Neutrophil Gelatinase-Associated Lipocalin Cutoff Value Selection and Acute Kidney Injury Classification System Determine Phenotype Allocation and Associated Outcomes

Albert Annemarie,Radtke Sebastian,Blume Louisa,Bellomo Rinaldo,Haase Michael,Stieger Philipp,Hinkel Ulrich Paul,Braun-Dullaeus Rüdiger C.,Albert Christian 대한진단검사의학회 2023 Annals of Laboratory Medicine Vol.43 No.6

Background: We explored the extent to which neutrophil gelatinase-associated lipocalin (NGAL) cutoff value selection and the acute kidney injury (AKI) classification system determine clinical AKI-phenotype allocation and associated outcomes. Methods: Cutoff values from ROC curves of data from two independent prospective cardiac surgery study cohorts (Magdeburg and Berlin, Germany) were used to predict Kidney Disease: Improving Global Outcome (KDIGO)- or Risk, Injury, Failure, Loss of kidney function, End-stage (RIFLE)-defined AKI. Statistical methodologies (maximum Youden index, lowest distance to [0, 1] in ROC space, sensitivity≈specificity) and cutoff values from two NGAL meta-analyses were evaluated. Associated risks of adverse outcomes (acute dialysis initiation and in-hospital mortality) were compared. Results: NGAL cutoff concentrations calculated from ROC curves to predict AKI varied according to the statistical methodology and AKI classification system (10.6–159.1 and 16.85–149.3 ng/mL in the Magdeburg and Berlin cohorts, respectively). Proportions of attributed subclinical AKI ranged 2%–33.0% and 10.1%–33.1% in the Magdeburg and Berlin cohorts, respectively. The difference in calculated risk for adverse outcomes (fraction of odds ratios for AKI-phenotype group differences) varied considerably when changing the cutoff concentration within the RIFLE or KDIGO classification (up to 18.33- and 16.11-times risk difference, respectively) and was even greater when comparing cutoff methodologies between RIFLE and KDIGO classifications (up to 25.7-times risk difference). Conclusions: NGAL positivity adds prognostic information regardless of RIFLE or KDIGO classification or cutoff selection methodology. The risk of adverse events depends on the methodology of cutoff selection and AKI classification system.

Incidence of interappointment emergencies in multiple-visit root canal treatments performed with or without intracanal medicament by undergraduate students

Baaij Annemarie,Visscher Corine Mirjam,Jansen Manon,Özok Ahmet Rifat 대한치과보존학회 2023 Restorative Dentistry & Endodontics Vol.48 No.3

Objectives This retrospective cohort study examined the incidence of interappointment emergencies during multiple-visit molar root canal treatments conducted by undergraduate students. Treatments performed without the use of intracanal medicament were compared to treatments that incorporated calcium hydroxide as an intracanal medicament. Materials and Methods Interappointment emergencies, defined as instances of pain or swelling that required the patient to make an unscheduled follow-up visit, were recorded for up to 2 months after the intervention. To avoid the influence of obturation on the observed incidence of emergency visits, only unscheduled visits occurring between the start and end of the root canal treatment were included. Results Of the 719 patients included in this study, 77 (10.7%) were recorded as experiencing interappointment emergencies. Of these emergencies, 62% occurred within 2 weeks following the most recent intervention. In the group of patients who did not receive intracanal medicament, the incidence of interappointment emergencies was 11.9% (46 of 385 patients). In comparison, this rate was 9.3% (31 of 334 patients) among those who received calcium hydroxide as an intracanal medicament (odds ratio, 1.33; 95% confidence interval, 0.82–2.15; p = 0.249). Conclusions Interappointment emergencies may arise at any point during root canal treatment, but they most commonly occur within the first 2 weeks following intervention. The omission of intracanal medicament in multiple-visit molar root canal treatments, performed by undergraduate students, did not significantly increase the incidence of these emergencies. Objectives This retrospective cohort study examined the incidence of interappointment emergencies during multiple-visit molar root canal treatments conducted by undergraduate students. Treatments performed without the use of intracanal medicament were compared to treatments that incorporated calcium hydroxide as an intracanal medicament. Materials and Methods Interappointment emergencies, defined as instances of pain or swelling that required the patient to make an unscheduled follow-up visit, were recorded for up to 2 months after the intervention. To avoid the influence of obturation on the observed incidence of emergency visits, only unscheduled visits occurring between the start and end of the root canal treatment were included. Results Of the 719 patients included in this study, 77 (10.7%) were recorded as experiencing interappointment emergencies. Of these emergencies, 62% occurred within 2 weeks following the most recent intervention. In the group of patients who did not receive intracanal medicament, the incidence of interappointment emergencies was 11.9% (46 of 385 patients). In comparison, this rate was 9.3% (31 of 334 patients) among those who received calcium hydroxide as an intracanal medicament (odds ratio, 1.33; 95% confidence interval, 0.82–2.15; p = 0.249). Conclusions Interappointment emergencies may arise at any point during root canal treatment, but they most commonly occur within the first 2 weeks following intervention. The omission of intracanal medicament in multiple-visit molar root canal treatments, performed by undergraduate students, did not significantly increase the incidence of these emergencies.

제 2 부 : 헤겔 미학 - 예술철학 강의로부터 현재의 유산에 이르기까지 이루어진 변형의 과정들

A.게트만지페르트(Annemarie Gethmann Siefert),조창오(Chang Oh Cho) 한국헤겔학회 2002 헤겔연구 Vol.11 No.-

덕(德)의 의미, 어제와 오늘

안네마리에 피퍼(Annemarie Pieper),김형수(번역자) 광주가톨릭대학교 신학연구소 2012 神學展望 Vol.- No.178

오늘날 덕이라는 용어가 시대에 뒤떨어지게 된 이유는, 개인의 자기 이해에 대한 그리스도교의 영향력이 사라진 것과 덕이라는 용어가 오랫동안 가부장적인 의미를 지녀왔다는 데에 있다. 더욱이 오늘날 동등한 성역할과 평등한 권리의 성취로 인해 이전의 확정된 위계질서가 와해되면서 덕의 본질적 의미가 퇴색하게 되었다. 이러한 상황에서 오늘날 덕의 의미를 숙고하기 위해서는 이전의 덕에 대한 중요한 이해를 살펴보는 것이 필요하다. 우선 플라톤 이래로 지혜로움, 용감한, 신중함(절제), 올바름(정의)이라는 사추덕이 중요한 역할을 해 왔는데, 여기서 나머지 세 부분 간의 균형 는 관계가 이루어질 띠 올바름(정의)이 성립된다. 그러나 이러한 사추덕은 오늘날 플라톤 시대와는 달리, 올바름, 곧 정의가 각 개인의 수행을 통해서 저절로 드러나는 것이 아니라 제 삼자(판사)의 개입을 통해 가시화된다. 뿐만 아니라 플라톤이 가장 하위의 단계로 생각한 경계는 오늘날 최상위의 단계에 올라가 있다. 그리스도교에서는 사추덕과 더불어 신앙, 사랑, 희망이라는 세 가지 덕이 추가되었다. 그리스도교의 이러한 세 덕 역시 오늘날 심각한 도전에 직면해 있다. 우선 신앙은 세속화와 개인의 자율성 때문에 순전히 개인적 사안으로만 치부된다. 그리고 이웃 사랑의 자리에 연대성과 관용이라는 윤리적 특성을 지닌 덕이 대신 들어섰다. 더욱이 희망은 더 이상 덕으로 여길 수 없게 되었다. 더 나아가 오늘날 이 일곱 가지 덕의 이해에서 벗어나는 것은 변화된 인간상과도 관련된다. 마키아벨리의 경우, 덕은 역할과 상황에 따라 달라지는 태도를 의미하며, 칸트의 경우, 자유의 표출로 의무지우는 규범과 가치로 향하게 하는 어떤 태도의 특성을 덕으로 규정한다. 더 나아가 니체는 개인화된 덕의 윤리를 주장함으로써, 그리스도교의 덕과 칸트의 윤리학을 모두 비판한다. 그러나 니체에 의해 확립된 개인 윤리는 덕을 개인적인 의미부여로 축소시킴으로써 공동체 윤리의 규범을 와해시킨다. 결국 오늘날 개인이 스스로를 규정할 권리를 인정하면서도 공동체적 의무를 다시 강화시키는 덕에 대한 새로운 이해가 필요하다.

The Health and Occupation Research Network: An Evolving Surveillance System

Melanie Carder,Louise Hussey,Annemarie Money,Matthew Gittins,Roseanne McNamee,Susan Jill Stocks,Dil Sen,Raymond M. Agius 한국산업안전보건공단 산업안전보건연구원 2017 Safety and health at work Vol.8 No.3

Vital to the prevention of work-related ill-health (WRIH) is the availability of good quality data regarding WRIH burden and risks. Physician-based surveillance systems such as The Health and Occupation Research (THOR) network in the UK are often established in response to limitations of statutory, compensation-based systems for addressing certain epidemiological aspects of disease surveillance. However, to fulfil their purpose, THOR and others need to have methodologic rigor in capturing and ascertaining cases. This article describes how data collected by THOR and analogous systems can inform WRIH incidence, trends, and other determinants. An overview of the different strands of THOR research is provided, including methodologic advancements facilitated by increased data quantity/quality over time and the value of the research outputs for informing Government and other policy makers. In doing so, the utility of data collected by systems such as THOR to address a wide range of research questions, both in relation to WRIH and to wider issues of public and social health, is demonstrated.

Urinary Biomarkers may Complement the Cleveland Score for Prediction of Adverse Kidney Events After Cardiac Surgery: A Pilot Study

Christian Albert,Michael Haase,Annemarie Albert,Siegfried Kropf,Rinaldo Bellomo,Sabine Westphal,Mark Westerman,Rüdiger Christian Braun-Dullaeus,Anja Haase-Fielitz 대한진단검사의학회 2020 Annals of Laboratory Medicine Vol.40 No.2

Background: The ability of urinary biomarkers to complement established clinical risk prediction models for postoperative adverse kidney events is unclear. We assessed the effect of urinary biomarkers linked to suspected pathogenesis of cardiac surgery-induced acute kidney injury (AKI) on the performance of the Cleveland Score, a risk assessment model for postoperative adverse kidney events. Methods: This pilot study included 100 patients who underwent open-heart surgery. We determined improvements to the Cleveland Score when adding urinary biomarkers measured using clinical laboratory platforms (neutrophil gelatinase-associated lipocalin [NGAL], interleukin-6) and those in the preclinical stage (hepcidin-25, midkine, alpha-1 microglobulin), all sampled immediately post-surgery. The primary endpoint was major adverse kidney events (MAKE), and the secondary endpoint was AKI. We performed ROC curve analysis, assessed baseline model performance (odds ratios [OR], 95% CI), and carried out statistical reclassification analyses to assess model improvement. Results: NGAL (OR [95% CI] per 20 concentration-units wherever applicable): (1.07 [1.01–1.14]), Interleukin-6 (1.51 [1.01–2.26]), midkine (1.01 [1.00–1.02]), 1-hepcidin-25 (1.08 [1.00–1.17]), and NGAL/hepcidin-ratio (2.91 [1.30–6.49]) were independent predictors of MAKE and AKI (1.38 [1.03–1.85], 1.08 [1.01–1.15], 1.01 [1.00–1.02], 1.09 [1.01–1.18], and 3.45 [1.54–7.72]). Category-free net reclassification improvement identified interleukin-6 as a model-improving biomarker for MAKE and NGAL for AKI. However, only NGAL/hepcidin-25 improved model performance for event- and event-free patients for MAKE and AKI. Conclusions: NGAL and interleukin-6 measured immediately post cardiac surgery may complement the Cleveland Score. The com

Double-Balloon Endoscopy in Overt and Occult Small Bowel Bleeding: Results, Complications, and Correlation with Prior Videocapsule Endoscopy in a Tertiary Referral Center

Carlijn Hermans,Arnold Stronkhorst,Annemarie Tjhie-Wensing,Jan Kamphuis,Bas van Balkom,Rob Dahlmans,Lennard Gilissen 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.1

Background/Aims: Videocapsule endoscopy (VCE) and double-balloon endoscopy (DBE) allow deep exploration in patients with suspected small bowel pathology. VCE is often performed as an initial small bowel examination to explore whether an intervention by DBE is indicated and to determine insertion route. The study aim was to evaluate the correlation between DBE and VCE in patients with obscure or overt bleeding or anemia, as well as intervention frequency, and complications. Methods: Retrospective observational study. Results: DBE procedures (n=205) showed small bowel lesions in 64% cases. Antegrade DBE showed positive results in 79% cases, mostly angiodysplasias (63%). Retrograde DBE showed positive results in 22% cases. An intervention was performed in 64% of DBE procedures. The major complication rate was 0.5%, which was one case of perforation. Pancreatitis did not occur. The overall diagnostic agreement was 66% among the 134 DBEs with preceded VCE. Conclusions: In cases of overt or occult bleeding or anemia, DBE was positive in 64%, with only a few complications. Positive correlation was 66% among initially performed VCEs and DBEs. Owing to the time-consuming and invasive character of DBE, performing VCE before DBE might still be clinically relevant.

The Health and Occupation Research Network: An Evolving Surveillance System

Carder, Melanie,Hussey, Louise,Money, Annemarie,Gittins, Matthew,McNamee, Roseanne,Stocks, Susan Jill,Sen, Dil,Agius, Raymond M. Occupational Safety and Health Research Institute 2017 Safety and health at work Vol.8 No.3

Vital to the prevention of work-related ill-health (WRIH) is the availability of good quality data regarding WRIH burden and risks. Physician-based surveillance systems such as The Health and Occupation Research (THOR) network in the UK are often established in response to limitations of statutory, compensation-based systems for addressing certain epidemiological aspects of disease surveillance. However, to fulfil their purpose, THOR and others need to have methodologic rigor in capturing and ascertaining cases. This article describes how data collected by THOR and analogous systems can inform WRIH incidence, trends, and other determinants. An overview of the different strands of THOR research is provided, including methodologic advancements facilitated by increased data quantity/quality over time and the value of the research outputs for informing Government and other policy makers. In doing so, the utility of data collected by systems such as THOR to address a wide range of research questions, both in relation to WRIH and to wider issues of public and social health, is demonstrated.

Biomarker-Guided Risk Assessment for Acute Kidney Injury: Time for Clinical Implementation?

Albert Christian,Haase Michael,Albert Annemarie,Zapf Antonia,Braun-Dullaeus Rüdiger Christian,Haase-Fielitz Anja 대한진단검사의학회 2021 Annals of Laboratory Medicine Vol.41 No.1

Acute kidney injury (AKI) is a common and serious complication in hospitalized patients, which continues to pose a clinical challenge for treating physicians. The most recent Kidney Disease Improving Global Outcomes practice guidelines for AKI have restated the importance of earliest possible detection of AKI and adjusting treatment accordingly. Since the emergence of initial studies examining the use of neutrophil gelatinase-associated lipocalin (NGAL) and cycle arrest biomarkers, tissue inhibitor metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein (IGFBP7), for early diagnosis of AKI, a vast number of studies have investigated the accuracy and additional clinical benefits of these biomarkers. As proposed by the Acute Dialysis Quality Initiative, new AKI diagnostic criteria should equally utilize glomerular function and tubular injury markers for AKI diagnosis. In addition to refining our capabilities in kidney risk prediction with kidney injury biomarkers, structural disorder phenotypes referred to as “preclinical-” and “subclinical AKI” have been described and are increasingly recognized. Additionally, positive biomarker test findings were found to provide prognostic information regardless of an acute decline in renal function (positive serum creatinine criteria). We summarize and discuss the recent findings focusing on two of the most promising and clinically available kidney injury biomarkers, NGAL and cell cycle arrest markers, in the context of AKI phenotypes. Finally, we draw conclusions regarding the clinical implications for kidney risk prediction.

Risk-based maternal group B Streptococcus screening strategy is compatible with the implementation of neonatal early-onset sepsis calculator

Niek B. Achten,J. Wendelien Dorigo-Zetsma,Annemarie M.C. van Rossum,Rianne Oostenbrink,Frans B. Plötz 대한소아청소년과학회 2020 Clinical and Experimental Pediatrics (CEP) Vol.63 No.10

Background: The early-onset sepsis (EOS) calculator was developed and validated in a setting with routine-based group B Streptococcus (GBS) screening. Purpose: The study aimed to evaluate the extent of influence exerted by risk-based GBS screening on management recommendations by the EOS calculator. Methods: All newborns with a gestational age greater than 35 weeks were screened for EOS risk factors in a Dutch regional teaching hospital using a risk-based GBS screening strategy. We calculated the EOS risk at birth and stratified the infants into the following 3 risk levels with corresponding management recommendations: low, <0.65; intermediate, 0.65–1.54; and high, >1.54 per 1000 live newborns. Thereafter, we recalculated the EOS risk and recommendation for the newborn infants without available maternal GBS screening results at birth. Results: In one year, 1,877 eligible births occurred; of them, 206 infants were included. Maternal GBS status was available for 28 of 206 infants (14%) at birth, while a definitive GBS status was later available for 162 of 206 infants (79%). Median EOS risk was slightly lower after definitive GBS status was determined (0.41 vs. 0.46 per 1,000 live births, P=0.004). In 199 of 206 newborn infants (97%), the EOS calculator recommendation remained unchanged after the GBS results unavailable at birth were updated to definitive GBS status. Use of GBS status at birth versus definitive GBS status did not result in the withholding of antibiotic treatment of the newborn infants included in this study. Conclusion: Risk-based GBS screening is compatible with EOS calculator recommendations. Larger studies are needed to develop the best strategy for combining GBS screening and EOS calculator recommendations.