Association Between Acute Kidney Injury and Long-Term Mortality in Patients With Aneurysmal Subarachnoid Hemorrhage: A Retrospective Study

Background: Though acute kidney injury (AKI) in the context of aneurysmal subarachnoid hemorrhage (aSAH) worsens short-term outcomes, its impact on long-term survival is unknown. Aim: We aimed to evaluate the association between long-term mortality and AKI during hospitalization for aSAH. Methods: This was a retrospective study of patients who survived \u3e12 months after aSAH. All patients were evaluated at West China Hospital, Sichuan University, between December 2013 and June 2019. The minimum follow-up time was over 1 year. the maximum follow-up time was about 7.3 years. AKI was defined by the KDIGO (The Kidney Disease Improving Global Outcomes) guidelines, which stratifies patients into three stages of severity. The primary outcome was long-term mortality, which was analyzed with Kaplan-Meier curves and Cox proportional hazards models. Results: During this study period, 238 (9.2%) patients had AKI among 2,592 patients with aSAH. We confirmed that AKI during care for aSAH significantly increased long-term mortality (median 4.3 years of follow-up) and that risk increased with the severity of the kidney failure, with an adjusted hazard ratio (HR) of 2.08 (95% CI 1.49-2.89) for stage 1 AKI, 2.15 (95% CI 1.05-4.43) for stage 2 AKI, and 2.66 (95% CI 1.08-6.53) for stage 3 AKI compared with patients without AKI. Among patients with an AKI episode, those with renal recovery still had increased long-term mortality (HR 1.96; 95% CI 1.40-2.74) compared with patients without AKI but had better long-term outcomes than those without renal recovery (HR 0.51, 95% CI 0.27-0.97). Conclusions: Among 12-month survivors of aSAH, AKI during their initial hospitalization for aSAH was associated with increased long-term mortality, even for patients who had normal renal function at the time of hospital discharge. Longer, multidisciplinary post-discharge follow-up may be warranted for these patients

Differentiation-dependent association of phosphorylated extracellular signal-regulated kinase with the chromatin of osteoblast-related genes

The ERK/MAP kinase pathway is an important regulator of gene expression and differentiation in postmitotic cells. To understand how this pathway controls gene expression in bone, we examined the subnuclear localization of P-ERK in differentiating osteoblasts. Induction of differentiation was accompanied by increased ERK phosphorylation and expression of osteoblast-related genes, including osteocalcin ( Bglap2 ) and bone sialoprotein ( Ibsp ). Confocal immunofluorescence microscopy revealed that P-ERK colocalized with the RUNX2 transcription factor in the nuclei of differentiating cells. Interestingly, a portion of this nuclear P-ERK was directly bound to the proximal promoter regions of Bglap2 and Ibsp . Furthermore, the level of P-ERK binding to chromatin increased with differentiation, whereas RUNX2 binding remained relatively constant. The P-ERK-chromatin interaction was seen only in RUNX2-positive cells, required intact RUNX2-selective enhancer sequences, and was blocked with MAPK inhibition. These studies show for the first time that RUNX2 specifically targets P-ERK to the chromatin of osteoblast-related genes, where it may phosphorylate multiple substrates, including RUNX2, resulting in altered chromatin structure and gene expression. © 2010 American Society for Bone and Mineral ResearchPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64899/1/90705_ftp.pd

Electrospinning as a route to advanced carbon fibre materials for selected low-temperature electrochemical devices: a review

Electrospinning has been proven as a highly versatile fabrication method for producing nano-structured fibres with controllable morphology, of both the fibres themselves and the void structure of the mats. Additionally, it is possible to use heteroatom doped polymers or to include catalytic precursors in the electrospinning solution to control the surface properties of the fibres. These factors make it an ideal method for the production of electrodes and flow media for a variety of electrochemical devices, enabling reduction in mass transport and activation overpotentials and therefore increasing efficiency. Moreover, the use of biomass as a polymer source has recently gained attention for the ability to embed sustainable principles in the materials of electrochemical devices, complementing their ability to allow an increase in the use of renewable electricity via their application. In this review, the historical and recent developments of electrospun materials for application in redox flow batteries, fuel cells, metal air batteries and supercapacitors are thoroughly reviewed, including an overview of the electrospinning process and a guide to best practice. Finally, we provide an outlook for the emerging use of this process in the field of electrochemical energy devices with the hope that the combination of tailored microstructure, surface functionality and computer modelling will herald a new era of bespoke functional materials that can significantly improve the performance of the devices in which they are used

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Driving Waveform Design of Electrowetting Displays Based on an Exponential Function for a Stable Grayscale and a Short Driving Time

The traditional driving waveform of the electrowetting display (EWD) has many disadvantages, such as the large oscillation of the target grayscale aperture ratio and a long time for achieving grayscale. Therefore, a driving waveform based on the exponential function was proposed in this study. First, the maximum driving voltage value of 30 V was obtained by testing the hysteresis curve of the EWD pixel unit. Secondly, the influence of the time constant on the driving waveform was analyzed, and the optimal time constant of the exponential function was designed by testing the performance of the aperture ratio. Lastly, an EWD panel was used to test the driving effect of the exponential-function-driving waveform. The experimental results showed that a stable grayscale and a short driving time could be realized when the appropriate time constant value was designed for driving EWDs. The aperture ratio oscillation range of the gray scale could be reduced within 0.95%, and the driving time of a stable grayscale was reduced by 30% compared with the traditional driving waveform

Malaria in China 2011-2015: an observational study

Objective To ascertain the trends and burden of malaria in China and the costs of intervention for 2011-2015 while experiencing transitions between funders during a national plan launched to interrupt malaria transmission in most counties by 2015 and ultimately eliminate malaria by 2020.Methods We analysed the spatiotemporal and demographic features of autochthonous and imported malaria using disaggregated surveillance data on malaria from 2011 to 2015, covering the range of dominant malaria vectors in China. The total and mean costs for malaria elimination were calculated by funding sources, interventions, and population at risk.Findings A total of 17,745 malaria cases, including 123 deaths (0.7%), were reported in mainland China from 2011-2015, with 89% being imported cases, mainly from Africa and Southeast Asia. Most counties (99.9%) have achieved their elimination goals by 2015, and autochthonous cases dropped from 1,469 cases in 2011 to 43 cases in 2015, mainly occurring in the regions bordering Myanmar where Anopheles minimus and An. dirus are the dominant vector species. A total of US$134.6 million was spent in efforts to eliminate malaria during 2011-2015, with US$57.2 million (42.5%) from the Global Fund and US$77.3 million (57.5$0.05 (SD 0.03) with the highest ($0.09) in 2012 and subsequent reductions between 2013 and 2015 after the Global Fund ceased providing investments.Conclusion The autochthonous malaria burden in China has decreased significantly, and malaria elimination is an achievable prospect in China. The key challenge is to address the remaining autochthonous transmission, as well as simultaneously reducing importation from Africa and Southeast Asia. Continued efforts and appropriate levels of investment are needed in the 2016-2020 period to achieve elimination. Keywords: Malaria; epidemiology; elimination; cost; importation; China.<br/