from the citrate complex. The same is true for plutonium uptake into rat hepatocytes, while the uptake of this metal into Hep G2 cells is very small regardless of the ligand. In contrast to iron, plutonium presented as citrate is taken up into HeLa cells much better than plutonium presented as transferrin. The uptake of both metals from the citrate complex requires a high activation energy and can be prevented only by inhibition of oxidative phosphorylation. Other processes such as endocytosis, intactness of microtubuli, assembly of microfilaments or pH of the lysosomes do not seem to be of importance. Metal uptake from the citrate complex can be prevented only by the presence of other chelating agents and/or by transferrin. It can be assumed, therefore, that the metals react directly with constituents of the cell membrane, a process in which chelating agents can successfully compete if they form strong enough complexes with the metals.

TDPAC studies of the metal-binding sites in serum transferrin: comparison between 181Hf-labeled human- and rat-serum transferrin

The binding of hafnium to human serum transferrin was studied using the time differential perturbed angular correlation (TDPAC-) technique. The samples were prepared in vitro by adding 181Hf-NTA solution to human serum. Two specific electric quadrupole interactions were observed, which correspond to two well-defined binding configurations. Their relative intensities depend on the pH, salt- and hafnium-concentrations, and on the incubation time. The present data may be compared with the results of a previous rat serum study, where the hafnium binding to transferrin behaved rather similarly. Small but significant differences, however, can be deduced from the TDPAC-parameters for these human and rat transferrin species. For either binding configuration, the electric field gradient (EFG) is slightly higher in the case of rat transferrin. The most characteristic difference, however, concerns the asymmetry parameter eta 2 of the second binding configuration, which is about 10% smaller for rat serum transferrin. The TDPAC-technique might be used as a sensitive and reliable analytical method to study the metal-binding sites of different transferrin species.

In vivo and in vitro studies of hafnium-binding to rat serum transferrin

The binding of hafnium to rat serum transferrin was studied using the time differential perturbed angular correlation (TDPAC) technique. Hafnium is interesting as a toxic metal binding to transferrin because it behaves metabolically similarly to plutonium. The isotope 181Hf offers favorable access to the TDPAC-method. Samples were prepared in vivo by intravenous injection of Hf-NTA, Hf-citrate, and Hf-oxalate solutions, respectively, into Sprague-Dawley rats and in vitro by adding Hf-NTA solution to fresh rat serum. In both cases two specific electric quadrupole interactions were observed, which correspond to two well-defined binding configurations. They may be attributed to the N-terminal and the C-terminal binding site in the transferrin molecule. The 181Hf-distribution between these two binding states depends on pH, salt and hafnium concentrations, temperature, and incubation time. With a fast TDPAC-setup of four BaF2-detectors a time resolution of about 600 ps could be achieved. The specific binding configurations of 181Hf and the comparatively slow relaxation times lead to spectra of considerable accuracy.

Identification of transferrin as the principal neptunium-binding protein in the blood serum of rats

The binding of 239Np(V) to blood serum components of rats was examined in vivo and in vitro. After gel filtration of the serum using a Sephacryl S-300 column, 98% of the applied activity appeared with protein fractions representing coeluted albumins and transferrin. A separation of the albumin- and transferrin-proteins by ion-exchange chromatography using DEAE-cellulose showed the 239Np being entirely bound to the iron-carrier protein transferrin. The high elution yields from the ion-exchange columns, greater than 90%, suggest that the binding may be quite strong. The binding capacity of transferrin for neptunium in vivo was found to decline when the iron level in blood serum was increased. Precipitation experiments showed that 84 +/- 2% of the 239Np was precipitated with 10% (w/v) trichloracetic acid, 77 +/- 3% with 90% ethanol but only 6 +/- 1% with saturated ammonium sulphate at pH 7.4. The available data indicate that as for plutonium, thorium, americium and curium, the iron transport protein, transferrin, may be the main carrier protein for neptunium in mammalian blood serum.