Septic acute kidney injury (AKI) and myocardial dysfunction are leading causes of mortality with no accepted method of therapy. In this study we demonstrate the role of growth differentiating factor 15 (GDF15) in septic AKI and myocardial dysfunction using a murine lipopolysaccharide (LPS)-induced sepsis model and an in vitro cell culture system. Data show that GDF15 deficiency augments inflammatory response and exacerbates renal and cardiac injury induced by LPS, while over-expression of GDF15 protects the kidney and heart from LPS-induced organ dysfunction. Therefore, this study highlights the therapeutic potential of GDF15 in the treatment of endotoxin-induced sepsis.
Clinical practice guideline: evidence, recommendations and algorithm for the preoperative optimization of anemia, hyperglycemia and smoking F or most of the 20th century, the focus of research in surgery was improvements in intraoperative technique, which led to major technical paradigm shifts exemplified by the evolution of transurethral resection of the prostate, 1 laparoscopic cholecystectomy, 2 endovascular aneurysm repair 3 and total mesorectal excision for rectal cancer, 4 among many others. The late 1990s and early 2000s marked a shift in surgical research toward the evidencebased management of patients in the perioperative period, beginning with the Enhanced Recovery After Surgery Group's systematic review of patients undergoing colorectal surgery. 5 That publication introduced a new paradigm focused on the impact that standardized perioperative care could have on patient outcomes such as length of stay, postoperative pain and overall complication rates. 6,7 Although a large body of literature now exists to help guide the intraoperative and perioperative management of surgical patients, our working group believes that the preoperative period, which we define as the 8 weeks
ObjectiveTo identify the advantages and disadvantages that group practices have on patients, physicians and healthcare systems.Study designA scoping review was performed based on the methodology proposed by Arksey and O’Malley, and refined by Levac et al. Titles and abstracts were screened by two reviewers. A quantitative analysis was performed to assess the type, year and region of publication, as well as the population studied. A qualitative descriptive analysis was performed to identify common themes.Study settingMEDLINE, EMBASE and Cochrane databases were searched from database inception to October 2018 for papers which assessed outcomes relevant to the research question.ResultsOur search strategy returned 2408 papers and 98 were included in the final analysis. Most papers were from the USA, were surveys and assessed physician outcomes. Advantages of group practices for patients included improved satisfaction and quality of care. Studies of physicians reported improved quality of life and income, while disadvantages included increased stress due to poor interpersonal relationships. Studies of healthcare systems reported improved efficiency and better utilisation of resources.ConclusionsGroup practices have many benefits for patients and physicians. However, further work needs to be done assessing patient outcomes and establishing the elements that make a group practice successful.
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