Perioperative fluid management and associated complications in children receiving kidney transplants in the UK.

BACKGROUND: Intravenous fluid administration is an essential part of perioperative care for children receiving a kidney transplant. There is a paucity of evidence to guide optimal perioperative fluid management. This study aimed to identify the volume of perioperative fluids administered across 5 UK paediatric kidney transplant centres and explore associations between fluid volume administered, graft function, and fluid-related adverse events. METHODS: Data were collected from five UK paediatric kidney transplant centres on perioperative fluid volumes administered, and incidence of pulmonary oedema, systemic hypertension, and requirement for intensive care support. Children < 18 years of age who received a kidney-only transplant between 1st January 2020 and 31st December 2021 were included. RESULTS: Complete data from 102 children were analysed. The median total volume of fluid administered in 72 h was 377 ml/kg (IQR 149 ml/kg) with a high degree of variability. A negative relationship between total fluid volume administered and day 7 eGFR was noted (p < 0.001). Association between urine volume post-transplant and day 7 eGFR was also negative (p < 0.001). Adverse events were frequent but no significant difference was found in the fluid volume administered to those who developed an adverse event, vs those who did not. CONCLUSIONS: This study describes a high degree of variability in perioperative fluid volumes administered to children receiving kidney transplants. Both fluid volume and urine output were negatively associated with short-term graft function. These data contrast traditional interpretation of high urine output as a marker of graft health, and highlight the need for prospective clinical trials to optimise perioperative fluid administration for this group. A higher resolution version of the Graphical abstract is available as Supplementary information.

Evidence inhibition responds reactively to the salience of distracting information during focused attention.

Along with target amplification, distractor inhibition is regarded as a major contributor to selective attention. Some theories suggest that the strength of inhibitory processing is proportional to the salience of the distractor (i.e., inhibition reacts to the distractor intensity). Other theories suggest that the strength of inhibitory processing does not depend on the salience of the distractor (i.e., inhibition does not react to the distractor intensity). The present study aimed to elucidate the relationship between the intensity of a distractor and its subsequent inhibition during focused attention. A flanker task with a variable distractor-target stimulus-onset asynchrony (SOA) was used to measure both distractor interference and distractor inhibition. We manipulated the intensity of the distractor in two separate ways, by varying its distance from the target (Experiment 1) and by varying its brightness (Experiment 2). The results indicate that more intense distractors were associated with both increased interference and stronger distractor inhibition. The latter outcome provides novel support for the reactive inhibition hypothesis, which posits that inhibition reacts to the strength of distractor input, such that more salient distractors elicit stronger inhibition.

Distractor inhibition: principles of operation during selective attention.

Research suggests that although target amplification acts as the main determinant of the efficacy of selective attention, distractor inhibition contributes under some circumstances. Here we aimed to gain insight into the operating principles that regulate the use of distractor inhibition during selective attention. The results suggest that, in contrast to target amplification, distractor inhibition does not onset earlier or strengthen in response to advance location information. Instead, when the location of the impending distractor was predictable, evidence of inhibitory processing weakened. Furthermore, the results suggest that distractor inhibition does not operate as a compensatory mechanism for target amplification, as evidenced by the lack of an increase in inhibitory effects when reliance on target amplification was disrupted. Unexpected emergence of inhibitory effects for improbable targets provided evidence that distractor inhibition was at work even when no inhibitory effects manifested. Overall, the pattern of inhibitory effects is interpreted as indicating that, although distractor inhibition mounts primarily reactively rather than preemptively, advance information can help prevent overreaction to the distractor. Of course, less overreaction reduces the chances of behavioral inhibitory effects manifesting even when distractor inhibition has contributed to selective attention; thus, interpreting an absence of inhibitory effects should be done cautiously.

Distractibility with advancing age and Parkinson's disease.

Focused attention can be compromised by the neurodegenerative processes associated with both healthy aging and Parkinson's disease (PD). Deficits in ignoring distractors with reflexive or overlearned response links have been attributed to impaired inhibition. The current research assessed whether similar deficits occur for distractors with recently learned arbitrary response associations, for which sensorimotor transformations are far less automatic and therefore considerably easier to resist. We used a selective attention task that evaluated distractibility and the use of distractor inhibition within the same context. The task involved stimuli that were arbitrarily assigned to responses based on a rule learned during the testing session. Performance showed that distraction increased with both healthy aging and PD. Moreover, these increases in distraction were accompanied by decreases in overt evidence of distractor inhibition, which appear to reflect at least in part a failure of reactive inhibition. Comparison of the deficits in the two groups indicates that the key difference reflects severity, rather than distinct symptoms, suggesting that they stem from neural changes associated with both aging and PD. These results demonstrate that aging- and PD-related hyper-distractibility and impaired inhibition during focused attention affect stimuli without prepotent response links, which implicates dopaminergic networks in the strategic control of arbitrary visuomotor transformations.

Action planning in the presence of distracting stimuli: an investigation into the time course of distractor effects.

Humans have a remarkable capability to respond efficiently to a stimulus of interest despite other stimuli competing for neural resources. The current study investigated how the human system copes with distracting stimuli. During each trial, participants viewed 2 sequential stimuli that were each associated with a specific action based on an arbitrary mapping. The 1st stimulus served as a distractor, and the 2nd stimulus required a response (target). When the distractor preceded the target by more than a few hundred milliseconds, response latencies were slower when the 2 stimuli were associated with the same response. The authors propose that this negative compatibility effect stemmed from an inhibitory mechanism that the human system utilizes to prevent the distractor from eliciting an unwanted response.

The responses of lymphocytes from Asian and Caucasian diabetic patients and non-diabetics to hydrogen peroxide and sodium nitrite in the Comet assay.

Numerous factors may influence the incidence of diabetes in the population. The production of reactive oxygen species (ROS) is elevated in diabetes patients. Based on the reported involvement of reactive species and nitrate/nitrite in diabetes, this present study has examined in the alkaline Comet assay, the effect of different levels of NaNO(2) in the presence of the oxygen radical generating agent, hydrogen peroxide (H(2)O(2)). Peripheral lymphocytes from diabetic and non-diabetic Caucasians and Asians of both sexes were studied in vitro. Endogenous factors (e.g., sex, age, body mass index-BMI) and exogenous factors (lifestyle factors e.g., smoking and drinking habits, diet) were taken into account. A preliminary study in two individuals showed that DNA damage remained constant over a wide dose range of NaNO(2) (1-75mM), but when H(2)O(2) was added at a constant concentration of 50microM per dose of NaNO(2), there was an increase in DNA damage corresponding with the varying levels of NaNO(2) investigated. This was also seen with the 44 individuals (non-diabetic, n=24; type 1 diabetic, n=11; type 2 diabetic, n=9) investigated. NaNO(2) was capable of inducing a significant level of DNA damage in lymphocytes (p<0.001), but only with the addition of H(2)O(2). When levels of DNA damage were analysed in terms of the different variables there were few significant differences in damage between diabetic and non-diabetic subjects, or other sub-population groups, and no statistically significant differences in susceptibility were observed between subject covariates using regression techniques.