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Introduction Renal scintigraphy (RS) is occasionally performed to assess the risk of persistent renal failure (PRF) in patients with acute kidney disease (AKD). However, its diagnostic performance has never been assessed. Methods We identified all patients with AKD for whom RS was performed in our institution between 2010 and 2017. PRF was defined as persistently low ( Results Among 97 patients included, 57 (59%) fulfilled the criteria for PRF. The PRF score was able to predict PRF with an AUC of 0.63. Similarly, the accumulation index and accumulation slope respective AUCs were 0.64 and 0.63. None of these parameters were able to improve the performance of the clinical model. Among new parameters, the 3rd/2nd minute activity ratio and 3rd/2nd minute activity slope had fair diagnostic performance (AUC 0.72 and 0.74, respectively) and improved the performance of the clinical model. Results were confirmed in sensitivity analyses. Conclusion Conventional renal scintigraphy can identify patients at high risk of PRF with a high specificity but a low sensitivity. New parameters, with comparable diagnostic abilities can be obtained within three minutes of injection. Graphical abstract

IntroductionPrevious studies demonstrated that the implementation of the Kidney Disease Improving Global Outcomes (KDIGO) guideline-based bundle, consisting of different supportive measures in patients at high risk for acute kidney injury (AKI), might reduce rate and severity of AKI after surgery. However, the effects of the care bundle in broader population of patients undergoing surgery require confirmation.Methods and analysisThe BigpAK-2 trial is an international, randomised, controlled, multicentre trial. The trial aims to enrol 1302 patients undergoing major surgery who are subsequently admitted to the intensive care or high dependency unit and are at high-risk for postoperative AKI as identified by urinary biomarkers (tissue inhibitor of metalloproteinases 2*insulin like growth factor binding protein 7 (TIMP-2)*IGFBP7)). Eligible patients will be randomised to receive either standard of care (control) or a KDIGO-based AKI care bundle (intervention). The primary endpoint is the incidence of moderate or severe AKI (stage 2 or 3) within 72 hours after surgery, according to the KDIGO 2012 criteria. Secondary endpoints include adherence to the KDIGO care bundle, occurrence and severity of any stage of AKI, change in biomarker values during 12 hours after initial measurement of (TIMP-2)*(IGFBP7), number of free days of mechanical ventilation and vasopressors, need for renal replacement therapy (RRT), duration of RRT, renal recovery, 30-day and 60-day mortality, intensive care unit length-of-stay and hospital length-of-stay and major adverse kidney events. An add-on study will investigate blood and urine samples from recruited patients for immunological functions and kidney damage.Ethics and disseminationThe BigpAK-2 trial was approved by the Ethics Committee of the Medical Faculty of the University of Münster and subsequently by the corresponding Ethics Committee of the participating sites. A study amendment was approved subsequently. In the UK, the trial was adopted as an NIHR portfolio study. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and will guide patient care and further research.Trial registration numberNCT04647396.

Bioimpedance vector analysis (BIVA) has been suggested as a valuable tool in assessing volume status in critically ill patients. However, its effectiveness in guiding fluid removal by continuous renal replacement therapy (CRRT) has not been evaluated.In this randomized controlled trial, 65 critically ill patients receiving CRRT were allocated on a 1:1 ratio to have UF prescribed and adjusted using BIVA fluid assessment in the intervention group (32 patients) or conventional clinical parameters (33 patients). The primary outcome was the lean body mass (LBM) water content at CRRT discontinuation, and the secondary outcomes included the mortality rate, urinary output, the duration of ventilation support, and ICU stay.The study group was associated with a lower water content of LBM (80.7 ± 9.4 vs. 85.9 ± 10.4%; p0.05), and a higher mean UF-rate and urinary output (1.5 ± 0.8 vs. 1.2 ± 0.5 ml/kg/h and 0.9 ± 0.9 vs 0.5 ± 0.6 ml/kg/h, both: p0.05). The mortality rate, the length of ICU stay, and ventilation support duration were similar.BIVA guided UF prescription may be associated with a lower rate of fluid overload. Larger studies are required to evaluate its impact on patients' outcomes.

HBM4EU chromates study team: Kukka Aimonen8, Guillaume Antoine1, Rob Anzion9, Manuella Burgart1, Andrea Cattaneo11, Domenico M. Cavallo11, Alcina Costa12, Giuseppe De Palma13, Flavien Denis1, Giovanni Forte3, Angela Gambelunghe14, Ogier Hanser1, Carina Ladeira15, Elisabeth Leese16, Risto Lehtinen8, Henriqueta Louro7 Piero Lovreglio17, Nicole Majery18, Philippe Marsan1, Mathieu Melczer1, Armandida Miranda12, Edna Ribeiro15, Françoise Schaefers4, Marta Senofonte3, Filomena Seuanes12, Maurice van Dael9, Riitta Velin8 1French National Research and Safety Institute, Vandoeuvre-les-Nancy, France 2Department of Public Health, University of Naples Federico II, Naples, Italy 3 Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy 4Department of Health Protection, Laboratoire National de Santé (LNS), Dudelange, Luxembourg 5Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven (University of Leuven), Kapucijnenvoer 35, 3000, Leuven, Belgium 6Nofer Institute of Occupational Medicine, Lodz, Poland 7National Institute of Health Dr. Ricardo Jorge, Department of Human Genetics and Environmental Health Lisbon, Portugal 8Finnish Institute of Occupational Health, Helsinki, Finland 9Radboud Institute for Health Sciences, Radboudumc, Nijmegen, the Netherlands 10NOVA NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600–560 Lisbon, Portugal; Comprehensive Health Research Center (CHRC), 1169–056 Lisbon, Portugal. 11Department of Science and High Technology, University of Insubria, Como, Italy 12National Institute of Health Dr. Ricardo Jorge, Department of Health Promotion, Lisbon, Portugal 13Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy 14Departement of Medicine and Surgery, University of Perugia, Perugia, Italy 15H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa; Comprehensive Health Research Center (CHRC), 1169–056 Lisbon, Portugal 16Health and Safety Executive, Buxton, SK17 9JN, United Kingdom 17Interdisciplinary Departement of Medecine, University of Bari, Bari, Italy 18Service de Santé Au Travail Multisectoriel (STM), Luxembourg Occupational exposures to hexavalent Chromium (Cr(VI)) can occur in welding, hot working stainless steel processing, chrome plating, spray painting and coating activities. Recently, within the human biomonitoring for Europe initiative (HBM4EU), a study was performed to assess the suitability of different biomarkers to assess the exposure to Cr(VI) in various job tasks. Blood-based biomarkers may prove useful when more specific infor-mation on systemic and intracellular bioavailability is necessary. To this aim, concentrations of Cr in red blood cells (RBC-Cr) and in plasma (P–Cr) were analyzed in 345 Cr(VI) exposed workers and 175 controls to understand how these biomarkers may be affected by variable levels of exposure and job procedures. Compared to controls, significantly higher RBC-Cr levels were observed in bath plating and paint application workers, but not in welders, while all the 3 groups had significantly greater P–Cr concentrations. RBC-Cr and P–Cr in chrome platers showed a high correlation with Cr(VI) in inhalable dust, outside respiratory protective equipment (RPE), while such correlation could not be determined in welders. In platers, the use of RPE had a significant impact on the relationship between blood biomarkers and Cr(VI) in inhalable and respirable dust. Low correlations between P–Cr and RBC-Cr may reflect a difference in kinetics. This study showed that Cr-blood-based biomarkers can provide information on how workplace exposure translates into systemic availability of Cr(III) (extracellular, P–Cr) and Cr(VI) (intracellular, RBC-Cr). Further studies are needed to fully appreciate their use in an occupational health and safety context. Highlights: Suitability of blood biomarkers was evaluated to assess occupational Cr(VI)exposure; Bath platers and painters had higher Red Blood Cells-Cr levels compared to controls; Bath platers, painters and welders had higher plasma-Cr levels compared to controls; Red Blood Cells- and Plasma-Cr were highly correlated with inhalable Cr(VI) in platers; Blood-Cr biomarkers can provide information on systemic and intracellular availability. This work has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No 733032 and received co-funding from the author’s organizations and/or Ministries. Luxembourg entered the study at a later stage and thus financed the study at its own means. info:eu-repo/semantics/publishedVersion

Situation-Background-Assessment-Recommendation (SBAR) is a tool for structuring communication between healthcare professionals. SBAR reduces medical errors, however few studies have evaluated its quality in real practice.To describe the quality of SBAR utilization by intensive care unit (ICU) nurses during phone conversations with physicians. To assess the influence of nurses' training, professional experience, and call circumstances on this quality.This observational study was conducted in the adult ICU of a university hospital in French speaking Switzerland. All consecutive telephone calls from nurses to physicians during a calendar month, were recorded. Those related to a change in patients' clinical status were selected and analysed. The quality of SBAR utilization was assessed using a pre-defined analysis grid. Scores ranged from 0 (worst quality) to 100% (best quality). Nurses' sociodemographics and training record were collected. Multiple regression was used to assess determinants of SBAR quality including nurses characteristics and level of training.We analysed 290 phone calls, made by 99 nurses. The median SBAR quality score was 41% (interquartile range [IQR] 33-48). Quality scores varied across the four items of SBAR: Situation 88% (81-94), Background 17% (6-27), Assessment 17% (0-33), and Recommendation 33% (17-40). Factors independently associated with higher SBAR quality were age (-0.66%, p = .002, 95% CI [-1.07; -0.25]), primary language other than French (-8.40%, p = .017, 95% CI [-15.29; -1.51]), lack of ICU expertise (-9.25%, p = .013, 95% CI [-16.5;1-1.99]), and SBAR training in pre-graduate nursing education (+11.53%, p = .028, 95% CI [1.27; 22.79]).The quality of SBAR utilization remains low in ICU clinical practice. Pre- and post-graduate training seem to improve its quality.Pre-graduate mandatory training associated with multiple repetitions could improve nurses' SBAR utilization. Training using the SBAR tool should be combined with the development of nursing skills in assessment and clinical judgment.

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Madelung's deformity is a rare congenital condition of the wrist that can cause pain, aesthetic concerns, reduced range of motion and grip strength. Currently, there is no consensus on the optimal age for surgery or whether operative procedures can be isolated or combined depending on the extent of the deformity. The main objective of our study was to analyze the postoperative functional clinical results at a minimum of 3-years follow-up in patients operated on for Madelung's deformity. The secondary objectives were (1) comparison of preoperative and postoperative radiographic parameters, and (2) to assess whether certain preoperative radiographic parameters influence the choice of surgical procedure.The surgery offered at our center achieves clinical and radiological result necessary for long-term activities of daily living, and varies according to the severity of the distal radial deformity.We carried out a retrospective observational monocentric study including patients operated on between 2004 and 2016. Clinical (VAS, mobility), functional (PRWE score), and radiographic assessments were performed before and after the last follow-up.The study included 11 patients (12 wrists) with a mean age of 17±7.3 years and a mean follow-up of 8.1 years (4-12.3). The mean VAS was 2.3 (0-6) and the mean PRWE score was 37 (0-108). The mean flexion-extension arc was 134° and that of pronation and supination was 142°. The mean grip strength was 25.8±11.8kg. Four out of 6 radiographic criteria were significantly improved. An isolated radial osteotomy or combined radioulnar osteotomy was performed when the sagittal radial tilt was greater than 30° and protrusion of the lunate greater than 5mm, otherwise below these values, an isolated ulnar osteotomy was performed.Our center offers surgical management of Madelung's deformity by osteotomy which improves the majority of postoperative radiographic parameters and gives satisfactory clinical and radiographic results after a mean follow-up of 8.1 years. The surgery is influenced by the severity of the distal radial deformity, including protrusion of the lunate and sagittal radial tilt.IV, Retrospective study.

This volume is the first book-length presentation of the relatively newly established grammatical category of Associated Motion. It provides a framework for understanding a grammatical phenomenon which, though present in many languages, has gone unrecognised until recently. Previously known mainly from languages of Australia and South America, grammatical AM marking has now been identified in languages from most parts of the world (except Europe) and is becoming an important topic of linguistic typology. The 22 chapters provide a thorough introduction to the subject, discussion of the relation between AM and related grammatical concepts, detailed descriptions of AM in a wide range of the world’s languages, and surveys of AM in particular language families and areas. All of the studies are richly illustrated by means of approximately 2000) example sentences.

Pictures and video stimuli help investigate specific semantic domains and/or grammatical categories. Such stimuli not only help to collect more occurrences of a given (possibly rare) morpheme in a semi-spontaneous setting, but also allow the study of variation across speakers and diversity across languages. The paper describes a stimulus in the form of a storybook, A Hunting Story, specifically conceived to elicit associated motion (AM) morphemes in Ese Ejja, an Amazonian language with a complex system of 14 such morphemes. The pictures of the storybook therefore represent an Amazonian setting, and the scenario incorporates the main parameters established in the AM literature (such as path/directionality, temporal relation, moving argument), as well as less frequent ones (such as aspectual realization). The paper describes the data collected from 14 speakers of Ese Ejja as well as data collected with the same stimulus in other languages, including languages with no morphological AM system.