Urine Microscopy Is Associated with Severity and Worsening of Acute Kidney Injury in Hospitalized Patients

Background and objectives: Serum creatinine concentration at the time of nephrology consultation is not necessarily indicative of the severity of acute kidney injury (AKI). Although urine microscopy is useful to differentiate AKI, its role in predicting adverse clinical outcomes has not been well described.Design, setting, participants, & measurements: The relationship between urine microscopy findings at the time of nephrology consultation for AKI and clinical outcomes was evaluated prospectively. A urinary sediment scoring system was created on the basis of the number of renal tubular epithelial cells and granular casts. The primary outcome was worsening of AKI (progressing to higher AKI Network stage, dialysis, or death) during hospitalization.Results: Of 249 patients consulted for AKI, 197 had acute tubular necrosis or prerenal AKI and were included in the analysis. At consultation, 80 (40%) had stage 1, 53 (27%) had stage 2, and 66 (33%) had stage 3 AKI. The urinary sediment combined scores were lowest in those with stage 1 and highest in stage 3 AKI. Seventy-nine patients (40%) experienced worsening of AKI from the time of consultation. The urinary scoring system was significantly associated with increased risk of worsening AKI (adjusted relative risk: 7.3; 95% confidence interval: 4.5 to 9.7 for worsening with score of ≥3 versus score of 0) and was more predictive than AKI Network stage at the time of consultation.Conclusions: The urinary sediment score may be a useful tool to predict worsening of AKI due to either acute tubular necrosis or prerenal AKI during hospitalization.Currently, diagnosis of acute kidney injury (AKI) is based on serum creatinine concentration and urine output. The Acute Kidney Injury Network (AKIN) definition is based on these two parameters and uses various cutoffs to define three distinct AKI stages (1). Urine microscopy and biochemistry are complementary to these diagnostic parameters and provide information that facilitates the differentiation of AKI into traditional categories, including prerenal AKI and acute tubular necrosis (ATN), the most common causes of hospital-acquired AKI (2–4). Urinary microscopy in patients with ATN classically is described as containing renal tubular epithelial (RTE) cells, RTE cell casts, granular casts, or mixed cellular casts, whereas sediment in patients with prerenal AKI usually is bland or contains occasional hyaline casts (5–9). In fact, we recently demonstrated that urine microscopy at the time of nephrology consultation, on the basis of the number of RTE cells and granular casts (10). We believe this is important because both prognosis and therapies for prerenal AKI and ATN differ substantially, making early clinical differentiation fundamental to AKI management.

Table 1.

Scoring system based on number of granular casts and RTE cells

Early detection of illicit drug use in teenagers

The illicit use of drugs, including alcohol, by teenagers has been extensively studied and documented. It is not uncommon for teenagers to be involved in illicit drug use before exhibiting signs and symptoms of drug use. Unsuspecting parents may be unaware of drug use in their children. The authors' objective in this article is to review the literature on illicit drug use in teenagers and highlight the risk factors for teen involvement. The authors also review the warning signs that a teen is using illicit drugs. The aim of this article is to assist parents and healthcare workers involved in substance use intervention programs to be more aware of these risk factors and warning signs in order to adopt early screening and intervention measures.     

Neuregulin-1 and the P300 waveform--a preliminary association study using a psychosis endophenotype

OBJECTIVE: Neuregulin-1 (NRG1) has been put forward as a susceptibility gene for schizophrenia. We investigated the association between Neuregulin-1 and the P300 wave, a schizophrenia endophenotype. METHODS: Participants were 64 patients with DSM-IV schizophrenia or schizoaffective disorder, 97 of their non psychotic relatives and 35 unrelated controls. The P300 wave was extracted from the electroencephalogram whilst the subjects conducted a two-tone discrimination task. The effect of three markers from the core NRG-1 at-risk haplotype including single nucleotide polymorphism SNP8NRG221533 and two microsatellites (478B14-848 and 420M9-1395) on P300 amplitude and latency was examined using multilevel modelling. RESULTS: Neuregulin-1 SNP8NRG221533 had a significant influence on P300 latency and the higher the number of C alleles carried, the greater the latency delay [Coef.=32.4 ms; 95%CI: 13.2 to 51.6 ms; p=0.001]. There was no association between latency and NRG1 microsatellites or between amplitude and any of the three markers examined. CONCLUSIONS: The P300 latency reflects the speed of neural transmission. We hypothesise that variation in NRG1 may convey risk for schizophrenia by disrupting neural connectivity, possibly white matter integrity, and leading to a slower speed of cognitive processing. This is a preliminary finding in a small sample and requires replication.     

Non-Thermal Plasma Reduction of Ag+ Ions into Silver Nanoparticles in Open Atmosphere under Statistically Optimized Conditions for Biological and Photocatalytic Applications

An environmentally friendly non-thermal DC plasma reduction route was adopted to reduce Ag⁺ ions at the plasma–liquid interface into silver nanoparticles (AgNPs) under statistically optimized conditions for biological and photocatalytic applications. The efficiency and reactivity of AgNPs were improved by statistically optimizing the reaction parameters with a Box–Behnken Design (BBD). The size of the AgNPs was chosen as a statistical response parameter, while the concentration of the stabilizer, the concentration of the silver salt, and the plasma reaction time were chosen as independent factors. The optimized parameters for the plasma production of AgNPs were estimated using a response surface methodology and a significant model p < 0.05. The AgNPs, prepared under optimized conditions, were characterized and then tested for their antibacterial, antioxidant, and photocatalytic potentials. The optimal conditions for these three activities were 3 mM of stabilizing agent, 5 mM of AgNO₃, and 30 min of reaction time. Having particles size of 19 to 37 nm under optimized conditions, the AgNPs revealed a 82.3% degradation of methyl orange dye under UV light irradiation. The antibacterial response of the optimized AgNPs against S. aureus and E. coli strains revealed inhabitation zones of 15 mm and 12 mm, respectively, which demonstrate an antioxidant activity of 81.2%.     

Music and Sound-Based Intervention in Autism Spectrum Disorder: A Scoping Review

To map the evidence from the relevant studies regarding the use of music and sound-based intervention for autism spectrum disorder (ASD) using a scoping review study design. Scoping review was conducted according to the inclusion criteria using Google Scholar, PubMed, CINAHL, MEDLINE, and Scopus. The review was accomplished in five steps: 1) identify the inclusion criteria, 2) search for relevant studies, 3) studies selection, 4) data extraction and charting, and 5) data analysis and presentation. Four major themes emerged from 39 studies that matched the inclusion criteria as follows: 1) forms of sound therapy discussing methods of sound therapy and stimulus used, 2) duration of the intervention explain in terms of listening time and total listening sessions, 3) clinical characteristics of the intervention exploring the main interest of sound therapy study in ASD, and 4) evidence for the intervention effectiveness looking into the positive, negative, and mixed findings of previous studies. Each theme was explored to identify the knowledge gaps in sound-intervention therapy. This review demonstrated the need for further studies to address several issues including identifying the effectiveness of sound-therapy intervention for ASD according to the individual sound types, the minimum duration for ASD sound-therapy intervention and more details on the use of technology, and clinical features of the sound-therapy intervention. These elements are important to further demonstrate the effectiveness of sound therapy intervention for ASD children.     

Cardiovascular risk factors in secondary progressive multiple sclerosis: A cross-sectional analysis from the MS-STAT2 randomized controlled trial

Background and purpose

There is increasing evidence that cardiovascular risk (CVR) contributes to disability progression in multiple sclerosis (MS). CVR is particularly prevalent in secondary progressive MS (SPMS) and can be quantified through validated composite CVR scores. The aim was to examine the cross-sectional relationships between excess modifiable CVR, whole and regional brain atrophy on magnetic resonance imaging, and disability in patients with SPMS.

Methods

Participants had SPMS, and data were collected at enrolment into the MS-STAT2 trial. Composite CVR scores were calculated using the QRISK3 software. Prematurely achieved CVR due to modifiable risk factors was expressed as QRISK3 premature CVR, derived through reference to the normative QRISK3 dataset and expressed in years. Associations were determined with multiple linear regressions.

Results

For the 218 participants, mean age was 54 years and median Expanded Disability Status Scale was 6.0. Each additional year of prematurely achieved CVR was associated with a 2.7 mL (beta coefficient; 95% confidence interval 0.8–4.7; p = 0.006) smaller normalized whole brain volume. The strongest relationship was seen for the cortical grey matter (beta coefficient 1.6 mL per year; 95% confidence interval 0.5–2.7; p = 0.003), and associations were also found with poorer verbal working memory performance. Body mass index demonstrated the strongest relationships with normalized brain volumes, whilst serum lipid ratios demonstrated strong relationships with verbal and visuospatial working memory performance.

Conclusions

Prematurely achieved CVR is associated with lower normalized brain volumes in SPMS. Future longitudinal analyses of this clinical trial dataset will be important to determine whether CVR predicts future disease worsening.     

Accelerated Diffusion-Weighted MR Image Reconstruction Using Deep Neural Networks

Journal of Digital Imaging - Under-sampling in diffusion-weighted imaging (DWI) decreases the scan time that helps to reduce off-resonance effects, geometric distortions, and susceptibility...