Bergfeldman6951

To describe the epidemiology and outcomes of acute kidney injury (AKI) among contemporary non-surgical cardiac intensive care unit (CICU) patients.

We reviewed adult non-surgical CICU patients admitted from 2007 to 2015. The highest AKI stage during hospitalization was defined using modified Kidney Disease Improving Global Outcomes (KDIGO) criteria, based on changes in serum creatinine. Hospital and 5-year mortality were examined using logistic regression and Cox proportional-hazards models, respectively.

We included 9311 patients with a mean age of 67.5years, including 37% females. AKI was present in 51% stage 1 AKI in 34%, stage 2 AKI in 9%, and stage 3 AKI in 8%. Hospital mortality was associated with AKI stage (adjusted OR for each AKI stage 1.17, 95% CI 1.04-1.31, p=0.007). Five-year mortality was incrementally associated with AKI stage (adjusted HR per AKI stage 1.13, 95% CI 1.08-1.18; p<0.001), particularly post-discharge mortality among hospital survivors (adjusted HR per AKI stage 1.20, 95% CI 1.15-1.25, p<0.001). Patients with stage 3 AKI (especially requiring dialysis) had the highest adjusted hospital and five-year mortality.

AKI severity is incrementally associated with higher short-term and long-term mortality in CICU patients, especially severe AKI requiring dialysis.

AKI severity is incrementally associated with higher short-term and long-term mortality in CICU patients, especially severe AKI requiring dialysis.

We aimed to describe epidemiology of diarrhea and cholestasis in critically ill patients and explore associations between these two conditions.

We performed a retrospective study including all consecutive patients who stayed in the ICU for at least 3days and in whom plasma measurements of liver enzymes/cholestasis parameters were performed. Diarrhea was defined as 3 or more loose or liquid stools per day and cholestasis as increase of alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) 1.5 times above the upper limit of normality.

Diarrhea was observed in 26.1% and cholestasis in 27.9% of study patients, about one third of the cases in both diarrhea and cholestasis occurred beyond the first week of patient's ICU stay. Cholestasis occurred in 45.6% of patients with diarrhea vs 28.0% of patients without diarrhea (p<0.001). In 94 patients (13.1%) both diarrhea and cholestasis occurred, cholestasis was more commonly (2/3 of cases) documented before manifestation of diarrhea.

Cholestasis is more common in patients with diarrhea and vice versa. Diarrhea and cholestasis both occur in approximately one quarter of ICU patients, with significant proportion manifesting beyond the first week in the ICU.

Cholestasis is more common in patients with diarrhea and vice versa. Diarrhea and cholestasis both occur in approximately one quarter of ICU patients, with significant proportion manifesting beyond the first week in the ICU.

To assess the effect on healthcare professional emergency response time and safety of small compared to large clog size.

Randomized controlled trial.

The intensive care unit of a single university medical centre in The Netherlands.

Intensive care medicine professionals.

Participants were randomized to wear European size 38 clogs (US male size 6½, US female size 7½) or European size 47 clogs (US male size 13½, US female size 14½) clogs and were required to run a 125m course from the coffee break room to the elevator providing access to the emergency department.

The primary outcome was the time to complete the running course. Height, shoe size, self-described fitness, age and staff category were investigated as possible effect modifiers. Secondary endpoints were reported clog comfort and suspected unexpected clog-related adverse events (SUCRAEs).

50 participants were randomized (25 to European size 38 clogs and 25 to size 47 clogs). Mean age was 37years (SD 12) and 29 participants (58%) were female. The primary outcome was 4.4s (95% CI -7.1; -1.6) faster in the size 5 clogs group compared to the size 12 clogs group. This effect was not modified by any of the predefined participant characteristics. No differences were found in reported clog comfort or SUCRAEs.

European size 38 clogs lead to faster emergency response times than size 47 clogs.

NCT04406220.

NCT04406220.

Since the SARS-CoV-2 pandemic, countries are overwhelmed by critically ill Coronavirus disease 2019 (COVID-19) patients. As ICU capacity becomes limited we characterized critically ill COVID-19 patients in the Netherlands.

In this case series, COVID-19 patients admitted to the ICU of the Jeroen Bosch Hospital were included from March 9 to April 7, 2020. COVID-19 was confirmed by a positive result by a RT-PCR of a specimen collected by nasopharyngeal swab. Clinical data were extracted from medical records.

The mean age of the 50 consecutively included critically ill COVID-19 patients was 65±10years, the mean BMI was 29±4.7 and 66% were men. Seventy-eight percent of patients had ≥1 comorbidity, 34% had hypertension. Ninety-six percent of patients required mechanical ventilation and 80% were ventilated in prone position. Venous thromboembolism was recognized in 36% of patients. Seventy-four percent of patients survived and were successfully discharged from the ICU, the remaining 26% died (median follow up 86days). The length of invasive ventilation in survivors was 15days (IQR 12-31).

The survival rate of COVID-19 critically ill patients in our population is considerably better than previously reported. Thrombotic complications are commonly found and merit clinical attention.

NL2020.07.04.01.

NL2020.07.04.01.

The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has emerged early December 2019 and was recently confirmed by the World Health Organization (WHO) to be a public health emergency of international concern. Earlier reports have shown coagulopathy in patients with severe coronavirus disease 2019 (Covid-19).

We present four critically ill Covid-19 patients, who were admitted to our hospital. They were treated with supportive care, oral chloroquine, and standard 2500 or 5000 International Units (IU) of dalteparine subcutaneously once daily. Two patients died during the course of their stay as a consequence of severe large vessel arterial thromboembolism. The other two patients survived but symptoms of paralysis and aphasia persisted after cerebral ischemia due to large vessel arterial thromboembolism. Patients showed no signs of overt disseminated intravascular coagulation (DIC) in their laboratory analysis.

This case series suggest that even in absence of overt DIC, arterial thromboembolic complications occur in critically ill patients with Covid-19. Further studies are needed to determine which parameters are useful in monitoring coagulopathy and which dose of anti-thrombotic therapy in Covid-19 patients is adequate, even when overt DIC is not present.

This case series suggest that even in absence of overt DIC, arterial thromboembolic complications occur in critically ill patients with Covid-19. Further studies are needed to determine which parameters are useful in monitoring coagulopathy and which dose of anti-thrombotic therapy in Covid-19 patients is adequate, even when overt DIC is not present.This study presents evaluation of the possible mechanisms of interaction between the antiepileptic drug lamotrigine (LMT) and single- and double-stranded DNA (ssDNA and dsDNA, respectively). These interactions were studied in phosphate-buffered saline (PBS) at physiological pH 7.4 by cyclic voltammetry (CV) and square wave voltammetry (SWV) using a glassy carbon electrode (GCE) in a bulk incubated solution. The addition of both types of DNA to LMT solution decreased peak currents and led to a negative shift in peak potentials, thus indicating the dominance of electrostatic interactions. UV-Vis absorption spectroscopy was also used to assess the interaction between ds/ssDNA and LMT. The data obtained from spectroscopic analysis confirmed that electrostatic interaction is the predominant interaction between LMT and both types of DNA. The calculated binding constants for LMT-dsDNA and LMT-ssDNA complexes as determined by SWV were 6.46 × 105 and 1.81 × 106, respectively, while the values obtained from UV-Vis spectroscopy were 6.93 × 105 and 1.19 × 106, respectively. The obtained results indicated a higher affinity of LMT for ssDNA than for dsDNA.The comparison of fly ash generated from lignite combustion in a thermal power plant Kolubara A (Veliki Crljeni) and bottom and fly ash from coal waste combustion in a semi-industrial fluidized bed boiler (Vinča) was performed as the function of particle size. The average total concentrations of the 16 EPA priority PAHs in ash fractions are 0.49 mg kg-1 of ash (thermal power plant) and 17.48 mg kg-1 of ash (fluidized bed boiler). The sum of 3- and 4-ring PAHs accounts for more than 93% of overall PAHs concentration, and the most abundant among them is fluoranthene. The portions of PAHs groups defined based on their physico-chemical properties, as obtained from quantitative structure-activity relationship (QSAR) models included in the Vega platform, were determined. These portions, emission factors, and benzo[a]pyrene equivalence concentrations were further on used to estimate the potential environmental impact of ash disposal. The PAHs emission factors are higher compared to values in the air pollutant emission inventory guidebook of the cooperative program for monitoring and evaluation of the long-range transmission of air pollutants in Europe (EMEP/EEA). The overall emission factors of 16 PAHs for combustion of lignite and coal waste are determined to be 0.15 and 249.97 mg kg-1 of fuel, respectively. Based on the ratios of benzo[a]pyrene equivalence concentrations of each ash and correspondent fuel, the disposal of fly ash from the cyclone of fluidized bed boiler represents the highest risk to the environment among tested ashes.Heavy metal pollution is widespread, and has an increasing trend in some countries and regions. It can be easily accumulated in plants, leading to plant species loss and affecting plant community composition. Artificial restoration can conserve plant diversity in contaminated soils and accelerate the recovery of polluted ecosystems. The application of nitrogen (N) and phosphorus (P) is inexpensive and convenient, which can increase the resistance of plants to adversity and promote the growth of plants in heavy metal polluted soils. In order to examine the effect of N and P nutrition on the conservation of plant community, we conducted a comparison experiment in greenhouse using soil with low N and P concentration, and set five treatments C (soil with no heavy metals and fertilizer addition), H (soil with heavy metals addition but with no fertilizer), HN (soil with heavy metals and N addition), HP treatment(soil with heavy metals and P addition), HNP treatment (soil with heavy metals, N and P addition). Our results showed that heavy metal pollution reduced plant species by 300%, and significantly decreased plant diversity (P less then 0.05). N addition increased the richness of plant species and increased the dominance of Euphorbia peplus, but had no significant effect on plant diversity and community structure, while reduced the evenness of plant species. P addition of HP and HNP treatments restored plant species richness and increased plant diversity under heavy metal pollution. The plant community structures of these two treatments were more similar to that of group C. see more Compared with N addition, P addition had a better performance to restoring the species composition and relative dominance of plant communities. Our results provided a guidance for the restoration of plant communities and the conservation of plant species in low N and P concentration soils with the context of heavy metal pollution.