Acute kidney injury in children with haematological malignancy: a territory-wide study.

BACKGROUND: In onco-nephrology, data on acute kidney injury (AKI) among children with haematological malignancies are scarce. METHODS: A retrospective cohort study of all patients in Hong Kong diagnosed with haematological malignancies from 2019 to 2021 before 18 years of age, was conducted to investigate the epidemiology, risk factors and clinical outcomes of AKI during the first year of treatment. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. RESULTS: We included 130 children with haematological malignancy at median age of 9.4 years (IQR, 3.9-14.1). Of these patients, 55.4% were acute lymphoblastic leukemia (ALL), 26.9% were lymphoma and 17.7% were acute myeloid leukemia (AML). Thirty-five patients (26.9%) developed 41 AKI episodes during the first year of diagnosis, corresponding to 32 episodes per 100-patient-year. A total of 56.1% and 29.2% of the AKI episodes occurred during induction and consolidation chemotherapy respectively. Septic shock (n = 12, 29.2%) was the leading cause of AKI; 21 episodes (51.2%) were stage 3 AKI; 12 episodes (29.3%) were stage 2 AKI; and 6 patients required continuous kidney replacement therapies. Tumor lysis syndrome and impaired baseline kidney function were significantly associated with AKI on multivariate analysis (P = 0.01). History of AKI was associated with chemotherapy postponement (37.1% vs. 16.8%, P = 0.01), worse 12-month patient survival (77.1% vs. 94.7%, log rank P = 0.002) and lower disease remission rate at 12-month (68.6% vs. 88.4%, P = 0.007), compared to patients without AKI. CONCLUSION: AKI is a common complication during treatment of haematological malignancies which is associated with worse treatment outcomes. A regular and dedicated surveillance program for at-risk patients should be studied in children with haematological malignancies for prevention and early detection of AKI. A higher resolution version of the Graphical abstract is available as Supplementary information.

How Does Topicality Affect the Choice of Referential Form? Evidence From Mandarin.

Many models of reference production suggest that speakers tend to use a reduced referential form, such as a pronoun, to signal the topicality of a particular referent, that is, the Topichood Hypothesis. However, little is known about the precise nature of the mapping between topichood and referential form and the mechanisms by which topichood affects referential form. The current study aims to address these issues by investigating how topicality influences different kinds of reduced expressions, namely, null and overt pronouns in Mandarin. We manipulated topicality using a left-dislocation structure in Experiment 1. We found that topicality increased the use of null pronouns, but not overt pronouns. This suggests that topicality may increase only the most reduced expression available in a given language. Experiment 2 examined whether the topicality effect was related to predictability. We found that participants used more null pronouns for less predictable referents. We suggest that the topicality effect could be better explained by an accessibility mechanism.

The role of grammatical role and thematic role predictability in reference form production in Mandarin Chinese.

Evidence suggests that English speakers use pronouns when referring to the grammatical subject and predictable thematic role. We tested how grammatical role and thematic role predictability affect different types of referential forms, namely, overt pronouns and null pronouns in Mandarin Chinese. We found that both overt and null pronouns were sensitive to grammatical role. However, we did not find any evidence that overt and null pronouns were sensitive to thematic role predictability. Although null pronouns were influenced by grammatical role, the rate of null pronouns for subject reference was very low compared to that of overt pronouns. Given the frequent occurrence of null pronouns in Mandarin, our results suggest that the use of null pronouns may not be explained by a simple grammatical role mechanism.