Clinical review: Volume of fluid resuscitation and the incidence of acute kidney injury - a systematic review

Intravenous fluids are widely administered to maintain renal perfusion and prevent acute kidney injury (AKI). However, fluid overload is of concern during AKI. Using the Pubmed database (up to October 2011) we identified all randomised controlled studies of goal-directed therapy (GDT)-based fluid resuscitation (FR) reporting renal outcomes and documenting fluid given during perioperative care. In 24 perioperative studies, GDT was associated with decreased risk of postoperative AKI (odds ratio (OR) = 0.59, 95% confidence interval (CI) = 0.39 to 0.89) but additional fluid given was limited (median: 555 ml). Moreover, the decrease in AKI was greatest (OR = 0.47, 95% CI = 0.29 to 0.76) in the 10 studies where FR was the same between GDT and control groups. Inotropic drug use in GDT patients was associated with decreased AKI (OR = 0.52, 95% CI = 0.34 to 0.80, P = 0.003), whereas studies not involving inotropic drugs found no effect (OR = 0.75, 95% CI = 0.37 to 1.53, P = 0.43). The greatest protection from AKI occurred in patients with no difference in total fluid delivery and use of inotropes (OR = 0.46, 95% CI = 0.27 to 0.76, P = 0.0036). GDT-based FR may decrease AKI in surgical patients; however, this effect requires little overall FR and appears most effective when supported by inotropic drugs

Economics of dialysis dependence following renal replacement therapy for critically ill acute kidney injury patients.

BACKGROUND: The obective of this study was to perform a cost-effectiveness analysis comparing intermittent with continuous renal replacement therapy (IRRT versus CRRT) as initial therapy for acute kidney injury (AKI) in the intensive care unit (ICU). METHODS: Assuming some patients would potentially be eligible for either modality, we modeled life year gained, the quality-adjusted life years (QALYs) and healthcare costs for a cohort of 1000 IRRT patients and a cohort of 1000 CRRT patients. We used a 1-year, 5-year and a lifetime horizon. A Markov model with two health states for AKI survivors was designed: dialysis dependence and dialysis independence. We applied Weibull regression from published estimates to fit survival curves for CRRT and IRRT patients and to fit the proportion of dialysis dependence among CRRT and IRRT survivors. We then applied a risk ratio reported in a large retrospective cohort study to the fitted CRRT estimates in order to determine the proportion of dialysis dependence for IRRT survivors. We conducted sensitivity analyses based on a range of differences for daily implementation cost between CRRT and IRRT (base case: CRRT day $632 more expensive than IRRT day; range from$200 to $1000) and a range of risk ratios for dialysis dependence for CRRT as compared with IRRT (from 0.65 to 0.95; base case: 0.80). RESULTS: Continuous renal replacement therapy was associated with a marginally greater gain in QALY as compared with IRRT (1.093 versus 1.078). Despite higher upfront costs for CRRT in the ICU ($4046 for CRRT versus $1423 for IRRT in average), the 5-year total cost including the cost of dialysis dependence was lower for CRRT ($37 780 for CRRT versus $39 448 for IRRT on average). The base case incremental cost-effectiveness analysis showed that CRRT dominated IRRT. This dominance was confirmed by extensive sensitivity analysis. CONCLUSIONS: Initial CRRT is cost-effective compared with initial IRRT by reducing the rate of long-term dialysis dependence among critically ill AKI survivors

Site-Specific Assembly of DNA-Based Photonic Wires by Using Programmable Polyamides**

The first example of a programmable DNA photonic wire is reported utilizing fluorophore-tethered pyrrole-imidazole polyamides for site-directed fluorophore assembly along a pre-formed DNA duplex (see scheme; PB=Pacific Blue, Cy3=Cyanine 3; orange rectangles=fluorophore). The importance of such control is revealed by efficient energy transport over distances in excess of 27 nm

Human Circadian Phenotyping and Diurnal Performance Testing in the Real World

In our continuously developing 'around the clock' society, there is a need to increase our understanding of how changes in biology, physiology and psychology influence our health and performance. Embedded within this challenge, is the increasing need to account for individual differences in sleep and circadian rhythms, as well as to explore the impact of time of day on performance in the real world. There are a number of ways to measure sleep and circadian rhythms from subjective questionnaire-based methods to objective sleep/wake monitoring, actigraphy and analysis of biological samples. This paper proposes a protocol that combines multiple techniques to categorize individuals into Early, Intermediate or Late circadian phenotype groups (ECPs/ICPs/LCPs) and recommends how to conduct diurnal performance testing in the field. Representative results show large differences in rest-activity patterns derived from actigraphy, circadian phase (dim light melatonin onset and peak time of cortisol awakening response) between circadian phenotypes. In addition, significant differences in diurnal performance rhythms between ECPs and LCPs emphasizes the need to account for circadian phenotype. In summary, despite the difficulties in controlling influencing factors, this protocol allows a real-world assessment of the impact of circadian phenotype on performance. This paper presents a simple method to assess circadian phenotype in the field and supports the need to consider time of day when designing performance studies

Chemical sensors for in situ data collection in the cryosphere

Glaciers and ice sheets are recognised as important components of global biogeochemical cycles. Chemical sensors have great potential for in situ monitoring in the cryosphere and are available for many analytes of interest, but they are frequently unsuitable for deployment since meltwaters are cold, turbid, experience freeze-thaw cycles and display low ionic strength and concentrations of target analytes. Here, we review in situ chemical sensors currently available for measurement of biogeochemically important analytes and assess their suitability for deployment. These include standard parameters such as dissolved oxygen and pH, along with macronutrients (nitrate/nitrite and phosphate), micronutrients (iron and manganese) and biogenic gases (methane). Where no commercial alternatives are available, we discuss sensors currently in development, and their applicability to these extreme environments. The information presented has great relevance for future science in polar environments, and for the ultimate goal of obtaining in situ data from extreme, inaccessible subglacial environments

Long-term risk of mortality after acute kidney injury in patients with sepsis: a contemporary analysis

<p>Abstract</p> <p>Background</p> <p>Acute kidney injury (AKI) is associated with increased short-term mortality of septic patients; however, the exact influence of AKI on long-term mortality in such patients has not yet been determined.</p> <p>Methods</p> <p>We retrospectively evaluated the impact of AKI, defined by the "Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease" (RIFLE) classification based on creatinine criteria, on 2-year mortality in a cohort of 234 hospital surviving septic patients who had been hospitalized at the Infectious Disease Intensive Care Unit of our Hospital.</p> <p>Results</p> <p>Mean-follow-up was 21 ± 6.4 months. During this period, 32 patients (13.7%) died. At 6 months, 1 and 2 years of follow-up, the cumulative probability of death of patients with previous AKI was 8.3, 16.9 and 34.2%, respectively, as compared with 2.2, 6 and 8.9% in patients without previous AKI (log-rank, P < 0.0001). In the univariate analysis, age (hazard ratio 1.4, 95% CI 1.2-1.7, P < 0.0001), as well as pre-existing cardiovascular disease (hazard ratio 3.6, 95% CI 1.4-9.4, P = 0.009), illness severity as evaluated by nonrenal APACHE II (hazard ratio 1.3, 95% CI 1.1-1.6, P = 0.002), and previous AKI (hazard ratio 4.2, 95% CI 2.1-8.5, P < 0.0001) were associated with increased 2-year mortality, while gender, race, pre-existing hypertension, cirrhosis, HIV infection, neoplasm, and baseline glomerular filtration rate did not. In the multivariate analysis, however, only previous AKI (hazard ratio 3.2, 95% CI 1.6-6.5, P = 0.001) and age (hazard ratio 1.4, 95% CI 1.2-1.6, P < 0.0001) emerged as independent predictors of 2-year mortality.</p> <p>Conclusions</p> <p>Acute kidney injury had a negative impact on long-term mortality of patients with sepsis.</p

A review of the compressive stiffness of the human head

Published 12 November 2022Synthetic surrogate head models are used in biomechanical studies to investigate skull, brain, and cervical spine injury. To ensure appropriate biofidelity of these head models, the stiffness is often tuned so that the surrogate’s response approximates the cadaveric response corridor. Impact parameters such as energy, and loading direction and region, can influence injury prediction measures, such as impact force and head acceleration. An improved understanding of how impact parameters affect the head’s structural response is required for designing better surrogate head models. This study comprises a synthesis and review of all existing ex vivo head stiffness data, and the primary factors that influence the force–deformation response are discussed. Eighteen studies from 1972 to 2019 were identified. Head stiffness statistically varied with age (pediatric vs. adult), loading region, and rate. The contact area of the impactor likely affects stiffness, whereas the impactor mass likely does not. The head’s response to frontal impacts was widely reported, but few studies have evaluated the response to other impact locations and directions. The findings from this review indicate that further work is required to assess the effect of head constraints, loading region, and impactor geometry, across a range of relevant scenarios.Darcy W. Thompson-Bagshaw, Ryan D. Quarrington, and Claire F. Jone