SummaryBackgroundIn a healthy kidney, contractile protein alpha-smooth muscle actin (ASMA) is immunohistochemically strongly expressed only in the blood vessels, while in pathological conditions it can be visualized in glomerular mesangial cells and interstitial myofibroblasts. The aim of this study was to explore the possible correlation between expression of ASMA in glomerulonephritis (GN) and indicators of renal function.Material/MethodsWe analyzed expression of ASMA in percutaneous renal biopsy of 142 adult and pediatric patients with GN and its correlation with blood pressure, serum creatinine, creatinine clearance and 24-hour urine protein at the time of biopsy. Immunoexpression of ASMA was analyzed quantitatively using computer-assisted morphometric analysis. Relative surface of ASMA expression in all glomeruli and interstitium was calculated for each patient.ResultsIn adults and children, greater expression of ASMA in interstitium was associated with higher serum creatinine and reduced creatinine clearance. Conversely, greater ASMA expression in glomeruli was associated with normal or decreased serum creatinine in adults and increased creatinine clearance in children. In children, correlation was found between high blood pressure and ASMA expression in interstitium.ConclusionsWe confirmed that interstitial expression of ASMA is associated with reduced renal function at time of biopsy. The connection of ASMA expression in glomeruli with lower serum creatinine and normal or increased creatinine clearance suggests a favorable role of this phenotypic change in glomerular filtration rate; further investigation is needed.

We investigate the wage work and family determinants of self‐employment entry using a panel study of Canadian workers (Canadian Work Stress and Health Study). Rather than treating the self‐employed as a homogenous group—a characterization that conflates entrepreneurial ventures with lower quality and more precarious self‐employment—we disaggregate self‐employment entrants by occupational class. Descriptive analyses show that the nonprofessional self‐employed—the most common form of self‐employment observed in the study—are considerably more likely to report low income (<$25,000) and insufficient work hours compared to wage workers and the professional self‐employed. Event history analyses based on a multinomial logistic model also reveal that poor wage‐work quality—including low income, job insecurity, and unchallenging work—increases the likelihood of a transition from wage work into nonprofessional self‐employment. In contrast, job autonomy and human capital predict an increased likelihood of a transition into professional self‐employment. Our results suggest that both classic entrepreneurial and forced motivations explain self‐employment entry when the self‐employed's occupational class is distinguished; however, findings are mixed regarding the salience of work‐family factors in predicting self‐employment entry. We discuss the value of using a “good jobs, bad jobs” perspective to disaggregate the pathways from wage work into lower versus higher quality self‐employment.

Valproate (VPA) poisoning is an increasing clinical problem. The most common finding in VPA overdose is the depression of the central nervous system, which may progress to coma and death. This type of poisoning is difficult to treat, as no antidote exists. This report describes a case with a 16-year-old girl who poisoned herself with valproate. Initial treatment included naloxone, but she did not respond. She became comatose, with serum VPA concentration of 1320 µg mL -1. Three sessions of haemodialysis were performed, effectively eliminating VPA and decreasing the serum concentration. The patient regained consciousness and fully recovered. To our knowledge, this is the highest serum VPA concentration reported by now in children aged 16 or less. Haemodialysis has proved to be the treatment of choice for life-threatening acute VPA overdose in children. Me{trovi} J, et al. VALPROATE OVERDOSE TREATED WITH HAEMODIALYSIS Arh Hig Rada Toksikol 2008;59:295-298: Valproate (VPA) is used as sodium valproate to manage childhood refractory epilepsy, behavioural disorders, and migraines. Cases of VPA overdosing have been on the rise (1). The most common finding is the central nervous system depression, and management is mainly symptomatic and supportive, including activated charcoal and naloxone (2). Haemodialysis, haemoperfusion, or both, have also been reported (3, 4). Here we report a case of a 16-year-old girl with VPA-induced coma who was successfully treated with haemodialysis. KEY WORDS: central nervous system depressants, intensive care, thrombocytopenia, toxicity CASE PRESENTATIONA 16-year-old girl was admitted to the Emergency Department of the University Hospital Split eight hours after ingesting 75 g (882 mg kg -1 ) of VPA (enteric-coated formulation marketed as Apilepsin ® ) in attempted suicide. On admission, her vital signs were: blood pressure 130/70 mmHg, pulse 100 min -1 , and respiratory rate 25 min -1 and her Glasgow Coma Scale (GCS) score was 6. Initial blood analysis revealed serum VPA concentration of 1320 µg mL -1. Arterial blood gas analysis showed compensated metabolic acidosis, with an anion gap of 22.3 mmol L -1 . Complete blood count, electrolytes, creatinine, and liver enzymes were normal. Two doses of naloxone, 0.9 mg each, were given intravenously, but without notable improvement of her neurological status. Four hours after admission, she was in a deep coma (GCS 3). Breathing and circulation were stable, the patent airway was secured with the oropharyngeal (Guedel) airway, and there was no need for mechanical ventilation. Haemodialysis was considered the best possible therapeutic intervention at that moment, and the first session was immediately started through a double-lumen internal jugular vein using a NIPRO FB 130 TGA dialyser.

Bogosavljević I. , Gašić M. , Filipović T. , Mandić P. , Đukić-Macut N. , Šaranović M. , Stajić S. ¹Institut za Anatomiju, Medicinski fakultet Priština, Kosovska Mitrovica, Srbija ²Služba za radiološku dijagnostiku, KBC "Dr Dragiša Mišović", Dedinje, Beograd, SrbijaUvod: U odraslih se dijagnostikovanje akutnih pijelonefritisa i glomerulonefritisa prvenstveno bazira na kliničkom i laboratorijsko-biohemijskom ispitivanju. Kod osoba kod kojih je klinička slika atipična, i kod osoba koje ne reaguju na terapiju pribegava se radiološkom ispitivanju. Ehotomografsko ispitivanje je nezaobilazno u dijagnostičkom algoritmu. Cilj: Cilj ovog istraživanja je bio da se ustanove pojedini ehotomografski parametri, kao i da se odredi njihova dijagnostička moć kod pacijenata obolelih od akutnih infekcija pijelo-kaliksnog sistema i parenhima bubrega (pijelonefritis i glomerulonefritis), a upoređujući ih sa adekvatnim referentnim testovima. Materijal i metode: Urađena je studija preseka u periodu od oktobra 2014. god. do maja 2015. god. Obuhvaćeno je 50 ispitanika sa akutnom inflamacijom parenhima bubrega i pijelokaliksnog sistema kojima je učinjen ehotomografski pregled abdomena i male karlice, u okviru Službe za radiološku dijagnostiku KBC "Dr Dragiša Mišović-Dedinje" u Beogradu. Ehotomografski pregledi bubrega su obuhvatali ispitivanje mnogobrojnih parametara koji bi mogli da ukažu na postojanje akutne inflamacije parenhima bubrega odnosno pijelo-kaliksnog sistema. Za zlatni standard smo uzimali nalaz dobijen CT (kompjuterizovana tomografija) snimanjem abdomena i male karlice, kao i pato-histološkim nalazom dobijenim biopsijom tankom iglom. Rezultati: Od 50 ispitanika sa akutnom inflamacijom gornjeg urinarnog trakta, 41 pacijent (82 %) je imao akutni pijelonefritis, dok je 9 (18 %) imalo akutni glomerulonefritis. Kod 70% ispitanika sa akutnim pijelonefritisom (29 osoba) bilo je prisutno uvećanje bubrega gde je senzitivnost testa 79,3 %, a specifičnost testa 91,7 %. Tačnost metode iznosila je 82,9 % kada su posmatrani parametri: gubitak centralnog eho-kompleksa i nejasna kortiko-medularna diferencijacija. Senzitivnost testa u kome su posmatrane karakteristike pijelo-kaliksnog sistema iznosila je 65 %, a specifičnost 90 %. Analizom prisustva kalkulusa u parenhimu bubrega dolazi se do vrednosti senzitivnosti testa od 54,8 %, a specifičnosti od 80 %. Hipoehogeni fokusi u parenhimu bubrega, uvećanje bubrega i gubitak kortikomedularne granice su parametri koji sa velikom senzitivnošću i specifičnošću ukazuju na akutni glomerulonefritis. Zaključak: Na osnovu visokih vrednosti senzitivnosti i specifičnosti testiranih pregleda procenjujemo da ultrazvučna dijagnostika ima obavezno mesto u djagnostičkom algoritmu. Upotreba ultrazvučnih aparata koji pružaju mogućnost visoko rezolutivnih pregleda, kao i široka dostupnost i dobra reproducibilnost metode, uz nisku cenu pregleda, idu u prilog prve eksploracije ultrazvučnim pregledom. Multidetektorsko CT skeniranje i biopsija tankom iglom ipak ostaje metoda izbora u postavljanju konačne dijagnoze.