Impact of an Electronic Alert in Combination with a Care Bundle on the Outcomes of Acute Kidney Injury.

Early diagnosis is essential for the appropriate management of acute kidney injury (AKI). We evaluated the impact of an electronic AKI alert together with a care bundle on the progression and mortality of AKI. This was a single-center prospective study that included AKI patients aged ≥ 18 years, whereas those in palliative care, nephrology, and transplantation departments were excluded. An AKI alert was issued in electronic medical records and a care bundle was suggested. A series of classes were administered to the multidisciplinary teams by nephrologists, and a clinical pharmacist audited prescriptions. Patients were categorized into pre-alert and post-alert groups. The baseline characteristics were comparable between the pre-alert (n = 1613) and post-alert (n = 1561) groups. The 30-day mortality rate was 33.6% in the entire cohort and was lower in the post-alert group (30.5% vs. 36.7%; p < 0.001). Age, pulmonary disease, malignancy, and ICU admission were associated with an increase in 30-day mortality. The electronic AKI alert together with a care bundle and a multidisciplinary education program was associated with a reduction in 30-day mortality in patients with AKI.

Constraint-Induced Movement Therapy Combined with Transcranial Direct Current Stimulation over Premotor Cortex Improves Motor Function in Severe Stroke: A Pilot Randomized Controlled Trial.

Objective. We compared the effects of transcranial direct current stimulation at different cortical sites (premotor and motor primary cortex) combined with constraint-induced movement therapy for treatment of stroke patients. Design. Sixty patients were randomly distributed into 3 groups: Group A, anodal stimulation on premotor cortex and constraint-induced movement therapy; Group B, anodal stimulation on primary motor cortex and constraint-induced movement therapy; Group C, sham stimulation and constraint-induced movement therapy. Evaluations involved analysis of functional independence, motor recovery, spasticity, gross motor function, and muscle strength. Results. A significant improvement in primary outcome (functional independence) after treatment in the premotor group followed by primary motor group and sham group was observed. The same pattern of improvement was highlighted among all secondary outcome measures regarding the superior performance of the premotor group over primary motor and sham groups. Conclusions. Premotor cortex can contribute to motor function in patients with severe functional disabilities in early stages of stroke. This study was registered in ClinicalTrials.gov database (NCT 02628561).

Singular optical lattice generation using light beams with orbital angular momentum.

In this Letter we numerically and experimentally demonstrated that a lattice with an optical vortex distributed over the entire lattice can be generated in the Fourier space using three higher-order Laguerre-Gauss beams placed at the vertices of an equilateral triangle in real space. In this scheme the optical vortice's lattice presents a topological defect in its central region. Probing the net topological charge of the whole lattice, we found that it corresponds to the topological charge associated with the orbital angular momentum of each beam in real space.

Extended hemodialysis in acute kidney injury.

About 10% of patients in the intensive care unit which develop acute renal failure will depend on renal replacement therapy. Although there are no data showing reduction in mortality when compared with intermittent therapy, continuous therapies provide higher cumulative doses of dialysis and greater hemodynamic stability. However, have high costs and are not available in many centers. In this context the Extended Hemodialysis gaining ground in clinical practice because it combines the hemodynamic tolerability, slow and sustained solute control and effective doses of continuous dialysis therapies associated with reduced costs and logistics facilities of intermittent therapy.

Measurement of Gaussian laser beam radius using the knife-edge technique: improvement on data analysis.

We revisited the well known Khosrofian and Garetz inversion algorithm [Appl. Opt.22, 3406-3410 (1983)] that was developed to analyze data obtained by the application of the traveling knife-edge technique. We have analyzed the approximated fitting function that was used for adjusting their experimental data and have found that it is not optimized to work with a full range of the experimentally-measured data. We have numerically calculated a new set of coefficients, which makes the approximated function suitable for a full experimental range, considerably improving the accuracy of the measurement of a radius of a focused Gaussian laser beam.