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Severe pneumonia is a crucial issue in the development of acute kidney injury (AKI). This study evaluated the efficacy of early goal-directed renal replacement therapy (GDRRT) for the treatment of severe pneumonia-associated AKI. In this real-world retrospective cohort study, we recruited 180 patients with severe pneumonia who were hospitalized and received GDRRT in a third-class general hospital in East China between January 1, 2017, and December 31, 2021. Clinical data on baseline characteristics, biochemical indicators, and renal replacement therapy were collected. Patients were divided into Early and Late RRT groups according to fluid status, inflammation progression, and pulmonary radiology. We investigated in-hospital all-cause mortality (primary endpoint) and renal recovery (secondary endpoint) between the two groups. Among the 154 recruited patients, 80 and 74 were in the early and late RRT groups, respectively. There were no significant differences in the demographic characteristics between the two groups. The duration of admission to RRT initiation was significantly shorter in Early RRT group [2.5(1.0, 8.7) d vs. 5.0(1.5,13.5) d, p = 0.027]. At RRT initiation, the patients in the Early RRT group displayed a lower percentage of fluid overload, lower doses of vasoactive agents, higher CRP levels, and higher rates of radiographic progression than those in the Late RRT group. The all-cause in-hospital mortality was significantly lower in the Early RRT group than in Late group (52.5% vs. 86.5%, p < 0.001). Patients in the Early RRT group displayed a significantly higher proportion of complete renal recovery at discharge (40.0% vs. 8.1%, p < 0.001). This study clarified that early GDRRT for the treatment of severe pneumonia-associated AKI based on fluid status and inflammation progression, was associated with reduced hospital mortality and better recovery of renal function. Our preliminary study suggests that early initiation of RRT may be an effective approach for severe pneumonia-associated AKI. [ABSTRACT FROM AUTHOR]

The autonomous vehicle consists of perception, decision-making, and control system. The study of path planning method has always been a core and difficult problem, especially in complex environment, due to the effect of dynamic environment, the safety, smoothness, and real-time requirement, and the nonholonomic constraints of vehicle. To address the problem of travelling in complex environments which consists of lots of obstacles, a two-layered path planning model is presented in this paper. This method includes a high-level model that produces a rough path and a low-level model that provides precise navigation. In the high-level model, the improved Bidirectional Rapidly-exploring Random Tree (Bi-RRT) based on the steering constraint is used to generate an obstacle-free path while satisfying the nonholonomic constraints of vehicle. In low-level model, a Vector Field Histogram- (VFH-) guided polynomial planning algorithm in Frenet coordinates is introduced. Based on the result of VFH, the aim point chosen from improved Bi-RRT path is moved to the most suitable location on the basis of evaluation function. By applying quintic polynomial in Frenet coordinates, a real-time local path that is safe and smooth is generated based on the improved Bi-RRT path. To verify the effectiveness of the proposed planning model, the real autonomous vehicle has been placed in several driving scenarios with different amounts of obstacles. The two-layered real-time planning model produces flexible, smooth, and safe paths that enable the vehicle to travel in complex environment., Author(s): Jiajia Chen [1]; Rui Zhang [1]; Wei Han [1]; Wuhua Jiang [1]; Jinfang Hu [1]; Xiaoshan Lu [1]; Xingtao Liu [1]; Pan Zhao (corresponding author) [2] 1. Introduction Nowadays, [...]

Introduction: Cardiac surgery-associated acute kidney injury (CSA-AKI) is one of the most prevalent complications of cardiac surgery, while the renal and overall prognoses of chronic kidney disease (CKD) patients with CSA-AKI are extremely poor. However, there is little published information on the occurrence of CSA-AKI in patients with CKD. The purpose of this study was to investigate the risk factors and prognostic factors of cardiac surgery-related AKI in patients with CKD. Methods: A retrospective study was performed on CKD patients who underwent cardiac surgery at a tertiary referral teaching hospital. CSA-AKI was defined based on the KDIGO criteria. The risk factors for CSA-AKI and the factors affecting renal function recovery at discharge or death in patients with AKI were investigated. Results: Among 1638 CKD patients enrolled, the incidence of CSA-AKI was 50.55%. AKI patients' in-hospital mortality was higher than patients without AKI (AKI vs. no AKI, 4.7 vs. 0.9%, p < 0.001). Multivariate logistic regression analysis showed that male (odds ratio [OR] 1.479), preoperative hypertension (OR 1.548), preoperative hemoglobin <110 g/L (OR 2.389), and aortic clamping time >58 min (OR 1.567) were independent risk factors for AKI after cardiac surgery in patients with CKD. Factors affecting renal function recovery of AKI patients included preoperative diabetes mellitus (OR 0.306), hyperchloremia (OR 0.927), estimate of the glomerular filtration rate (OR 1.034), and AKI progression. Compared with patients with AKI stage 1, the rate of renal function recovery in patients with AKI stage 2 and stage 3 was reduced by 78.9% and 82.3%, respectively. Conclusions: In the population of patients with CKD, the incidence of CSA-AKI was high, which significantly affected renal and overall prognosis. The prompt intervention of modifiable factors may help improve the prognosis of patients with CKD. [ABSTRACT FROM AUTHOR]