Abstract Background Growing evidence highlights that poor oral health may increase the risk of cognitive decline. However, the association of oral frailty and its dimensions with cognitive function remains under-explored. This study aimed to evaluate the association of oral frailty and its dimensions with cognitive impairment among older adults in China. Methods This cross-sectional study used convenience sampling to recruit older adults aged ≥ 60 years who received routine oral examinations at the West China Hospital of Stomatology, Sichuan University, from June 2022 to March 2024. Cognitive function was assessed with the Montreal Cognitive Assessment Scale (MoCA), and the oral frailty status was evaluated using the Oral Frailty Index-8 (OFI-8) scale. Binary logistic regression was performed to analyze the independent association between oral frailty and cognitive impairment, with adjustment for potential confounding variables. Results A total of 407 older adults were included, revealing a prevalence rate of 42.0% for cognitive impairment. In the fully adjusted binary logistic regression model, oral frailty was associated with an increased risk of cognitive impairment (OR = 1.89, 95%CI: 1.43–2.50). As to the specific dimensions, chewing difficulty (OR = 2.98, 95%CI: 1.86–4.78), low social participation (OR = 4.69, 95%CI: 1.14–19.23), the number of remaining teeth (OR = 0.91, 95%CI: 0.88–0.95), and the GOHAI score (OR = 0.95, 95%CI: 0.92–0.98) were found independent association with cognitive impairment (p < 0.05). Conclusion Oral frailty is closely associated with cognitive impairment in older adults. Further longitudinal research is required to investigate the underlying mechanisms.

Hemodialysis catheter dysfunction remains a major challenge in end-stage renal disease because thrombogenesis and elevated recirculation can reduce access performance. Catheter tip location in the superior vena cava (SVC), cavoatrial junction (CAJ), or right atrium (RA) affects local hemodynamics, but the optimal position remains uncertain in physiologically realistic models. In this study, a high-fidelity right atrial computational fluid dynamics model was developed to evaluate stepped-tip catheters at three placement locations and five arteriovenous (A/V) offsets (20-30 mm). Recirculation ratio was quantified using particle tracking, and thrombosis-related hemodynamic descriptors, including time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), blood stasis volume, and platelet activation state (PAS), were assessed. Recirculation varied with A/V offset and increased with decreasing dialysis flow rate, rising from 13.11% at 20 mm to 14.21% at 30 mm and from 12.81% at 400 mL/min to 13.04% at 300 mL/min. SVC placement produced the lowest recirculation ratio (10.96%), whereas RA placement produced the highest (13.53%). However, CAJ placement showed the most balanced hemodynamic profile, with near-physiological TAWSS, the lowest high-OSI burden among catheterized cases, and intermediate RRT. These results suggest that catheter tip position should be evaluated by balancing dialysis efficiency against thrombosis-related flow disturbance rather than by minimizing recirculation alone. Within the present model, CAJ provided the most favorable overall compromise.

Background The platelet-to-lymphocyte ratio (PLR), a readily available marker that integrates systemic inflammatory burden and immune competence, has emerged as a cost-effective prognostic biomarker in critical care medicine. Elevated PLR has been linked to adverse outcomes across a spectrum of critical illnesses, yet its utility in predicting prognosis among patients with septic acute kidney injury (AKI) remains undefined. Moreover, little is known about how in-hospital trajectories of PLR influence survival outcomes. Method This retrospective study employed data from the Medical Information Mart for Intensive Care IV and West China Hospital of Sichuan University. The primary endpoints were 28-day and 90-day all-cause mortality. The association between baseline PLR/changes in PLR (ΔPLR) and 28-day and 90-day mortality was investigated by survival analysis and Cox proportional hazards models. ΔPLR was calculated as PLR at discharge minus PLR at admission. Patients were stratified based on optimal PLR cut-off values determined from the training cohort, and results were validated internally and externally. Predefined subgroup analyses probed for effect modification across key clinical populations, and mediation analysis was conducted to quantify intermediate variables linking PLR/ΔPLR dynamics to patient outcomes. Result A total of 1,478 patients were included in the baseline-PLR cohort and 982 in the ΔPLR cohort. In the training set, an elevated baseline PLR (≥335.44) was associated with significantly higher 28-day mortality (26.56% vs. 18.66%, P = 0.009) and 90-day mortality (46.48% vs. 35.61%, P = 0.003). These findings were confirmed in both the internal validation cohort and an external cohort, and remained robust after adjustment for demographic, clinical and laboratory confounders. Conversely, lower ΔPLR also predicted the 28-day (14.81% vs. 6.94%, P = 0.007; HR = 2.261, P = 0.005) and 90-day mortality (24.07% vs. 15.41%, P = 0.029; HR = 1.702, P = 0.017), as well as prolonged hospital stay (28.64 vs. 21.64 days, P = 0.004). The associations between PLR or ΔPLR and mortality remained robust after adjusting for confounding factors. Subgroup analyses indicated that the prognostic value of PLR was particularly pronounced in non-urinary tract infection patients, and a low baseline PLR conferred a significant survival benefit in male patients. Mediation analysis revealed that changes in white blood cell count (ΔWBC) mediated 27.99% of the association between ΔPLR and 28-day mortality. Conclusion Both baseline PLR and its dynamic change during hospitalization may serve as significant predictors of mortality in septic AKI. PLR-based indices could aid in risk stratification and early identification of high-risk patients.

ABSTRACT Hyperbilirubinemia, which stems from bilirubin accumulation caused by liver failure, can lead to jaundice, multi‐organ damage, and mortality. Hemoperfusion is the most effective detoxification approach, and its efficacy critically depends on the adsorbent system. However, most developed adsorbents exhibit poor hemocompatibility, posing risks of coagulation and bacterial infection. Herein, we report a facile and highly biocompatible strategy to fabricate bioactive superstructures for blood purification, enabling toxin removal. The formation of the bioactive superstructures is mediated by the assembly of polydopamine/Zn II networks on natural polymer templates, followed by surface modification with human serum albumin. The obtained superstructures enable rapid bilirubin clearance owing to the synergistic effects of metal coordination and polyphenol‐mediated noncovalent interactions (hydrogen bonding and hydrophobic and electrostatic interactions). Furthermore, these bioactive superstructures exhibit excellent antibacterial efficacy, achieving > 99.9% killing efficiency of both Escherichia coli and Staphylococcus aureus , while enhancing anticoagulant performance by 2.6‐fold (compared to the control) through inhibition of platelet adhesion/activation and modulation of the intrinsic coagulation pathway. This work expands our understanding of metal–phenolic‐mediated superstructure assembly. Furthermore, the efficient toxin removal, antibacterial protection, and anticoagulant activity of the developed bioactive superstructures are expected to underpin the rational design of blood‐contacting materials based on metal–phenolic complexation.

Introduction: The metabolic complications and poor biocompatibility of conventional glucose-based (GLU) peritoneal dialysis fluid (PDF) have driven the need for improved alternatives. To address this, we developed and evaluated a novel PDF utilizing succinylated gelatin (GEL) as osmotic agent and citrate as buffer, designed to provide effective solute clearance while offering enhanced biocompatibility. Methods: Physicochemical parameters (pH and osmolality) of the novel GEL-PDF were measured. Its performance was assessed in rats with chronic kidney disease. A total of 20 rats were randomized into short-term experiments to evaluate 4 h creatinine clearance and ultrafiltration (UF). A 12-week long-term experiment (n = 35) compared the GEL-PDF against normal saline (NS), GLU, and icodextrin-based (ICO) PDFs, monitoring survival, biochemical parameters, peritoneal membrane histology, and kidney histology. Results: The GEL-PDF demonstrated a neutral pH (7.30) and lower osmolality (317 mOsm/L) compared to GLU-PDF. In the short-term experiment, GEL-PDF achieved effective creatinine clearance by 4 h and provided higher 4 h UF than NS and GLU, comparable to ICO. However, during prolonged dwells (6-16 h), its UF was inferior to ICO. In the long-term experiment, GEL-PDF preserved peritoneal membrane structure, showing the least thickness and collagen deposition. Furthermore, the GEL-PDF demonstrated superior preservation of serum albumin compared to the GLU-PDF. It also exhibited a more favorable lipid profile, as evidenced by significantly lower total cholesterol levels than the ICO group at 12 weeks (p = 0.035), with no adverse effects on electrolytes, liver function, or glucose metabolism. Conclusions: The novel GEL and citrate-based PDF provide effective short-dwell UF and solute removal while exhibiting superior biocompatibility, as evidenced by significant protection against peritoneal membrane injury and favorable metabolic profiles. Although its long-duration UF was lower than that of ICO, it substantially outperformed GLU-PDF. These properties position the GEL-PDF as a promising candidate for short- to medium-dwell exchanges, particularly for daytime use, where it could fill an important clinical gap by providing enhanced UF without the high GLU exposure associated with conventional PDF.

ObjectiveGlucose-free dialysate may heighten the risk of hypoglycemia, which is associated with seizures, stroke, and increased mortality. Incorporating an appropriate amount of glucose into the dialysate potentially helps to reduce the incidence of hypoglycemia. However, the efficacy and safety of glucose-containing dialysates during hemodialysis (HD) remain contentious.MethodsPubMed, Embase, Web of Science, Scopus, the Cochrane database, the China National Knowledge Infrastructure, and WanFang Database were searched from inception to 30 June 2025. All comparative studies involving glucose-containing and glucose-free dialysates for diabetic and nondiabetic end-stage kidney disease (ESKD) patients with HD were included. The risk of bias was assessed using the RoB 2.0 tool for randomized trials, ROBINS-I for nonrandomized interventional studies, and the Newcastle-Ottawa Scale (NOS) for observational studies. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled. The quality of evidence was evaluated using the GRADE approach.ResultsThirty-nine studies from 41 articles with 2043 HD patients were included in this study. Both randomized and nonrandomized studies demonstrated that low glucose-containing dialysate significantly reduced the proportion of participants with hypoglycemia compared to glucose-free dialysate (randomized studies: OR 0.18, 95% CI 0.09-0.33, high certainty; nonrandomized studies: OR 0.15, 95% CI 0.06-0.35). Similarly, the proportion of hypoglycemic events was also lower with low glucose-containing dialysate (randomized studies: OR 0.14, 95% CI 0.05-0.38, high certainty; nonrandomized studies: OR 0.14, 95% CI 0.07-0.31). High glucose-containing dialysate further reduced hypoglycemia incidence compared to both glucose-free (OR 0.03, 95% CI 0.00-0.19, high certainty) and low-glucose dialysates (OR 0.43, 95% CI 0.19-0.97, moderate certainty). Subgroup analyses of diabetic and nondiabetic patients and network meta-analysis (NMA) yielded consistent results. Although the overall statistical analysis did not reveal significant differences for both blood pressure parameters, patients receiving low glucose-containing dialysate may exhibit higher post-HD SBP (randomized studies: MD 0.71, 95% CI -0.22 to 1.64, low certainty) and DBP (randomized studies: MD 1.18, 95% CI 0.15 to 2.20, low certainty) compared to those using glucose-free dialysate. Additionally, low glucose-containing dialysate was associated with a lower incidence of intradialytic hypotension (IDH) than glucose-free dialysate. However, insufficient data were available for meta-analysis on the effects of glucose-containing dialysates on heart rate variability (HRV), fatigue severity, erythrocytes, and oxidative stress.ConclusionGlucose-containing dialysates showed advantages in preventing hypoglycemia and maintaining stable blood pressure during HD. Further studies are warranted to investigate the influence on HRV, fatigue severity, and oxidative stress.Systematic review registrationPROSPERO (CRD42024559339). Date of registration: 25 June 2025

This case describes an 82-year-old male patient presenting with persistent upper abdominal colic, diagnosed as severe acute pancreatitis. The patient then suffered a cytokine storm, as well as renal dysfunction. Therefore, the patient underwent two sessions of coupled plasma filtration adsorption (CPFA) therapy utilising the CA330 cytokine adsorption cartridge as the adsorbent. The first CPFA session lasted 8 h, followed by a 4-h interval (during which continuous veno-venous haemodialysis therapy was provided), and the second 8-h CPFA session started. Due to family requests and comprehensive consideration by the medical team, the second CPFA session was extended to 20 h. Ultimately, the patient was weaned off blood purification therapy (43 h after its initiation). The study demonstrated a significant reduction in cytokine levels as the course of treatment increased. However, beyond a specific threshold, cytokine adsorption may reach saturation. The medicinal applications of CPFA (particularly CA330) deserve more investigation.

A 48-year-old male patient was diagnosed with critical acute pancreatitis, renal dysfunction and liver dysfunction. Because of the presence of multiorgan dysfunction, continuous renal replacement therapy (CRRT) was required on the first day of the patient's admission to the ICU in order to help stabilize the patient's internal environment. Meanwhile, the patient also received a total of five double plasma molecular adsorption system plus sequential half-dose plasmapheresis (DPMAS-PE) treatments, of which the first, fourth, and fifth DPMAS-PE treatments were chosen to be administered concurrently with CRRT. This report is to clarify how four CRRT machines using three parallel modalities successfully completed DPMAS-PE in tandem with CRRT (DPMAS-PE-CRRT). Furthermore, DPMAS-PE-CRRT showed similar effectiveness in removing total bilirubin and total bile acid when compared to nonparallel CRRT. During the parallel therapy, there were no serious adverse reactions. To validate this case, more clinical trials are needed.

BACKGROUND:Catheter-related bloodstream infections (CRBSIs) are a major cause of complications in critically ill patients receiving continuous renal replacement therapy (CRRT), especially those with nontunneled catheters. These infections can lead to longer hospital stays, higher costs, and worse patient outcomes. Although sterile dressings are commonly used to prevent CRBSIs, antimicrobial dressings, such as those containing chlorhexidine, may offer better protection. This study aimed to compare the effectiveness of antimicrobial glucose chlorhexidine dressings and sterile dressings in preventing CRBSIs in patients receiving CRRT. METHODS:A prospective, randomized controlled, single-blind study was conducted. All participants were kept blinded to group assignment. We enrolled patients admitted to the Intensive Care Unit (ICU) of West China Hospital, Sichuan University between September 2022 and November 2023 who were scheduled for vascular catheter placement before receiving continuous renal replacement therapy (CRRT). The participants were randomly allocated to either the intervention group (receiving glucose chlorhexidine antimicrobial dressing) or the control group (receiving sterile dressing) via a random number table. The dressing was changed every 7 days for the glucose chlorhexidine antimicrobial group and every 48 h for the sterile dressing group, in accordance with the guideline. Dressings were replaced immediately if they became rolled, loose, or visibly soiled. The primary outcomes were the local infection rate at the catheter insertion site, suspected catheter-related bloodstream infections (CRBSIs), incidence of CRBSIs, length of hospital stay, ICU stay duration, and hospital mortality rates. RESULTS:A total of 520 patients were screened, and 410 patients were ultimately included in the study, with 205 patients in each group (glucose chlorhexidine antimicrobial dressing group and sterile dressing group). The incidence of local infection at the catheter insertion site was 40.0% in the sterile dressing group, which was significantly greater than the 15.6% reported in the glucose chlorhexidine antimicrobial dressing group (p < 0.001). The total CRBSI rate in the intervention group was significantly lower (6.3%) than that in the control group (13.7%) (p = 0.014). No significant differences were found between the two groups in terms of suspected catheter-related bloodstream infections (CRBSIs), CRBSI incidence, length of hospital stay, ICU stay duration, or hospital mortality rates (p > 0.05). The Cox proportional hazards model suggested that patients in the control group were at a substantially greater risk of local infections and CRBSIs over time than those in the intervention group. CONCLUSION:Glucose chlorhexidine antimicrobial dressings significantly reduce catheter insertion site infections and overall CRBSI incidence, demonstrating their clinical value in preventing infection in patients receiving CRRT.

INTRODUCTION:ABO-incompatible (ABOi) kidney transplantation (KT) is now an established form of renal replacement therapy. However, it is important to note that ABO antibody clearance affects the procedure's success. As demonstrated in prior studies, both double-filtration plasmapheresis (DFPP) and plasma exchange (PE) can eliminate IgM and IgG isoagglutinins. However, relatively few studies have examined the long-term prognosis in patients with both conditions. The present study aimed to compare the efficacy and long-term prognosis of DFPP with those of PE in patients with ABOi-KT. METHODS:From September 2014 to April 2024, 230 consecutive ABOi living-donor KTs were performed. The participants were divided into DFPP and PE groups. Following propensity score matching (PSM), the primary outcomes included acute rejection (AR), infection, graft loss, patient death, and the effects of the two modalities on isoagglutinin titers (IgG and IgM). RESULTS:After 1:4 PSM, a total of 24 patients in the PE group and 63 patients in the DFPP group were included in the final analysis. Compared with PE, DFPP was associated with a significantly lower incidence of 6-month AR (6.3% vs. 33.3%, p = 0.003) and 6-month patient mortality (0% vs. 12.5%, p = 0.019), along with shorter hospital stays (22 [18-29] vs. 42 [36-48] days, p < 0.001). Multifactorial analysis revealed that the risk of AR in ABOi-KTs with antibody rebound was 6.43 times greater than that in ABOi-KTs without antibody rebound (OR = 6.43, 95% CI: 1.21-34.1, p = 0.029), whereas the risk of AR in ABOi-KTs pretreated with DFPP was 85.8% lower than that in ABOi-KTs pretreated with PE (OR = 0.142, 95% CI: 0.04-0.57, p = 0.006). However, no statistically significant differences were observed between the two groups in 6-month creatinine levels or 6-month graft loss. No significant differences were observed between the two groups in the reduction of IgG and IgM isoagglutinins. A single PE session led to a reduction in the IgM isoagglutinin titer by approximately 3-fold, in comparison with a 2-fold reduction that was observed with a single session of DFPP. Similarly, a single PE session led to a 2-fold reduction in IgG isoagglutinin titer. DFPP sessions resulted in a reduction that was marginally less than 2-fold. It is noteworthy that DFPP exhibited a more pronounced depletion of albumin (10.6 ± 6.7 vs. 4.8 ± 5.5 g/L, p < 0.001), globulin (10.4 ± 6.5 vs. 5.5 ± 5.7 g/L, p = 0.002), and fibrinogen (1.5 [1.2-2.2] vs. 1.1 [0.1-1.9] g/L, p = 0.024). CONCLUSIONS:Compared with PE, DFPP might be more advantageous in the ABOi-KT preconditioning regimen, but close monitoring of fibrinogen, albumin, and globulin is needed.

Introduction For critically ill patients requiring continuous renal replacement therapy, regional citrate anticoagulation is the preferred strategy to maintain extracorporeal circuit patency. Current clinical practice relies on two citrate-based protocols, with the widely used but complex 4% trisodium citrate solution posing a hypernatraemia risk and haemofiltration replacement fluid of sodium citrate offering procedural simplification and a more physiological electrolyte profile. Direct prospective comparison of their circuit lifespan efficacy is currently unavailable.Methods and analysis This single-centre, prospective, open-label, parallel-group randomised controlled trial will be conducted in China. 90 patients will be enrolled and randomly assigned (1:1) to receive anticoagulation with either citrate-based haemofiltration replacement fluid or 4% trisodium citrate solution, with all patients undergoing a standardised continuous venovenous haemofiltration protocol. The primary outcome is circuit lifespan, with a non-inferiority margin set at 2.43 hours. Secondary outcomes include the 72-hour circuit survival probability, duration of hospitalisation, and all-cause mortality rates at 28 and 90 days. The primary analysis will follow the intention-to-treat principle.Ethics and dissemination The study protocol has been approved by the Biomedical Research Ethics Committee of West China Hospital, Sichuan University (Approval No. (2025)1157). Any subsequent amendments must be submitted to the same ethics committee for further review and approval prior to implementation. Furthermore, the findings of this trial will be disseminated through presentations at relevant national and international conferences and via publication in peer-reviewed scientific journals.Trial registration number Chinese Clinical Trial Registry ChiCTR2500106991.

Context Chronic kidney disease (CKD) is a major clinical kidney disease associated with numerous adverse events, such as heart failure and premature mortality. Dietary modifications are prioritized in the management of CKD due to the long-term effects of this disease. Objective In this review we sought to consolidate evidence from published systematic reviews and meta-analyses performed to investigate the associations between different dietary patterns and kidney health. Data Sources We searched related systematic reviews and meta-analyses in PubMed, Embase, Ovid, and the Cochrane Database of Systematic Reviews. Data Extraction Two independent reviewers undertook screening, data extraction, and quality assessment. The corrected covered area was used to identify the degree of overlap between reviews. Exposures included the amount of protein/salt intake, types of dietary protein, ketoanalogue (KA) supplementation, the Mediterranean diet, and the Dietary Approaches to Stop Hypertension (DASH) diet. Data Analysis In total, 28 reviews evaluating the associations between multiple dietary patterns and kidney health were included. According to reported review findings, a low-protein diet (LPD) reduced proteinuria in CKD patients. A very low-protein diet (VLPD) was shown to decrease the occurrence of end-stage renal disease. Supplementation with KA based on the LPD/VLPD further reduced levels of proteinuria, blood urea nitrogen, and serum creatinine and preserved the estimated glomerular filtration rate (eGFR) in CKD patients. Lower sodium intake effectively decreased urinary sodium and protein excretion and produced a significant reduction in the incidence of composite endpoints in CKD patients. Both the Mediterranean and the DASH diet mitigated the risk of CKD, while the latter also showed benefits in reducing proteinuria and rate of eGFR decline. Conclusions Although the aforementioned dietary interventions did not directly improve patient mortality, they showed protective effects in lowering proteinuria, preserving renal function in CKD patients and reducing the risk of CKD in the non-CKD population. Clinicians should acknowledge the impact of various dietary patterns on kidney health to achieve better prevention and management of kidney diseases. Systematic Review Registration PROSPERO registration No. [CRD42022313262].

Regional citrate anticoagulation (RCA) is standard in continuous renal replacement therapy (CRRT). Post-Filter ionized calcium (Post-Filter iCa) is the gold standard for monitoring anticoagulation efficacy, but it requires blood sampling. Effluent fluid iCa can be measured without blood sampling. This study assessed the correlation and agreement between Effluent Fluid iCa and Post-Filter iCa in critically ill patients undergoing RCA-CRRT. We conducted a prospective non-interventional study from June to November 2024 at West China Hospital of Sichuan University. Thirty-six critically ill patients receiving CVVHDF with RCA were enrolled, yielding 216 paired samples. Ionized calcium was measured in Pre-Filter, Post-Filter, and Effluent Fluid samples using a point-of-care analyzer. CRRT was performed using the Prismaflex system with ST150 filters and Oxiris tubing. Post-filter blood and effluent fluid samples were drawn simultaneously to ensure direct comparability. This study analyzed 216 paired samples from 36 critically ill patients on CVVHDF with RCA to assess the relationship between Post-Filter and Effluent Fluid ionized calcium. A moderate correlation was found (r = 0.551 [CI 0.45,0.64], p < 0.001). Bland-Altman analysis showed a mean difference of − 0.024 mmol/L (95

Peritoneal dialysis (PD) is a critical renal replacement therapy for end-stage kidney disease. However, its adoption remains limited, partly due to peritoneal fibrosis and metabolic complications induced by conventional glucose-based peritoneal dialysis fluid (PDF), the primary complications in PD patients and the leading cause of technique failure. This review outlines three innovative approaches to overcome these limitations: (1) novel biocompatible osmotic agents (L-carnitine can improve the metabolism of the peritoneum, and hyperbranched polyglycerol provides sustained ultrafiltration with dual peritoneal/renal protection), (2) advanced biocompatible buffers (citrate and pyruvate), and (3) peritoneal protectants (glycosaminoglycans and molecular hydrogen) that collectively mitigate fibrosis while protecting membrane function. These developments indicate a future direction for biocompatible PDF: integrating dual or triple protective functions of “osmotic agents + buffers + additives” synergy—optimizing hybrid formulations and accelerating clinical translation. Furthermore, we explored the emerging role of PD in refractory heart failure, where specialized PDF and steady-concentration protocols enhanced ultrafiltration efficiency. These advances address volume overload in cardiorenal syndrome, expanding PD’s therapeutic scope of PD to systemic conditions such as heart failure.

OBJECTIVES:Net ultrafiltration (UFnet) is widely used for fluid management during continuous renal replacement therapy (CRRT) for critically ill patients over extended periods. Despite widespread use, the relationship between UFnet intensity and clinical outcomes, particularly mortality, remains controversial. METHODS:This retrospective observational study examined critically ill patients undergoing CRRT for more than 72 h from January 2021 to September 2023. Patients were stratified by their UFnet intensity during the initial 72 h of CRRT into low (<1.01 mL/kg/h), moderate (1.01-1.75 mL/kg/h), and high (>1.75 mL/kg/h) groups. The primary outcome was 28-day mortality. Kaplan-Meier's survival curves with log-rank tests, Cox proportional hazards models, and propensity score matching were employed to assess the association between UFnet intensity and mortality. RESULTS:A total of 683 patients were included. Compared with the moderate UFnet intensity, the low UFnet intensity (adjusted hazard ratio (HR) 1.54, 95%CI 1.24-1.91, p = .024) and high UFnet intensity (adjusted HR 1.27, 95%CI 1.03-1.57, p < .001) were associated with higher 28-day mortality. Sensitivity analyses showed similar trends for 60-day and 90-day mortality. Subgroup analyses based on admission diagnosis did not reveal significant differences in the effect of UFnet intensity on mortality risk. CONCLUSIONS:UFnet intensity between 1.01 and 1.75 mL/kg/h during the first 72 h of CRRT was associated with lower 28-day mortality compared to both lower and higher UFnet intensities. However, future studies are needed to better define optimal UFnet thresholds in multicenter ICU cohorts.

Background Clearance of circulating myoglobin is crucial to prevent further damage in patients with rhabdomyolysis (RM) and acute kidney injury (AKI). The objective of the present study was to evaluate the efficacy and safety of haemoadsorption (HA) combined with continuous renal replacement therapy (CRRT) in critically ill patients with RM and AKI. Methods Patients with RM and AKI who received CRRT + HA or CRRT with concomitant creatine kinase (CK) >10 000 IU/l in our intensive care unit (ICU) between May 2021 and December 2023 were retrospectively included. The primary outcome was 90-day mortality; secondary outcomes were kidney function recovery and CK decline rate. Adverse events were also evaluated, including hypotension, circuit clotting, albumin leakage and blood loss. Propensity score matching and Cox retrospective analysis were performed. Results A total of 111 RM patients with AKI were ultimately included. The ICU and in-hospital mortality were significantly lower in the CRRT + HA group compared with the CRRT group (ICU mortality: 18% versus 42%, P = .025; in-hospital mortality: 21% versus 42%, P = .048). However, the CRRT + HA group only showed a non-significant reduction in 90-day mortality compared with the CRRT group (47% versus 68%, P = .063). After treatment for 90 days, the number of patients with kidney function recovery was not significantly different between the CRRT + HA and CRRT groups (95% versus 84%, P = .639). Moreover, the incidence of hypotension and circuit clotting events did not increase during CRRT + HA treatment. In addition, the CRRT + HA group also appeared to have a higher rate of CK reduction and reduction of CK than the CRRT group at 24 and 48 hours after the initiation of CRRT. A multivariate Cox regression model demonstrated that CRRT + HA {hazard ratio [HR] 0.477 [95% confidence interval (CI) 0.234-0.972], P = .042}, mean arterial blood pressure [per 1 mmHg; HR 0.967 (95% CI 0.943-0.992), P = .009] and CRRT treatment duration [per 1 h; HR 0.995 (95% CI 0.992-0.998), P = .002] played a favourably important role in the survival prognosis of RM and AKI patients. In contrast, serum phosphate before RRT [per 1 mmol/l; HR 1.531 (95% CI 1.113-2.106), P = .009] and McMahon score [per 1 score; HR 1.15 (95% CI 1.006-1.313), P = .04] were independent risk factors for 90-day mortality. Conclusions CRRT combined with HA therapy reduced ICU and in-hospital mortality in patients with RM and AKI and also had a cleansing effect on creatine kinase without significant adverse events.

PurposeWe aimed to perform a Bayesian network meta-analysis to assess the comparative diagnostic performance of different imaging modalities in chronic pancreatitis(CP).MethodsThe PubMed, Embase and Cochrane Library databases were searched for relevant publications until March 2024. All studies evaluating the head-to-head diagnostic performance of imaging modalities in CP were included. Bayesian network meta-analysis was performed to compare the sensitivity and specificity between the imaging modalities. The Quality Assessment of Diagnostic Performance Studies (QUADAS-2) tool was used to evaluate the quality of studies.ResultsThis meta-analysis incorporated 17 studies. Network meta-analytic results indicated that endoscopic ultrasonography (EUS) achieved the highest surface under the cumulative ranking (SUCRA) value at 0.86 for sensitivity. Conversely, magnetic resonance imaging (MRI) demonstrated best specificity, recording the highest SUCRA value at 0.99. Ultrasonography (US) displayed comparatively lower sensitivity than endoscopic retrograde cholangiopancreatography (ERCP) (relative risk[RR]: 0.83, 95% Confidence Interval[CI]: 0.69-0.99) and EUS (RR: 0.73, 95% CI: 0.57-0.91). MRI outperformed all other imaging modalities in terms of specificity.ConclusionsIt appears that EUS demonstrates higher sensitivity, while MRI exhibits higher specificity in patients with chronic pancreatitis. However, it is crucial to note that our analysis was limited to the diagnostic performance and did not evaluate the cost-effectiveness of these various imaging modalities. Consequently, further extensive studies are needed to assess the benefit-to-risk ratios comprehensively.

Hemodialysis is an important means to sustain life in patients with end-stage renal disease In China, more than 100,000 hemodialysis patients need to have a catheter fitted at least once (temporary or long term) for dialysis. Despite the widespread use and low cost of HD catheters, they remain prone to critical issues such as high thrombosis rates, infections, and dysfunction. This study addresses the persistent challenge of thrombosis formation in dialysis catheters by investigating the incorporation of helical flow inducers, a strategy inspired by the naturally occurring helical blood flow in arterial systems. In this research, helical flow inducers with varying pitch and diameter were integrated into the widely used Niagara@ catheter. Computational fluid dynamics simulations were conducted to evaluate the impact on key parameters such as local normalized helicity (LNH), residence time (RT), shear stress, and flow velocity. The results demonstrated that 1) small-diameter inducers produce helical flow. Among inducers with identical diameter, those with a smaller thread pitch are more likely to induce increased LNH; 2) a small thread pitch helical flow inducer reduced the percentage of blood volume, with RT exceeding 0.015 s from 40.8% in the control to 12.7%, suggesting a substantial reduction in thrombosis risk; 3) the study also found that the introduction of small thread pitch helical flow inducers led to increased shear stress, with Model A showing an average shear stress of 49.2 Pa, compared to 32.0 Pa in the control. This highlights the need for careful optimization to balance the benefits of reduced thrombosis risk with the potential for shear-induced hemolysis. In conclusion, the integration of helical flow inducers into dialysis catheters offers a promising strategy for improving intraluminal flow dynamics and reducing the risk of thrombosis.

BACKGROUND:Therapeutic plasma exchange (TPE) is acknowledged as the standard therapy for anti-glomerular basement membrane (GBM) nephritis. In recent years, double-filtration plasmapheresis (DFPP) has been proposed as an equally effective plasmapheresis modality. The present study aimed to compare the efficacy and safety of TPE and DFPP for the treatment of anti-GBM nephritis. METHODS:We conducted a retrospective cohort study of anti-GBM patients who received plasmapheresis from February 2011 to October 2023 at West China Hospital of Sichuan University. The primary outcome was a composite endpoint of in-hospital death or dialysis dependency at discharge. The secondary outcomes included length of hospitalization, long-term mortality and end-stage renal disease (ESRD). We also compared anti-GBM antibody titer reduction, plasmapheresis-related adverse events. Logistic regression and Cox hazard proportional regression analyses were performed to investigate potential risk factors of primary outcome and long-term patient/renal survival. RESULTS:In total, 58 anti-GBM nephritis patients were included in this study. No significant differences were observed in the incidence of primary outcome between patients receiving DFPP and TPE in fully adjusted logistic regression model (OR=0.23, 95 % CI=0.04-1.37, P = 0.106). In surviving patients, the length of hospitalization was similar (21 vs. 23 days, P = 0.165). With a follow-up of 3-years, K‒M survival analysis revealed similar risk of death or ESRD between the 2 groups (P = 0.424; P = 0.987). According to fully adjusted Cox regression analyses, anti-GBM nephritis patients receiving DFPP achieved comparable patient (HR=1.18, 95 % CI=0.23-6.04; P = 0.845) and kidney survival (HR=0.96, 95 % CI=0.13-6.86; P = 0.967) to those receiving TPE. After plasmapheresis treatment, the anti-GBM antibody concentration significantly decreased in both groups (DFPP: 136.47 vs 27.20 AU/mL, P < 0.001; TPE: 122.09 vs 27.40 AU/mL, P = 0.016), with fewer allergy episodes observed in the DFPP group (13.64 % vs 42.86 %, P = 0.049). Besides, older age and concomitant infection were independently related to 3-year patient mortality (P < 0.001, P = 0.031), whereas high-dose methylprednisolone treatment seemed to be associated with a lower risk of ESRD (P = 0.034). CONCLUSIONS:Anti-GBM nephritis patients who received DFPP achieved comparable short- and long-term prognosis to those who received TPE. With less plasma consumption, DFPP was also associated with fewer allergy episodes. DFPP might be an alternative modality of plasmapheresis for anti-GBM nephritis, especially in the setting of limited blood resources.