Abstract The relationship between albumin corrected anion gap (ACAG) and mortality in acute kidney injury (AKI) patients who received continuous renal replacement therapy (CRRT) has not been investigated in any previous studies. This study aimed to investigate the relationship between ACAG at CRRT initiation and all-cause mortality among these patients in the intensive care unit (ICU). Patients diagnosed with AKI and treated with CRRT in the ICU from the Medical Information Mart for Intensive Care-IV version 1.0 (MIMIC IV) database and Huzhou Central Hospital were retrospectively enrolled. Participants were divided into two groups: the normal ACAG group (12–20 mmol/L) and high ACAG group (&gt; 20 mmol/L). The Kaplan–Meier method and log-rank test were used to compare the survival rate between the two groups. Restricted cubic spine (RCS) and Cox proportional-hazards models were utilized to analyze the relationship between ACAG at CRRT initiation and ICU all-cause mortality of these patients. A total of 708 patients met the inclusion criteria in the study. The all-cause mortality of these patients during ICU hospitalization was 41.95%. Patients in the high ACAG group exhibited significantly higher ICU all-cause mortality rate than patients in the normal ACAG group (all P &lt; 0.001). The Kaplan–Meier survival curves showed that the normal ACAG group had a higher ICU cumulative survival rate than the high ACAG group (log-rank test, χ 1 2 = 13.620, χ 2 2 = 12.460, both P &lt; 0.001). In the multivariate COX regression analyses, patients with higher ACAG (&gt; 20 mmol/L) levels at the time of CRRT initiation in the MIMIC IV database and Huzhou Central Hospital were significantly correlated with ICU all-cause mortality after adjusting multiple potential confounding factors with hazard ratios of 2.852 (95% CI 1.718–4.734) and 2.637(95% CI 1.584–4.389), respectively. In critically AKI patients who undergo CRRT, higher ACAG (&gt; 20 mmol/L) level at the initiation of CRRT was significantly correlated with ICU all-cause mortality. Therefore, clinicians should pay more attention to those patients with a higher ACAG value. 

https://link.springer.com/content/pdf/10.1007/s11739-022-03093-8.pdf

The association between albumin corrected anion gap and ICU mortality in acute kidney injury patients requiring continuous renal replacement therapy

Results : There were significantly lower Apgar scores in the late-preterm infant group (35-36 weeks) compared to other term infant groups and the proportion of infants born from mothers with preeclampsia gradually decreased as gestational age increased. There were significant differences in O 2 supplement, duration of O2 (>24 hours), checked chest radiography, transient tachypnea of newborn (TTN), transfer to neonatal intensive care unit (NICU), endotracheal intubation, and ventilator uses including nasal continuous positive airway pressure in four groups (P<0.05). By logistic regression analysis, compared to births at 38 weeks, births at 35-36 weeks and at 37 weeks were associated with an increased risk of respiratory morbidities [odds ratios (OR) and 95% confidence intervals (CI) for births at 35-36 weeks, 122.5 (17.4-863.4) for TTN; 54.0 (10.1-289.4) for transfer to NICU; 99.5 (14.9-666.2) for ventilator apply; OR and 95% CI for births at 37 weeks, 8.8 (1.6-50.1) for TTN; 5.3 (1.1-24.7) for transfer to NICU; 8.4 (1.5-47.7) for ventilator apply; P<0.05]. There were no significant dif ferences in respiratory morbidities between births at 38 weeks and births at 39-40 weeks. Conclusion : Postponing the timing of elective cesarean section to beyond 38 weeks of gestation would be helpful in reducing the neonatal respiratory morbidities.

/pdf/respiratory-morbidities-in-newborn-infants-by-gestational-stqscsk6x9.pdf

Respiratory Morbidities in Newborn Infants by Gestational Age Following Elective Cesarean Section beyond 35 Weeks of Gestation

Purpose: We aimed to evaluate the respiratory illness-related hospital visits (out-patient clinics, emergency room, and re-admission) of preterm infants, and compare them according to corrected age and prematurity. Methods: We reviewed the medical records of preterm infants born at <37 weeks of gestation admitted to the neonatal intensive care unit (NICU) at Inha University Hospital between January 2012 and June 2015. Infant follow-up appointments in both neonatology and pulmonology out-patient clinics occurred for at least 2 years after NICU discharge. Results: The proportion of infants who visited the hospital due to any respiratory illness was as high as 50% until 12 months of corrected age, and subsequently decreased over time. Hospital admission was significantly higher in early preterm infants (<34 weeks of gestation) compared to late preterm infants (≥34 and <37 weeks of gestation). The proportion of infants who were re-admitted due to lower respiratory tract illness was significantly higher until 6 months of corrected age compared to the later, and did not differ between early and late preterm infants. Conclusion: The proportion of hospital visits of preterm infants due to respiratory disease was high until 12 months of corrected age. Most notably, the re-admission proportion from lower respiratory tract illness was high under 6 months in both early and late preterm infants. Preterm infants within this age that are visiting the hospital with respiratory symptoms should be carefully observed and followed up.

/pdf/hospital-visits-from-respiratory-diseases-of-early-and-late-3cpdo4wxq1.pdf

Hospital Visits from Respiratory Diseases of Early and Late Preterm Infants

Pes planus, one of the most common foot deformities, includes the loss of the medial arch, misalignment of the rearfoot, and abduction of the forefoot, which negatively affects posture and gait. Foot orthosis, which is effective in normalizing the arch and providing stability during walking, is prescribed for the purpose of treatment and correction. Currently, machine learning technology for classifying and diagnosing foot types is being developed, but it has not yet been applied to the prescription of foot orthosis for the treatment and management of pes planus. Thus, the aim of this study is to propose a model that can prescribe a customized foot orthosis to patients with pes planus by learning from and analyzing various clinical data based on a decision tree algorithm called classification and regressing tree (CART). A total of 8 parameters were selected based on the feature importance, and 15 rules for the prescription of foot orthosis were generated. The proposed model based on the CART algorithm achieved an accuracy of 80.16%. This result suggests that the CART model developed in this study can provide adequate help to clinicians in prescribing foot orthosis easily and accurately for patients with pes planus. In the future, we plan to acquire more clinical data and develop a model that can prescribe more accurate and stable foot orthosis using various machine learning technologies.

/pdf/decision-tree-based-foot-orthosis-prescription-for-patients-3kj0w9m0.pdf

Decision Tree-Based Foot Orthosis Prescription for Patients with Pes Planus

Abstract Background We hypothesized that a low mean arterial pressure (MAP) at CRRT initiation would influence the early death or withdrawal of CRRT and in-hospital mortality. Methods This prospective cohort study collected data for CRRT patients seen at the Third Affiliated Hospital from January 2016 to December 2020. We collected MAP data at the initiation of CRRT, reasons for CRRT termination, and in-hospital mortality data. We divided the patients into four groups based on quartiles of the initial MAP and analyzed its influence on early death/withdrawal of CRRT. Results A total of 2,346 patients with acute kidney injury (AKI) were included in this study. The median age of the participants was 68.0 (57.0–76.0) years, and 62.4% were male. CRRT was discontinued in 49.9% of our patients after renal recovery or HD transition; in 48.8%, CRRT was terminated by death (36.6%) or withdrawal (12.2%). An initial low MAP (Q1, MAP ≤ 69 mmHg and Q2, MAP ≤ 77.1 mmHg) was associated with a 1.3-fold greater risk of death/withdrawal during CRRT. Older age, a higher SOFA score, and oliguria at the time of CRRT initiation also predicted death/withdrawal during CRRT. Conclusions In patients on CRRT, a lower MAP at CRRT initiation was closely associated with a higher probability of terminating CRRT due to death/withdrawal, and it was associated with an increased risk of in-hospital mortality. 

/pdf/influence-of-mean-arterial-pressure-on-the-decision-to-16a0x3o9.pdf

Influence of mean arterial pressure on the decision to terminate CRRT and in-hospital mortality: A single-center prospective study

Hypoalbuminemia at the initiation of continuous renal replacement therapy (CRRT) is a risk factor for poor patient outcomes. However, it is unknown whether the patterns of changes in serum albumin levels during CRRT can be used to predict patient outcomes.This retrospective study analyzed data that had been consecutively collected from January 2016 to December 2020 at the Third Affiliated Hospital. We included patients with acute kidney injury who received CRRT for ≥ 72 h. We divided the patients into four groups based on their serum albumin levels (albumin ≥ 3.0 g/dL or < 3.0 g/dL) at the initiation and termination of CRRT.The 793 patients in this study were categorized into the following albumin groups: persistently low, 299 patients (37.7%); increasing, 85 patients (10.4%); decreasing, 195 patients (24.6%); and persistently high, 214 patients (27.1%). In-hospital mortality rates were highest in the persistently low and decreasing groups, followed by the increasing and persistently high groups. The hazard ratio for in-hospital mortality was 0.481 (0.340-0.680) in the increasing group compared to the persistently low group; it was 1.911 (1.394-2.620) in the decreasing group compared to the persistently high group. The length of ICU stay was 3.55 days longer in the persistently low group than in the persistently high group.Serum albumin levels changed during CRRT, and monitoring of patterns of change in serum albumin levels is useful for predicting in-hospital mortality and the length of ICU stay. 

/pdf/worsening-or-improving-hypoalbuminemia-during-continuous-quzm6g6w.pdf

Worsening or improving hypoalbuminemia during continuous renal replacement therapy is predictive of patient outcome: a single-center retrospective study

Purpose: We examined the respiratory morbidities in late-preterm infants compared to those of the early-preterm infants and term infants throughout the first year of life. Methods: Data were retrospectively collected for 87 late-preterm, 72 early-preterm, and 608 term infants who were admitted to NICU and the nursery of Busan St. Mary's Medical Center from Jan 2007 to Oct 2009. Results: There were significant differences in the proportions of the out-born infants, twin pregnancy, small for gestational age, and Caesarean section in the three groups (P<0.05). Late-preterm and early-preterm infants had longer duration of hospitalization, larger proportions of respiratory distress syndrome, mechanical ventilation at birth, oxygen therapy after 48 hours of birth, oxygen dependency at 28 days, and continuous positive airway pressure support at 28 days compared to term infants during the neonatal period (P=0.000). Late-preterm infants and early-preterm infants were re-admitted more often than term infants during the first year of life (P=0.000). Also Late-preterm and early-preterm infants had increased chance of respiratory tract illness than term infants (P=0.001). Conclusion: In this study, we demonstrated that there are higher chances of respiratory morbidities in the late-preterm infants than the term infants either during the neonatal period or throughout the first year of life, although early-preterm infants showed greatest respiratory morbidities.

http://www.neo-med.org/upload/pdf/J Korean Soc Neonatol._19_4_245_252.pdf

The Respiratory Morbidities in Late-preterm Infants Compared with the Early-preterm and Term Infants throughout the First Year of Life

Internal tibial torsion is more common in the Asian population than in Western populations. Generally, surgery should be considered for the treatment of severe internal tibial torsion. As an alternative approach, the usefulness of a tibia counter rotator (TCR), a corrective orthosis based on the theory of the tibia torsional transformer, has been demonstrated, but the evidence is limited. In the present study, the efficacy and safety of TCR treatment were investigated in pediatric patients with internal tibial torsion. The subjects were 124 pediatric patients with internal tibial torsion who were between 3 and 15 years of age and had no underlying diseases. The severity of tibial intorsion was evaluated by the tibial transmalleolar angle (TMA). A TMA less than 5° was defined as internal tibial torsion, and less than −20° was defined as severe in this study. The median duration of TCR use was 11 (9, 12) (median (IQR: interquartile range)) months, and the treatment completion rate was 94.4% (117/124). The TMA at 12 months from the start of treatment in patients who completed treatment was 5° (0°, 10°) on the right (n = 66) (p < 0.01 vs. pretreatment) and 0° (−5°, 8°) on the left (n = 71) (p < 0.01 vs. pretreatment). The tibial torsional transformer used in this study is effective in the initial treatment of mild to severe internal tibial torsion, with no adverse effects. Although internal tibial torsion is generally expected to resolve spontaneously, TCR treatment may be an effective alternative to surgical therapy in the Asian pediatric population.

/pdf/efficacy-of-a-tibia-counter-rotator-system-for-the-treatment-2gnfkr57.pdf

Efficacy of a Tibia Counter Rotator System for the Treatment of Internal Tibial Torsion in Children

During the COVID-19 pandemic, maintenance of essential healthcare systems became very challenging. We describe the triage system of our institute, and assess the quality of care provided to critically ill non-COVID-19 patients requiring continuous renal replacement therapy (CRRT) during the pandemic.We introduced an emergency triage pathway early in the pandemic. We retrospectively reviewed the medical records of patients who received CRRT in our hospital from January 2016 to March 2021. We excluded end-stage kidney disease patients on maintenance dialysis. Patients were stratified as medical and surgical patients. The time from hospital arrival to intensive care unit (ICU) admission, the time from hospital arrival to intervention/operation, and the in-hospital mortality rate were compared before (January 2016 to December 2019) and during (January 2021 to March 2021) the pandemic.The mean number of critically ill patients who received CRRT annually in the surgical department significantly decreased during the pandemic in (2016-2019: 76.5 ± 3.1; 2020: 56; p < 0.010). Age, sex, and the severity of disease at admission did not change, whereas the proportions of medical patients with diabetes (before: 44.4%; after: 56.5; p < 0.005) and cancer (before: 19.4%; after: 32.3%; p < 0.001) increased during the pandemic. The time from hospital arrival to ICU admission and the time from hospital arrival to intervention/operation did not change. During the pandemic, 59.6% of surgical patients received interventions/operations within 6 hours of hospital arrival. In Cox's proportional hazard modeling, the hazard ratio associated with the pandemic was 1.002 (0.778-1.292) for medical patients and 1.178 (0.783-1.772) for surgical patients.Our triage system maintained the care required by critically ill non-COVID-19 patients undergoing CRRT at our institution. 

/pdf/maintenance-of-the-critical-care-system-during-the-pandemic-3p9tw5sy.pdf

Maintenance of the critical care system during the pandemic in non-COVID-19 patients requiring continuous renal replacement therapy: a single center experience

Sungmi Kim

Papers

Worsening or improving hypoalbuminemia during continuous renal replacement therapy is predictive of patient outcome: a single-center retrospective study

The Respiratory Morbidities in Late-preterm Infants Compared with the Early-preterm and Term Infants throughout the First Year of Life

Efficacy of a Tibia Counter Rotator System for the Treatment of Internal Tibial Torsion in Children

Maintenance of the critical care system during the pandemic in non-COVID-19 patients requiring continuous renal replacement therapy: a single center experience