Uric acid changes in serum during different forms of hepatic vascular inflow occlusion

A prospective randomized controlled trial: Comparison of two different methods of hepatectomy

Objective To explore the feasibility and safety of regional hepatic vascular inflow occlusion in laparoscopic hepatectomies.Methods 35 patients with liver lesions received laparoscopic hepatectomy using regional hepatic vascular inflow occlusion.The mean age was 46.1 ± 3.5 years.The relevant branches of portal vein and hepatic artery were isolated with sharp and blunt dissections and were then occluded regionally.Results Laparoscopic regional hepatic vascular inflow occlusion and hepatectomies were successfully carried out in 35 patients.The mean operative time was 60.6±15.2 minutes.The mean blood loss was 230.8±56.5 ml.The mean postoperative hospital stay was 6.6±1.3 days.Conclusions Regional hepatic vascular inflow occlusion is a safe and feasible method in laparoscopic hepatectomies. Key words: Hepatectomy; Laparoscopic; Hepatic blood inflow; Occlusion

Objective To evaluate the value of serum uric acid(UA) levels with reference to the age, waist circumference, and body mass index(BMI) in predicting the metabolic syndrome(MS) in obese children. Methods A total of 300 obese children, including 180 boys and 120 girls, were enrolled in this study.The height, BMI, waist and hip circumference, blood pressure, serum glucose, insulin and lipid profile in all participants were measured.Oral glucose tolerance test and insulin releasing test were performed.The boys or girls were divided into 4 groups according to the 4 quantile of UA level, respectively.The clinical characteristics and correlation of UA with the clinical indexes and MS components were compared.The binary Logistic regression analysis was applied in the risk of MS and its components for the 4 groups of obese children.The area under the receiver operating characteristic curve(ROC curve) of UA level, age, waist circumference and BMI were used to predict the MS. Results UA level was increased with the increase of age, waist circumference and BMI, and the UA level was significantly correlated with triacylglycerol, postprandial 2 h glucose(2 h PG)(r=0.196, 0.174 in boys; r=0.291, 0.179 in girls). In boys, the adjusted odds ratio and 95%CI of the highest quartile of UA for triglyceridemia was 2.71(95%CI: 0.77-9.58); which in girls, the adjusted odds ratio and 95%CI of the highest quartile of UA for hyperglycemia, hypertension were 8.45(95%CI: 1.76-40.52) and 3.93(95%CI: 0.66-23.33), respectively, with significant differences.In boys, the area under the ROC curve of UA level, age, waist circumference and BMI which predict the MS were 0.652 0.626, 0.621, 0.62, respectively, and the differences were significant(all P<0.05). Conclusions The UA level is significantly correlated with the composition of MS, UA detection combining with reference to the age, waist circumference, and BMI is helpful for the identification of high risk groups of metabolic syndrome. Key words: Uric acid; Metabolic syndrome; Obesity; Child

BackgroundHyperuricemia is closely related to renal diseases. Therefore, the aim of this study was to explore the relationship between the longitudinal changes in serum uric acid and the estimated glomerular filtration rate (eGFR) in a cohort of elderly hypertensive patients.MethodsEighty hundred and thirty-seven re-hospitalized patients with hypertension were included in this retrospective cohort study. Multiple regression analysis was used to investigate the relationship between changes in serum uric acid and renal function after 3.5 years follow-up.ResultsThe average age at baseline was 69.0+/-10.0 years, and the average follow-up duration was 3.5 years. Multiple linear regression analysis showed that the baseline uric acid levels had a linearly negative correlation with baseline eGFR (P < 0.01), after adjustment for age, gender, blood pressure, and body mass index, et al. An increase of 100 μmol/L baseline uric acid level resulted in a decrease of 5.684 ml/min/1.73 m2 in eGFR [95 % confidence interval (CI): 7.735-3.633]. Patients with increased uric acid levels had higher risk of renal function decline over the follow-up period, with an adjusted odds ratio of 1.639 (95 % CI: 1.129-2.378, P = 0.009) , whereas eGFR was remained unchanged in patients with hyperuricemia at baseline and with normal uric acid level 3.5-year later.ConclusionsLongitudinal changes in uric acid levels were independently associated with the renal function decline in elderly patients with hypertension. Uric acid level should be considered in hypertension management in the elderly.

We hypothesized that longitudinal changes in uric acid (UA) may have independent associations with changes in nutritional parameters over time and consequently, long-term survival of patients on maintenance hemodialysis. We conducted a retrospective, longitudinal cohort study of a clinical database containing the medical records of patients on maintenance hemodialysis receiving dialysis between June of 1999 and December of 2012 in a single center; 200 patients (130 men and 70 women) with a median age of 69.0 (interquartile range, 59.3-77.0) years old were included in the study. Dietary intake, biochemical markers of nutrition, anthropometric measurements, and UA levels were recorded at 0, 6, 12, 18, 24, 30, and 36 months followed by 15 additional months of clinical observations. The patients were followed until January 31, 2015 (median follow-up was 38.0 [interquartile range, 30.0-46.8] months). In a linear mixed effects model adjusted for baseline demographics and clinical parameters, each 1.0-mg/dl longitudinal increase in UA was associated with a 13.4% slower rate of decline in geriatric nutritional risk index (GNRI) levels over 3 years of observation (95% confidence interval [95% CI], 0.11 to 0.39; P<0.001 for UA × time interaction). UA remained associated with the rate of change in GNRI, even after controlling for C-reactive protein. During the follow-up, 87 (43.5%) all-cause and 38 (19.0%) cardiovascular deaths were reported. For each 1.0-mg/dl increase in serum UA over time, the multivariate adjusted all-cause mortality hazard ratio using Cox models with the effect of time-varying risk was 0.83 (95% CI, 0.74 to 0.95; P<0.01), which continued to be significant, even after including the baseline GNRI levels in this model: 0.89 (95% CI, 0.79 to 0.98; P=0.02). Longitudinal changes in serum UA seem to track with changes in nutritional status over time, and these changes are associated with survival of patients on maintenance hemodialysis. An increase in serum UA levels over time is accompanied by improvement of nutritional status and lower mortality rate.

Cardiometabolic risk factors are frequent in children and adolescents with excess weight. The aim of this study was to evaluate the effects of lifestyle modifications on alterations in lipid and glycemic profiles and uric acid values in a pediatric population at increased cardiovascular risk. The study involved 276 subjects with a mean age of 10.6 (2.3) years. Body mass index (BMI) z-score and biochemical parameters (serum low-density lipoprotein (LDL) cholesterol, triglycerides and uric acid and homeostasis model assessment to quantify insulin resistance (HOMA index)) were assessed at baseline and at the end of a median follow-up of 14.7 (12.4, 19.3) months. Throughout follow-up, all children received a non-pharmacological treatment based on increased physical activity, reduced sedentary activity and administration of a personalized, healthy and balanced diet. All children attended periodic quarterly control visits during follow-up. Multivariable statistical analyses showed that each BMI z-score point reduction at follow-up was associated with an 8.9 (95% CI −14.2; −3.6) mg/dL decrease in LDL cholesterol (p = 0.001), 20.4 (95% CI −30.0; −10.7) mg/dL in triglycerides (p < 0.001), 1.6 (95% CI −2.2; −1.0) in HOMA index (p < 0.001), and 0.42 (95% CI −0.66; −0.18) mg/dL in uric acid (p = 0.001) values. At each reduction of the BMI z-score by one point, the odds of presenting with insulin resistance and hyperuricemia at follow-up significantly decreased (OR 0.23, 95% CI 0.10–0.50, and OR 0.32, 95% CI 0.10–0.95, p < 0.001 and p < 0.05, respectively). Improvement of dietary habits and lifestyles may improve lipid and glycemic profiles and serum uric acid values in a pediatric population.

This study assessed the relationship between the progression of Parkinson's disease (PD) with cognitive impairment and changes in serum uric acid (UA) and homocysteine (Hcy) concentrations and explored the factors influencing PD with cognitive impairment. The study randomly selected 74 patients with PD and evaluated their cognitive function using the Montreal Cognitive Assessment Scale (MoCA). Patients with PD were divided into two subgroups: those with and without cognitive impairment. PD severity was evaluated and graded using the Hoehn and Yahr (H-Y) scale. Another 60 middle-aged and older individuals without PD during the same period were selected as a control group. Blood UA and Hcy concentrations in each group were measured to assess the relationship between PD, cognitive impairment, and changes in UA and Hcy concentrations. The PD group with cognitive impairment had a lower UA concentration and higher Hcy concentration. The UA concentration was significantly higher in the early PD stages than in the middle and late stages (P<0.05). A significant negative relationship between MoCA scores and serum UA levels was found in patients with PD, whereas a positive relationship existed between MoCA scores and serum Hcy concentrations. Regression analysis showed that a higher UA concentration was an independent protective factor for PD with cognitive impairment, while a higher Hcy concentration was a risk factor (P<0.05). A serum UA concentration of 212.9 mmol/L and Hcy concentration of 13.35 mmol/L could distinguish between patients with PD with or without cognitive impairment with a sensitivity of 93.2% and specificity of 43.3%. PD and cognitive impairment were associated with a decrease in UA concentration; the later the H-Y stage was, the lower the UA concentration was. The increase in Hcy concentration was related to PD and its cognitive impairment, whereas it is not significantly correlated with PD progression.

Introduction. Adverse Pregnancy outcomes (APO) continue to trouble physicians worldwide, and uric acid has become a marker of interest in its prediction. Despite this, the correlation of uric acid in the third trimester is rarely studied, and the reference value for normal uric acid levels in pregnancy has yet to be established. This study was done to evaluate the association of uric acid levels in the third trimester of pregnancy and the development of APO, specifically gestational hypertension (GH), pre-eclampsia (PE), gestational diabetes mellitus (GDM), small for gestational age (SGA) and to determine a cut-off value of serum uric acid levels for screening of the APO. Materials and methods. A retrospective observational study was conducted among 374 women who delivered at Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) and developed the APO of interest and had serum uric acid levels taken during the third trimester of pregnancy. A cut off value of 309 µmol/L was used to assess the sensitivity and specificity in predicting the APO. Results. Associations are observed between 309 µmol/L and the development of GH (p&lt;0.0005), PE (p&lt;0.0005), GDM (p&lt;0.0005), SGA (p=0.0264). Plotted ROC curves with cutoff point of 309 µmol/L demonstrated moderate predictive value of serum uric acid and the development of GH (AUC 0.639), PE (AUC 0.713), SGA (AUC 0.649) and low predictive value for GDM (AUC 0.4). Conclusion. Serum uric acid level of 309 µmol/L in the third trimester of pregnancy is a moderate predictor of GH, PE, SGA and a poor predictor of GDM.&#x0D; KEYWORDS: Uric acid; pregnancy trimester, third; pregnancy outcome

Laser speckle contrast imaging for assessment of liver microcirculation

Hepatic artery and portal vein thrombosis are devastating complications of partial liver transplantation. Early detection of inflow complications is important, as re-reconstruction can salvage the graft. Near-infrared spectroscopy or laser Doppler flowmetry can be used to detect tissue oxygenation or microcirculation on the liver surface. The aim of this study was to examine which of these two methods better detects changes in hepatic inflow. Sangen-strain pigs (n = 5) were used. The tips of the near-infrared spectroscopy and laser Doppler flowmetry probes were placed separately on the surface of the right liver. Inflow to the liver was controlled during the following seven conditions: control (not clamped), half- and totally clamped portal vein, half- and totally clamped hepatic artery, and half- and totally clamped portal vein and artery. Tissue blood flow was calculated using laser Doppler flowmetry. Oxyhemoglobin, deoxyhemoglobin, and the tissue oxygenation index were measured and calculated using a near-infrared spectroscopy system. The tissue blood flow and oxygenation index could not be used to differentiate between the half-clamped portal vein, half-clamped hepatic artery, and totally clamped portal vein conditions. The oxyhemoglobin minus deoxyhemoglobin value was significantly decreased after half or total clamping of the portal vein or hepatic artery (p <. 001 for each condition). The findings of the present study indicate that near-infrared spectroscopy was more sensitive than Doppler flowmetry for detecting changes in hepatic tissue inflow from the liver surface.

BackgroundThe high prevalence of hepatitis B virus (HBV) imposes a huge burden of hepatocellular carcinoma (HCC) in Asia. Surgical resection remains an important therapeutic strategy for HCC. Hepatic inflow occlusion, known as the Pringle maneuver, is the most commonly used method of reducing blood loss during liver parenchymal transection. A major issue with this maneuver is ischemia-reperfusion injury to the remnant liver, and the hemodynamic disturbance it induces in the tumor-bearing liver raises an oncological concern. Given the technical advances in living donor liver transplantation, vascular occlusion in liver resection can be avoided in experienced hands. The aim of this study is to compare the perioperative and long-term outcomes of liver resection for HBV-related HCC without versus with hepatic inflow occlusion.Methods/designThis study will include eligible patients with HBV-related HCC elected for liver resection. Fifty-seven patients will be enrolled in each randomization arm to detect a 20 % difference in the serum level of total bilirubin on postoperative day 5 (80 % power and α = 0.05). The secondary endpoints include procedural parameters, perioperative liver function and inflammatory response, postoperative morbidity and mortality, and long-term outcomes. Patients will be followed for up to 5 years. Data will be statistically analyzed on an intention-to-treat basis.DiscussionThis prospective randomized controlled trial is designed to compare the perioperative and long-term outcomes of liver resection for HBV-related HCC without versus with vascular occlusion. The clinical implications of these outcomes may change current surgical practice and fill the oncological gaps therein.Trial registrationClinicaltrials.gov identifier NCT02563158. Registered on 28 September 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1621-9) contains supplementary material, which is available to authorized users.

Studies have shown that obesity is associated with an increase in serum uric acid; and few data are available on the relationship between changes in measures of obesity and changes in uric acid concentrations. We investigated the relationship among percentage changes in waist circumference (%dWC), body mass index (%dBMI), and serum uric acid (%dUA). The data of 3153 individuals [1968 men, 1185 women (536 premenopausal, 649 postmenopausal)] who underwent general health screening over a 2-year period and were not taking antihyperuricemic medication were analyzed. Stepwise multiple regression analysis showed that %dBMI was associated positively with %dUA in postmenopausal women and men, and the association retained statistical significance after adjustment for changes in blood pressure and in renal function. Association between %dBMI and %dUA was not significant in premenopausal women. In men, %dWC was a predicting factor for %dUA, although it did not remain significant when %dBMI was used as a covariate in the statistical model. Multivariate logistic regression analysis showed that the odds ratio of the association between the lowest %dBMI quartile (%dBMI < -1.86) and the lowest %dUA quartile (%dUA < -7.41) was 2.04 (95% CI 1.35-3.07) in postmenopausal women and 1.46 (95% CI 1.14-1.86) in men. Weight loss may represent an effective nonmedical strategy for reducing serum UA levels, especially in postmenopausal women and men.

Background: Chronic kidney disease is one of the most serious public health burdens globally, with significant morbidity, mortality, and reduced patient life expectancy. Many sub-Saharan African countries face double-burden challenges in the treatment of chronic kidney disease and its complications. This study aims to evaluate serum uric acid and its correlation with estimated glomerular filtration rate, as well as other risk factors among chronic kidney disease patients on follow-up at Jimma University specialised referral hospital. Method: A hospital-based cross-sectional study was conducted at Jimma University Medical Centre from August 6, 2022, to November 13, 2022. Using a consecutive sampling technique, a total of 140 CKD follow-up patients were recruited into the current study. Data were collected using interviewer-based structured questionnaires, record reviews, and physical examinations. The collected data were analysed by SPSS version 25.0. The correlation between eGFR and uric acid concentrations was examined by Pearson’s correlation analyses. Univariate and multivariate linear regression were used to test predictors of serum uric acid in the study participants. Result: A total of 140 study participants were recruited for this study. Subjects included (54.3% [n=76]) men and (45.7% [n=64]) women, respectively. The mean (SD) age of the study subjects was 51.04±9.02 years. The mean value of serum uric acid was 7.2±2.1mg/dl, whereas the mean of estimated glomerular filtration rate (eGFR) was 54.2±31 mL/min/1.73m2. Furthermore, the mean values of serum creatinine and blood urea nitrogen among participants in this study were 3.2±1.4 and 67.8±35.8 mg/dL. In the current study, estimated glomerular filtration rate (eGFR) value was negatively correlated (r=-0.912, P&lt;0.001) with uric acid. However, systolic blood pressure was positively correlated (r=0.584, P&lt;0.001) with uric acid. Moreover, the eGFR value was negatively associated (β=-0.060, P=&lt;0.001) with uric acid among study participants. Conclusion: Based on the current study findings, an increase in serum uric acid was associated with a decrease in eGFR value. Increased serum uric acid, increased body mass index (BMI) and high blood pressure are independent risk factors for disease progression in patients with CKD.

Serum uric acid and incident diabetes in Mauritian Indian and Creole populations

Microvascular graft dysfunction