Frequency and Prognostic Significance of Acute Kidney Recovery in Patients Who Underwent Transcatheter Aortic Valve Implantation.

Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) is associated with increased mortality. As significant hemodynamic improvement may occur with relief of aortic stenosis, we hypothesized that TAVI patients may demonstrate the opposite phenomena: acute kidney recovery (AKR). We studied the incidence and predictors of AKR in post-TAVI patients. A total of 366 consecutive patients underwent TAVI (January 2012 to January 2017) at a single center. We defined AKR as a 25% improvement in glomerular filtration rate (GFR) at 48 hours after TAVI. AKI-creatinine (Cr) was defined as an increase in Cr of ≥0.3 mg/dl at 48 hours. Patients were categorized in 3 groups: AKR (≥25% increase in GFR), unchanged GFR, and AKI-GFR (inverse definition of AKR, ≥25% decrease in GFR). Multivariable logistic regression defined independent predictors of AKR. AKR occurred in 1/3 of patients. AKI-Cr occurred in 13% of patients, whereas AKI-GFR occurred similarly in 15%. AKR and AKI occurred most frequently in patients with chronic kidney disease (CKD: GFR ≤ 60 ml/min/1.73 m2). Independent predictors of AKR-GFR by multivariable analysis were male gender, lack of chronic ß-blocker utilization, and presence of CKD. Notably, left ventricular dysfunction and contrast volume were not predictive of AKR. Transfusion occurred less frequently among patients with AKR compared with patients with AKI-GFR (11% vs 26%, p = 0.03). Death occurred in 0% of AKR patients versus 9.3% of AKI-GFR patients (p <0.01). In conclusion, this is the first report of AKR after TAVI. Patients with CKD, male gender, and lack of pre-TAVI beta blockade were more likely to demonstrate AKR.

Multiple sclerosis: Frequency, cost, and economic burden in the United States.

Multiple sclerosis (MS) is one of the most common neurological diseases, affecting young and middle-aged adults. The full economic cost of managing chronic MS is substantial. To investigate the recent trend of medical cost and economic burden of MS management in the United States (U.S.), we inquired for available data from the National Inpatient Sample database (NIS; from 1994 to 2013). The annual rates of changes were determined by linear regression analysis. We found an estimated half million increase in MS admissions, annually, which was projected to exceed 43.5 million by the end of year 2017. We also found the charge and the costs associated with MS care increased at rates of US$ 40 million a year and US$ 8 million a year, respectively. We revealed a 1.6 fold increase in the inflation of medical bill in the past decade, and the inflation of medical bills was inversely correlated to the cost-to-charge ratios. In sum, we outline the national trends of medical care use and the expenditure of caring for patients with MS. Periodic reviews and characterizations of expenditure trends are critical for formulating future policy.

Bottle feeding simulates child loss: postpartum depression and evolutionary medicine.

At the level of a mother's basic biology, the decision to bottle feed unwittingly mimics conditions associated with the death of an infant. Child loss is a well documented trigger for depression particularly in mothers, and growing evidence shows that bottle feeding is a risk factor for postpartum depression. The implications of this hypothesis for infant feeding practices, hospital procedures that lead to intermittent separation between mothers and infants during the immediate postpartum period, parallels between an increased desire to hold infants by mothers who bottle feed and responses to infant death among nonhuman primates, and the relationship between weaning and depression are discussed in the context of an emerging discipline known as evolutionary medicine.