Severe anemia is associated with increased short-term and long-term mortality in patients hospitalized with cirrhosis.

INTRODUCTION AND OBJECTIVES: The relationship between anemia and the outcome of patients with cirrhosis is not completely clear. Therefore, we performed this large-scale epidemiological study to investigate the prevalence and severity of anemia in patients with cirrhosis and acute decompensation or liver injury and how anemia impacts short-term and long-term outcomes. PATIENTS AND METHODS: Patients with cirrhosis and acute decompensation (AD) or acute liver injury (ALI) were enrolled in the Chinese AcuTe on CHronic LIver FailurE (CATCH-LIFE) studies, which consisted of two large, multicenter, prospective, observational cohorts between January 2015 and December 2016 and July 2018 and January 2019. We conducted data analysis on the prevalence of anemia and determined the relationship between anemia and prognosis. RESULTS: Among 1979 patients, 1389 (70.2%) had anemia, among whom 599 (41.3%) had mild anemia, 595 (15.8%) had moderate anemia and 195 (2.4%) had severe anemia. A linear association between hemoglobin level and 90-day or 1-year LT-free mortality was shown, and a 10 g/L decrease in hemoglobin level was associated with a 6.8% extra risk of 90-day death and a 5.7% extra risk of 1-year death. Severe anemia was an independent risk factor for 90-day [HR=1.649 (1.100, 2.473), p=0.016] and 1-year LT-free mortality [HR=1.610 (1.159, 2.238), p=0.005]. Multinomial logistic regression analysis further identified that severe anemia was significantly associated with post-28-day mortality but not within-28-day mortality. CONCLUSIONS: Anemia is common in patients with cirrhosis admitted for acute events. Severe anemia was associated with poor 90-day and 1-year prognoses in these patients.

Comparison of greenhouse gas emissions from rice paddy fields under different nitrogen fertilization loads in Chongming Island, Eastern China.

Rice is one of the major crops of southern China and Southeast Asia. Rice paddies are one of the largest agricultural greenhouse gas (GHG) sources in this region because of the application of large quantities of nitrogen (N) fertilizers to the plants. In particular, the production of methane (CH4) is a concern. Investigating a reasonable amount of fertilizers to apply to plants is essential to maintaining high yields while reducing GHG emissions. In this study, three levels of fertilizer application [high (300 kg N/ha), moderate (210 kg N/ha), and low (150 kg N/ha)] were designed to examine the effects of variation in N fertilizer application rate on carbon dioxide (CO2), methane (CH4), and nitrous oxide (N2O) emissions from the paddy fields in Chongming Island, Shanghai, China. The high level (300 kg N/ha) represented the typical practice adopted by the local farmers in the area. Maximum amounts of CH4 and N2O fluxes were observed upon high-level fertilizer application in the plots. Cumulative N2O emissions of 23.09, 40.10, and 71.08 mg N2O/m(2) were observed over the growing season in 2011 under the low-, moderate-, and high-level applications plots, respectively. The field data also indicated that soil temperatures at 5 and 10 cm soil depths significantly affected soil respiration; the relationship between Rs and soil temperature in this study could be described by an exponential model. Our study showed that reducing the high rate of fertilizer application is a feasible way of attenuating the global-warming potential while maintaining the optimum yield for the studied paddy fields.

Malicious use of pharmaceuticals in children.

OBJECTIVE: To describe malicious administration of pharmaceutical agents to children. STUDY DESIGN: We performed a retrospective study of all pharmaceutical exposures involving children <7 years old reported to the US National Poison Data System from 2000 to 2008 for which the reason for exposure was coded as "malicious." RESULTS: A total of 1439 cases met inclusion criteria. The mean number of cases per year was 160 (range, 124 to 189) that showed an increase over time. The median (IQR) age was 2 (1.5) years. Outcome data were available for 1244 (86.4%) patients. Of these exposures, 172 resulted in moderate or major outcomes or death. 9.7% of cases involved >1 exposed substance. The most common reported major pharmaceutical categories were analgesics, stimulants/street drugs, sedatives/hypnotics/antipsychotics, cough and cold preparations, and ethanol. In 51% of cases there was an exposure to at least one sedating agent. There were 18 (1.2%) deaths. Of these, 17 (94%) were exposed to sedating agents, including antihistamines (8 cases) and opioids (8 cases). CONCLUSIONS: Malicious administration of pharmaceuticals should be considered an important form of child abuse.