Duration of acute kidney injury in critically ill patients

BACKGROUND:Duration of acute kidney injury (AKI) has been recognized a risk factor for adverse outcomes following AKI. We sought to examine the relationship of AKI duration and recurrent AKI with short-term outcomes in critically ill patients who were mechanically ventilated and met criteria for the acute respiratory distress syndrome. METHODS:Participants in the NHLBI ARDS Network SAILS multicenter trial who developed AKI were included in this analysis and divided into groups based on AKI duration. Differences in outcomes were evaluated using t test and Chi-square test. Competing risks regression and Cox regression were used to evaluate factors associated with resolving AKI and recurrent AKI. RESULTS:In total, 238 patients were included in the study. Seventy-seven patients had short duration AKI (1-2 days), 47 medium duration AKI (3-7 days), 87 persistent AKI (> 7 days) and 38 died during their AKI episode. Persistent AKI was associated with worse outcomes including increased ICU length of stay, time on the ventilator and days with cardiovascular failure. We found no clinical differences between patients with short and medium duration AKI, even when accounting for AKI severity and recurrent AKI. Patients with resolving AKI were less likely to have oliguria or moderate/severe ARDS on the day AKI criteria were met. Recurrent AKI was associated with poorer clinical outcomes. No baseline clinical factors were found to predict development of recurrent AKI. CONCLUSIONS:In critically ill patients with sepsis-associated ARDS and AKI, the impact of short and medium duration AKI on clinical outcomes was modest. Persistent and recurrent AKI were both associated with worse clinical outcomes, emphasizing the importance of identifying these patients, who may benefit from novel interventions

Functional Dissociation in Frontal and Striatal Areas for Processing of Positive and Negative Reward Information

Reward-seeking behavior depends critically on processing of positive and negative information at various stages such as reward anticipation, outcome monitoring, and choice evaluation. Behavioral and neuropsychological evidence suggests that processing of positive (e.g., gain) and negative (e.g., loss) reward information may be dissociable and individually disrupted. However, it remains uncertain whether different stages of reward processing share certain neural circuitry in frontal and striatal areas, and whether distinct but interactive systems in these areas are recruited for positive and negative reward processing. To explore these issues, we used a monetary decision-making task to investigate the roles of frontal and striatal areas at all three stages of reward processing in the same event-related functional magnetic resonance imaging experiment. Participants were instructed to choose whether to bet or bank a certain number of chips. If they decided to bank or if they lost a bet, they started over betting one chip. If they won a bet, the wager was doubled in the next round. Positive reward anticipation, winning outcome, and evaluation of right choices activated the striatum and medial/middle orbitofrontal cortex, whereas negative reward anticipation, losing outcome, and evaluation of wrong choices activated the lateral orbitofrontal cortex, anterior insula, superior temporal pole, and dorsomedial frontal cortex. These findings suggest that the valence of reward information and counterfactual comparison more strongly predict a functional dissociation in frontal and striatal areas than do various stages of reward processing. These distinct but interactive systems may serve to guide human\u27s reward-seeking behavior

Microstructural Characterization of Graphite Spheroids in Ductile Iron

The present work brings new insights by transmission electron microscopy allowing disregarding or supporting some of the models proposed for spheroidal growth of graphite in cast irons. Nodules consist of sectors made of graphite plates elongated along a hai direction and stack on each other with their c axis aligned with the radial direction. These plates are the elementary units for spheroidal growth and a calculation supports the idea that new units continuously nucleate at the ledge between sectors

Cosmological Consequences of Slow-Moving Bubbles in First-Order Phase Transitions

In cosmological first-order phase transitions, the progress of true-vacuum bubbles is expected to be significantly retarded by the interaction between the bubble wall and the hot plasma. We examine the evolution and collision of slow-moving true-vacuum bubbles. Our lattice simulations indicate that phase oscillations, predicted and observed in systems with a local symmetry and with a global symmetry where the bubbles move at speeds less than the speed of light, do not occur inside collisions of slow-moving local-symmetry bubbles. We observe almost instantaneous phase equilibration which would lead to a decrease in the expected initial defect density, or possibly prevent defects from forming at all. We illustrate our findings with an example of defect formation suppressed in slow-moving bubbles. Slow-moving bubble walls also prevent the formation of `extra defects', and in the presence of plasma conductivity may lead to an increase in the magnitude of any primordial magnetic field formed.Comment: 10 pages, 7 figures, replaced with typos corrected and reference added. To appear in Phys. Rev.

An Exception to the Carothers Equation Caused by the Accelerated Chain Extension in a Pd/Ag Cocatalyzed Cross Dehydrogenative Coupling Polymerization

The Carothers equation is often used to predict the utility of a small molecule reaction in a polymerization. In this study, we present the mechanistic study of Pd/Ag cocatalyzed cross dehydrogenative coupling (CDC) polymerization to synthesize a donor–acceptor (D–A) polymer of 3,3′-dihexyl-2,2′-bithiophene and 2,2′,3,3′,5,5′,6,6′-octafluorobiphenyl, which go counter to the Carothers equation. It is uncovered that the second chain extension cross-coupling proceeds much more efficiently than the first cross-coupling and the homocoupling side reaction (at least 1 order of magnitude faster) leading to unexpectedly low homocoupling defects and high molecular weight polymers. Kinetic analyses show that C–H bond activation is rate-determining in the first cross-coupling but not in the second cross-coupling. Based on DFT calculations, the high cross-coupling rate in the second cross-coupling was ascribed to the strong Pd-thiophene interaction in the Pd-mediated C–H bond activation transition state, which decreases the energy barrier of the Pd-mediated C–H bond activation. These results have implications beyond polymerizations and can be used to ease the synthesis of a wide range of molecules where C–H bond activation may be the limiting factor

The SOS Pilot Study: a RCT of routine oxygen supplementation early after acute stroke—effect on recovery of neurological function at one week

Mild hypoxia is common after stroke and associated with poor long-term outcome. Oxygen supplementation could prevent hypoxia and improve recovery. A previous study of routine oxygen supplementation showed no significant benefit at 7 and 12 months. This pilot study reports the effects of routine oxygen supplementation for 72 hours on oxygen saturation and neurological outcomes at 1 week after a stroke

Supramolecular assemblies involving metal organic ring interactions: Heterometallic Cu(II)-Ln(III) two dimensional coordination polymers

Three isostructural two-dimensional coordination polymers of the general formula [Ln2(CuL)3(H2O)9]$5.5H2O, where Ln is La (1), Nd (2), and Gd (3), have been synthesized and isolated from aqueous solutions and their single-crystal structures determined by X-ray diffraction. The supramolecular interaction between the non-aromatic metallorings plays an important role in stabilizing the structure of these compounds. The thermal stability, reversible solvent uptake, electronic properties and magnetic studies of these compounds are also reported