What is the real impact of acute kidney injury?

Background: Acute kidney injury (AKI) is a common clinical problem. Studies have documented the incidence of AKI in a variety of populations but to date we do not believe the real incidence of AKI has been accurately documented in a district general hospital setting. The aim here was to describe the detected incidence of AKI in a typical general hospital setting in an unselected population, and describe associated short and long-term outcomes. Methods: A retrospective observational database study from secondary care in East Kent (adult catchment population of 582,300). All adult patients (18 years or over) admitted between 1st February 2009 and 31st July 2009, were included. Patients receiving chronic renal replacement therapy (RRT), maternity and day case admissions were excluded. AKI was defined by the acute kidney injury network (AKIN) criteria. A time dependent risk analysis with logistic regression and Cox regression was used for the analysis of in-hospital mortality and survival. Results: The incidence of AKI in the 6 month period was 15,325 pmp/yr (adults) (69% AKIN1, 18% AKIN2 and 13% AKIN3). In-hospital mortality, length of stay and ITU utilisation all increased with severity of AKI. Patients with AKI had an increase in care on discharge and an increase in hospital readmission within 30 days. Conclusions: This data comes closer to the real incidence and outcomes of AKI managed in-hospital than any study published in the literature to date. Fifteen percent of all admissions sustained an episode of AKI with increased subsequent short and long term morbidity and mortality, even in those with AKIN1. This confers an increased burden and cost to the healthcare economy, which can now be quantified. These results will furnish a baseline for quality improvement projects aimed at early identification, improved management, and where possible prevention, of AKI

Determinants of mortality in patients with cirrhosis and uncontrolled variceal bleeding

BACKGROUND AND AIM: Failure to control oesophago-gastric variceal bleeding (OGVB) and acute-on-chronic liver failure (ACLF) are both important prognostic factors in liver cirrhosis. The aims of this study were to determine whether ACLF and its severity define the risk of death in OGVB and whether insertion of rescue transjugular intrahepatic stent-shunt (TIPSS) improves the survival of patients with failure to control OGVB and ACLF. METHODS: From a prospectively maintained ICU registry, data of 174 consecutive eligible patients with failure to control OGVB between 2005 and 2015, were included. Rescue TIPSS was defined as technically successful TIPSS within 72-hours of presentation with failure to control OGVB. Cox proportional hazards regression analyses were applied to explore the impact of ACLF and TIPSS on survival in failure-to-control OGVB. RESULTS: ACLF patients (n=119) were significantly older, had organ failures and higher white cell count compared with patients with acute decompensation (AD, n=55). Mortality at 42-days and 1-year was significantly higher in ACLF (47.9% and 61.3%) as compared to AD patients (9.1% and 12.7%, p<0.001), whereas there was no difference in the number of endoscopies and transfusion requirements between these groups. TIPSS was inserted in 78 patients [AD: 21 (38.2%); ACLF: 57 (47.8%), p=0.41]. In ACLF, rescue TIPSS insertion was an independent favorable prognostic factor for 42-day mortality. In contrast, rescue TIPSS did not impact on the outcome of AD patients. CONCLUSIONS: This study shows for the first time that in patients with failure to control OGVB, the presence and severity of ACLF determines the risk of 42-day and 1-year mortality. Rescue TIPSS is associated with improved survival of ACLF patients

Sensory profile of kombucha brewed with New Zealand ingredients by focus group and word clouds

Kombucha is a yeast and bacterially fermented tea that is often described as having an acetic, fruity and sour flavour. There is a particular lack of sensory research around the use of Kombucha with additional ingredients such as those from the pepper family, or with hops. The goal of this project was to obtain a sensory profile of Kombucha beverages with a range of different ingredients, particularly of a novel Kombucha made with only Kawakawa (Piper excelsum) leaves. Other samples included hops and black pepper. Instrumental data were collected for all the Kombucha samples, and a sensory focus group of eight semi-trained panellists were set up to create a sensory profile of four products. Commercially available Kombucha, along with reference training samples were used to train the panel. Kawakawa Kombucha was found to be the sourest of the four samples and was described as having the bitterest aftertaste. The instrumental results showed that the Kawakawa Kombucha had the highest titratable acidity (1.55 vs. 1.21–1.42 mL) as well as the highest alcohol percentage (0.40 vs. 0.15–0.30%). The hops sample had the highest pH (3.72 vs. 3.49–3.54), with the lowest titratable acidity (1.21), and, from a basic poll, was the most liked of the samples. Each Kombucha had its own unique set of sensory descriptors with particular emphasis on the Kawakawa product, having unique mouthfeel descriptors as a result of some of the compounds found in Kawakawa. This research has led to a few areas that could be further studied, such as the characteristics of the Piperaceae family under fermentation and the different effects or the foaminess of the Kawakawa Kombucha, which is not fully explained

Pituitary macroadenomas: are combination antiplatelet and anticoagulant therapy contraindicated? A case report

<p>Abstract</p> <p>Background</p> <p>Pituitary apoplexy is a life-threatening endocrine emergency that is caused by haemorrhage or infarction of the pituitary gland, commonly within a pituitary adenoma. Patients classically present with headache, ophthalmoplegia, visual field defects and altered mental state, but may present with a typical symptoms such as fever and altered conscious level.</p> <p>Case presentation</p> <p>A 57-year-old female with a known pituitary macroadenoma was treated for suspected acute coronary syndrome with aspirin, clopidogrel and full dose enoxaparin. She developed a severe and sudden headache, nausea and vomiting and visual deterioration. A CT scan showed haemorrhage into the pituitary macroadenoma. She underwent neurosurgical decompression. Post-operatively her visual fields and acuity returned to baseline. She was continued on hydrocortisone and thyroxine replacement on discharge.</p> <p>Conclusion</p> <p>This case illustrates the risks of anticoagulation in a patient with a known pituitary macroadenoma, and raises the issue of whether these tumours present a relative contraindication to the use of dual antiplatelet and anticoagulation in acute coronary syndrome.</p

Influence of Forest Management Regimes on Forest Dynamics in the Upstream Region of the Hun River in Northeastern China

Balancing forest harvesting and restoration is critical for forest ecosystem management. In this study, we used LANDIS, a spatially explicit forest landscape model, to evaluate the effects of 21 alternative forest management initiatives which were drafted for forests in the upstream region of the Hun River in northeastern China. These management initiatives included a wide range of planting and harvest intensities for Pinus koraiensis, the historically dominant tree species in the region. Multivariate analysis of variance, Shannon's Diversity Index, and planting efficiency (which indicates how many cells of the target species at the final year benefit from per-cell of the planting trees) estimates were used as indicators to analyze the effects of planting and harvesting regimes on forests in the region. The results showed that the following: (1) Increased planting intensity, although augmenting the coverage of P. koraiensis, was accompanied by decreases in planting efficiency and forest diversity. (2) While selective harvesting could increase forest diversity, the abrupt increase of early succession species accompanying this method merits attention. (3) Stimulating rapid forest succession may not be a good management strategy, since the climax species would crowd out other species which are likely more adapted to future climatic conditions in the long run. In light of the above, we suggest a combination of 30% planting intensity with selective harvesting of 50% and 70% of primary and secondary timber species, respectively, as the most effective management regime in this area. In the long run this would accelerate the ultimate dominance of P. koraiensis in the forest via a more effective rate of planting, while maintaining a higher degree of forest diversity. These results are particularly useful for forest managers constrained by limited financial and labor resources who must deal with conflicts between forest harvesting and restoration

Web-based monitoring tools for Resistive Plate Chambers in the CMS experiment at CERN

The Resistive Plate Chambers (RPC) are used in the CMS experiment at the trigger level and also in the standard offline muon reconstruction. In order to guarantee the quality of the data collected and to monitor online the detector performance, a set of tools has been developed in CMS which is heavily used in the RPC system. The Web-based monitoring (WBM) is a set of java servlets that allows users to check the performance of the hardware during data taking, providing distributions and history plots of all the parameters. The functionalities of the RPC WBM monitoring tools are presented along with studies of the detector performance as a function of growing luminosity and environmental conditions that are tracked over time

Radiation background with the CMS RPCs at the LHC

The Resistive Plate Chambers (RPCs) are employed in the CMS Experiment at the LHC as dedicated trigger system both in the barrel and in the endcap. This article presents results of the radiation background measurements performed with the 2011 and 2012 proton-proton collision data collected by CMS. Emphasis is given to the measurements of the background distribution inside the RPCs. The expected background rates during the future running of the LHC are estimated both from extrapolated measurements and from simulation