Telemedicine in the emergency department to decrease personal protective equipment use: a before-and-after study.

Background: Personal protective equipment (PPE) used by healthcare workers was scarce during the COVID-19 pandemic The aim of this study was to assess whether telemedicine (using iPads) reduced PPE use in emergency department (ED) patients who were treated in contact isolation, and whether telemedicine had a positive effect on patient anxiety and satisfaction.

Methods: We conducted a prospective single centre before-and-after study including ED patients ≥18 years who were treated in contact isolation. PPE use, the Hospital Anxiety Scale and the 15-item Picker Patient Experience Questionnaire were compared between the control period (8 April to 14 April 2020) and intervention period (15 April to 24 April 2020).

Performance of the Manchester triage system in older emergency department patients: a retrospective cohort study.

Background: Studies on the reliability of the MTS and its predictive power for hospitalisation and mortality in the older population have demonstrated mixed results. The objective is to evaluate the performance of the Manchester Triage System (MTS) in older patients (≥65 years) by assessing the predictive ability of the MTS for emergency department resource utilisation, emergency department length of stay (ED-LOS), hospitalisation, and in-hospital mortality rate. The secondary goal was to evaluate the performance of the MTS in older surgical versus medical patients.

Staging and management of axillary lymph nodes in patients with local recurrence in the breast or chest wall after a previous negative sentinel node procedure.

Objective: To evaluate axillary staging and management in patients with local recurrence (LR) after a previous negative sentinel lymph node biopsy (SNB).

Methods: Between 1999 and 2008, 130 patients with previous negative SNB developed a LR of breast or chest wall. After examination of clinical records, 70 patients met the inclusion criteria and remained available for analysis.

Renin and prorenin disappearance in humans post-nephrectomy: evidence for binding?

To study the distribution of kidney-derived renin-angiotensin system (RAS) components in humans, we monitored the decline in plasma prorenin, renin, angiotensin (Ang) I and Ang II post-nephrectomy. Prorenin and renin decreased biphasically, prorenin displaying a slower elimination. The distribution half life was similar for both.

Newly developed renin and prorenin assays and the clinical evaluation of renin inhibitors.

Background: The last decade has seen the introduction of renin inhibitors and new plasma renin and prorenin assays, which has led to a better understanding of the tissue renin-angiotensin system.

Aim Of The Study: To clarify the consequences of these developments for the methodology and interpretation of measurements of renin and prorenin.

Methods: The principles and application of the newly developed immunosorbent assays (ISAs) are surveyed and the results are compared with those of enzyme-kinetic assays (EKAs).

Predictors for clinical success at one year following renal artery stent placement.

Purpose: To determine pretreatment variables that may predict 1-year clinical outcome of stent placement for renal artery stenosis.

Methods: In a prospective study, 40 consecutive patients (29 men; mean age 60 +/- 9.1 years) with angiographically proven atherosclerotic renal artery stenosis were treated with stent placement because of drug resistant hypertension (n=14), renal function impairment (n=14), or both (n=12).

Effects of L-arginine and L-NAME on the renal function in hypertensive and normotensive subjects.

Background/aim: Renal vasodilation in response to L-arginine has been reported to be diminished in hypertensive (HT) subjects. If this diminished renal vasodilator response indicates disturbance of the renal NO pathway, a diminished renal vasoconstrictor response to NO synthase inhibition may be present in HT subjects as well. The present study was conducted to compare the effects of L-arginine and N(G)-nitro-L-arginine methyl ester (L-NAME) on renal and systemic hemodynamics between HT and normotensive (NT) subjects.

Functional effects of renal artery stent placement on treated and contralateral kidneys.

Background: This study examined the effects of stent placement for renal artery stenosis on the function of treated and contralateral kidneys.

Methods: Eighteen patients who underwent stent placement for unilateral renal artery stenosis presenting with hypertension and/or renal failure were studied before angiography and stent placement and at their one-year follow-up. Renal vein blood samples were taken at both sides, at each side simultaneously with a sample from the aorta, to measure the plasma renin concentration and the concentrations of 131I-hippuran and 125I-thalamate during constant systemic infusion of these radiochemicals.

Resistance to antihypertensive medication as predictor of renal artery stenosis: comparison of two drug regimens.

Background: Renal artery stenosis is among the most common curable causes of hypertension. The definitive diagnosis is made by renal angiography, an invasive and costly procedure. The prevalence of renal artery stenosis is less than 1% in non-selected hypertensive patients but is higher when hypertension is resistant to drugs.

Prorenin accumulation and activation in human endothelial cells: importance of mannose 6-phosphate receptors.

ACE inhibitors improve endothelial dysfunction, possibly by blocking endothelial angiotensin production. Prorenin, through its binding and activation by endothelial mannose 6-phosphate (M6P) receptors, may contribute to this production. Here, we investigated this possibility as well as prorenin activation kinetics, the nature of the prorenin-activating enzyme, and M6P receptor-independent prorenin binding.

High-affinity prorenin binding to cardiac man-6-P/IGF-II receptors precedes proteolytic activation to renin.

Mannose-6-phosphate (man-6-P)/insulin-like growth factor-II (man-6-P/IgF-II) receptors are involved in the activation of recombinant human prorenin by cardiomyocytes. To investigate the kinetics of this process, the nature of activation, the existence of other prorenin receptors, and binding of native prorenin, neonatal rat cardiomyocytes were incubated with recombinant, renal, or amniotic fluid prorenin with or without man-6-P. Intact and activated prorenin were measured in cell lysates with prosegment- and renin-specific antibodies, respectively.

Cardiomyocytes bind and activate native human prorenin : role of soluble mannose 6-phosphate receptors.

Cardiomyocytes bind, internalize, and activate recombinant human prorenin through mannose 6-phosphate/insulin-like growth factor II (M6P/IGFII) receptors. To investigate whether this also applies to native human prorenin, neonatal rat myocytes were incubated for 4 hours at 37 degrees C with various prorenin-containing human body fluids. Uptake and activation by M6P/IGFII receptors were observed for plasma prorenin from subjects with renal artery stenosis and/or hypertension and for follicular fluid prorenin.

The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Cooperative Study Group.

Background: Patients with hypertension and renal-artery stenosis are often treated with percutaneous transluminal renal angioplasty. However, the long-term effects of this procedure on blood pressure are not well understood.

Methods: We randomly assigned 106 patients with hypertension who had atherosclerotic renal-artery stenosis (defined as a decrease in luminal diameter of 50 percent or more) and a serum creatinine concentration of 2.

Do older hospital patients recognize adverse drug reactions?

Objective: To establish the relationship between subjective complaints of side effects of drugs and the objective presence of adverse drug reactions in older patients.

Design: Observational cross-sectional study.

Setting: Five medical wards at the University Hospital Rotterdam Dijkzigt.

Contribution of adverse drug reactions to hospital admission of older patients.

Objective: To describe the severity of adverse drug reactions as a factor in hospital admission of older patients, and to identify risk indicators for severe adverse drug reactions in these patients.

Design: Observational cross-sectional study.

Setting: Five wards in a university hospital in The Netherlands.

Inter-observer variability in the angiographic assessment of renal artery stenosis. DRASTIC study group. Dutch Renal Artery Stenosis Intervention Cooperative.

Objective: To assess inter-observer agreement in the interpretation of renal angiograms.

Design: Comparison of the assessment of renal angiograms by three experienced radiologists, who evaluated the number of renal arteries and the presence, location, aspect and severity of a renal artery stenosis.

Setting: General hospital and university hospital serving urban and rural populations.

Increase in serum prorenin precedes onset of microalbuminuria in patients with insulin-dependent diabetes mellitus.

Aims/hypothesis: The renin-angiotensin system is possibly involved in the pathogenesis of diabetic nephropathy. The most striking change in renin-angiotensin system components in blood of patients with diabetic nephropathy is an increased prorenin concentration. We investigated prospectively serum concentrations of renin-angiotensin system components and the time course of prorenin increase in normoalbuminuric diabetic patients developing microalbuminuria.

Plasma renin and prorenin and renin gene variation in patients with insulin-dependent diabetes mellitus and nephropathy.

Background: The most striking abnormality in the renin angiotensin system in diabetic nephropathy (DN) is increased plasma prorenin. Renin is thought to be low or normal in DN. In spite of altered (pro)renin regulation the renin gene has not been studied for contribution to the development of DN.

Uptake and proteolytic activation of prorenin by cultured human endothelial cells.

Objective: To investigate the mechanisms of vascular uptake of prorenin and renin and to explore the possibility of vascular activation of prorenin.

Design And Methods: Human umbilical vein endothelial cells (HUVECs) cultured in a chemically defined medium were incubated with recombinant human prorenin or renin in the presence or absence of putative inhibitors of renin internalization. Cell surface-bound and internalized prorenin or renin were separated by the acid-wash method and were quantified by enzyme-kinetic assays.

Improved immunoradiometric assay for plasma renin.

Background: Our renin IRMA overestimated renin in plasmas with high prorenin-to-renin ratios. We suspected that the overestimation of renin was caused less by cross-reactivity of the renin-specific antibody with prorenin than by a conformational change of prorenin into an enzymatically active form during the assay.

Methods: Because the inactive form of prorenin converts slowly into an active form at low temperature, we raised the assay temperature from 22 degrees C to 37 degrees C, simultaneously shortening the incubation time from 24 to 6 h.

Angiotensin I-to-II conversion in the human renal vascular bed.

Objective: During previous studies in humans and pigs, using infusions of 125I-angiotensin into the right antecubital vein or the left cardiac ventricle, we were unable to demonstrate conversion of arterial angiotensin I in the renal vascular bed. The arterial 125I-angiotensin I levels in these studies may have been too low to result in detectable renal venous 125I-angiotensin II levels, especially in view of the extensive degradation of angiotensins in the kidney. To overcome this problem, we now infused 125I-angiotensin I directly into the renal artery.

Angiotensinogen (M235T) and angiotensin-converting enzyme (I/D) polymorphisms in association with plasma renin and prorenin levels.

Objective: The angiotensinogen T235 allele is associated with elevated plasma angiotensinogen levels whereas the angiotensin-converting enzyme (ACE) deletion (D) allele is associated with elevated ACE activity. It remains unclear, however, whether these genetically mediated elevations of angiotensinogen and ACE levels are functionally relevant Given that the renin-angiotensin system is subject to renin feedback regulation, we specifically investigated the associations between the angiotensinogen T235 allele and the ACE D allele with plasma renin and prorenin levels.

Design And Methods: Plasma levels of renin, prorenin, angiotensinogen, ACE and aldosterone, as well as angiotensinogen and ACE genotypes were determined in 228 men and 168 women (age 52-65 years), who had participated in a population survey in southern Germany.

Probing epitopes on human prorenin during its proteolytic and non-proteolytic activation.

The conformational changes of prorenin (PR) that are associated with its reversible non-proteolytic activation and irreversible proteolytic activation were monitored with immunoradiometric assays, using antibodies against epitopes belonging to the propeptide or the renin part of PR. Binding of PR to the renin inhibitor remikiren or protonation of PR resulted in the slowly progressive and simultaneous expression (t1/2 congruent with3.5-5.

The Dutch Renal Artery Stenosis Intervention Cooperative (DRASTIC) Study: rationale, design and inclusion data.

Rationale: Renal artery stenosis may lead to renovascular hypertension, risking multiple organ damage including damage to the contralateral kidney. Progression of stenosis may impair the function of the affected kidney. It is important to identify individuals with this disease among hypertensive patients.