The mortality of hospitalized patients with COVID-19 and non-cirrhotic chronic liver disease: a retrospective multi-center study.

Background: Patients with chronic liver disease (CLD) have a higher risk of mortality when infected with severe acute respiratory syndrome coronavirus 2. Although the fibrosis-4 (FIB-4) index, aspartate aminotransferase-to-platelet ratio index (APRI), and albumin-bilirubin grade (ALBI) score can predict mortality in CLD, their correlation with the clinical outcomes of CLD patients with coronavirus disease 2019 (COVID-19) is unclear. This study aimed to investigate the association between the liver severity and the mortality in hospitalized patients with non-cirrhotic CLD and COVID-19. Methods: This retrospective study analyzed 231 patients with non-cirrhotic CLD and COVID-19. Clinical characteristics, laboratory data, including liver status indices, and clinical outcomes were assessed to determine the correlation between liver status indices and the mortality among patients with non-cirrhotic CLD and COVID-19. Results: Non-survivors had higher levels of prothrombin time-international normalized ratio (PT-INR), alanine aminotransferase, aspartate aminotransferase, and high-sensitivity C-reactive protein (hs-CRP) and lower albumin levels. Multivariable analysis showed that ALBI grade 3 (odds ratio (OR): 22.80, 95% confidence interval (CI) [1.70-305.38], p = 0.018), FIB-4 index ≥ 3.25 (OR: 10.62, 95% CI [1.12-100.31], p = 0.039), PT-INR (OR: 19.81, 95% CI [1.31-299.49], p = 0.031), hs-CRP (OR: 1.02, 95% CI [1.01-1.02], p = 0.001), albumin level (OR: 0.08, 95% CI [0.02-0.39], p = 0.002), and use of vasopressors (OR: 4.98, 95% CI [1.27-19.46], p = 0.021) were associated with the mortality. Conclusion: The ALBI grade 3 and FIB-4 index ≥ 3.25, higher PT-INR, hsCRP levels and lower albumin levels could be associated with mortality in non-cirrhotic CLD patients with COVID-19. Clinicians could assess the ALBI grade, FIB-4 index, PT-INR, hs-CRP, and albumin levels of patients with non-cirrhotic CLD upon admission.

Acute kidney injury in patients with COVID-19 compared to those with influenza: a systematic review and meta-analysis.

Background: COVID-19 and influenza can both lead to acute kidney injury (AKI) as a common complication. However, no meta-analysis has been conducted to directly compare the incidence of AKI between hospitalized patients with COVID-19 and influenza. The objective of our study aims to investigate the incidence and outcomes of AKI among hospitalized patients between these two groups. Materials and methods: A systematic search of PubMed, Embase, and Cochrane databases was conducted from December 2019 to August 2023 to identify studies examining AKI and clinical outcomes among hospitalized patients with COVID-19 and influenza. The primary outcome of interest was the incidence of AKI, while secondary outcomes included in-hospital mortality, recovery from AKI, hospital and ICU stay duration. The quality of evidence was evaluated using Cochrane and GRADE methods. Results: Twelve retrospective cohort studies, involving 17,618 hospitalized patients with COVID-19 and influenza, were analyzed. COVID-19 patients showed higher AKI incidence (29.37% vs. 20.98%, OR: 1.67, 95% CI 1.56-1.80, p < 0.01, I2 = 92.42%), and in-hospital mortality (30.95% vs. 5.51%, OR: 8.16, 95% CI 6.17-10.80, p < 0.01, I2 = 84.92%) compared to influenza patients with AKI. Recovery from AKI was lower in COVID-19 patients (57.02% vs., 80.23%, OR: 0.33, 95% CI 0.27-0.40, p < 0.01, I2 = 85.17%). COVID-19 patients also had a longer hospital stay (SMD: 0.69, 95% CI 0.65-0.72, p < 0.01, I2 = 98.94%) and longer ICU stay (SMD: 0.61, 95% CI 0.50-0.73, p < 0.01, I2 = 94.80%) than influenza patients. In our study, evidence quality was high (NOS score 7-9), with low certainty for AKI incidence and moderate certainty for recovery form AKI by GRADE assessment. Conclusion: COVID-19 patients had higher risk of developing AKI, experiencing in-hospital mortality, and enduring prolonged hospital/ICU stays in comparison to influenza patients. Additionally, the likelihood of AKI recovery was lower among COVID-19 patients.

Dapagliflozin protects against doxorubicin-induced nephrotoxicity associated with nitric oxide pathway-A translational study.

Doxorubicin (Dox) is a potent anticancer agent, but its associated organ toxicity, including nephrotoxicity, restricts clinical applications. Dapagliflozin (DAPA), a sodium-glucose cotransporter-2 inhibitor, has been shown to slow the progression of kidney disease in patients with and without diabetes. However, the effect of DAPA to counteract Dox-induced nephrotoxicity remains uncertain. Therefore, in this study, we aimed to elucidate the effects of DAPA in mitigating Dox-induced nephrotoxicity. We analyzed the Taiwan National Health Insurance Database to evaluate the incidence of renal failure among breast cancer patients receiving Dox treatment compared to those without. After adjusting for age and comorbidities, we found that the risk of renal failure was significantly higher in Dox-treated patients (incidence rate ratio, 2.45; confidence interval, 1.41-4.26; p = 0.0014). In a parallel study, we orally administered DAPA to Sprague-Dawley rats for 6 weeks, followed by Dox for 4 weeks. DAPA ameliorated Dox-induced glomerular atrophy, renal fibrosis, and dysfunction. Furthermore, DAPA effectively suppressed Dox-induced apoptosis and reactive oxygen species production. On a cellular level, DAPA in HK-2 cells mitigated Dox-mediated suppression of the endothelial NOS pathway and reduced Dox-induced activities of reactive oxygen species and apoptosis-associated proteins. DAPA improved Dox-induced apoptosis and renal dysfunction, suggesting its potential utility in preventing nephrotoxicity in patients with cancer undergoing Dox treatment.

Using Rasch KIDMAP to identify whether China dominates the research area of computer science (CS) based on the specialization index of article citations: Bibliometric analysis.

BACKGROUND: Scientific comparative advantage is measured by using a specialization index (SI) of article citations. The profile data have been published in the literature. However, no such research has been conducted to determine which countries dominate the field of computer science (CS) (subject category [SC]) using the SI. A KIDMAP in the Rasch model has been applied to the display of individual student performance in school. Based on the SI of article citations, we used KIDMAP to determine whether China dominates the field of CS. METHODS: The data were derived from published research in the Web of Science, which included 199 countries and 254 subject categories (SC, between 2010 and 2019). A total of 96 SC related to biomedicine were extracted. We examined 7 factors associated with CS using exploratory factor analysis. Based on the SI in CS under the Rasch model, 1-dimensional SCs on CS were displayed on Wright Maps and KIDMAPs. An analysis of the dominance of CS in China was presented on the basis of a scatter plot. RESULTS: Our findings indicate that (1) CS domains are divided into 2 groups (traditional and advanced domains); (2) no evidence has been found that China dominates CS; based on SI indicators, China was ranked third with --2.62 and 0.79 logits after Taiwan and Slovenia (-(-2.62 and 9.24 logits in Factors 1 and 2) in the period from 2010 to 2019. CONCLUSIONS: There is insufficient evidence to demonstrate that China has a dominant role over other countries/regions despite ranking third in CS. In future studies, it is recommended to include a KIDMAP visual to assess dominant roles in other areas of research, rather than to confine ourselves to CS as we did in this study.

The 95% control lines on both confirmed cases and days of infection with COVID-19 were applied to compare the impact on public health between 2020 and 2021 using the hT-index.

BACKGROUND: COVID-19, the disease caused by the novel coronavirus, is now a worldwide pandemic. The number of infected people has continually increased, and currently, this pandemic continues to present challenges to public health. Scatter plots are frequently used to interpret the impact in relation to confirmed cases. However, the 95% confidence intervals are rarely given to the scatter plot. The objective of this study was to; Develop 95% control lines on daily confirmed cases and infected days for countries/regions in COVID-19 (DCCIDC) and; Examine their impacts on public health (IPH) using the hT-index. METHODS: All relevant COVID-19 data were downloaded from GitHub. The hT-index, taking all DCCIDCs into account, was applied to measure the IPHs for counties/regions. The 95% control lines were proposed to highlight the outliers of entities in COVID-19. The hT-based IPHs were compared among counties/regions between 2020 and 2021 using the choropleth map and the forest plot. The features of the hT-index were explained using the line chart and the box plot. RESULTS: The top 2 countries measured by hT-based IPHs were India and Brazil in 2020 and 2021. The outliers beyond the 95% confidence intervals were Hubei (China), with a lower hT-index favoring 2021 ( = 6.4 in 2021 vs 15.55 in 2020) and higher hT indices favoring 2021 in Thailand (28.34 vs 14,77) and Vietnam (27.05 vs 10.88). Only 3 continents of Africa, Asia, and Europe had statistically and significantly fewer DCCIDCs (denoted by the hT-index) in 2021. The hT-index generalizes the h-index and overcomes the disadvantage without taking all elements (e.g., DCCIDCs) into account in features. CONCLUSIONS: The scatter plot combined with the 95% control lines was applied to compare the IPHs hit by COVID-19 and suggested for use with the hT-index in future studies, not limited to the field of public health as we did in this research.

Authors who contributed most to the fields of hemodialysis and peritoneal dialysis since 2011 using the hT-index: Bibliometric analysis.

BACKGROUND: The h-index does not take into account the full citation list of a researcher to evaluate individual research achievements (IRAs). As a generalization of the h-index, the hT-index takes all citations into account to evaluate IRAs. Compared to other bibliometric indices, it is unclear whether the hT-index is more closely associated with the h-index. We utilized articles published on hemodialysis and peritoneal dialysis (HD/PD) to validate the hT-index as a measure of the most significant contributions to HD/PD. METHODS: Using keywords involving HD/PD in titles, subject areas, and abstracts since 2011, we obtained 7702 abstracts and their associated metadata (e.g., citations, authors, research institutes, countries of origin). In total, 4752 first or corresponding authors with hT-indices >0 were evaluated. To present the author's IRA, the following 4 visualizations were used: radar, Sankey, impact beam plot, and choropleth map to investigate whether the hT-index was more closely associated with the h-index than other indices (e.g., g-/x-indices and author impact factors), whether the United States still dominates the majority of publications concerning PD/HD, and whether there was any difference in research features between 2 prolific authors. RESULTS: In HD/PD articles, we observed that (a) the hT-index was closer to and associated with the h-index; (b1) the United States (37.15), China (34.63), and Japan (28.09) had the highest hT-index; (b2) Sun Yat Sen University (Chian) earned the highest hT-index (=20.02) among research institutes; (c1) the authors with the highest hT-indices (=15.64 and 14.39, respectively) were David W Johnson (Australia) and Andrew Davenport (UK); and (c2) their research focuses on PD and HD, respectively. CONCLUSION: The hT-index was demonstrated to be appropriate for assessing IRAs along with visualizations. The hT-index is recommended in future bibliometric analyses of IRAs as a complement to the h-index.

Research features between Urology and Nephrology authors in articles regarding UTI related to CKD, HD, PD, and renal transplantation.

BACKGROUND: A urinary tract infection (UTI) is one of the most common types of infections affecting the urinary tract. When bacteria enter the bladder or kidney and multiply in the urine, a URI can occur. The urethra is shorter in women than in men, which makes it easier for bacteria to reach the bladder or kidneys and cause infection. A comparison of the research differences between Urology and Nephrology (UN) authors regarding UTI pertaining to the 4 areas (i.e., Chronic Kidney Disease, Hemodialysis, Peritoneal Dialysis, and Renal Transplantation [CHPR]) is thus necessary. We propose and verify 2 hypotheses: CHPR-related articles on UTI have equal journal impact factors (JIFs) in research achievements (RAs) and UN authors have similar research features (RFs). METHODS: Based on keywords associated with UTI and CHPR in titles, subject areas, and abstracts since 2013, we obtained 1284 abstracts and their associated metadata (e.g., citations, authors, research institutes, departments, countries of origin) from the Web of Science core collection. There were 1030 corresponding and first (co-first) authors with hT-JIF-indices (i.e., JIF was computed using hT-index rather than citations as usual). The following 5 visualizations were used to present the author's RA: radar, Sankey, time-to-event, impact beam plot, and choropleth map. The forest plot was used to distinguish RFs by observing the proportional counts of keyword plus in Web of Science core collection between UN authors. RESULTS: It was observed that CHPR-related articles had unequal JIFs (χ2 = 13.08, P = .004, df = 3, n = 1030) and UN departments had different RFs (Q = 53.24, df = 29, P = .004). In terms of countries, institutes, departments, and authors, the United States (hT-JIF = 38.30), Mayo Clinic (12.9), Nephrology (19.14), and Diana Karpman (10.34) from Sweden had the highest hT-JIF index. CONCLUSION: With the aid of visualizations, the hT-JIF-index and keyword plus were demonstrated to assess RAs and distinguish RFs between UN authors. A replication of this study under other topics and in other disciplines is recommended in the future, rather than limiting it to UN authors only, as we did in this study.

Comparison of the risk of gastrointestinal perforation between patients with and without rheumatoid arthritis: A nationwide cohort study in Asia.

Objectives: Patients with rheumatoid arthritis (RA) may have an increased risk for gastrointestinal perforation (GIP) caused by medications or chronic inflammation. However, the risk of GIP between patients with and without RA remains unclear. Therefore, we conducted this study to clarify it. Methods: Using the Taiwan National Health Insurance Research Database, we identified patients with and without RA matched at 1:1 ratio by age, sex, and index date between 2000 and 2013 for this study. Comparison of the risk of GIP between the two cohorts was performed by following up until 2014 using Cox proportional hazard regression analyses. Results: In total, 11,666 patients with RA and an identical number of patients without RA were identified for this study. The mean age (±standard deviation) and female ratio were 55.3 (±15.2) years and 67.6% in both cohorts. Patients with RA had a trend of increased risk for GIP than patients without RA after adjusting for underlying comorbidities, medications, and monthly income [adjusted hazard ratio (AHR) 1.42; 95% confidence interval (CI) 0.99-2.04, p = 0.055]. Stratified analyses showed that the increased risk was significant in the female population (AHR 2.06; 95% CI 1.24-3.42, p = 0.005). Older age, malignancy, chronic obstructive pulmonary disease, and alcohol abuse were independent predictors of GIP; however, NSAIDs, systemic steroids, and DMARDs were not. Conclusion: RA may increase the risk of GIP, particularly in female patients. More attention should be paid in female population and those with independent predictors above for prevention of GIP.

Regular use of aspirin is associated with a lower cardiovascular risk in prostate cancer patients receiving gonadotropin-releasing hormone therapy.

Gonadotropin-releasing hormone (GnRH) therapy has been known to increase risks of major adverse cardiovascular and cerebrovascular events (MACCEs). Herein, we aim to estimate whether regular use of aspirin attenuates risks of MACCEs in prostate cancer patients receiving GnRHs. Using Taiwanese National Health Insurance Research Database (NHIRD), we identified 7719 patients diagnosed with prostate cancer who were either aspirin-naïve, received irregular or regular aspirin from 2008 to 2015. Through a multivariable logistic regression model, we investigated the impact of aspirin on MACCEs. Compared with nonusers and irregular users, most patients receiving regular aspirin were older and had more comorbidities. The crude incidence of one-year MACCEs was lowest in aspirin nonusers but highest in irregular users of aspirin compared with regular users of aspirin (2.65% vs. 4.41% vs. 2.85%, p=0.0099). After adjusting for age, cancer stage and comorbidities, irregular aspirin users had a higher risk of one-year MACCEs (adjusted OR: 1.33; 95% CI: 0.93-1.90, p=0.1139) than aspirin nonusers, but conversely, there was a trend of reducing the risk of MACCEs among those who received regular aspirin (adjusted OR: 0.79; 95% CI: 0.44-1.42, p=0.4256). In the subgroup analysis, there were age- and cancer stage-independent higher risks of MACCEs in patients who took aspirin irregularly compared to those in patients who did not take aspirin. The risks were attenuated in patients receiving regular aspirin. Collectively, regular use of aspirin presented a trend of reducing risks of MACCEs in prostate cancer patients receiving GnRHs. However, irregular use of aspirin diminished the benefits.

Assessing the Global Impact on the Mouse Kidney After Traumatic Brain Injury: A Transcriptomic Study.

Purpose: In this study, we use animal models combined with bioinformatics strategies to investigate the potential changes in overall renal transcriptional expression after traumatic brain injury. Methods: Microarray analysis was performed after kidney acquisition using unilateral controlled cortical impact as the primary mouse TBI model. Multi-oriented gene set enrichment analysis was performed for differentially expressed genes. Results: The results showed that TBI affected the gene set associated with mitochondria function in kidney cells, and a negative enrichment of gene sets associated with immune cell migration and epidermal development was also observed. Analysis of the disease phenotype gene set revealed that differential expression of mitochondria-related genes was associated with lactate metabolism. Alternatively, activation and adhesion of immune cells associated with the complement system may promote autoinflammation in kidney tissue. The simulated immune cell infiltration analysis showed an increase in the proportion of activated memory CD4 T cells and a decrease in the proportion of resting memory CD4 T cells, suggesting that activated memory CD4 T cell infiltration may be involved in the inflammation of renal tissue and cause damage to renal cells, such as principal cells, mesangial cells and loops of Henle cells. Conclusion: This study is the first to reveal the effects of brain trauma on the kidney. TBI may affect the expression of mitochondria function-related gene sets in renal cells by increasing lactate. It may also affect renal mesangial cells by inducing increased infiltration of immune cells through mechanisms related to complement system activation or autoimmune antibodies.

Sepsis and Acute Kidney Injury: A Review Focusing on the Bidirectional Interplay.

Although sepsis and acute kidney injury (AKI) have a bidirectional interplay, the pathophysiological mechanisms between AKI and sepsis are not clarified and worthy of a comprehensive and updated review. The primary pathophysiology of sepsis-associated AKI (SA-AKI) includes inflammatory cascade, macrovascular and microvascular dysfunction, cell cycle arrest, and apoptosis. The pathophysiology of sepsis following AKI contains fluid overload, hyperinflammatory state, immunosuppression, and infection associated with kidney replacement therapy and catheter cannulation. The preventive strategies for SA-AKI are non-specific, mainly focusing on infection control and preventing further kidney insults. On the other hand, the preventive strategies for sepsis following AKI might focus on decreasing some metabolites, cytokines, or molecules harmful to our immunity, supplementing vitamin D3 for its immunomodulation effect, and avoiding fluid overload and unnecessary catheter cannulation. To date, several limitations persistently prohibit the understanding of the bidirectional pathophysiologies. Conducting studies, such as the Kidney Precision Medicine Project, to investigate human kidney tissue and establishing parameters or scores better to determine the occurrence timing of sepsis and AKI and the definition of SA-AKI might be the prospects to unveil the mystery and improve the prognoses of AKI patients.

Using the forest plot to compare citation achievements in bibliographic and meta-analysis studies since 2011 using data on PubMed Central: A retrospective study.

BACKGROUND: We saw a steady increase in the number of bibliographic studies published over the years. The reason for this rise is attributed to the better accessibility of bibliographic data and software packages that specialize in bibliographic analyses. Any difference in citation achievements between bibliographic and meta-analysis studies observed so far need to be verified. In this study, we aimed to identify the frequently observed MeSH terms in these 2 types of study and investigate whether the highlighted MeSH terms are strongly associated with one of the study types. METHODS: By searching the PubMed Central database, 5121 articles relevant to bibliometric and meta-analysis studies were downloaded since 2011. Social network analysis was applied to highlight the major MeSH terms of quantitative and statistical methods in these 2 types of studies. MeSH terms were then individually tested for any differences in event counts over the years between study types using odds of 95% confidence intervals for comparison. RESULTS: In these 2 studies, we found that the most productive countries were the United States (19.9%), followed by the United Kingdom (8.8%) and China (8.7%); the most number of articles were published in PLoS One (2.9%), Stat Med (2.5%), and Res Synth (2.4%); and the most frequently observed MeSH terms were statistics and numerical data in bibliographic studies and methods in meta-analysis. Differences were found when compared to the event counts and the citation achievements in these 2 study types. CONCLUSION: The breakthrough was made by developing a dashboard using forest plots to display the difference in event counts. The visualization of the observed MeSH terms could be replicated for future academic pursuits and applications in other disciplines using the odds of 95% confidence intervals.

Dapagliflozin protects against doxorubicin-induced cardiotoxicity by restoring STAT3.

Doxorubicin (Dox), an effective therapy in different types of cancer, is known to exhibit cardiotoxic effects. Despite previous studies indicating the benefits of dapagliflozin (DAPA) in patients experiencing heart failure, it remains uncertain whether DAPA exerts a protective effect on Dox-induced cardiac dysfunction. Signal transducer and activator of transcription 3 (STAT3) participates in various mechanisms of cardioprotection. Herein, we aimed to investigate the effects of DAPA on Dox-induced cardiotoxicity and the role of STAT3. Sprague-Dawley rats were pretreated with oral DAPA for 6 weeks followed by Dox for 4 weeks. Sequential echocardiography was applied to assess cardiac function. For in vitro analysis, cardiomyocytes were treated with 10 µM DAPA and subsequently exposed to 1 µM Dox. The expression of reactive oxygen species- and apoptosis-related proteins was measured. Using STAT3 siRNA, we further examined the effects of STAT3 effect on DAPA-associated protection against Dox-induced apoptosis. In rats treated with Dox, DAPA significantly reduced cardiac fibrosis and improved cardiac function and hemodynamics. Additionally, DAPA effectively inhibited Dox-induced apoptosis and reactive oxygen species (ROS) in cardiomyocytes. Mechanistically, we showed that DAPA decreased cardiac expression of Bax and cleaved caspase 3 but increased Bcl-2 expression. DAPA also significantly rescued Dox-suppressed STAT3 expression. Conversely, knocking down STAT3 in cardiomyocytes reversed the DAPA-related protective effects on Dox-induced cell apoptosis and ROS. Collectively, our findings indicate that DAPA could be useful for preventing Dox-induced cardiotoxicity by restoring STAT3.

Acute Kidney Injury and Gut Dysbiosis: A Narrative Review Focus on Pathophysiology and Treatment.

Acute kidney injury (AKI) and gut dysbiosis affect each other bidirectionally. AKI induces microbiota alteration in the gastrointestinal (GI) system, while gut dysbiosis also aggravates AKI. The interplay between AKI and gut dysbiosis is not yet well clarified but worthy of further investigation. The current review focuses on the pathophysiology of this bidirectional interplay and AKI treatment in this base. Both macrophages and neutrophils of the innate immunity and the T helper type 17 cell from the adaptive immunity are the critical players of AKI-induced gut dysbiosis. Conversely, dysbiosis-induced overproduction of gut-derived uremic toxins and insufficient generation of short-chain fatty acids are the main factors deteriorating AKI. Many novel treatments are proposed to deter AKI progression by reforming the GI microbiome and breaking this vicious cycle. Data support the benefits of probiotic treatment in AKI patients, while the results of postbiotics are mainly limited to animals. Prebiotics and synbiotics are primarily discussed in chronic kidney disease patients rather than AKI patients. The effect of adsorbent treatment seems promising, but more studies are required before the treatment can be applied to patients. Immune therapy and some repurposed drugs such as allopurinol are prospects of future treatments and are worth more discussion and survey.

Outcome of Non-Muscle Invasive Upper Tract Urothelial Carcinoma Receiving Endoscopic Ablation: An Inverse Probability of Treatment Weighting Analysis.

We compared the outcomes in early-stage upper tract urothelial carcinoma (UTUC) patients receiving endoscopic ablation (EA) with radical nephroureterectomy (RNU). From 2004 to 2018, cTa/T1N0M0 UTUC patients undergoing EA and RNU were enrolled. For reducing observational bias, propensity scores based on inverse probability of treatment weighting (IPTW) were utilized for comparing the oncologic outcomes and renal function changes. In total, 65 of 184 cTa/T1 UTUC patients were analyzed after exclusion of 119 patients with end-stage renal disease, and lack of previous ureteroscopic biopsy. The studied patients included 23 who received EA and 42 RNU, and both groups were well balanced after adjusting with IPTW. The median follow-up period was 43.6 months. There was no statistical difference between the two groups in terms of oncological outcome. The EA group exhibited less estimated glomerular filtration rate (eGFR) decline one year later (0.0% vs. 20.2%, p < 0.001) and less worsening of chronic kidney status (13.2% vs. 46.5%, p = 0.026). Among patients receiving EA, high-grade tumors exhibited higher subsequent recurrence in the residual urinary tract than did the low-grade ones. (p = 0.037). In summary, endoscopic ablation preserves renal function without compromising oncological outcome in selected UTUC patients. High-grade tumors should be strictly followed up following endoscopic ablation.

Vancomycin-Associated Acute Kidney Injury: A Narrative Review from Pathophysiology to Clinical Application.

Vancomycin is the most frequently used antibiotic, accounting for up to 35% of hospitalized patients with infection, because of its optimal bactericidal effectiveness and relatively low price. Vancomycin-associated AKI (VA-AKI) is a clinically relevant but not yet clearly understood entity in critically ill patients. The current review comprehensively summarizes the pathophysiological mechanisms of, biomarkers for, preventive strategies for, and some crucial issues with VA-AKI. The pathological manifestations of VA-AKI include acute tubular necrosis, acute tubulointerstitial nephritis (ATIN), and intratubular crystal obstruction. The proposed pathological mechanisms of VA-AKI include oxidative stress and allergic reactions induced by vancomycin and vancomycin-associated tubular casts. Concomitant administration with other nephrotoxic antibiotics, such as piperacillin-tazobactam, high vancomycin doses, and intermittent infusion strategies compared to the continuous infusion are associated with a higher risk of VA-AKI. Several biomarkers could be applied to predict and diagnose VA-AKI. To date, no promising therapy is available. Oral steroids could be considered for patients with ATIN, whereas hemodialysis might be applied to remove vancomycin from the patient. In the future, disclosing more promising biomarkers that could precisely identify populations susceptible to VA-AKI and detect VA-AKI occurrence early on, and developing pharmacological agents that could prevent or treat VA-AKI, are the keys to improve the prognoses of patients with severe infection who probably need vancomycin therapy.

Warm-water footbath improves dysmenorrhoea and heart rate variability in college students: a randomised controlled trial.

The effect of warm-water footbath in improving dysmenorrhoea has been rarely investigated. The study aimed to examine whether a warm-water footbath effectively reduces dysmenorrhoea pain and improves the autonomic nervous system (ANS) activity. The randomised controlled trial was registered at ClinicalTrials.gov. (NCT04071028) We enrolled college students with dysmenorrhoea in Northern Taiwan from December 1 2013 to June 30 2014, and randomised them into footbath (n = 35, median age 19 years) and control groups (n = 33, 18 years). Pain visual analogue scale and Short-Form McGill Pain Questionnaire were used for pain assessment, while heart rate variability (HRV) was measured to assess ANS function. After the interventions, the footbath group significantly improved ANS activity and reduced pain severity comparing to the control group. Furthermore, the changes in HRV positively correlated with the improvement of pain severity. In conclusion, a warm-water footbath is beneficial in improving the pain severity among college students with dysmenorrhoea.Impact StatementWhat is already known on this subject? Dysmenorrhoea is the most common gynaecological condition affecting 34-94% of young women. The existing conventional therapeutic strategies for dysmenorrhoea have potential adverse events. Among the complementary therapies for pain, the warm-water footbath is a widely used thermal therapy in improving peripheral neuropathy symptoms and improving patients' quality of life. The subjects with dysmenorrhoea associate with significantly altered autonomic nervous system (ANS) activity. However, the association among warm-water footbath, menstrual pain and ANS was rarely investigated previously.What the results of this study add? The randomised controlled trial enrolling 68 college students with dysmenorrhoea found warm-water footbath improved ANS activity and reduced pain severity. Furthermore, the changes in heart rate variability positively correlated with pain severity improvement.What the implications are of these findings for clinical practice and/or further research? A warm-water footbath for 20 minutes on menstruation days 1 and 2 is beneficial in improving pain among college students with dysmenorrhoea.

Comparison of Surgical or Medical Castration-Related Cardiotoxicity in Patients with Prostate Cancer.

PURPOSE: Androgen deprivation therapy (ADT) includes bilateral orchiectomy or long-acting gonadotropin-releasing hormone (GnRH) agonists/antagonists. It remains controversial with respect to ADT associated cardiovascular outcomes. Hereby, we compared the risk of major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with prostate cancer receiving either surgical castration or GnRH therapies. MATERIALS AND METHODS: Using the Taiwan Cancer Registry and Taiwan's National Health Insurance Research Database, we identified 8,413 patients receiving GnRH therapies compared with 694 receiving surgical castration from 2008 to 2017. The median followup duration was 3 years. RESULTS: The crude incidences of 3-year mortality and MACCEs were 19.90% vs 26.51% and 8.23% vs 8.65% in patients receiving GnRH therapies or surgical castration, respectively. After adjusting for age, cancer stage and comorbidities, despite no significant differences in MACCEs between groups there was a slight increase in the incidence of acute myocardial infarction (AMI) in patients receiving surgical castration compared with those receiving GnRH therapies. The mortality adjusted hazard ratios of MACCEs and AMI among patients receiving surgical castration were 1.11- and 1.8-fold higher than those receiving GnRH therapies. Notably, in subgroup analysis regarding cancer stage, patients with cancer stage IV showed the most significantly increasing risk of AMI in those receiving surgical castration compared with GnRH therapies. CONCLUSIONS: Collectively, we indicated an increased risk of AMI in patients with prostate cancer, especially in patients receiving surgical castration rather than those receiving GnRH therapies. Our findings highlight concerns regarding the cardiac safety of surgical castration compared with GnRH therapies.

Myocardial Infarction and Azygos Vein Thrombosis After ChAdOx1 nCoV-19 Vaccination in a Hemodialysis Patient.

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare complication after vaccination of Oxford-AstraZeneca coronavirus disease 2019 (COVID-19) vaccine (AZD1222) or Janssen COVID-19 vaccine. It makes a rare complication of thrombosis at common and/or uncommon organs with thrombocytopenia after COVID-19 vaccination four to 28 days later and most patients were younger than 60 years of age. We reported the case of a 75-year-old female with end-stage renal disease who received regular hemodialysis. She received Oxford-AstraZeneca COVID-19 vaccination eight days ago and then she suffered from intermittent chest tightness and epigastric pain with tarry stool passage for two days. Severe thrombocytopenia with elevated D-dimer value was noted and computed tomography of the chest showed azygos vein thrombosis. Elevated cardiac enzyme with ST-T change in 12-lead electrocardiogram was also noted. For positive anti-platelet factor 4 antibodies, VITT with myocardial infarction and azygos vein thrombosis was diagnosed.

Predictive Ability of Procalcitonin for Acute Kidney Injury: A Narrative Review Focusing on the Interference of Infection.

Acute kidney injury (AKI) is a common yet complicated clinical entity with high morbidity and mortality. An essential strategy to improve AKI patients' prognoses is finding optimal biomarkers to identify AKI in a timely manner. Procalcitonin (PCT), a well-recognized biomarker for diagnosing infection and guiding antibiotics therapy, has been proposed to predict AKI development and recovery in many clinical settings. The current review provides comprehensive and updated information from relevant studies to evaluate PCT's AKI-predictive ability and the influence of infection on this predictive ability. PCT has demonstrated optimal predictive ability for AKI in various populations irrespective of infection. However, the predictive ability seems to be blunted by infection since infection and inflammation have a more potent influence than AKI on PCT elevation. We furthermore explain the complicated association between elevated PCT levels and AKI in infection and inflammation situations and recommend directions for further investigations to clarify the essential issue. In conclusion, although conflicting data exist, serum PCT level is a potential biomarker for predicting AKI in many clinical settings regardless of infection. Nevertheless, further studies are warranted to clarify the association between PCT, infection, and AKI and to confirm the utilization of PCT for AKI prediction.