The Dose Response Multicentre Investigation on Fluid Assessment (DoReMIFA) in critically ill patients

Background

The previously published “Dose Response Multicentre International Collaborative Initiative (DoReMi)” study concluded that the high mortality of critically ill patients with acute kidney injury (AKI) was unlikely to be related to an inadequate dose of renal replacement therapy (RRT) and other factors were contributing. This follow-up study aimed to investigate the impact of daily fluid balance and fluid accumulation on mortality of critically ill patients without AKI (N-AKI), with AKI (AKI) and with AKI on RRT (AKI-RRT) receiving an adequate dose of RRT.

Methods

We prospectively enrolled all consecutive patients admitted to 21 intensive care units (ICUs) from nine countries and collected baseline characteristics, comorbidities, severity of illness, presence of sepsis, daily physiologic parameters and fluid intake-output, AKI stage, need for RRT and survival status. Daily fluid balance was computed and fluid overload (FO) was defined as percentage of admission body weight (BW). Maximum fluid overload (MFO) was the peak value of FO.

Results

We analysed 1734 patients. A total of 991 (57 %) had N-AKI, 560 (32 %) had AKI but did not have RRT and 183 (11 %) had AKI-RRT. ICU mortality was 22.3 % in AKI patients and 5.6 % in those without AKI (p < 0.0001). Progressive fluid accumulation was seen in all three groups. Maximum fluid accumulation occurred on day 2 in N-AKI patients (2.8 % of BW), on day 3 in AKI patients not receiving RRT (4.3 % of BW) and on day 5 in AKI-RRT patients (7.9 % of BW). The main findings were: (1) the odds ratio (OR) for hospital mortality increased by 1.075 (95 % confidence interval 1.055–1.095) with every 1 % increase of MFO. When adjusting for severity of illness and AKI status, the OR changed to 1.044. This phenomenon was a continuum and independent of thresholds as previously reported. (2) Multivariate analysis confirmed that the speed of fluid accumulation was independently associated with ICU mortality. (3) Fluid accumulation increased significantly in the 3-day period prior to the diagnosis of AKI and peaked 3 days later.

Conclusions

In critically ill patients, the severity and speed of fluid accumulation are independent risk factors for ICU mortality. Fluid balance abnormality precedes and follows the diagnosis of AKI.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-016-1355-9) contains supplementary material, which is available to authorized users.

Ultrahigh photoconductivity of bandgap-graded CdSxSe1-x nanowires probed by terahertz spectroscopy

Superiorly high photoconductivity is desirable in optoelectronic materials and devices for information transmission and processing. Achieving high photoconductivity via bandgap engineering in a bandgap-graded semiconductor nanowire has been proposed as a potential strategy. In this work, we report the ultrahigh photoconductivity of bandgap-graded CdSxSe1-x nanowires and its detailed analysis by means of ultrafast optical-pump terahertz-probe (OPTP) spectroscopy. The recombination rates and carrier mobility are quantitatively obtained via investigation of the transient carrier dynamics in the nanowires. By analysis of the terahertz (THz) spectra, we obtain an insight into the bandgap gradient and band alignment to carrier transport along the nanowires. The demonstration of the ultrahigh photoconductivity makes bandgap-graded CdSxSe1-x nanowires a promising candidate as building blocks for nanoscale electronic and photonic devices.

Visible-Frequency Metasurface for Structuring and Spatially Multiplexing Optical Vortices

A multifocus optical vortex metalens, with enhanced signal-to-noise ratio, is presented, which focuses three longitudinal vortices with distinct topological charges at different focal planes. The design largely extends the flexibility of tuning the number of vortices and their focal positions for circularly polarized light in a compact device, which provides the convenience for the nanomanipulation of optical vortices.

Numb induces e-cadherin adhesion dissolution, cytoskeleton reorganization, and migration in tubular epithelial cells contributing to renal fibrosis

Numb, an endocytic protein, is involved in both neural differentiation and protein post-endocytic trafficking. Although negative Numb expression has been linked to human mammary carcinomas, little is known about its expression and functions in other diseases. In the present study, we observed that Numb is expressed in renal tubule epithelia and its expression is increased in the fibrotic kidney in vivo. We determined that in proximal tubular epithelial cells (NRK52E cells), TGF-β1 induces the expression of Numb and ectopic expression of Numb leads to dissolution of E-cadherin adhesion, reorganization of cytoskeleton, activation of Rac1 and Cdc42, and enhancement of migration. Either knockdown of α-adaptin or overexpression of Numb asparagine-proline-phenylalanine (NPF) mutant interferes with AP-2 dependent endocytosis and rescues Ecadherin level in NRK52E cells. Moreover, knockdown of integrin β1 or α-adaptin, and overexpression of a Numb dominant-negative form (Numb phosphotyrosine binding [PTB] domain) impair integrin endocytosis, and markedly inhibit Numb-induced cell migration and activation of Rac1 and Cdc42. Taken together, our work identifies Numb as an important player in renal fibrosis, by regulating epithelial-to-mesenchymal transition (EMT) process including E-cadherin adhesion dissolution, actin reorganization, and migration enhancement in NRK52E cells.

On-chip integrated optofluidic complex refractive index sensing using silicon photonic crystal nanobeam cavities

Complex refractive index sensing is proposed and experimentally demonstrated in optofluidic sensors based on silicon photonic crystal nanobeam cavities. The sensitivities are 58 and 139 nm/RIU, respectively, for the real part (n) and the imaginary part (κ) of the complex refractive index, and the corresponding detection limits are 1.8×10(-5) RIU for n and 4.1×10(-6) RIU for κ. Moreover, the capability of the complex refractive index sensing method to detect the concentration composition of the ternary mixture is demonstrated without the surface immobilization of functional groups, which is impossible to realize with the conventional refractive index sensing scheme.

On-chip discrimination of orbital angular momentum of light with plasmonic nanoslits

The orbital angular momentum (OAM) of light can be taken as an independent and orthogonal degree of freedom for multiplexing in an optical communication system, potentially improving the system capacity to hundreds of Tbits per second. The high compactness and miniaturization of devices required for optical communications impose strict requirements on discriminating OAM modes of light at a small (micro- or even nano-meter) scale for demultiplexing; these requirements represent a challenge for traditional OAM sorting strategies. Here, we propose a semi-ring plasmonic nanoslit to directly and spatially sort various OAM modes of light into ∼120 nm-spaced mode intervals on the metallic surface. Making use of the constructive interference of a helical-phase modulated surface wave excited by a vortex beam, this on-chip interval can be stably demonstrated both theoretically and experimentally with a quasi-linear dependence on the plasmonic wavelength. Furthermore, its immunity to semi-ring geometry (i.e., the radius and number of rings) is verified by simulations. As a result, OAM discriminating is guaranteed by this stable sorting function. This technique shows a viable solution to discriminate the OAM of light at the nano-scale and might lead to broad benefits across the fields of optical communications, plasmonic physics and singular optics.

Hybrid bilayer plasmonic metasurface efficiently manipulates visible light

Metasurfaces operating in the cross-polarization scheme have shown an interesting degree of control over the wavefront of transmitted light. Nevertheless, their inherently low efficiency in visible light raises certain concerns for practical applications. Without sacrificing the ultrathin flat design, we propose a bilayer plasmonic metasurface operating at visible frequencies, obtained by coupling a nanoantenna-based metasurface with its complementary Babinet-inverted copy. By breaking the radiation symmetry because of the finite, yet small, thickness of the proposed structure and benefitting from properly tailored intra- and interlayer couplings, such coupled bilayer metasurface experimentally yields a conversion efficiency of 17%, significantly larger than that of earlier single-layer designs, as well as an extinction ratio larger than 0 dB, meaning that anomalous refraction dominates the transmission response. Our finding shows that metallic metasurface can counterintuitively manipulate the visible light as efficiently as dielectric metasurface (~20% in conversion efficiency in Lin et al.'s study), although the metal's ohmic loss is much higher than dielectrics. Our hybrid bilayer design, still being ultrathin (~λ/6), is found to obey generalized Snell's law even in the presence of strong couplings. It is capable of efficiently manipulating visible light over a broad bandwidth and can be realized with a facile one-step nanofabrication process.

Management of hypoparathyroidism in pregnancy and lactation - A report of 10 cases

INTRODUCTION

Hypoparathyroidism in pregnancy is rare, but important, as it is associated with maternal morbidity and foetal loss. There are limited case reports and no established management guidelines. Optimal maintenance of calcium levels during pregnancy is required to minimise the risk of related complications. This study aims to identify causes and examine outcomes of hypoparathyroidism in pregnancy in a cohort of women delivering at a large referral centre.

DESIGN AND METHOD

The Monash Health maternity service database captures pregnancy and birthing outcomes in over 9000 women each year. We audited this database between 2000 and 2014 to examine the clinical course, treatment and outcomes of pregnant women with hypoparathyroidism.

RESULTS

We identified 10 pregnancies from 6 women with pre-existing hypoparathyroidism secondary to idiopathic hypoparathyroidism (n = 3), autosomal dominant branchial arch disorder with hypoparathyroidism (n = 3) and autosomal dominant hypocalcaemia (n = 1), surgery for thyroid cancer (n = 2) and Graves' disease (n = 1). Maternal calcium levels were monitored through pregnancy and management adjusted to maintain normocalcaemia. One woman was delivered by caesarean section at 34 weeks' gestation because of intrauterine growth restriction, and oligohydramnios complicated two other pregnancies. The postpartum period was complicated by severe hypercalcaemia in one woman and by symptomatic, labile serum calcium levels during lactation in another woman, requiring close monitoring over a 6 month period.

CONCLUSION

Although rare, hypoparathyroidism in pregnancy poses a management challenge for clinicians, and co-ordinated care is required by obstetricians and endocrinologists to ensure optimal outcomes for both mother and baby. Continued monitoring of maternal calcium levels during lactation and weaning is essential to avoid the potential complications of either hypercalcaemia or hypocalcaemia.

Branchlike nano-electrodes for enhanced terahertz emission in photomixers

Branchlike nano-electrode structures were found to improve the THz emission intensity of a photomixer by approximately one order of magnitude higher than that of a photomixer with one row of nano-electrodes separated by the same 100 nm gap. The enhancement is attributed to a more efficient collection of generated carriers, which is in turn due to a more intense electric field under the branchlike nano-electrodes' structures. This is coupled with an increased number of effective areas where strong tip-to-tip THz field enhancements were observed. The optical-to-THz conversion efficiency of the photomixers with the new branchlike nano-electrodes was found to be 10 times higher. The more efficient THz photomixer will greatly benefit the development of continuous-wave THz imaging and spectroscopy systems.

Effect of dielectric cladding on active plasmonic device based on InGaAsP multiple quantum wells

The Surface Plasmon Polariton (SPP) planar waveguide with amorphous silicon (α-Si) cladding is studied, for empowering the device modulation response. The device is fabricated with multiple quantum wells (MQWs) as the gain media electrically pumped for compensating SPP propagation loss on Au film waveguide. The SPP propagation greatly benefits from the modal gain for the long-range hybrid mode, which is optimized by adopting an α-Si cladding layer accompanied with minimal degradation of mode confinement. The proposed structure presented more sensitive response to electrical manipulation than the one without cladding in experiment.

Fabrication of well-ordered binary colloidal crystals with extended size ratios for broadband reflectance

Binary colloidal crystals (BCCs) possess great potentials in tuning material properties by controlling the size ratio of small to large colloidal spheres (γS/L). In this paper, we present a method for the fabrication of BCCs with much more extended size ratios than those obtained in conventional convective self-assembly method. It is found that γS/L can be extended to 0.376 by adding TEOS sol into the colloidal suspension. The resulting polystyrene/silica (PS/SiO2) BCCs show distinctive reflections, indicating their well-ordered structure. The extended size ratios render more flexibility in engineering the photonic bandgap structures of BCCs and hence provide a better platform for developing a range of applications such as photonics, spintronics, sensing and bioseparation.

Manipulating DC currents with bilayer bulk natural materials

A novel and general method for spatially manipulating DC currents has been proposed and experimentally verified by only using bilayer bulk natural conductive materials. Our approach shows distinctive advantages with respect to homogeneity, isotropy, and independence of complicated microfabrication techniques. Our design scheme can be readily extended to robust manipulations of magnetic fields, thermal heat, elastic mechanics, and matter waves.

Cab45S inhibits the ER stress-induced IRE1-JNK pathway and apoptosis via GRP78/BiP

Disturbance of endoplasmic reticulum (ER) homeostasis causes ER stress and leads to activation of the unfolded protein response, which reduces the stress and promotes cell survival at the early stage of stress, or triggers cell death and apoptosis when homeostasis is not restored under prolonged ER stress. Here, we report that Cab45S, a member of the CREC family, inhibits ER stress-induced apoptosis. Depletion of Cab45S increases inositol-requiring kinase 1 (IRE1) activity, thus producing more spliced forms of X-box-binding protein 1 mRNA at the early stage of stress and leads to phosphorylation of c-Jun N-terminal kinase, which finally induces apoptosis. Furthermore, we find that Cab45S specifically interacts with 78-kDa glucose-regulated protein/immunoglobulin heavy chain binding protein (GRP78/BiP) on its nucleotide-binding domain. Cab45S enhances GRP78/BiP protein level and stabilizes the interaction of GRP78/BiP with IRE1 to inhibit ER stress-induced IRE1 activation and apoptosis. Together, Cab45S, a novel regulator of GRP78/BiP, suppresses ER stress-induced IRE1 activation and apoptosis by binding to and elevating GRP78/BiP, and has a role in the inhibition of ER stress-induced apoptosis.

Creation of vectorial bottle-hollow beam using radially or azimuthally polarized light

We propose a single-beam generation scheme to obtain a bottle-hollow (BH) beam using a binary phase mask and a focusing lens. The resulting BH beam is shown to possess an open bottle-shaped null intensity region, which has two hollow tube-shaped null intensity regions located on two opposite sides of this bottle. It is found that this scheme works identically under incident illumination with radial or azimuthal polarization. Another advantage of this scheme is that the same binary mask can be employed as a focusing lens with different choices of numerical aperture (NA). Furthermore, we observe that the length of the BH beam is inversely proportional to NA2 while the diameters of both the bottle and hollow regions are inversely proportional to NA; thereby leading to an adjustable BH beam. This BH beam may find attractive applications in noninvasive manipulation of microscopic particles over large distances.

High sensitivity molecule detection by plasmonic nanoantennas with selective binding at electromagnetic hotspots

We report a highly sensitive biomolecule detection by plasmonic nanoantenna arrays with selective binding at the optical hotspots. The plasmonic nanoantennas consist of two separated Au nanorods with a thin Ti disk placed in between. By using selective surface modification chemistry, controlled binding occurs only in the gaps between the plasmonic nanoantennas, which ensures a high detection sensitivity. Both optical characterization using a dark field microscope and the FDTD simulation show that after the streptavidin binding, the signal increases with decreasing gap size. Compared to a single nanorod, the signal obtained per bound molecule in the nanoantennas increases by a factor of six, which is promising with respect to the future detection of single molecules.

Calumenin-15 facilitates filopodia formation by promoting TGF-β superfamily cytokine GDF-15 transcription

Filopodia, which are actin-rich finger-like membrane protrusions, have an important role in cell migration and tumor metastasis. Here we identify 13 novel calumenin (Calu) isoforms (Calu 3-15) produced by alternative splicing, and find that Calu-15 promotes filopodia formation and cell migration. Calu-15 shuttles between the nucleus and cytoplasm through interacting with importin α, Ran GTPase, and Crm1. The phosphorylation of the threonine at position 73 (Thr-73) by casein kinase 2 (CK2) is essential for the nuclear import of Calu-15, and either Thr-73 mutation or inhibition of CK2 interrupts its nuclear localization. In the nucleus, Calu-15 increases the transcription of growth differentiation factor-15 (GDF-15), a member of the transforming growth factor-β (TGF-β) superfamily, via binding to its promoter region. Furthermore, Calu-15 induces filopodia formation mediated by GDF-15. Together, we identify that Calu-15, a novel isoform of Calu with phosphorylation-dependent nuclear localization, has a critical role in promoting filopodia formation and cell migration by upregulating the GDF-15 transcription.