Volume control strategy and patient survival in sepsis-associated acute kidney injury receiving continuous renal replacement therapy: a randomized controlled trial with secondary analysis.

Optimal strategy for volume control and the clinical implication of achieved volume control are unknown in patients with sepsis-associated acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT). This randomized controlled trial aimed to compare the survival according to conventional or bioelectrical impedance analysis (BIA)-guided volume control strategy in patients with sepsis-associated AKI receiving CRRT. We also compared patient survival according to achieved volume accumulation rate ([cumulative fluid balance during 3 days × 100]/fluid overload measured by BIA at enrollment) as a post-hoc analysis. We randomly assigned patients to conventional volume control strategy (n = 39) or to BIA-guided volume control strategy (n = 34). There were no differences in 28-day mortality (HR, 1.19; 95% CI, 0.63-2.23) or 90-day mortality (HR, 0.99; 95% CI 0.57-1.75) between conventional and BIA-guided volume control group. In the secondary analysis, achieved volume accumulation rate was significantly associated with patient survival. Compared with the achieved volume accumulation rate of ≤ - 50%, the HRs (95% CIs) for the risk of 90-day mortality were 1.21 (0.29-5.01), 0.55 (0.12-2.48), and 7.18 (1.58-32.51) in that of - 50-0%, 1-50%, and > 50%, respectively. Hence, BIA-guided volume control in patients with sepsis-associated AKI receiving CRRT did not improve patient outcomes. In the secondary analysis, achieved volume accumulation rate was associated with patient survival.

Trends in the association between body mass index and blood pressure among 19-year-old men in Korea from 2003 to 2017.

The strength of association between the body mass index (BMI) and blood pressure (BP) varies with population and time. Therefore, identifying the trends in BMI-BP association in adolescents can help predict the upcoming metabolic and cardiovascular disease burden. For this reason, from physical examination data collected from 2003 to 2017, a total of 5,133,246 Korean men aged 19 years were assessed for the annual trends and changes in the BMI-BP association. During the 15-year period, the mean BMI increased from 22.5 to 23.5 kg/m2, and the prevalence of obesity increased from 16.7 to 21.4%. Meanwhile, the mean systolic BP (SBP) decreased from 122.8 to 122.3 mmHg in the first year and gradually increased to 125.9 mmHg afterward. The diastolic BP (DBP) decreased from 71.5 to 70.0 mmHg in the first 4 years and then rose to 74.8 mmHg in the following years. The association analysis between BMI and SBP resulted in an annual increase in the correlation coefficient (SBP: 0.257-0.495, DBP: 0.164-0.413). The regression coefficient similarly increased between 2003 and 2015 but slightly decreased between 2015 and 2017 (SBP: 0.896-1.569, DBP: 0.405-0.861). The BMI-BP association increased over time (coefficient of the interaction term > 0, P < 0.001). Moreover, as the BMI increased, the annual increase in BP and BP per unit BMI also increased. In conclusion, this study emphasized a continuous shift towards obesity in BMI distribution and intensifying BMI-BP association over time in young men. Further research on factors affecting this BMI-BP association is needed to fully validate the potential applications of this hypothesis.

Distribution and outliers of anteversion of short-length cementless stem.

INTRODUCTION: Inadequate stem version might lead to impingement and instability after cementless total hip arthroplasty (THA). We evaluated (1) the distribution of short-stem anteversion, (2) the proportion of stems with an anteversion less than 5° or larger than 25°, (3) combined cup and stem anteversion, and (4) dislocation rate. MATERIALS AND METHODS: We evaluated the native femoral anteversion and stem anteversion in 340 patients (340 THAs): 144 men and 196 women. Their mean age was 56.2 (22-87) years and mean body mass index was 25.1 (15.2-40.7) kg/m2. The femoral neck anteversion was measured on pre-operative CT scan and the stem anteversion was obtained during the operation. The safe zone of the stem anteversion was defined as 5 to 25°. RESULTS: The femoral neck anteversion ranged from -15 to 61° (mean, 15.0°; SD, ±10.6°). The stem anteversion ranged -7 to 50° (mean, 15.7°; SD, ±9.5°). It was optimal (5-25°) in 71.2% (242/340), insufficient (<5°) in 13.3% (45/340), and excessive (>25°) in 15.6% (53/340). The stem anteversion had a medium correlation with the femoral neck anteversion (correlation coefficient = 0.449). The combined anteversion was 42.0° (range, 35.2-52.3°; SD, ±2.8°). During two to four year follow-up, no hip dislocated. CONCLUSIONS: Short-length stem had a great variability in the anteversion and considerable portion (28.9%, 98/340) of stems had an anteversion outside the safe zone. Surgeons should be aware of this variability of stem anteversion to compensate for abnormal stem anteversion, which might lead to impingement and instability after THA.