The VPT combination was associated with both an increased AKI risk and a more rapid onset of AKI compared to the VC combination.

Background Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0•9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0•9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.

No abstract

Fish waste water nutrient recycling in an aquaponic system was studied under different stocking densities of Koi Carp, Cyprinus carpio var. koi, along with spinach, Beta vulgaris var. bengalensis. Fish growth performance, plant growth, nutrient dynamics, and nutrient removal and their dependence on different stocking densities, namely 1.4, 2.1, and 2.8, were observed, of the different combinations, fish stocked at 1.4 kg/m3 had the best growth. Percent nutrient removal (NO3–N, PO4–P, and K) was significantly higher at 1.4 kg/m3. Thus, 1.4 kg/m3 stocking density can be suggested as optimum for Koi Carp production in spinach aquaponic systems.

Donkeys have been serving mankind for 5000 years [1]. The phrase 'beasts of burden' describes their utility as pack animals and [2] in many parts of the world they play a significant economic and social role in the transport of water, building materials, relief supplies, animal feed and other critical supplies [2,3]. Donkey cart ambulances are an increasing trend in Africa where they are used for transporting sick people to hospital. Donkeys are particularly suited to this role because they are easy to keep and do not show fatigue [2,4]. It is estimated that there are about 90 million donkeys worldwide and they are especially widespread in Central and South American and parts of Europe. China has the largest population with about 11 million donkeys [5]. In recent years, donkey-related research is increasing with the goal of using this species to further improve human health and provide greater societal benefit.

Experiment with varied water circulation periods having 4, 8, 12, and 24 hrs/day as T1, T2, T3 and T4, respectively in aquaponics, evaluated against a control (without aquaponics) revealed higher fish and plant growth in T3 and T4. The mean growth of fish varied significantly among treatments showing higher growth in T4 and control followed by T3, T2 and T1. Survival rate was 100% in all the treatments as well as control. Percentage weight gain, SGR (% day -1 ) also showed the similar trend as that of growth showing T4 as better treatment immediately followed by T3 then T2 and T1. The system maintained favourable water quality throughout the experiment. The growth in T3 and T4 did not vary significantly and was higher than the T1, T2 and control. Also percentage length gain at the end of the trial was maximum in T3 and T4. The Chl (a+b) content in the control was higher than all the treatments whereas, T4 showed the maximum concentration among treatments followed by T3, T2 and then T1. Comparison of all the growth attributes and water quality parameters indicated that water circulation can be reduced to 12 hrs/day for economically effective aquaponics and can be considered as optimum water circulation period for goldfish production in aquaponic system.

No abstract

Whether aldosterone itself contributes directly to macro‐ or microcirculatory disease in man or to adverse cardiovascular outcomes is not fully known. We report our long‐term single‐practice experience in 5 patients with chronic hyperaldosteronism (HA, including 3 with glucocorticoid remediable aldosteronism, GRA) treated with low‐dose amiloride (a specific epithelial sodium channel [ENaC] blocker) 5‐10 (mean 7) mg daily for 14‐28 (mean 20) years. Except for 1 GRA diagnosed in infancy, all had severe resistant hypertension. In each case, BP was normal or near‐normal within 1‐4 weeks after starting amiloride and office BP’s were well controlled for 20 years thereafter. Vascular studies and 24‐hour ambulatory BP monitoring with pulse wave analysis (cardiac output, vascular resistance, augmentation index, and reflection magnitude) were assessed after a mean of 18 years as were regional pulse wave velocities, pulse stiffening ratio, ankle‐brachial index, serum creatinine, estimated glomerular filtration rate, and spot urinary albumin:creatinine ratio. All indicators were completely normal in all patients after 18 years of amiloride, and none had a cardiovascular event during the 20‐year mean follow‐up. We conclude that long‐term ENaC blockade can normalize BP and protect macro‐ and microvascular function in patients with HA. This suggests that (a) any vasculopathic effects of aldosterone are mediated via ENaC, not MR activation itself, and are fully preventable or reversible with ENaC blockade or (b) aldosterone may not play a major BP‐independent role in human macro‐ and microcirculatory diseases. These and other widely divergent results in the literature underscore the need for additional studies regarding aldosterone, ENaC, and vascular disease.