Renal replacement therapies for infants and children in the ICU

PURPOSE OF REVIEW: Pediatric acute kidney injury (AKI) in critically ill patients is associated with increased morbidity and mortality. Emerging data support that the incidence of pediatric AKI in the ICU is rising. For children with severe AKI, renal replacement therapy (RRT) can provide a lifesaving supportive therapy. The optimal timing to deliver and modality by which to deliver RRT remain a point of discussion within pediatric (and adult) literature. This review discusses the use of RRT for pediatric patients in the ICU. We discuss the most recent evidence-based methods for RRT with a focus on continuous RRT. RECENT FINDINGS: The feasibility of dialyzing the smallest infants and more medically complex children in the ICU is dependent on the advancements in dialysis access and circuit technology. At present, data indicate that upward of 27% of children in the ICU develop AKI and 6% require RRT. Newer dialysis modalities including prolonged intermittent hemodialysis and continuous flow peritoneal dialysis as well as newer dialysis technologies such as the smaller volume circuits (e.g., Cardio-Renal Pediatric Dialysis Emergency Machine, Newcastle Infant Dialysis and Ultrafiltration System) have made the provision of dialysis safer and more effective for pediatric patients of a variety of sizes. SUMMARY: Renal replacement in the ICU requires a multidisciplinary team approach that is facilitated by a pediatric nephrologist in conjunction with intensivists and skilled nursing staff. Although mortality rates for children on dialysis remain high, outcomes are improving with the support of the multidisciplinary team and dialysis technology advancements

Effect of photoperiod and host distribution on the horizontal transmission of Isaria fumosorosea (Hypocreales: Cordycipitaceae) in greenhouse whitefly assessed using a novel model bioassay

A model bioassay was used to evaluate the epizootic potential and determine the horizontal transmission efficiency of Isaria fumosorosea Trinidadian strains against Trialeurodes vaporariorum pharate adults under optimum conditions (25±0.5°C, ~100% RH) at two different photoperiods. Untreated pharate adults were arranged on laminated graph paper at different distributions to simulate varying infestation levels on a leaf surface. Four potential hosts were located 7, 14 and 21 mm away from a central sporulating cadaver simulating high, medium and low infestation levels, respectively. Percent hosts colonized were recorded 7, 12, 14 and 21 days post-treatment during a 16- and 24-h photophase. After 21 days, mean percent hosts colonized at the highest, middle and lowest infestation levels were 93 and 100%, 22 and 58%, 25 and 39% under a 16- and 24-h photophase, respectively. From the results, it was concluded that the longer the photophase, the greater the percentage of hosts colonized, and as host distance increased from the central sporulating cadaver, colonization decreased. The use of this novel model bioassay technique is the first attempt to evaluate the epizootic potential and determine the horizontal transmission efficiency of I. fumosorosea Trinidadian strains under optimal environmental conditions at different photoperiods. This bioassay can be used to assess horizontal transmission efficiency for the selection of fungi being considered for commercial biopesticide development

Social Media and the Politics of Gender, Race and Identity: The case of Serena Williams.

This study investigates issues of gender, race and identity, as enacted through social media, focusing on the abuse experienced by tennis player Serena Williams during the 2015 Wimbledon Championships. A netnographic analysis of discriminatory or abusive comments relating to Williams were collected from 24 sites on two social media platforms, Facebook and Twitter. These platforms are popular sites commonly used for fan/athlete interaction. Williams identifies as female and African American, therefore intersectionality is adopted to examine the representation of Williams in social media spaces. Several pertinent themes were uncovered relating to Williams including ‘Gender questioning’, ‘Accusations of performance enhancing drugs use’ and ‘Racism’. Such themes showed a simultaneous overlapping of multiple forms of oppression encountered by Williams, reinforcing the notion of the black female athlete as ‘other’ in virtual spaces. Such oppression is perpetuated by the online environment

WD 0141−675: a case study on how to follow-up astrometric planet candidates around white dwarfs

This work combines spectroscopic and photometric data of the polluted white dwarf WD 0141−675, which has a now retracted astrometric super-Jupiter candidate, and investigates the most promising ways to confirm Gaia astrometric planetary candidates and obtain follow-up data. Obtaining precise radial velocity measurements for white dwarfs is challenging due to their intrinsic faint magnitudes, lack of spectral absorption lines, and broad spectral features. However, dedicated radial velocity campaigns are capable of confirming close-in giant exoplanets (a few MJup) around polluted white dwarfs, where additional metal lines aid radial velocity measurements. Infrared emission from these giant exoplanets is shown to be detectable with JWST Mid-Infrared Instrument (MIRI) and will provide constraints on the formation of the planet. Using the initial Gaia astrometric solution for WD 0141−675 as a case study, if there were a planet with a 33.65 d period or less with a nearly edge-on orbit, (1) ground-based radial velocity monitoring limits the mass to <15.4 MJup, and (2) space-based infrared photometry shows a lack of infrared excess and in a cloud-free planetary cooling scenario, a substellar companion would have to be <16 MJup and be older than 3.7 Gyr. These results demonstrate how radial velocities and infrared photometry can probe the mass of the objects producing some of the astrometric signals, and rule out parts of the brown dwarf and planet mass parameter space. Therefore, combining astrometric data with spectroscopic and photometric data is crucial to both confirm and characterize astrometric planet candidates around white dwarfs

Route and duration of antibiotic therapy in acute cellulitis: a systematic review and meta-analysis of the effectiveness and harms of antibiotic treatment

Objectives Compared with guideline recommendations, antibiotic overuse is common in treating cellulitis. We conducted a systematic review and meta-analyses on antibiotic route and duration of treatment for cellulitis in adults and children. Methods We searched MEDLINE, EMBASE and trial registries from inception to Dec 11, 2019 for interventional and observational studies of antibiotic treatment for cellulitis. Exclusions included case series/reports, pre-septal/orbital cellulitis and non-English language articles. Random-effects meta-analyses were used to produce summary relative risk (RR) estimates for our primary outcome of clinical response. PROSPERO CRD42018100602. Results We included 47/8423 articles, incorporating data from eleven trials (1855 patients) in two meta-analyses. The overall risk of bias was moderate. Only two trials compared the same antibiotic agent in each group. We found no evidence of difference in clinical response rates for antibiotic route or duration (RR(oral:IV)=1.12, 95%CI 0.98–1.27, I 2=32% and RR(shorter:longer)=0.99, 95%CI 0•96–1.03, I 2 = 0%, respectively). Findings were consistent in observational studies. Follow-up data beyond 30 days were sparse. Conclusions The evidence base for antibiotic treatment decisions in cellulitis is flawed by biased comparisons, short follow-up and lack of data around harms of antibiotic overuse. Future research should focus on developing patient-tailored antibiotic prescribing for cellulitis to reduce unnecessary antibiotic use

IBD risk loci are enriched in multigenic regulatory modules encompassing putative causative genes.

GWAS have identified >200 risk loci for Inflammatory Bowel Disease (IBD). The majority of disease associations are known to be driven by regulatory variants. To identify the putative causative genes that are perturbed by these variants, we generate a large transcriptome data set (nine disease-relevant cell types) and identify 23,650 cis-eQTL. We show that these are determined by ∼9720 regulatory modules, of which ∼3000 operate in multiple tissues and ∼970 on multiple genes. We identify regulatory modules that drive the disease association for 63 of the 200 risk loci, and show that these are enriched in multigenic modules. Based on these analyses, we resequence 45 of the corresponding 100 candidate genes in 6600 Crohn disease (CD) cases and 5500 controls, and show with burden tests that they include likely causative genes. Our analyses indicate that ≥10-fold larger sample sizes will be required to demonstrate the causality of individual genes using this approach