Acute kidney injury (AKI) is a common critical illness in clinical practice, with complex etiologies, acute onset, and rapid progression. It not only significantly increases the mortality rate of patients, but also may progress to chronic kidney disease. Currently, its incidence remains high, and improving early diagnosis rate and treatment efficacy is a major clinical challenge. Artificial intelligence (AI), with its powerful data processing and analysis capabilities, is developing rapidly in medical field, providing new ideas for disease diagnosis and treatment, and showing great potential in revolutionizing the early diagnosis, condition assessment, and treatment decision-making models in the AKI field. This article will review the application progress of AI in AKI prediction, condition assessment, and treatment decision-making, so as to provide references for clinicians and promote the further application and development of AI in the AKI field.
Chronic kidney disease (CKD) has been highlighted as one of the most important public health problems due to sharply climbing incidence and prevalence. To efficiently attenuate the disease burden and improve the disease management, not only active and effective treatment should be administrated, but also comprehensive follow-up nursing management with innovative and evolving spirits should be implemented. Thus dynamic changes of diseases could be acquired in time and patients are under appropriate medical instruction as soon as possible. This editorial is based on quickly developing medical big data resources and advanced internet techniques, from both aspects of patients and health care providers, briefly talking about integrated management strategy of CKD and its future development in China.
目的:觀察抗菌素聯合療法結合BMP紅外光治療宮頸糜爛的療效和作用機理。方法:用抗菌素職合療法結合BMP紅外光治療宮頸糜爛92例與83例單用BMP紅外光作對比。結果:治療組痊愈率97.83%,對照組為73.49%,兩組比較有顯著性差異(Plt;0.005)。治療組副反應明顯低于對照組,創面愈合時間與對照組比較有顯著性差異(Plt;0.005)。結論:抗菌素聯合治療法結合BMP紅外光治療宮頸糜爛能提高治愈率,減少副反應,加速創面愈合。
Patients undergoing maintenance hemodialysis are characterized with lower cardiorespiratory capacity and muscle atrophy, thus easily leading to a sedentary lifestyle. These patients are usually associated with lower quality of life and worse prognosis. Evidence indicates appropriate exercise rehabilitation plan could help maintenance hemodialysis patients achieve better health outcomes. However, there is still a lack of evidence data to precisely recommend exercise type, intensity, frequency and timing specially designed for maintenance hemodialysis patients. This article aims to summarize the existing expert consensus on exercise rehabilitation for maintenance hemodialysis patients, important considerations in the implementation process, factors that affect exercise rehabilitation, with a view to encouraging maintenance hemodialysis patients to participate in the development of appropriate exercise rehabilitation plan and maximize health benefits.
Sepsis is a common clinical critical illness, which often leads to multiple organ damage including the kidney damage, which is difficult to treat and has a high mortality rate. In recent years, extracorporeal blood purification therapy has made some progress in the field of sepsis. There are a variety of blood purification modes to choose, but there is still no unified standard for the initiation timing of blood purification therapy. Clinicians mainly evaluate the indicators and the initiation timing of blood purification therapy according to the patient’s needs for renal function replacement and/or inflammatory mediator clearance. This article mainly summarizes and discusses the initiation timing of blood purification therapy in sepsis.
Blood purification, as a critical medical intervention for renal function replacement, metabolic waste clearance, and homeostasis maintenance, relies heavily on the optimization of therapeutic solutions to ensure clinical efficacy. In recent years, significant advancements have been made in the formulation design, biocompatibility, and clinical outcomes of blood purification solutions, driven by progress in clinical medicine and biomedical engineering. This article systematically elaborates on the latest research developments in key therapeutic solutions, including continuous renal replacement therapy replacement fluids, hemodialysis dialysate, hemodialysis catheter lock solutions, and peritoneal dialysate. By synthesizing current evidence, the aim is to offer scientific guidance for clinicians in selecting optimal treatment regimens while exploring future directions and emerging trends in the development of blood purification solutions.
ObjectiveTo compare dialysis catheter function and complications according to catheter site in patients undergoing hemopurification.MethodsLiteratures were searched from PubMed, Medline, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Data, and VIP Database according to the inclusion and exclusion criteria. Publication years of these literatures ranged from April 1998 to April 2018. Meta-analysis was performed with RevMan 5.3 software. The odds ratio (OR) and 95% confidence intervals (CI) were calculated for uncontinuous outcomes, and the weighted mean difference (WMD) and 95%CI were calculated for continuous outcomes. The incidence of catheter related infection, other complications and patients outcome were compared between different sites for dialysis vascular access.ResultsA total of 9 articles were included, including 2 randomized controlled trials and 7 observational clinical studies, and 5 220 adult patients undergoing renal replacement therapy. Meta-analysis showed that there was no significant difference in incidences of catheter colonization or catheter-related bloodstream infection, as well as arterial puncture, local thrombosis, catheter dysfunction and spontaneous catheter withdrawal, between femoral and non-femoral (jugular or subclavian) catheterization (P≥0.05). Whereas the incidence of bleeding and local hematoma was lower in femoral catheterization [OR=0.44, 95%CI (0.23, 0.82), P=0.009], and the duration of catheters was shorter in femoral catheterization [WMD=–1.40 d, 95%CI (–2.17, –0.62) d, P=0.000 4]. The blood flow rate, filters clotting incidence and patients intensive case unit mortality were similar in different catheterization.ConclusionsIn patients undergoing renal replacement therapy, the bleeding and local hematoma incidence is lower in femoral catheterization but the duration of catheters is shorter. Nevertheless the patients have similar clinical outcome. This result may provide reference for clinical decision-making.
In 2017, the Acute Dialysis Quality Initiative (ADQI) Consensus Group released a series of guidelines on the topic of "Precision Continuous Renal Replacement Therapy (CRRT)". The updated content in this guideline included four parts: patient selection and timing of CRRT, precision CRRT and solute control, precision fluid management in CRRT, and role of technology for the management of AKI in critically ill patients. This review will interpret the 2017 ADQI guidelines update in detail.
The presence of thrombus on the surface of blood-contacting biomaterials in clinical practice can significantly impact both the longevity of the biomaterials and the overall survival prognosis of patients. The administration of anticoagulant and antiplatelet medications may heighten the risk of systemic bleeding. Developing biomaterials with anti-thrombogenetic properties and enabling localized anti-thrombosis may offer a solution to these challenges. The development strategies for anti-thrombogenetic biomaterials can be categorized into three main approaches based on the mechanisms of thrombus formation on biomaterial surfaces: altering physical and chemical properties, designing coatings containing or releasing active substances, and promoting endothelialization. However, due to the intricate and interconnected nature of these mechanisms, biomaterials constructed using a single approach may not effectively prevent thrombus formation. The collaborative intervention of various mechanisms can facilitate the development of biomaterials with enhanced blood compatibility.