IntroductionA potential independent association was recently demonstrated between high red blood cell distribution width (RDW) and the risk of all-cause mortality in critically ill patients, although the mechanism underlying this relationship remains unclear. Little is known about the impact changes in RDW may have on survival in critically ill patients. Therefore, we investigated the prognostic significance of changes in RDW during hospital stay in patients with severe sepsis or septic shock.MethodsWe prospectively enrolled 329 patients who were admitted to the emergency department (ED) and received a standardized resuscitation algorithm (early-goal directed therapy) for severe sepsis or septic shock. The relationship between the changes in RDW during the first 72 hours after ED admission and all-cause mortality (28-day and 90-day) were analyzed by categorizing the patients into four groups according to baseline RDW value and ΔRDW72hr-adm (RDW at 72 hours – RDW at baseline).ResultsThe 28-day and 90-day mortality rates were 10% and 14.6%, respectively. Patients with increased RDW at baseline and ΔRDW72hr-adm >0.2% exhibited the highest risks of 28-day and 90-day mortality, whereas the patients with normal RDW level at baseline and ΔRDW72hr-adm ≤0.2% (the reference group) had the lowest mortality risks. For 90-day mortality, a significantly higher mortality risk was observed in the patients whose RDW increased within 72 hours of ED admission (normal RDW at baseline and ΔRDW72hr-adm >0.2%), compared to the reference group. These associations remained unaltered even after adjusting for age, sex, Sequential Organ Failure Assessment (SOFA) score, Charlson Comorbidity Index, renal replacement therapy, albumin, hemoglobin, lactate, C-reactive protein and infection sites in multivariable models.ConclusionsWe found that an increase in RDW from baseline during the first 72 hours after hospitalization is significantly associated with adverse clinical outcomes. Therefore, a combination of baseline RDW value and an increase in RDW can be a promising independent prognostic marker in patients with severe sepsis or septic shock.

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IntroductionMean platelet volume (MPV) is suggested as an index of inflammation, disease activity, and anti-inflammatory treatment efficacy in chronic inflammatory disorders; however, the effect of MPV on sepsis mortality remains unclear. Therefore, we investigated whether the change in MPV between hospital admission and 72 hours (ΔMPV72h-adm) predicts 28-day mortality in severe sepsis and/or septic shock.MethodsWe prospectively enrolled 345 patients admitted to the emergency department (ED) who received standardized resuscitation (early goal-directed therapy) for severe sepsis and/or septic shock between November 2007 and December 2011. Changes in platelet indices, including ΔMPV72h-adm, were compared between survivors and non-survivors by linear mixed model analysis. The prognostic value of ΔMPV72h-adm for 28-day mortality was ascertained by Cox proportional hazards model analysis.ResultsThirty-five (10.1%) patients died within 28 days after ED admission. MPV increased significantly during the first 72 hours in non-survivors (P = 0.001) and survivors (P < 0.001); however, the rate of MPV increase was significantly higher in non-survivors (P = 0.003). Nonetheless, the difference in the platelet decline rate over the first 72 hours did not differ significantly between groups (P = 0.360). In multivariate analysis, ΔMPV72h-adm was an independent predictor of 28-day mortality, after adjusting for plausible confounders (hazard ratio, 1.44; 95% confidence interval, 1.01–2.06; P = 0.044).ConclusionsAn increase in MPV during the first 72 hours of hospitalization is an independent risk factor for adverse clinical outcomes. Therefore, continuous monitoring of MPV may be useful to stratify mortality risk in patients with severe sepsis and/or septic shock.

The surface of a fused silica and oxidized silicon wafer (SiO2/Si(100)) was treated with (3-aminopropyl)triethoxysilane (1), (3-aminopropyl)diethoxymethylsilane (2), and (3-aminopropyl)ethoxydimethylsilane (3) for 72 h in solution. Thickness of the aminosilylated film out of 1 increases rapidly, and it turns out to be around 100 Å in 72 h. Rather slow increase of the thickness is observed for 2, which produces the layers of 8 and 14 Å in 10 and 72 h, respectively. The reagent 3 produces the monolayers of constant thickness 7−8 Å during the whole span of the reaction. The aminosilane layer was allowed to react with 4-nitrobenzaldehyde to form an imine, and absorbance (A surf) of the imine was recorded by UV−vis spectroscopy. The imine was hydrolyzed in a known volume of water to produce 4-nitrobenzaldehyde, and subsequently its absorbance was measured. Thus observed number of the aldehyde molecules is equivalent to the number of the imine molecules on the surface. With the known surface area of the substrates, the absolute surface density of the imine, that is, the reactive amine group on the surface, was calculated. At an early stage of the aminosilylation with 2, a surface density of 3.9 amine groups per 100 Å2 was measured. A relatively low value was observed for 3. It is also observed that 1 produces a multilayer with rough surface morphology, of which surface density increases sharply by the reaction time. Tilt angle of the imine was estimated from the A surf and the absolute surface density. The angles vary among 23−47° depending on the reaction condition. Second harmonic generation of a laser light of 1064 nm was observed for the imine-formed substrates. X-ray photoelectron spectroscopy utilizing a synchrotron radiation source, in particular for the N(1s) binding energy region, confirmed the chemical transformation. Also, it is observed that the nitro group of the imine is cleaved by X-rays.

Background: Subclinical hypothyroidism (SCH) is not a rare condition in females, the elderly, or patients with chronic kidney disease (CKD). Even though previous studies have demonstrated that thyroid hormone replacement therapy (THRT) improves cardiac function and dyslipidemia in patients with SCH, it remains unclear as to whether THRT can improve renal function in CKD patients with SCH. This study investigated the impact of THRT on changes in estimated glomerular filtration rates (eGFR) in this patient population. Methods: A total of 113 CKD patients with SCH who were treated with L-thyroxine and had eGFR available for at least 24 months before and after THRT were enrolled between January 2005 and December 2011. A linear mixed model was used to compare patients' clinical and biochemical parameters at various time points. The slope of the decline in eGFR over time, both before and after THRT, was also calculated and compared using a linear mixed model. Results: The mean age of the study participants was 63.2 -12.7 years, and 36 patients (31.9%) were men. The mean follow-up duration before and after THRT was 28.6 -4.5 and 30.6 -6.4 months respectively. After 24 months of THRT, serum thyrotropin (TSH) levels were significantly reduced-8.86 -0.49 versus 1.41 -0.73 lIU/ mL, p < 0.001-but there were no significant changes in triiodothyronine and free thyroxine concentrations. Serum albumin, calcium, phosphate, cholesterol, and triglyceride levels were also comparable before and after THRT. The rates of decline in eGFR were significantly attenuated by THRT (-4.31 -0.51 vs. -1.08 -0.36 [mL/ min]/[year$1.73 m 2 ], p < 0.001), even after adjustment for age, sex, diabetes, mean arterial pressure, and serum albumin, cholesterol, and triglyceride concentrations ( p < 0.001). Conclusion: THRT attenuated the rate of decline in renal function in CKD patients with SCH, suggesting that THRT may delay reaching end-stage renal disease in these patients.

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Background: Interdialytic weight gain (IDWG) has been regarded as a surrogate of volume overload, but also as a marker of a better nutritional status in end-stage renal disease (ESRD) patients on hemodialysis (HD). This paradoxical meaning of IDWG requires further investigation, particularly in adverse cardiovascular outcomes. Methods: A prospective cohort of 1,013 incident HD patients from 36 HD centers of the Clinical Research Center for ESRD in Korea was included. Patients were categorized into five groups according to the IDWG%, a ratio of absolute IDWG to dry weight: <1.0, ≥4.0, and every 1.0 increment in between. Primary outcome was major adverse cardiac and cerebrovascular events (MACCE). Results: During a mean follow-up of 18.7 months, primary outcome was observed in 104 patients (10.3%). In multivariate analysis, compared to patients with IDWG% of 1.0-1.9 (reference group), the hazard ratios (HRs) for primary outcome in the IDWG% <1.0, 2.0-2.9, 3.0-3.9, and ≥4.0 groups were 1.10 [95% confidence interval (CI) 0.55-2.20, p = 0.80], 1.15 (95% CI 0.59-2.27, p = 0.68), 1.80 (95% CI 0.95-3.41, p = 0.07), and 1.93 (95% CI 1.02-3.64, p = 0.04), respectively. Furthermore, even when residual renal function and 24-hour urine volume were adjusted, IDWG% ≥4.0 remained as a significant predictor of primary outcome (HR 2.03, 95% CI 1.02-4.02, p = 0.04). Conclusion: Increased IDWG% is a significant independent predictor of MACCE in incident HD patients. It could be helpful to prevent excessive IDWG for improving clinical outcomes in incident HD patients.

Recently, there has been emerging concern that crescents, the main histologic feature of Henoch-Schö nlein purpura nephritis, merely reflect active inflammation, and may not be useful in predicting long-term outcomes. We therefore conducted a single-center retrospective study to evaluate whether the new Oxford classification of immunoglobulin A nephropathy can be used to predict long-term outcome in patients with Henoch-Schö nlein purpura nephritis. We included 61 biopsy-proven patients with Henoch-Schö nlein purpura nephritis between January 1991 and August 2010. In addition to the International Study of Kidney Disease in Children classification, pathologic findings were also evaluated by the Oxford classification. Primary outcomes were defined as either the onset of estimated glomerular filtration rate o60 ml/min per 1.73 m 2 with Z30% decrease in estimated glomerular filtration rate from baseline or end-stage renal disease. During a median follow-up of 49.3 months, 13 (21%) patients reached the primary end point. A Kaplan-Meier plot showed that renal event-free survival was significantly longer in patients with o50% crescents than in those with crescents in Z50% of glomeruli (P ¼ 0.003). Among the components of the Oxford classification, patients with endocapillary hypercellularity (E1; P ¼ 0.016) and tubular atrophy/interstitial fibrosis (T1/T2; P ¼ 0.018) had lower renal survival rates than those with E0 and T0. In a multivariate Cox model adjusted for clinical and pathologic factors, E1 (hazard ratio ¼ 8.91; 95% confidence interval ¼ 1.47-53.88; P ¼ 0.017) and T1/T2 (hazard ratio ¼ 8.74; 95% confidence interval ¼ 1.40-54.38; P ¼ 0.020) were independently associated with reaching a primary outcome, whereas the extent of crescentic lesions was not. Our findings suggest that the Oxford classification can be used in predicting long-term outcomes of Henoch-Schö nlein purpura nephritis.