Intralesional vitamin D is a safe, effective, and an inexpensive treatment option for recalcitrant warts.

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These findings suggest that the severity of proximal renal artery lesions is often unrelated to the severity of renal dysfunction in patients with ARVD. Associated renal parenchymal damage is the more probable arbiter of renal dysfunction, and this should be considered when revascularization procedures are contemplated.

Background: Maintaining optimal fluid balance is essential in haemodialysis (HD) patients but clinical evaluation remains problematic. Other technologies such as bioimpedance are emerging as valuable adjuncts. This study was undertaken to explore the potential utility of the natriuretic peptides -atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) in the assessment of fluid status and cardiovascular risk in this setting. Methods: This was a cross-sectional study carried out in an unselected cohort of 170 prevalent HD patients. Volume status was assessed by clinical parameters -the presence or absence of peripheral oedema, raised jugular venous pressure and basal lung crepitations; by extracellular fluid volume (ECFV) status determined by whole body bioimpedance; and by serum levels of BNP and ANP (pre-and post -dialysis). The relationships of ANP and BNP levels to clinical and bioimpedance parameters of volume status was determined. Patients were followed up for 5 years to assess the relationship of natriuretic peptide levels to mortality. Results: Bioimpedance estimates of ECFV expansion (>105 % of ideal ECFV) was present in 52 % of patients pre-dialysis. A significant proportion (21 %) of pre-dialysis patients had a depleted ECFV (<95 % of ideal ECFV) pre-dialysis. The situation was reversed post-dialysis. A raised JVP >3 cm was the most reliable clinical sign of ECFV expansion inferred from bioimpedance measurements and natriuretic peptide levels. The vast majority of patients with this sign also had lung crepitations or peripheral oedema or both. BNP was a stronger predictor of ECFV expansion than either pre-or post-dialysis ANP. BNP was also a stronger predictor of five-year survival. Conclusion: Serum levels of BNP have a strong relationship to both volume status and survival in HD patients. We found no clear role for measurement of ANP, though changes in blood levels may be a sensitive indicator of acute changes in volume status. Whether monitoring levels of these peptides has a role in the management of volume status and cardiovascular risk requires further study.

Background Hemorrhagic shock can be mitigated by timely and accurate resuscitation designed to restore adequate delivery of oxygen (DO2) by increasing cardiac output (CO). However, standard care of using systolic blood pressure (SBP) as a guide for resuscitation has proven ineffective and can be associated with increased morbidity. We have developed a novel vital sign called the compensatory reserve (CRM) generated from analysis of arterial pulse waveform feature changes that has been validated in experimental and clinical models of hemorrhage. We tested the hypothesis that thresholds of DO2 could be accurately defined by CRM while avoiding over resuscitation during whole blood resuscitation following a 25% hemorrhage in non‐human primates. Methods To accomplish this, adult male baboons (n=12) were exposed to a progressive controlled hemorrhage that resulted in an average (± SD) maximal reduction of 601 ± 18 ml of their estimated circulating blood volume of 1,262 ± 64 ml based on body weight. Values of DO2 were calculated as the product of CO times O2 carrying capacity of hemoglobin (i.e., Hb content × 1.34). Results Average (± SD) CRM increased from 6 ± 5 % at the end of hemorrhage to 70 ± 7 % at the end of resuscitation. DO2 of 12.1, 10.3, and 7.0 ml O2·kg−1 ·min−1 were calculated at 0% (baseline), 12.5% and 25% blood loss. By linear regression, CRM values of 6% (decompensation), 35%, and 68% corresponded to calculated DO2 values of 6.0, 9.2, and 12.1 ml O2·kg−1 ·min−1 during resuscitation. As such, return of CRM to baseline during resuscitation with only ~ 450 ml provided adequate DO2 (12.5 ml O2·kg−1 ·min−1) while total blood volume replacement (~600 ml) resulted in over resuscitation as indicated by an average increase in SBP (+17 mmHg) and CO (+0.1 L/min) over baseline values. Conclusion Consistent with our hypothesis, thresholds of DO2 were associated with specific CRM values. A target resuscitation CRM value of 70% minimized the requirement for whole blood, while avoiding over resuscitation. Furthermore, CRM at 0% provided a noninvasive metric for determining critical DO2 at approximately 5.4 ml O2·kg−1 ·min−1. Support or Funding Information This research was supported in part by appointment of Ms. Koons to the Postgraduate Research Fellowship Program at the US Army Institute of Surgical Research administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the US Department of Energy and USAMRMC. Study funding was provided by a grant from the US Army Combat Casualty Care Research Program (D‐009‐2014‐USAISR). This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.