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BACKGROUND: The ventilatory ratio (VR) is a dead-space marker associated with mortality in mechanically ventilated adults with ARDS. The end-tidal alveolar dead space fraction (AVDSf) has been associated with mortality in children. However, AVDSf requires capnography measurements, whereas VR does not. We sought to examine the prognostic value of VR, in comparison to AVDSf, in children and young adults with acute hypoxemic respiratory failure. METHODS: We conducted a retrospective study of prospectively collected data from 180 mechanically ventilated children and young adults with acute hypoxemic respiratory failure. VR was calculated as (minute ventilation x PaCO2)/(age-adjusted predicted minute ventilation x 37.5). AVDSf was calculated as (PaCO2 -- PETCO2)/PaCO2. RESULTS: VR and AVDSf had a moderate correlation (rho 0.31, P < .001). VR was similar between survivors at 1.22 (interquartile range [IQR] 1.0-1.52) and nonsurvivors at 1.30 (IQR 0.96-1.95) (P = .2). AVDSf was lower in survivors at 0.12 (IQR 0.03-0.23) than nonsurvivors at 0.24 (IQR 0.13-0.33) (P < .001). In logistic regression and competing risk regression analyses, VR was not associated with mortality or rate of extubation at any given time (competing risk death; all P > .3). An AVDSf in the highest 2 quartiles, in comparison to the lowest quartile (AVDSf < 0.06), was associated with higher mortality after adjustment for oxygenation index and severity of illness (AVDSf ≥ 0.15-0.26: odds ratio 3.58, 95% CI 1.02-12.64, P = .047, and AVDSf ≥ 0.26: odds ratio 3.91 95% CI-1.03-14.83, P = .045). At any given time after intubation, a child with an AVDSf ≥ 0.26 was less likely to be extubated than a child with an AVDSf < 0.06, after adjustment for oxygenation index and severity of illness (AVDSf ≥ 0.26: subdistribution hazard ratio 0.55, 95% CI 0.33-0.94, P = .03). CONCLUSIONS: VR should not be used for prognostic purposes in children and young adults. AVDSf added prognostic information to the severity of oxygenation defect and overall severity of illness in children and young adults, consistent with previous research. [ABSTRACT FROM AUTHOR]

B Learning Objectives: b Acute kidney injury (AKI) adversely affects patient outcomes in the pediatric intensive care unit (PICU). When the risk threshold was adjusted to have equal false positive and false negative rates, and tested 48 hours before KDIGO detection, the Stage 2/3 model could identify 71 out of 105 Stage 2/3 patients in Hospital 1, and 13 out of 17 Stage 2/3 patients in Hospital 2. B Conclusions: b The pediatric AKI algorithm can predict the onset of AKI before KDIGO staging is possible, allowing extra intervention time of up to 48 hours. [Extracted from the article]

Gardenia jasminoides J.Ellis, a well-known traditional Chinese medicine, has been widely used in Asian countries for centuries. This study presented the skin barrier repair efficacy and safety evaluation of an extract from G. jasminoides . The results showed that GarPepair was primarily composed of geniposide and genipin-1- β -D-gentiobioside with concentrations of 3.39 and 1.03 mg/mL, respectively. GarPepair (1.25%, w / w ), geniposide (50 μg/mL), and genipin-1- β -D-gentiobioside (50 μg/mL) showed no cytotoxicity but could significantly up-regulate mRNA level (82.5%, 54.4%, and 99.4%, respectively) and protein expression (68.7%, 57.1%, and 92.6%, respectively) of ZO-1 in HaCat cells induced by lipopolysaccharide. Moreover, GarPepair showed low acute toxicity on zebrafish with an IC 50 value of 5.91% ( w / w ), indicating that GarPepair had high safety. In summary, we can conclude that GarPepair and its active ingredients (geniposide and genipin-1- β -D-gentiobioside) had significant skin barrier repair efficacy with high safety, making it suitable for use as an active substance in cosmetics.