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To assess whether loop diuretic challenge predicts the need for dialysis among critically ill patients with acute kidney injury (AKI) stage 3.

In this study, the structure of a service supply chain is analysed using social network analysis approach. Service supply chains consist of peoples and organisations connected in form of a network. The network is formed by the combination of ties between different players in the chain/network. These players are dependent upon each other and there exists flow of material or flow of information between players. Despite the longevity of the 'social networks' perspective, the product supply chains as well as the supply chain in services are less explored from the social network perspective. A case study on supply chain of property purchase has been discussed in this paper that is analysed with the help of social network analysis approach.

Logistics services are keys to the success of almost all the manufacturing firms. Logistics companies have great responsibility to minimise the supply chain risks. Third-party logistics provider has limited role in the supply chain, whereas fourth-party logistics provider performs series of operations in the supply chain. In this study, the role of logistics service providers has been quantified and the structure of 3PL and 4PL network is compared using social network analysis approach. A case study on logistics network has been discussed in this paper which is analysed with the help of social network analysis approach. The role of individual players in 3PL and 4PL has been described based on the outcomes of social network analysis of the networks. The work is an attempt to understand the role of key players in the network and thus can aid in making important decisions while collaborating with partners and making negotiations.

ABSTRACTBackground: The aim of this study was to assess the relationship between admission serum phosphate levels and in-hospital mortality in all hospitalized patients.Methods: All adult hospitalized patients who had admission serum phosphate available between years 2009 and 2013 were enrolled. Admission serum phosphate was categorized based on its distribution into six groups (<2.5, 2.5–3.0, 3.1–3.6, 3.7–4.2, 4.3–4.8 and ≥4.9 mg/dL). The odds ratio (OR) of in-hospital mortality by admission serum phosphate, using the phosphate category of 3.1–3.6 mg/dL as the reference group, was obtained by logistic regression analysis.Results: 42,336 patients were studied. The lowest incidence of in-hospital mortality was associated with a serum phosphate within 3.1–4.2 mg/dL. A U-shaped curve emerged demonstrating higher in-hospital mortality associated with both serum phosphate <3.1 and >4.2 mg/dL. After adjusting for potential confounders, both serum phosphate <2.5 and >4.2 mg/dL were associated with in-hospital mortality with ORs of 1.60 (95%CI 1.25–2.05), 1.60 (95%CI 1.29–1.97), and 3.89 (95%CI 3.20–4.74) when serum phosphate were <2.5, 4.3–4.8 and ≥4.9 mg/dL, respectively. Among subgroups of patients with chronic kidney disease (CKD) and cardiovascular disease (CVD), the highest mortality was associated with a serum phosphate ≥4.9 mg/dL with ORs of 4.11 (95%CI 3.16–5.39) in CKD patients and 5.11 (95%CI 3.33–7.95) in CVD patients.Conclusion: Hospitalized patients with admission serum phosphate <2.5 and >4.2 mg/dL are associated with an increased risk of in-hospital mortality. The highest mortality risk is associated with CKD and CVD patients with admission hyperphosphatemia.

The impact of pre‐donation obesity on long‐term outcomes of living kidney donors remains controversial. Published guidelines offer varying recommendations regarding BMI(kg/m2) thresholds for donor acceptance. We examined temporal and center‐level variation in BMIof accepted donors across UStransplant centers. Using national transplant registry data, we performed multivariate hierarchical logistic regression modeling using pairwise comparisons (overweight, BMI: 25‐29.9; mildly obese, BMI: 30‐34.9; very obese, BMI: ≥35; versus normal BMI: 18.5‐24.9). Metrics of heterogeneity, including median odds ratio (MOR), were calculated. Among 90 013 living kidney donors, 2001‐2016, proportions who were very obese decreased and proportions who were mildly obese or overweight increased. Significant center‐level heterogeneity was noted in BMIof accepted donors; the MORvaried from 1.10 for overweight to 1.93 for very obese donors. At centers located in the 10 states with the highest general population obesity rates, adjusted odds of very obese donor status were 185% higher (reference: normal BMI) than in states with the lowest obesity rates. Although there is a declining trend in acceptance of very obese living kidney donors, variation across centers is significant. Furthermore, local population obesity rates may affect the decision to accept obese individuals as donors. This study identifies and quantitates the variability in the acceptance of overweight and obese living donors and assesses the obesity rates prevalent in the local living donor pool on the acceptance of such donors.

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BackgroundCoeliac disease (CD) is a gluten-sensitive enteropathy diagnosed on the basis of ESPGHAN criteria and clinical response to gluten-free diet (GFD). Histological abnormalities on liver biopsy have been noted in CD but have seldom been described.AimsTo assess the histological spectrum of ‘coeliac hepatitis’ and possibility of reversal of such features after a GFD.MethodsTwenty-five patients with concomitant CD and hepatic derangement were analysed for clinical profile, laboratory investigations and duodenal and liver biopsy. A histological comparison of pre- and post-GFD duodenal and liver biopsies was carried out, wherever possible.ResultsFifteen patients presenting with CD subsequently developed abnormal liver function tests; 10 patients presenting with liver disease were found to have tissue positive transglutaminase in 70% and antigliadin antibodies in 60%. Serological markers for autoimmune liver disease (AILD) were positive in eight patients. Liver histology ranged from mild reactive hepatitis, chronic hepatitis, steatosis to cirrhosis. Liver biopsies after a GFD were available in six cases, of which five showed a decrease in steatosis, portal and lobular inflammation and fibrosis score.ConclusionCoeliac hepatitis could be a distinct entity and the patients may present with either CD or secondary hepatic derangement. Evaluation for the presence of CD is recommended for patients presenting with AILD, unexplained transaminasaemia or anaemia. This is one of the very few studies demonstrating the continuum of liver histological changes in ‘coeliac hepatitis’. Trial of a GFD may result in clinicopathological improvement of ‘coeliac hepatitis’.

We studied the incidence, trend, underlying conditions, microbiology, and outcomes of infective endocarditis (IE) in children during 11 years using Nationwide Inpatient Sample (NIS) database. This is the largest all‐payer inpatient care database in the United States containing data for more than 8 million hospital stays from over 1000 hospitals. NIS data from 2000 to 2010 of primary discharge diagnosis of IE in children aged ≤19 years old were studied. Children with underlying congenital heart defects and acquired heart conditions were identified. Microbiological causative agents were recorded. Linear regression was used to assess trend of incidence over time. An estimated 3,840 (95% CI: 3,395‐4,285) children had a discharge diagnosis of IE. The overall incidence was 0.43 per 100 000 children. The incidence was stable over the study period (P= .4 for trend). The majority of patients 56.2% were ≥11 years old and 15.4% were ≤ 1 year. Underlying cardiac conditions were present in 53.5% of patients. Overall 30.2% of cases were culture‐negative. Among those with identified pathogens, Staphylococcus species were most common (43.1%) followed by Streptococcus species (39.5%). Viridans Streptococcus group was most common in those with underlying heart disease (32.7%) and S. aureuswas most common in those without heart disease (46.9%). Among culture‐positive patients, there was a decline in proportion of Staphylococcal IE (P= .03) and an increase in proportion of Streptococcal IE (P= .04). Overall mortality was 2.8%. Patients with Staphylococcal IE had longer median length of stay (12 vs. 9 days; P< .01) and the highest mortality (4.7%). The incidence of IE in children has remained unchanged in the United States during the 11‐year study period. Among culture‐positive patients there was a significant decrease in Staphylococcal IE and a significant increase of Streptococcal IE. Staphylococcal IE was associated with increased LOS and highest mortality.

Background:Chronic stress experienced at home or work has been associated with acute increases in blood pressure (BP) measured in the doctor’s office, but few data are available on the association of chronic stress with BP measured outside of the office setting.Methods:We analyzed data from 473 African-American adults enrolled in the Jackson Heart Study with office BP < 130/80 mm Hg to examine the association between chronic stress and masked hypertension (MHT). Chronic stress related to jobs, relationships, neighborhoods, caregiving, legal problems, medical problems, racism and discrimination, and meeting basic needs experienced over the previous 12 months was assessed using the 8-item Global Perceived Stress Scale (GPSS). We grouped participants by tertile of the composite GPSS score. Any MHT was defined as awake BP ≥ 130/80 mm Hg, asleep BP ≥ 110/65 mm Hg, or 24-hour BP ≥ 125/75 mm Hg. Analyses were stratified by antihypertensive medication use.Results:Among participants not taking antihypertensive medication (mean age 53 years), the prevalence of any MHT was 59.0%, 75.0% and 61.8% for the low (GPSS score ≤ 3), middle (GPSS score 4 - 6), and upper tertiles of the GPSS score (GPSS score > 6), respectively. Among those taking antihypertensive medication (mean age 61 years), the prevalence of any MHT was 77.4%, 80.7%, and 77.9% for participants in the low, middle, and upper tertile of the GPSS score, respectively. After multivariable adjustment, the prevalence ratio (95% confidence interval) for any MHT associated with the middle and upper versus low tertile of the GPSS score was 1.23 (0.96, 1.57) and 1.07 (0.83, 1.39), respectively, among those not taking antihypertensive medication and 0.97 (0.82, 1.14) and 1.02 (0.85, 1.21), respectively, among those taking antihypertensive medication (Table).Conclusion:No association was present between chronic stress and MHT among African Americans in the Jackson Heart Study.

Although 28% to 49% of severe sepsis hospitalizations have been described as being “culture negative,” there are very limited data on the epidemiology and outcomes of those with culture-negative severe sepsis (CNSS). The objectives of this study were to investigate the proportion and trends of CNSS and its association with mortality.

Age is the strongest contributor to 10-year predicted atherosclerotic cardiovascular disease (ASCVD) risk. Some older adults have a predicted ASCVD risk ≥7.5%, without established risk factors. We sought to compare ASCVD incidence among adults with predicted ASCVD risk ≥7.5%, with and without established ASCVD risk factors, to adults with predicted risk <7.5%.

Pyridyloxy-directed Rh(III)-catalyzed regioselective C3Ar–H alkenylation of protected tyrosines was achieved with N-aryl and N-alkyl maleimides, furnishing a series of maleimide-appended tyrosine-based unnatural amino acids in good yields. Further, the late-stage exemplification of the strategy was successfully accomplished on tyrosine-containing dipeptides, tripeptides, and tetrapeptides in moderate reactivity. Also, the chemical applications of the strategy were successfully executed toward nailing tyrosine with other amino acids via a maleimide linker and intramolecular hydroarylation to produce tyrosine-centered stapled products and succinimide-glued macrocyclized products, respectively.