Association of endothelial and glycocalyx injury biomarkers with fluid administration, development of acute kidney injury, and 90-day mortality : data from the FINNAKI observational study

Abstract Background Injury to endothelium and glycocalyx predisposes to vascular leak, which may subsequently lead to increased fluid requirements and worse outcomes. In this post hoc study of the prospective multicenter observational Finnish Acute Kidney Injury (FINNAKI) cohort study conducted in 17 Finnish intensive care units, we studied the association of Syndecan-1 (SDC-1), Angiopoetin-2 (Ang-2), soluble thrombomodulin (sTM), vascular adhesion protein-1 (VAP-1) and interleukin-6 (IL-6) with fluid administration and balance among septic critical care patients and their association with development of acute kidney injury (AKI) and 90-day mortality. Results SDC-1, Ang-2, sTM, VAP-1 and IL-6 levels were measured at ICU admission from 619 patients with sepsis. VAP-1 decreased (p  12 h from ICU admission (AKI>12 h). They had higher sTM levels than patients without AKI, and after multivariable adjustment log, sTM level was associated with AKI>12 h with OR (95% CI) of 12.71 (2.96–54.67), p = 0.001). Ninety-day non-survivors (n = 180; 29.1%) had higher SDC-1 and sTM levels compared to survivors. After adjustment for known confounders, log SDC-1 (OR [95% CI] 2.13 [1.31–3.49], p = 0.002), log sTM (OR [95% CI] 7.35 [2.29–23.57], p < 0.001), and log Ang-2 (OR [95% CI] 2.47 [1.44–4.14], p = 0.001) associated with an increased risk for 90-day mortality. Finally, patients who had high levels of all three markers, namely, SDC-1, Ang-2 and sTM, had an adjusted OR of 5.61 (95% CI 2.67–11.79; p < 0.001) for 90-day mortality. Conclusions VAP-1 and IL-6 associated with fluid administration on the first ICU day. After adjusting for confounders, sTM was associated with development of AKI after 12 h from ICU admission. SDC-1, Ang-2 and sTM were independently associated with an increased risk for 90-day mortality

The Nexus between Study Burnout Profiles and Social Support —The Differences between Domestic (Finnish) and International Master’s Degree Students

The present study investigated the variation in higher education students’ study burnout experiences and how they are related to academic success and social support needs. Similarities and differences between the international and domestic students were also explored. In this mixed-methods study, the data were collected through a self-reported questionnaire, and a total of 902 (response rate 42%) first year master’s students from the fields of arts, business and technology responded. Using Latent Profile Analysis (LPA), we detected three distinct study burnout risk profiles (No exhaustion or cynicism; Exhausted; Exhausted and cynical). The following distinct forms of social support needs were found using theory-based qualitative content analysis: informational, instrumental, emotional, and co-constructional support. We found out that the students with highest risk of burnout had the lowest grade point averages (GPAs). Further investigation showed that international students pass their courses despite the experiences of study burnout, even though the GPAs might deteriorate. When the domestic students experience study burnout symptoms, they both gain fewer study credits and earn lower GPAs. Finally, a relationship between the form of support needed and the burnout profile was identified

The Nexus between Study Burnout Profiles and Social Support —The Differences between Domestic (Finnish) and International Master’s Degree Students

The present study investigated the variation in higher education students’ study burnout experiences and how they are related to academic success and social support needs. Similarities and differences between the international and domestic students were also explored. In this mixed-methods study, the data were collected through a self-reported questionnaire, and a total of 902 (response rate 42%) first year master’s students from the fields of arts, business and technology responded. Using Latent Profile Analysis (LPA), we detected three distinct study burnout risk profiles (No exhaustion or cynicism; Exhausted; Exhausted and cynical). The following distinct forms of social support needs were found using theory-based qualitative content analysis: informational, instrumental, emotional, and co-constructional support. We found out that the students with highest risk of burnout had the lowest grade point averages (GPAs). Further investigation showed that international students pass their courses despite the experiences of study burnout, even though the GPAs might deteriorate. When the domestic students experience study burnout symptoms, they both gain fewer study credits and earn lower GPAs. Finally, a relationship between the form of support needed and the burnout profile was identified

Fluid management in patients with acute kidney injury-A post-hoc analysis of the FINNAKI study

Purpose: Whether positive fluid balance among patients with acute kidney injury (AKI) stems from decreased urine output, overzealous fluid administration, or both is poorly characterized. Materials and methods: This was a post hoc analysis of the prospective multicenter observational Finnish Acute Kidney Injury study including 824 AKI and 1162 non-AKI critically ill patients. Results: We matched 616 AKI (diagnosed during the three first intensive care unit (ICU) days) and non-AKI patients using propensity score. During the three first ICU days, AKI patients received median [IQR] of 11.4 L [8.0-15.2]L fluids and non-AKI patients 10.2 L [7.5-13.7]L, p < 0.001 while the fluid output among AKI patients was 4.7 L [3.0-7.2]L and among non-AKI patients 5.8 L [4.1-8.0]L, p < 0.001. In AKI patients, the median [IQR] cumulative fluid balance was 2.5 L [-0.2-6.0]L compared to 0.9 L [-1.4-3.6]L among non-AKI patients, p < 0.001. Among the 824 AKI patients, smaller volumes of fluid input with a multivariable OR of 0.90 (0.88-0.93) and better fluid output (multivariable OR 1.12 (1.07-1.18)) associated with enhanced change of resolution of AKI. Conclusions: AKI patients received more fluids albeit having lower fluid output compared to matched critically ill non-AKI patients. Smaller volumes of fluid input and higher fluid output were associated with better AKI recovery. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).Peer reviewe

Unsupervised denoising for sparse multi-spectral computed tomography

Multi-energy computed tomography (CT) with photon counting detectors (PCDs) enables spectral imaging as PCDs can assign the incoming photons to specific energy channels. However, PCDs with many spectral channels drastically increase the computational complexity of the CT reconstruction, and bespoke reconstruction algorithms need fine-tuning to varying noise statistics. \rev{Especially if many projections are taken, a large amount of data has to be collected and stored. Sparse view CT is one solution for data reduction. However, these issues are especially exacerbated when sparse imaging scenarios are encountered due to a significant reduction in photon counts.} In this work, we investigate the suitability of learning-based improvements to the challenging task of obtaining high-quality reconstructions from sparse measurements for a 64-channel PCD-CT. In particular, to overcome missing reference data for the training procedure, we propose an unsupervised denoising and artefact removal approach by exploiting different filter functions in the reconstruction and an explicit coupling of spectral channels with the nuclear norm. Performance is assessed on both simulated synthetic data and the openly available experimental Multi-Spectral Imaging via Computed Tomography (MUSIC) dataset. We compared the quality of our unsupervised method to iterative total nuclear variation regularized reconstructions and a supervised denoiser trained with reference data. We show that improved reconstruction quality can be achieved with flexibility on noise statistics and effective suppression of streaking artefacts when using unsupervised denoising with spectral coupling

Association of endothelial and glycocalyx injury biomarkers with fluid administration, development of acute kidney injury, and 90-day mortality: data from the FINNAKI observational study

Background Injury to endothelium and glycocalyx predisposes to vascular leak, which may subsequently lead to increased fluid requirements and worse outcomes. In this post hoc study of the prospective multicenter observational Finnish Acute Kidney Injury (FINNAKI) cohort study conducted in 17 Finnish intensive care units, we studied the association of Syndecan-1 (SDC-1), Angiopoetin-2 (Ang-2), soluble thrombomodulin (sTM), vascular adhesion protein-1 (VAP-1) and interleukin-6 (IL-6) with fluid administration and balance among septic critical care patients and their association with development of acute kidney injury (AKI) and 90-day mortality. Results SDC-1, Ang-2, sTM, VAP-1 and IL-6 levels were measured at ICU admission from 619 patients with sepsis. VAP-1 decreased (p 12 h from ICU admission (AKI(>12 h)). They had higher sTM levels than patients without AKI, and after multivariable adjustment log, sTM level was associated with AKI(>12 h) with OR (95% CI) of 12.71 (2.96-54.67), p = 0.001). Ninety-day non-survivors (n = 180; 29.1%) had higher SDC-1 and sTM levels compared to survivors. After adjustment for known confounders, log SDC-1 (OR [95% CI] 2.13 [1.31-3.49], p = 0.002), log sTM (OR [95% CI] 7.35 [2.29-23.57], p < 0.001), and log Ang-2 (OR [95% CI] 2.47 [1.44-4.14], p = 0.001) associated with an increased risk for 90-day mortality. Finally, patients who had high levels of all three markers, namely, SDC-1, Ang-2 and sTM, had an adjusted OR of 5.61 (95% CI 2.67-11.79; p < 0.001) for 90-day mortality. Conclusions VAP-1 and IL-6 associated with fluid administration on the first ICU day. After adjusting for confounders, sTM was associated with development of AKI after 12 h from ICU admission. SDC-1, Ang-2 and sTM were independently associated with an increased risk for 90-day mortality

Non-interventional follow-up versus fluid bolus in RESPONSE to oliguria in hemodynamically stable critically ill patients : a randomized controlled pilot trial

Peer reviewe

Effects of doping and epitaxy on optical behavior of NaNbO3 films

Cube-on-cube epitaxy of perovskite sub-cell of Pr-doped and undoped NaNbO3 is obtained in 130-nm-thick films on top of (La0.18Sr0.82)(Al0.59Ta0.41)O3 (001) substrates. Experimental studies show that the edge of optical absorption red-shifts and some interband transitions change in the films compared to crystals. Bright red luminescence is achieved at room-temperature under ultraviolet excitation in the Pr-doped film. An interband mechanism of luminescence excitation is detected in the film, which is in contrast to the intervalence charge transfer mechanism in the crystal. The results are discussed in terms of epitaxially induced changes of crystal symmetry and ferroelectric polarization in the films. It is suggested that the band structure and interband transitions in NaNbO3and the transition probabilities in the Pr ions can be significantly modified by these changes.Peer reviewe

Local edge computing for radiological image reconstruction and computer-assisted detection: A feasibility study

Computational requirements for data processing at different stages of the radiology value chain are increasing. Cone beam computed tomography (CBCT) is a diagnostic imaging technique used in dental and extremity imaging, involving a highly demanding image reconstruction task. In turn, artificial intelligence (AI) assisted diagnostics are becoming increasingly popular, thus increasing the use of computation resources. Furthermore, the need for fully independent imaging units outside radiology departments and with remotely performed diagnostics emphasize the need for wireless connectivity between the imaging unit and hospital infrastructure. In this feasibility study, we propose an approach based on a distributed edge-cloud computing platform, consisting of small-scale local edge nodes, edge servers with traditional cloud resources to perform data processing tasks in radiology. We are interested in the use of local computing resources with Graphics Processing Units (GPUs), in our case Jetson Xavier NX, for hosting the algorithms for two use-cases, namely image reconstruction in cone beam computed tomography and AI-assisted cancer detection from mammographic images. Particularly, we wanted to determine the technical requirements for local edge computing platform for these two tasks and whether CBCT image reconstruction and breast cancer detection tasks are possible in a diagnostically acceptable time frame. We validated the use-cases and the proposed edge computing platform in two stages. First, the algorithms were validated use-case-wise by comparing the computing performance of the edge nodes against a reference setup (regular workstation). Second, we performed qualitative evaluation on the edge computing platform by running the algorithms as nanoservices. Our results, obtained through real-life prototyping, indicate that it is possible and technically feasible to run both reconstruction and AI-assisted image analysis functions in a diagnostically acceptable computing time. Furthermore, based on the qualitative evaluation, we confirmed that the local edge computing capacity can be scaled up and down during runtime by adding or removing edge devices without the need for manual reconfigurations. We also found all previously implemented software components to be transferable as such. Overall, the results are promising and help in developing future applications, e.g., in mobile imaging scenarios, where such a platform is beneficial