Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Diverse definitions of the early course of schizophrenia - a targeted literature review

Schizophrenia is a debilitating psychiatric disorder and patients experience significant comorbidity, especially cognitive and psychosocial deficits, already at the onset of disease. Previous research suggests that treatment during the earlier stages of disease reduces disease burden, and that a longer time of untreated psychosis has a negative impact on treatment outcomes. A targeted literature review was conducted to gain insight into the definitions currently used to describe patients with a recent diagnosis of schizophrenia in the early course of disease ('early' schizophrenia). A total of 483 relevant English-language publications of clinical guidelines and studies were identified for inclusion after searches of MEDLINE, MEDLINE In-Process, relevant clinical trial databases and Google for records published between January 2005 and October 2015. The extracted data revealed a wide variety of terminology and definitions used to describe patients with 'early' or 'recent-onset' schizophrenia, with no apparent consensus. The most commonly used criteria to define patients with early schizophrenia included experience of their first episode of schizophrenia or disease duration of less than 1, 2 or 5 years. These varied definitions likely result in substantial disparities of patient populations between studies and variable population heterogeneity. Better agreement on the definition of early schizophrenia could aid interpretation and comparison of studies in this patient population and consensus on definitions should allow for better identification and management of schizophrenia patients in the early course of their disease

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Not AvailableThe experiment was conducted to study the effect of integrated nutrient management on nutrient content and uptake in alfalfa under central dry zone of Karnataka at the farm field of Krishi Vigyan Kendra, Konehalli, Tiptur, Tumkuru district of Karnataka state during kharif and rabi seasons from June 2016 to July 2017. There were nine treatments and four replication with Randomized complete block design. The results revealed that, the maximum nitrogen content of plant at first (1.14% & 1.15%), second (1.12% & 1.14%), third (1.16% & 1.15%), fourth (1.12% & 1.12%), fifth (1.11% & 1.09%), sixth (1.08% & 1.06%) and seventh harvest (1.07% & 1.05%) were recorded respectively during kharif and rabi season with the application 50% RDF+25% N through vermicompost+Rhizobium+PSB+VAM. The least nitrogen content of plant was recorded with the application of 10 t/ha FYM+100% N through FYM at all the harvests. The application of 50% RDF+25% N through vermicompost+Rhizobium+PSB+VAM has recorded maximum cumulative uptake of nitrogen (250.74 kg ha-1 & 235.36 kg ha-1), phosphorus (91.47 kg ha-1 & 84.36 kg ha-1) and potassium (176.46 kg ha-1 & 166.66 kg ha-1) by plant respectively during kharif and rabi season. The highest crude protein content of plant at first and subsequent harvesting of ratoon crops were recorded with the application of 50% RDF+25% N through vermicompost+Rhizobium+PSB+VAM in both the season. The experiment concluded that, the application of 50% RDF+25% N through vermicompost+Rhizobium+PSB+VAM has recorded maximum nutrient content and uptake in alfalfa during kharif and rabi season under central dry zone of Karnataka.Not Availabl

Dorsolateral prefrontal cortex activity predicts responsiveness to cognitive-behavioral therapy in schizophrenia

BACKGROUND: Given the variable response to cognitive–behavioral therapy (CBT) when added to antipsychotic medication in psychosis and the evidence for a role of pretherapy level of frontal lobe–based cognitive function in responsiveness to CBT in other disorders, this study examined whether pretherapy brain activity associated with working memory neural network predicts clinical responsiveness to CBT in schizophrenia. METHODS: Fifty-two outpatients stable on medication with at least one distressing symptom of schizophrenia and willing to receive CBT in addition to their usual treatment and 20 healthy participants underwent functional magnetic resonance imaging during a parametric n-back task. Subsequently, 26 patients received CBT for psychosis (CBT+treatment-as-usual [TAU], 19 completers) for 6–8 months, and 26 continued with TAU alone (17 completers). Symptoms in both patient groups were assessed (blindly) at entry and follow-up. RESULTS: The CBT+TAU and TAU-alone groups did not differ clinically or in performance at baseline. The CBT+TAU group showed significant improvement in relation to the TAU-alone group, which showed no change, at follow-up. Stronger dorsolateral prefrontal cortex (DLPFC) activity (within the normal range) and DLPFC–cerebellum connectivity during the highest memory load condition (2-back > 0-back) were associated with post-CBT clinical improvement. CONCLUSIONS: DLPFC activity and its connectivity with the cerebellum predict responsiveness to CBT for psychosis in schizophrenia. These effects may be mediated by PFC–cerebellum contributions to executive processing

Functional MRI of verbal self-monitoring in schizophrenia: performance and illness-specific effects

Previous small-sample studies have shown altered fronto-temporal activity in schizophrenia patients with auditory hallucinations and impaired monitoring of self-generated speech.We examined a large cohort of patients with schizo-phrenia (n5 63) and a representative group of healthy con-trols (n 5 20) to disentangle performance, illness, and symptom-related effects in functional magnetic resonance imaging–detected brain abnormalities during monitoring of self- and externally generated speech in schizophrenia. Our results revealed activation of the thalamus (medial genicu-late nucleus, MGN) and frontotemporal regions with accu-rate monitoring across all participants. Less activation of the thalamus (MGN, pulvinar) and superior-middle tempo-ral and inferior frontal gyri occurred in poorly performing patients (1 standard deviation below controls ’ mean; n