Search Results (141)

Background/Objectives: Intraoperative oliguria has long been considered a marker of impaired renal perfusion, but its prognostic value for postoperative acute kidney injury (AKI) remains controversial, particularly within Enhanced Recovery After Surgery (ERAS) protocols. We investigated the association between intraoperative oliguria and postoperative AKI in patients undergoing major hepatobiliary and pancreatic surgery within an ERAS protocol. Methods: Patients who underwent major hepatobiliary and pancreatic surgery within an institutional ERAS protocol were retrospectively analyzed. Intraoperative oliguria was defined as urine output < 0.3 mL kg⁻¹ h⁻¹. Postoperative AKI was defined according to the KDIGO serum creatinine criterion within 7 days after surgery. The association was assessed using multivariable logistic regression and sensitivity analyses were performed using an alternative oliguria threshold of <0.5 mL kg⁻¹ h⁻¹ and incorporating additional surgical covariates. Results: Among 816 patients, intraoperative oliguria occurred in 51 (6.3%), and postoperative AKI developed in 60 (7.4%). AKI incidence did not differ between the oliguria and non-oliguria groups (11.8% vs. 7.1%, p = 0.332), and median intraoperative urine output was comparable between the AKI and non-AKI groups (0.7 [0.5–1.1] vs. 0.8 [0.6–1.4] mL kg⁻¹ h⁻¹, p = 0.069). In multivariable analysis, intraoperative oliguria was not independently associated with AKI (OR 1.68, 95% CI 0.60–4.01; p = 0.276). Oral carbohydrate loading, thoracic epidural analgesia, and total intraoperative fluid volume were not associated with AKI. Results were consistent across both sensitivity analyses. Conclusions: In patients undergoing hepatobiliary and pancreatic surgery within the ERAS protocol, intraoperative oliguria was not associated with postoperative AKI, although modest association cannot be excluded given the limited number of AKI and oliguria events. These findings suggest that intraoperative urine output alone may not be a reliable indication for additional fluid administration, and larger prospective studies are needed to confirm this. Full article

Objectives: This study compared the risk profiles, nutrient intake, and kidney function of calcium oxalate stone formers with and without enteric hyperoxaluria. Methods: Thirty-seven patients with calcium oxalate stone disease and enteric hyperoxaluria (cases) and 37 sex- and age-matched idiopathic calcium oxalate stone formers (controls) were enrolled. Patients did not receive any nutritional counseling prior to the start of the study, and they discontinued medications affecting urinary parameters four weeks before their study participation. Anthropometric, clinical, and metabolic parameters were recorded. Dietary and 24-h urinary variables were measured under the habitual diet and under a balanced, standardized diet. The [¹³C₂] oxalate absorption and calcium loading tests were carried out. Results: The median [¹³C₂] oxalate absorption was significantly higher in cases (14.8%) than in controls (8.9%). Under the balanced diet, hypocitraturia, hypomagnesuria, low urine volume and pH value were significantly more common in the case group, whereas hypercalciuria occurred more frequently in the control group, affecting 45.9% of controls and 5.4% of cases. Furthermore, the control group exhibited a greater reduction in urinary calcium excretion under the balanced diet. Urinary oxalate excretion and the ion-activity product index of calcium oxalate were significantly higher under both diets, with a greater decline observed in the case group under the balanced diet. The estimated glomerular filtration rate (eGFR) was lower in cases. A multivariable linear regression analysis revealed a significant association between urine pH and eGFR. Conclusions: Calcium oxalate stone formers with and without enteric hyperoxaluria benefit from a balanced diet and sufficient fluid intake. The reduction in urinary oxalate excretion and the biochemical risk of recurrent calcium oxalate stone formation were even more pronounced in patients with enteric hyperoxaluria. Particular attention should be paid to low urine pH, as it is hypothesized to be a potential indicator of impaired kidney function. Full article

Background: Turnaround time (TAT) is a key performance indicator in clinical microbiology, particularly for urine cultures, which represent a high-volume workload and directly impact antimicrobial stewardship. Methods: This retrospective observational study compared urine culture TAT before (2023, manual workflow) and after (2025, total laboratory automation using WASPLab™) implementation in a high-volume reference laboratory. A total of 16,210 cultures in 2023 and 60,474 in 2025 were included. TAT was defined as the time from laboratory receipt to final report validation. Results: Implementation of total laboratory automation significantly reduced median TAT for both negative cultures (from 49.68 to 34.38 h) and positive cultures (from 50.42 to 34.62 h) (p < 0.001). In addition, variability in reporting times decreased, indicating improved consistency. Laboratory productivity increased from 2316 to 7559 cultures per full-time equivalent, representing a 3.26-fold improvement. Conclusions: Total laboratory automation significantly improved the speed and consistency of urine culture reporting, supporting enhanced laboratory efficiency and facilitating timely clinical decision-making. Full article

Background: Evaporative water loss from burn wounds is a major but often neglected component of early fluid requirements. Despite its physiological importance, no dedicated review has quantified acute post-burn evaporative water loss (TEWL) and its interaction with modern resuscitation strategies in over 40 years. Recent mass-casualty burn events in specialized centers have re-emphasized the clinical importance of accurate early fluid balance, which is particularly challenging. Methods: A scoping review (PRISMA-ScR) of historical quantitative studies and 23 contemporary (2015–2025) adult major-burn resuscitation cohorts was conducted. Expected TEWL was derived from Lamke benchmarks; interstitial edema was estimated from the only available regression of simultaneous fluid input and 24 h weight change. A novel TEWL/edema ratio was tested against resuscitation volume (mL/kg/%TBSA) and the established input/output (I/O) ratio. Results: In the acute phase, the median TEWL normalized to total body surface area was 71 mL/m²/h [52–79 mL/m²/h], allowing for calculation of the TEWL/edema ratio. The TEWL/edema ratio was inversely correlated with the resuscitation fluid dose (R² = 0.811) and the I/O ratio as well (R² = 0.86), crossing unity at 2.85 mL/kg/%TBSA. A ratio > 1 signals high evaporative drive and/or possible under-resuscitation; a ratio < 1 alerts to fluid creep before significant weight gain. Conclusions: The TEWL/edema ratio is the first physiology-grounded, easily calculable resuscitation endpoint that complements urine output by providing insight into whether administered fluid is lost as obligatory evaporation or sequestered as edema. Routine estimation of expected TEWL and early monitoring of the TEWL/edema ratio may help guide goal-directed burn resuscitation, especially when early excision is delayed or impossible. Given the substantial inter-individual variability, the ratio derived from aggregate data should not be interpreted as a patient-specific predictor. Full article

Apolipoprotein epsilon (APOE) is a small molecular protein that regulates lipid and lipoprotein homeostasis. Several reports demonstrated that apolipoprotein epsilon-4 allele (APOE4) expression significantly increases the genetic risk of Alzheimer’s disease (AD) and chronic kidney disease. However, there is inconsistent evidence of the association of AD with dietary habits, especially salt intake. Therefore, we hypothesized that high dietary salt intake would exacerbate cognitive decline in mice expressing the human APOE4 allele. We used human APOE (APOE4 and APOE3) knock-in mice to test this hypothesis. Young adult male and female mice aged 5–7 months old (n = 18 in each group) were fed a 4% NaCl (high-salt) or a 0.1% NaCl (low-salt) diet for 4 weeks. Metabolic cage studies were used to assess 24 h measurements of food and water intake, and urine output. Spatial memory and learning were determined using the Barnes maze test. Both the APOE3 and APOE4 mice on a low-salt diet had significantly decreased urinary volume, and female mice had lower body weight. The APOE4 mice on the low-salt diet (0.1%) performed significantly better on the 72 h probe test as compared to the APOE4 mice on 4% salt diet. The results demonstrate an association among dietary salt, memory, and APOE4 genotype. Full article

Background: Intraoperative high-volume diuresis is a common but under-recognized phenomenon during off-pump coronary artery bypass grafting (OPCABG). Its clinical correlates and implications for perioperative management remain incompletely characterized. Methods: This single-center retrospective cohort study included 1274 adults undergoing elective OPCABG between January and August 2025. High-volume diuresis was defined as urine output ≥ 5 mL·kg⁻¹·h⁻¹. Multivariable logistic regression was used to identify factors independently associated with intraoperative high-volume diuresis. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Results: High-volume diuresis occurred in 39.6% of patients. Older age, hypertension and greater intraoperative fluid infusion were independently associated with high-volume diuresis, whereas preoperative diuretic and greater cumulative exposure to systolic blood pressure < 100 mmHg were inversely associated with diuresis. The multivariable model demonstrated acceptable discrimination (AUC = 0.756). Postoperative outcomes, including acute kidney injury, duration of mechanical ventilation, intensive care unit stay, and hospital length of stay, did not differ between groups. Conclusions: Intraoperative high-volume diuresis during OPCABG reflects complex physiological and hemodynamic responses and can be anticipated based on preoperative and intraoperative factors. These findings support a more individualized interpretation of urine output and perioperative management strategies in OPCABG. Full article

Membrane distillation (MD) was a promising approach for treating highly concentrated ammonia–nitrogen wastewater. However, membrane wetting often limited large-scale application. To address this, we built an anti-wetting layer on a commercial PVDF membrane surface by coating fluoride and depositing SiO₂ nanoparticles. Three PVDF/ SiO₂/F membranes were prepared with different silicon contents: 1%, 6%, and 12% (volume) of tetraethyl orthosilicate (TEOS). These processes created different surface roughness on the modified membranes. Results showed that the membrane containing 6% TEOS exhibited the best resistance to sodium dodecyl sulfate (SDS) in NaCl solution. This optimized membrane was subsequently tested with real wastewater, including source-separated urine and landfill leachate. In 10 h, it removed 97.5% of total organic carbon (TOC) from urine, achieving an ammonia absorption rate of 55.1% and removed 92.4% from leachate, with an ammonia absorption rate of 37.58%. These results provide a reference for membrane fabrication parameter optimization to enhance the membrane’s anti-wetting ability. Full article

Background/Objectives: Hemodynamic and neurohormonal factors, including renal perfusion and venous pressure, may affect diuretic response, which may be modulated by body position. This study aimed to assess whether supine versus upright positioning influences diuretic efficacy and neurohormonal activation during early decongestion in patients with AHF and reduced ejection fraction (HFrEF). Methods: This single-center, prospective, pilot randomized study enrolled 12 hospitalized patients with decompensated HFrEF receiving guideline-directed medical therapy. Participants were randomized (1:1) to remain in either the supine or upright/seated position during intravenous furosemide administration (1 mg/kg: half of the dose administered as a bolus, half as a 2-h infusion). Serial measurements of urine volume, electrolyte excretion, and neurohormonal biomarkers (renin, aldosterone, catecholamines) were performed at baseline, 2, and 6 h after diuretic administration. Results: No significant differences were found between supine and upright groups in total urine output, urine dilution, sodium excretion, or weight change after 6 h. There were no statistically significant differences in renin and aldosterone levels across subsequent timepoints; however, renin concentration tended to be higher in upright than in supine individuals. Interestingly, supine participants demonstrated greater urinary adrenaline concentration after furosemide administration, alone and after adjustment for urinary creatinine. Conclusions: No clinically meaningful differences were found between supine versus upright position patients with AHF, receiving neurohormonal blockade. Full article

Introduction: Nocturnal enuresis is defined as involuntary urination during sleep in children, particularly those aged 5 years or older. Primary monosymptomatic nocturnal enuresis (PMNE) involves nighttime wetting without daytime symptoms, and although factors like reduced bladder capacity, nocturnal polyuria, and impaired arousal contribute, predictors of long-term relapse remain uncertain. Methods: This retrospective cohort study included 227 children aged ≥5 years with strictly defined PMNE who achieved complete remission following a standardized 3-month treatment protocol (alarm therapy, desmopressin, or desmopressin plus oxybutynin). All children underwent ICCS-based assessment, including physical examination, urinalysis, ultrasonography, UFM, a 48 h frequency/volume (F/V) diary, and post-void residual measurement. One year after treatment discontinuation, patients were reassessed using a 14-day wet-night diary. Predictors of relapse were analyzed using comparative statistics. Result: At 1-year follow-up, 48.5% of children experienced relapse. Age, sex, treatment modality, family history, and baseline wet-night frequency were not associated with relapse (p > 0.05). Diary-based FBC was significantly higher than UFM-based capacity (p < 0.001). Reduced diary-based mean FBC/EBC ratios were significantly more common among relapsing children (p < 0.001), whereas UFM-derived ratios showed no significant difference (p = 0.052). ROC analysis demonstrated moderate discriminatory performance for diary-based FBC/EBC (AUC 0.671). A ratio > 79% predicted sustained remission with 83.6% specificity and a positive predictive value of 73.5%. Conclusions: Diary-derived bladder capacity is the strongest predictor of long-term relapse in PMNE and outperforms UFM-based assessment. A mean FBC/EBC ratio > 79% provides a clinically useful threshold for identifying children at low risk of recurrence. Those with reduced diary-based capacity may benefit from closer follow-up or extended maintenance therapy. Full article

Background/Objectives: Volatile organic compounds (VOCs) are emerging as non-invasive biomarkers of metabolic and disease-related processes, yet their reliable detection from complex biological matrices such as urine remains analytically challenging. This study aimed to establish a robust, non-targeted headspace solid-phase microextraction gas chromatography–mass spectrometry (HS–SPME GC–MS) workflow optimized for very small-volume urinary samples. Methods: We systematically evaluated the effects of pH adjustment and NaCl addition on VOC extraction efficiency using a 75 µm CAR/PDMS fiber and a sample volume of only 0.75 mL. Method performance was further assessed using concentration-dependent experiments with representative VOC standards and by application to real human urine samples analyzed in technical triplicates. Results: Acidification to pH 3 markedly improved extraction performance, increasing both total signal intensity and the number of detectable VOCs, whereas alkaline conditions and additional NaCl produced only minor effects. Representative VOC standards showed compound-specific linear dynamic ranges with minimal carry-over within the relevant analytical range. Application to real urine samples confirmed high analytical reproducibility, with triplicates clustering tightly in principal component analysis and most metabolites exhibiting relative standard deviations below 25%. Conclusions: The optimized HS–SPME GC–MS method enables comprehensive, non-targeted urinary VOC profiling from limited sample volumes. This workflow provides a robust analytical foundation for exploratory volatilomics studies under sample-limited conditions and supports subsequent targeted method refinement once specific compounds or chemical classes have been prioritized. Full article

Iodine is essential for thyroid hormone synthesis and is particularly critical during pregnancy, where excess and mainly its deficiencies can impair fetal neurodevelopment and increase maternal complications. Bromine has also gained attention due to its potential to interfere with iodine metabolism and contribute to adverse health effects when present in excess. Monitoring iodine and bromine in biological samples, especially urine and serum, is therefore important for assessing thyroid function and population health. This work presents a simple and robust ICP-MS method for simultaneous determination of bromine and iodine in urine and serum. The procedure uses a 20-fold dilution with 10 mmol L⁻¹ ammonia containing 0.1% (w/w) EDTA-2Na, ensuring solution stability, minimizing sample-to-sample variability, and eliminating the need for matrix-matched calibration. EDTA-2Na effectively prevents precipitation of metal species at high pH, avoiding blockages in the sample introduction system. Method accuracy was confirmed through certified reference materials and spike-recovery experiments, both showing suitable agreement for the two analytes. Precision was consistently strong (RSD < 6%), and low detection limits were achieved (0.78 μg L⁻¹ for Br and 0.24 μg L⁻¹ for I). The use of a high-efficiency nebulizer enabled analysis with only 50 µL of sample, making the method suitable for limited-volume specimens. Overall, this approach provides a sensitive, accurate, and practical solution for large-scale population studies and clinical applications. Full article

Background: Intraoperative high-volume diuresis is a frequent but underrecognized complication in cardiac surgery, potentially leading to hypovolemia, electrolyte imbalances, and hemodynamic instability. Its mechanisms remain poorly defined. This study investigated the hormonal and biochemical regulation of urine output during off-pump coronary artery bypass grafting (OPCABG). Methods: For this single-center observational cohort study, 70 patients undergoing OPCABG were enrolled (diuresis: urine output > 5 mL/kg/h, n = 38; normal, n = 32). Hormonal markers and osmolality parameters were measured perioperatively. Logistic regression was used to identify independent predictors, and receiver operating characteristic (ROC) curves was used to assess model performance. Results: Intraoperative high-volume diuresis occurred in 54.2% of patients. Logistic regression identified a low Body Mass Index (BMI) (OR 0.72, p = 0.002), reduced albumin (OR 0.75, p = 0.014), and lower copeptin (OR 0.43, p = 0.037) as independent predictors (AUC 0.855). Perioperatively, NT-proBNPT0 rose in both groups, aldosterone increased only in the diuresis group, and copeptin showed a slight nonsignificant rise. Plasma sodium was higher in cases of diuresis at the end of surgery (148.4 vs. 144.9 mmol/L, p < 0.001). Despite greater urine output and fluid infusion, the rates of intensive care unit (ICU) admission and hospital stays were similar. Conclusions: Intraoperative high-volume diuresis in OPCABG is strongly associated with reduced antidiuretic hormone activity, suggesting a partial central diabetes insipidus-like mechanism. Although not affecting short-term outcomes, it posed challenges for intraoperative fluid and electrolyte management. Larger multicenter studies are needed for validation. Full article

Purpose: This study examined hydration responses to sodium hyperhydration in female athletes at rest and during cycling across the early follicular and mid-luteal phases of the menstrual cycle. Methods: Twelve cyclists/triathletes consumed 30 mL·kg⁻¹ fat-free mass fluid with either sodium chloride (7.5 g·L⁻¹) or placebo (sucrose) 2 h before 75 min of steady-state cycling (60% VO_2peak) and a 200 kJ time trial (TT) in a hot environment (34 °C, 60% RH). Body mass was measured, and urine was collected every 30 min, whilst blood samples were taken hourly pre-exercise, post-steady-state, and post-TT. Results: During pre-exercise, sodium hyperhydration increased fluid retention (509.0 mL, 95% CI: [349.0, 669.0]; p < 0.001), while reducing urine volume (−107.4 [−146.7, −68.1] mL; p < 0.001). During exercise, body mass loss was lower with sodium during steady-state (−0.20%; p = 0.001) and TT (−0.15%; p = 0.037), but sweat rates were reduced with sodium only during steady-state (−0.08 L·h⁻¹; p = 0.001). Exploratory analyses showed greater effects in the early-follicular phase, with reductions in body mass loss (−0.26%; p = 0.004), sweat rate (−0.1 L·h⁻¹; p = 0.003), and post-TT arginine vasopressin (−10.8 [−19.2, −2.3] pg·mL⁻¹; p = 0.013). Conclusions: Sodium hyperhydration effectively enhanced fluid retention and reduced body mass loss during exercise in the heat. While no consistent main effects of menstrual cycle phase were observed, some phase-specific differences emerged, particularly in the early-follicular phase. These findings highlight the importance of monitoring hydration responses across the menstrual cycle and tailoring strategies to individual needs, rather than applying universal phase-specific recommendations. Full article

Background/Objectives: Pelvic organ prolapse (POP) is a common condition affecting women. When conservative treatment fails, surgical correction is indicated. Anterior colporrhaphy (AC) is a standard procedure for anterior vaginal wall prolapse repair. Postoperatively, an indwelling urinary catheter (IUC) is typically inserted to prevent urinary retention; however, prolonged catheterization is a known risk factor for urinary tract infection (UTI). This study aimed to evaluate whether postoperative catheterization can be safely shortened from 4 days to 24 h after vaginal POP surgery, and to compare the incidence of urinary retention and UTI between the two groups. Methods: A prospective randomized controlled trial was conducted, including 119 patients scheduled for AC for POP repair. All patients received an IUC after surgery and were randomized to catheter removal after either 24 h (group 1) or 4 days (group 2). Urinary retention was defined as a postvoid residual volume > 200 mL after IUC removal. UTI was diagnosed based on typical symptoms and a positive urine culture (≥10⁵ CFU/mL). Results: Data from 80 patients were analyzed. There were no statistically significant differences in catheter reinsertion rates (15% in group 1 vs. 7.5% in group 2, p = 0.288). The incidence of urinary retention was not influenced by the use of Kelly sutures, concomitant procedures, or patient age. No UTIs were confirmed in either group. Median hospital stay was significantly shorter in group 1 (3 [2–4] days vs. 4 [4–4] days, p < 0.001). Conclusions: Short-term catheterization following anterior colporrhaphy is not associated with increased risk of urinary retention or infection. Reducing catheterization duration results in a shorter hospital stay, which may lower healthcare costs and improve patient throughput. Full article

The hybrid Sechium edule H387 07, commonly known as chayote, has shown potential as an antiproliferative, cytotoxic, and pro-apoptotic agent in the murine leukemia cell lines P388 (macrophagic) and J774 (monocytic) and in the myelomonocytic leukemia cell line WEHI-3. However, despite these reported bioactivities, its pharmacokinetic profile remains largely unexplored. Understanding the absorption, distribution, and elimination of this hybrid is critical for addressing unmet therapeutic needs and for advancing the development of natural product-based therapies. These effects are attributed to the presence of phenols, flavonoids, and cucurbitacins in its organic extracts. In this study, the pharmacokinetic parameters of secondary metabolites from methanolic extracts of Sechium H387 07 were evaluated after oral administration in mice, while its segregant H387 M16 was subjected to complementary phytochemical characterization. Methanolic extracts of Sechium edule H387 07 were orally administered to mice at doses of 8, 125, and 250 mg/kg, and plasma, liver, and urine samples were collected at 1, 6, 24, and 48 h post-treatment. High-performance liquid chromatography (HPLC) identified polyphenols and cucurbitacins, notably cucurbitacin B (CuB) and cucurbitacin IIA (CuIIA), in the biological samples, and pharmacokinetic variables such as the maximum plasma concentration (C_max), time to reach maximum concentration (T_max), half-life (T_1/2), and volume of distribution (V_d) were determined. For instance, CuB exhibited a C_max of 37.56 µg/mL at 1 h post-dose after oral administration of 125 mg/kg, confirming its rapid absorption and systemic distribution. Notably, the presence of CuIIA in plasma was documented for the first time, along with the pharmacokinetic profiles of apigenin, phloretin, CuB, CuE, and CuI. In parallel, the segregant H387 M16 was characterized via colorimetric assays, thin-layer chromatography (TLC), HPLC, and antioxidant activity tests, which revealed high levels of flavonoids, phenols, and cucurbitacins, with an antioxidant activity of approximately 75% at the highest tested dose (1 mg/mL), supporting its suitability for future bioassays. Overall, these findings not only provide novel pharmacokinetic data for key metabolites of the H387 07 hybrid but also establish the phytochemical and antioxidant profile of its segregant H387 M16. This dual characterization strengthens the evidence of the therapeutic potential of Sechium genotypes and provides a valuable foundation for future studies aiming to develop standardized protocols and explore translational applications in drug development and natural product-based therapies. Full article