Incidence Of Injury Research Articles

Annual incidence and prevalence of injuries in elite male academy cricketers: A 4-year prospective cohort study

ObjectivesThe aim of this study was to describe the epidemiology of injuries; time-loss and non-time loss, in elite male academy cricket. DesignProspective cohort analysis. MethodsAnnual injury incidence and prevalence from all cricket related injuries were calculated for 348 male academy players (under-13 to under-18) from the 18 First-Class County Cricket clubs in England and Wales across four years (2017/18, 2018/19, 2020/21 and 2021/22), in accordance with the updated consensus statement for injury surveillance methods in cricket. ResultsThe average annual injury incidence was 115.0 injuries/100 players/year, with similar rates between time-loss (59.7 injuries/100 players/year) and non-time loss injury incidence (55.3 injuries/100 players/year). On average, 8.5 ​% of players were unavailable on any given day of the year due to injury. Match injury incidence (48.8 injuries/100 players/year) was higher than cricket-based training (25.2 injuries/100 players/year), gym-based training, illness, and ‘other’ injury incidences. Match bowling was the activity associated with the highest total (17.7 injuries/100 players/year), time-loss (10.3 injuries/100 players/year) and non-time loss (7.4 injuries/100 players/year) injury incidence. The lumbar spine was the body location most frequently injured (15.3 injuries/100 players/year) and was the most prevalent body location injured (2.9 ​% of players). ConclusionsThe findings from this study provide, robust evidence of the extent of the injury problem in elite male academy cricketers. Bowling poses the greatest risk to players and the lumbar spine is the most common and prevalent injury location.

Incidence of contrast-associated acute kidney injury: a prospective cohort.

Contrast-associated acute kidney injury (CA-AKI) is a deterioration of kidney function that occurs after the administration of a iodinated contrast medium (ICM). Most studies that defined this phenomenon used older ICMs that were more prone of causing CA-AKI. In the past decade, several articles questioned the true incidence of CA-AKI. However, there is still a paucity of a data about the safety of newer ICM. To assess the incidence of CA-AKI in hospitalized patients that were exposed to computed tomography (CT) with and without ICM. Prospective cohort study with 1003 patients who underwent CT in a tertiary hospital from December 2020 through March 2021. All inpatients aged > 18 years who had a CT scan during this period were screened for the study. CA-AKI was defined as a relative increase of serum creatinine of ≥ 50% from baseline or an absolute increase of ≥ 0.3 mg/dL within 18 to 48 hours after the CT. Chi-squared test, Kruskal-Wallis test, and linear regression model with restricted cubic splines were used for statistical analyses. The incidence of CA-AKI was 10.1% in the ICM-exposed group and 12.4% in the control group when using the absolute increase criterion. The creatinine variation from baseline was not significantly different between groups. After adjusting for baseline factors, contrast use did not correlate with worse renal function. The rate of CA-AKI is very low, if present at all, with newer ICMs, and excessive caution regarding contrast use is probably unwarranted.

Incidence and risk factors of acute kidney injury after transcatheter aorticvalve replacement.

Acute kidney injury (AKI) is a common early complication secondary to transcatheter aortic valve replacement (TAVR). Studies on the incidence and risk factors for AKI after TAVR surgery are limited to date. Here, we retrospectively analyzed the incidence and risk factors for AKI after TAVR surgery in our hospital. Patients who underwent TAVR surgery at our hospital from November 2017 to February 2023 were selected. AKI was defined using the 2012 KDIGO definition and staging criteria. The relevant data and information between the AKI group and the non-AKI group were compared and analyzed, and a binary logistic regression model was used to analyze the risk factors for AKI. A total of 75 patients who underwent TAVR surgery were included in the retrospective analysis. After TAVR, the incidence of AKI was 17.3% (13/75), of which 8 (61.5%) had stage 1 AKI, 2 (15.4%) had stage 2 AKI, 3 (23.1%) had stage 3 AKI, and 3 needed renal replacement therapy. After multivariate logistic analysis, contrast volume (OR = 1.024 (1.001, 1.047)) was found to be an independent risk factor for AKI, while patients with high estimated glomerular filtration rate (eGFR) (OR = 0.903 (0.826, 0.986)) have a reduced risk of AKI. A retrospective study revealed a 17.3% incidence of AKI after TAVR surgery in our hospital, most of which were stage 1 AKI. A low preoperative eGFR and contrast volume were found to be independent risk factors for AKI.

Reframing acute kidney injury as a pathophysiological continuum of disrupted renal excretory function.

Surrogate measures of glomerular filtration rate (GFR) continue to serve as pivotal determinants of the incidence, severity, and management of acute kidney injury (AKI), as well as the primary reference point underpinning knowledge of its pathophysiology. However, several clinically important deficits in aspects of renal excretory function during AKI other than GFR decline, including acid-base regulation, electrolyte and water balance, and urinary concentrating capacity, can evade detection when diagnostic criteria are built around purely GFR-based assessments. The use of putative markers of tubular injury to detect "sub-clinical" AKI has been proposed to expand the definition and diagnostic criteria for AKI, but their diagnostic performance is curtailed by ambiguity with respect to their biological meaning and context specificity. Efforts to devise new holistic assessments of overall renal functional compromise in AKI would foster the capacity to better personalize patient care by replacing biomarker threshold-based diagnostic criteria with a shift to assessment of compromise along a pathophysiological continuum. The term AKI refers to a syndrome of sudden renal deterioration, the severity of which is classified by precise diagnostic criteria that have unquestionable utility in patient management as well as blatant limitations. Particularly, the absence of an explicit pathophysiological definition of AKI curtails further scientific development and clinical handling, entrapping the field within its present narrow GFR-based view. A refreshed approach based on a more holistic consideration of renal functional impairment in AKI as the basis for a new diagnostic concept that reaches beyond the boundaries imposed by the current GFR threshold-based classification of AKI, capturing broader aspects of pathogenesis, could enhance AKI prevention strategies and improve AKI patient outcome and prognosis.

What are the risk factors of injury for a rowing athlete?

The aim of this study was to examine the specific characteristics of injuries (injury location, injury type, and time to return to sports) based on sex and rowing style. We included 60 adolescent rowers (Sweep male and female, 12 respectively; Sculling male and female, 18 respectively) who underwent training in Korea from January to December 2023. Sports injuries were meticulously recorded using the Daily Injury Report form issued by the International Olympic Committee for rowers characteristics (sex, rowing style) and injury characteristics (injury location, injury type). The injury incidence rate (IIR) per 1000 h of training was calculated using the 95% Poisson Confidence Interval. A χ2 test was performed to compare the characteristics of the rowers and injury characteristics. The overall IIR was 4.25 injuries per 1000 training hours. The IIR was lower for men than for women (P<0.001). However, sweep and sculling were similar (P=0.269). There was a difference in the affected body regions according to the sex and rowing style (P=0.028, P=0.005; respectively). Time to return to sports varied between rowing styles (P=0.049) and sexes (P=0.033), and it also differed in sweep (P=0.002) and sculling (P=0.045) depending on body regions. These results should be incorporated into programs that are aimed at improving the performance of these rowers and preventing sports injuries. In addition, can be used as data to determine their return to sport.

The Injury Risk Prediction of Firefighters with Biomechanical Parameters during Single- and Double-Leg Jumps

The incidence of knee injuries during firefighter training is high, but there is a lack of research on predictive factors and risk assessment for such injuries. Biomechanical assessments can provide a better understanding of how the body’s load changes during exercise, which may alter the risk of injury. Ten firefighters were recruited for our study. Each participant completed the FMS test and the single- and double-leg jump tasks. Motion information was collected and musculoskeletal models of the participants were constructed using OpenSim 4.4 to obtain the joint angle and joint moment. The peak GRF and CoM-CoP angle were also calculated. The findings showed a significantly larger PKFM (p = 0.0195), VAFM (p = 0.0039), and peak AP GRF (p = 0.0039) during the single-leg jump. The opposite performance was observed for KFA (p = 0.0098) and MPA (p = 0.0273). A stepwise multiple linear regression analysis was used to explore the relationship between these parameters and both the FMS score and the times of injuries. The risk of injury is higher in the single-leg jump compared to the double-leg jump. The biomechanical parameters of these two jumps can be used to assess sports injuries and to provide methods and references for injury risk monitoring during firefighter occupational training.

FAST and Furious About Quality: Impact of Continuous Review and Feedback on Point-of-Care Ultrasound Examinations.

Background: Focused Assessment with Sonography in Trauma (FAST) examination is a point-of-care ultrasound study used to evaluate for abdominal hemorrhage, pneumothorax, or pericardial blood in trauma patients as an adjunct to their initial assessment. The quality of the image can be limited, and its diagnostic value is heavily dependent on operator skill. Our objective was to determine whether a standardized review process improved image quality and reduced incidence of nondiagnostic or insufficient imaging by 10% over a 6-month period. Study Design: Between July 1, 2021, and March 31, 2022, we evaluated 1106 trauma activations at our level II trauma center. Two exams per practitioner per month were reviewed by an emergency medicine trained traumatologist with specialized training in point-of-care ultrasound and board certification in echocardiography. Priority was given to exams on patients with known injuries identified on other studies. If there were no exams that matched these criteria, random exams were selected. Images were reviewed for image quality, diagnostic accuracy, and labeling with counseling given to the provider if indicated. Categorical variables were compared using chi squared analysis, while continuous non-normally distributed variables were compared using the Mann-Whitney U test. Results: A total of 305 FAST exams were reviewed (186 pre-intervention and 119 during intervention). Image quality improved from 46.3% (n = 31/65) to 79.0% (n = 94/119) (P < .01) with need for counseling falling from 63.1% (n = 41/65) pre-QI to 42.0% (n = 50/119) post-QI (P < .01). Incidence of detectable injury, BMI, ISS, and AIS body regions were consistent across the study period. This was seen in both the geriatric and non-geriatric cohorts despite a significant increase in ISS in the post-intervention geriatric patients.Discussion: A FAST review program is associated with improvement in image quality and decreased need for counseling of trauma providers.

Characterization and clinical significance of hemolysis after pulsed-field ablation for atrial fibrillation: insights from a multicentric analysis

Abstract Background Pulsed-field ablation is a novel non-thermal ablation modality which is being increasingly used in clinical practice for the treatment of atrial fibrillation (AF). While the susceptibility of erythrocytes to electroporation is well-established, the effect of cardiac PFA technologies on erythrocyte destruction has not been described so far. Purpose The aim of this study was to investigate whether PFA induces clinically significant hemolysis. Methods We included 187 patients undergoing AF catheter ablation with either PFA (n=145) or RFA (n=42) at four high-volume centers. PFA was performed using a pentaspline catheter (biphasic, bipolar pulses of 2kV) and RFA with a 3.5 mm irrigated-tip catheter (40-60 W). The lesion set comprised pulmonary vein isolation (PVI) for paroxysmal AF and PVI ± additional lesions/lines for persistent AF. Established biomarkers of hemolysis, anemia and renal function were analyzed in blood samples obtained at baseline (T1), at the end of ablation (T2) and 24 hours after the procedure (T3). Results Baseline characteristics were well-balanced between groups (65.5 ± 9.6 years, 72.7% male, p&amp;gt;0.05). The ablation procedures comprised a mean of 61.4 ± 27.2 deliveries (PFA group) and a mean RF duration of 31.0 ± 16.3 min (RFA group). Atrial ablation in addition to PVI was performed in 55.2% vs. 61.9% patients, respectively (p=0.469). The direct hemolysis marker free plasma hemoglobin was significantly higher with PFA (592.8 ± 330.6 mg/dl) than with RFA (186.6 ± 215.8 mg/dl, p&amp;lt;0.001) at the end of ablation. A strong correlation was found between free plasma hemoglobin and PFA deliveries (Pearson r=0.615, p&amp;lt;0.001). PFA was further associated with a 2.2-fold increase in bilirubin (21.3 ± 11.3 vs. 9.6 ± 4.7 µmol/l), a 2.4-fold decrease in haptoglobin (0.5 ± 0.4 vs. 1.2 ± 0.4 g/l) and a 1.8-fold increase in LDH (352.7 ± 115.7 vs. 192.2 ± 51.6 U/l, T3 vs. T1, all p&amp;lt;0.001). There were no significant changes in bilirubin and haptoglobin in the RFA group (p&amp;gt;0.05). A slight decrease in red blood cells, hemoglobin and hematocrit was detected after both PFA and RFA (Abstract Figure), with no significant differences between groups (all p&amp;gt;0.05). While mean creatinine levels and glomerular filtration rates did not significantly change after ablation in either group, acute kidney injury occurred in 4/124 (3.2%) with PFA vs. 0/32 (0%) with RFA (p=0.303). Conclusion Intravascular hemolysis is a frequent finding after PFA for AF and increases with the number of PFA deliveries. While PFA was not associated with clinically significant anemia, the incidence of acute kidney injury in the present study warrants future large-scale investigations assessing the biological impact and nephrotoxicity of PFA-induced hemolysis.Abstract Figure

Efficacy of neuromuscular exercises to promote movement quality and reduce musculoskeletal injury during initial military training in Royal Navy recruits

IntroductionMusculoskeletal injuries (MSKIs) are a significant problem in the Royal Navy, contributing to 48% of all medical discharges from service between 2019 and 2020. The objective of the study was...

#1505 Late-onset lupus nephritis: clinical-epidemiological, histological, prognostic and therapeutical implications: a single center experience

Abstract Background and Aims Systemic lupus erythematosus (SLE), a chronic autoimmune disease, and lupus nephritis (LN), are typically diagnosed in women in fertile age. Late-onset SLE is defined as a disease onset over 50 years. Our main objective was to analyze the clinical, histological, prognostic and therapeutical features related to LN in our late-onset SLE population. Method A single center and retrospective study was performed comparing clinical-demographic, histological, prognostic and therapeutical data of 45 LN biopsied patients from 1994 to 2023. We divided the study population according to the age of onset of LN into classic-onset (&amp;lt; 45 years) and late-onset (&amp;gt; 45 years). Results Late-onset LN patients showed a higher association with Sjögren's and antiphospholipid syndrome, more cardiovascular comorbidities at presentation, poorer renal function at diagnosis and higher SDI score. On histology they showed more non-proliferative LN classes (II followed by V). Late-onset LN responders needed more time to achieve response but had fewer relapses. Non responsive patients had more incidence of acute kidney injury (AKI) and more glomerulosclerosis and interstitial fibrosis-tubular atrophy (IFTA) at presentation, as well as more need for renal replacement therapy (RRT) at diagnosis and at follow-up. The principal independent variables associated with relapse were the younger age at SLE diagnosis and an initial partial renal response (PRR). Patients of both groups who experienced relapse received higher doses of intravenous cyclophosphamide and less mycophenolic acid (MFA) analogues. Patients who received induction with MFA analogues were more likely to achieve complete renal response (CRR) or non-renal response (NRR). Conclusion late-onset LN is often accompanied by poor renal function at presentation. It seems imperative to establish a tailored approach in this fragile population in order to avoid unnecessary immunosuppression.

#2033 Patient characteristics and outcomes of an inter- and multidisciplinary nephrology and cardiology clinic

Abstract Background and Aims The prevalence of cardiorenal syndrome is increasing due to the growing number of patients with chronic kidney disease (CKD) and heart failure (HF). To further improve outcomes in this high risk population, an interdisciplinary, evidence-based and patient-centered approach is advocated. Hence, it was the aim of this study to identify and describe the patient population which might profit from an inter- and multidisciplinary nephrology and cardiology clinic at a tertiary university hospital. Method We screened 552 patients who from 01.01.2015 and 30.06.2022 had been in the nephrology and in the cardiology outpatient clinics of the University Hospital of Zurich. Patients with kidney or heart transplantation or on dialysis were excluded. Out of the remaining patients, we identified 223 patients having CKD 2-5 and HF. Characteristics with respect to entity and cause of kidney and heart disease, cardiovascular risk factors, therapy, incidence of acute kidney injury (AKI), hospitalisations and patient survival were recorded. Results The most common cause of CKD was a cardiorenal syndrome type 2 (42%, 95/223). 59/223 (26%) had at least moderate albuminuria. At the beginning of follow-up, 61/223 (26%) were in CKD2, 95/223 (42%) in CKD3a, 47/223 (21%) in CKD3b, 6/223 (7%) in CKD4 1, 2/223 (1%) in CKD5. Ischemic cardiomyopathy was the most common cause of heart failure, (36%, 80/223 patients). 119/223 patients (53%) had HFrEF, 41/223 (19%) HFmrEF and 63/223 (28%) HFpE. 64/223 (28%) of the patients were treated with SGLT2i,159/223 (71%) with RASi of which 37 (17%) were on an ARNI. Patients under combined RASi and SGLT2i were younger (66 vs 73 years, p = 0.005), were more likely to have diabetes (44% vs 30%), HFrEF rather than HFpEF (70% vs 7% p = 0.002) and had a better kidney function at the beginning of follow-up (eGFR 65 vs 55 ml/min/1.73 m2, p &amp;lt; 0.001). Hospitalization-rate due to HF and incidence of AKI were high with 0.6/patient/year and 4.8/patient/year respectively. 72/223 (32%) patients died during the mean follow-up of 3.1 years. Conclusion We identified a high-risk patient population with cardiorenal disease that might particularly benefit from evidence-based and patient-centered interdisciplinary care. A cardiorenal outpatient clinic may have the potential to improve a personalized approach in more vulnerable patients.

#1738 Renal endogenous hepcidin alleviates ferroptosis of collecting duct in ischemia/reperfusion induced AKI

Abstract Background and Aims Recent studies have demonstrated that urinary and serum hepcidin predicted the incidence of acute kidney injury (AKI) among critically ill patients. As an endogenous acute phase hormone, hepcidin is synthesized not only by the liver but also secreted by distal nephron. However, the autocrine impact of hepcidin secreted by distal nephron on collecting duct cells in AKI remains poorly understood. Method We determined the expression and location of hepcidin in murine kidney in different severity of bilateral ischemia/reperfusion (bIRI) induced AKI model with ischemic duration for 20 min and 32 min. The effect of renal endogenous hepcidin was explored in cultured M-1 (Murine Cortical collecting duct) exposed to hypoxia/reoxygenation (H/R), as well as in bIRI mice with collecting duct-specific overexpression of hepcidin. Transgenic mice were generated by genetic cross between Hepcidin floxed mice which knocked the gene fragment of CAG-LSL-mHamp-flag-WPRE-PolyA into H11 locus and Cdh16-cre mice. Mechanistically, RNA-seq was performed in M-1 cells under H/R condition. Results The expression of renal endogenous hepcidin was significantly elevated in bIRI32min mice compared to both bIRI20min and sham group, suggesting that augmented secretion of hepcidin was induced by more severe AKI. Interestingly, renal endogenous hepcidin was mainly localized to distal convoluted tubule and collecting tubule as indicated by its co-staining with AQP2 and Calbindin-D28k in the kidney. To investigate the role of hepcidin in collecting duct, M-1 cells were cultured under hypoxia condition. We observed remarkable ferroptosis in collecting duct cells other than apoptosis nor necroptosis. Subsequently, hepcidin knockdown further exacerbated ferroptosis under H/R condition, as evidenced by an upregulation of PTGS2 expression and downregulation of GXP4 expression, lower proportion of GSH/GSSG ratio as well as enhanced lipid peroxide accumulation and production of Fe2+. Then, RNA-seq data revealed that hepcidin knockdown promoted the enrichment of genes related to oxidative stress and glutathione metabolic pathway which may be responsible for the deterioration of ferroptosis. To investigate the role of hepcidin in vivo, bIRI induced AKI was established in Cdh16-cre+Hepcidinflox/+ mice. We observed remarkable overexpression of Hepcidin-Flag localized to collecting duct and interstium area. Impressively, Cdh16-cre+Hepcidinflox/+ mice showed ameliorated renal dysfunction adrenal tubule injury histologically. Ferroptosis of renal was alleviated in Cdh16-cre+Hepcidinflox/+ mice as confirmed by an upregulation of GPX4 expression and downregulation of PTGS2, ACSL4, FPN expression, higher proportion of GSH/GSSG ratio, as well as reduced lipid peroxide accumulation and production of Fe2+ by Lipofluo (lipid peroxides) and FerroOrange (Fe2+) staining on frozen section of kidney. Ferroptosis of the collecting duct was alleviated as indicated by downregulation of PTGS2 expression which co-staining with AQP2. To demonstrate the beneficial role of hepcidin, exogenous hepcidin was applied to bIRI induced AKI mice to strengthen the endogenous protective response. Conclusion Renal endogenous hepcidin is induced in the distal tubule and collecting duct after AKI as a protective response via alleviating ferroptosis of collecting duct. Hepcidin may represent a novel therapeutic approach to promote tubule repair by targeting ferroptosis for AKI.

#2475 Glomerulonephritis associated with anti -TNF-α therapy

Abstract Background and Aims Biologic agents like tumor necrosis factor α inhibitors/ anti-TNF-α/, IL6 and CD80/26 are widely used in many rheumatologic diseases but these may also elicit effects on renal function. These drugs, as well as rheumatic diseases themselves, can cause autoimmune renal disorders. Though effective on the main inflammatory process the incidence of kidney injury associated with their administration is increasing. Various forms of glomerulopathies have been described in connection with biological therapy - proliferative lupus nephritis, oligo immune necrotizing crescentic glomerulonephritis, membranous glomerulonephritis, IgA nephropathy and others. Method We report the clinical and pathologic findings in two patients with Rheumatoid arthritis and Ankylosing spondylitis on biologic therapy with an anti-TNF-α agent. During the treatment they presented with nephritic syndrome requiring kidney histology. Results Case 1: The first patient is a 52-year-old man diagnosed with ankylosing spondylitis, HLA-B27 positive, 15 years before admission. Four years before admission treatment with Golimumab /anti-TNF-α/ has been initiated. During the follow-up period urine tests revealed proteinuria and hematuria, which required more detailed tests. The patient presented with clinical features of nephritic syndrome, marked lower extremity edema, hematuria, nephrotic range proteinuria, impaired hypertension control. Kidney biopsy revealed membranoproliferative glomerulonephritis. It was assumed that kidney injury was most likely associated with Golimumab therapy. Its administration was discontinued, and therapy was started with pulses of Methylprednisolone 500 mg i.v. in three consecutive days, Cyclophosphamide 500 mg i.v., repeated the second and third month, followed by low steroid doses 0,5 mg/kg with gradual tapering. Mycophenolate Mofetil 1500 mg was started from the third month. General condition and laboratory results improved considerably. The occurrence of stiffness and pain in the sacroiliac joints several months after stopping biologic treatment necessitated the inclusion of Sulfasalazine to the therapy. Initiation of therapy with another class of biologic agent, Anti-IL-17 monoclonal antibody, was discussed with the follow-up rheumatologists. Case 2: The second patient is a 66-year-old woman, with a history of hypertension and essential thrombocythemia, who was diagnosed with seropositive rheumatoid arthritis 3 years before admission, treated with Adalimumab /anti-TNF-α/. Follow-up examinations revealed low-grade proteinuria, hematuria and impaired renal function. Kidney biopsy revealed IgA nephropathy. Following the discontinuation of Adalimumab, the patient was treated with pulses of Methylprednisolone 500 mg i.v. in three consecutive days, Cyclophosphamide 500 mg i.v., repeated the second and third month, followed by low steroid doses 0,5 mg/kg with gradual tapering. Kidney function significantly improved at the third month of treatment and proteinuria was gradually reduced. Initiation of Rituximab /antiCD20/ treatment was discussed with rheumatologists. Conclusion Treatment with biological drugs can cause immune-mediated glomerular disorder/IGD/. These events are rare, and the causative effects of a specific drug is hard to establish. When a patient is suspected of having an IGD, kidney biopsy should be performed for the exact diagnosis. The drug should be discontinued, and the treatment for the new-onset renal disorder should be promptly started. A rechallenge test of the same or a similar drug should be avoided, whereas switching to a different therapy is a reasonable option.

#976 Empagliflozin limits AKI incidence and severity following cardiac surgery: an open-label phase IV randomized pilot study

Abstract Background and Aims Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent complication of cardiac surgery assisted by cardiopulmonary bypass (CPB). Currently, no effective preventative strategies exist to reduce the incidence of acute kidney injury (AKI). Sodium-glucose transport protein 2 (SGLT2) inhibitors are effective in reducing the incidence of AKI in studies conducted in patients with chronic kidney disease. Therefore, we hypothesized that perioperative SGLT2 inhibition could reduce the incidence of CSA-AKI. Method In this open-label phase IV, randomized, parallel-group, balanced (1:1), pilot study, adult patients undergoing elective cardiac surgery with CPB were randomized to receive 10 mg empagliflozin per os once daily three days before surgery until two days after surgery, or standard care. The primary outcome was AKI incidence according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Other outcomes included hypoxia-inducible factor 1 alpha (HIF1A) and urinary Kidney Injury Molecule (KIM-1), urinary neutrophil gelatinase associated lipocalin (NGAL) and metabolic parameters such as plasma ketone and glucose concentrations. Results Between March 2022 and April 2023, 60 patients were randomized to empagliflozin (n = 29) or control (n = 31). All patients who underwent cardiac surgery with CPB were included in the intention-to-treat analysis (n = 25; empagliflozin group, n = 30; control group). SGLT2 inhibition significantly reduced the incidence of all stages of AKI (20% vs 66.7%; absolute difference 46%, 95% CI .13 to .63, P &amp;lt; .001). This decline in AKI incidence was reflected in the kidney biomarkers. SGLT2 inhibition also significantly reduced the number of patients with postoperative hyperglycemia (28% vs 60%; absolute difference 32%, 95% CI −56.8 to −7.2, P = .029). We observed no differences in the incidence of neither ketoacidosis nor hypoglycemic events. Conclusion Perioperative SGLT2 inhibition, compared with standard of care, demonstrated a significant reduction in AKI incidence rates. These findings merit validation in a larger placebo-controlled trial which is currently ongoing. Supplementary figures:

Evaluating the efficacy of a novel periosteal flap in cochlear implantation: a retrospective surgical audit at a tertiary teaching hospital

BackgroundThis research aimed to critically evaluate the safety and reliability of a new periosteal flap technique in cochlear implantation through a comprehensive surgical audit. A surgical audit was conducted on a cohort of 39 patients who underwent cochlear implantation at a tertiary teaching hospital from July 2020 to September 2021. The novel periosteal flap technique was utilized in all cases. Patients were followed up for a period ranging from 2 to 12 months. For comparison, outcomes were assessed by comparing 51 children who had undergone cochlear implant surgery between July 2017 and June 2019, utilizing the anteriorly based palva flap. A scoring system was employed to evaluate various aspects, including ease of surgical exposure, flap maneuverability, ease of closure after device fixation, immediate postoperative complications (up to 24 h), and delayed complications (up to 30 days). Scores ranging from 1 (fair assessment) to 4 (excellent assessment) were assigned, with a maximum score of 18 indicating optimal outcomes.ResultsThe comparison between the two groups revealed a reduced incidence of emissary vein injury and easier wound closure after device fixation in the novel periosteal flap group (p = 0.000). The mean total scores were significantly higher in the novel periosteal flap group, indicating superior outcomes. Only 2 out of 39 children with the novel flap experienced minor skin color changes during the initial postoperative period, which resolved within approximately 7 days. Major complications such as wound infection, hematoma, or device migration were not observed with the new periosteal flap. Furthermore, no flap revisions were required.ConclusionsThe novel and innovative periosteal flap demonstrated both safety and reliability in cochlear implantation procedures. This well-vascularized and robust flap offered effective device coverage with minimal flap-related complications. Its time-saving nature further enhances its clinical utility. Additional validation from different medical centers would further corroborate the advantages of this easily implemented periosteal flap technique.Level of evidenceLevel 3.

#1378 A single-center retrospective study on clinical characteristics and outcomes of extended-spectrum beta-lactamases positive acute pyelonephritis

Abstract Background and Aims The increase of extended-spectrum beta-lactamases (ESBL) releasing bacteria in acute pyelonephritis (APN) is a growing problem world-wide. Recently, little is known about the incidence, clinical features and outcomes of ESBL positive APN. This study intends to describe the epidemiology and clinical outcomes of ESBL positive APN. Method A retrospective study of 1631 culture positive patients with APN admitted from Jan, 2011 to Dec, 2019 in a single-center was performed. Adults over 18 years of age were included, and outpatient treatment, pregnant women, and transplant patients were excluded. Result A total of 2818 patients were diagnosed as APN during this period and causative bacteria was confirmed in1631 patients among them (57.9%). ESBL positive bacteria were found in 553 patients (33.9%). There were no differences in baseline characteristics between ESBL positive and negative groups. Most common strain was Escherichia coli, followed by Klebsiella and Pseudomonas species. The proportion of ESBL positive APN increased when evaluated at one-year intervals for 8 years (from 4.9% in 2011 to 20.9% in 2019). The rate of positive blood culture was higher in ESBL positive patients (39.2% vs 21.1%, p&amp;lt;0.001). Hospital stay was longer in ESBL positive patients (12.3 ± 2.2 vs. 5.4 ± 5.2, p&amp;lt;0.001) and the number of re-admission is higher (1.7 ± 1.3 vs. 1.2 ± 0.6, p&amp;lt;0.001). The incidence of acute kidney injury according to KDIGO was higher in ESBL positive groups (25.4% vs 12.3%, p&amp;lt;0.001). There was no hospital mortality between two groups. Conclusion We should attempt to detect ESBL positive bacteria through timely performing blood and urine culture and administer appropriate antibiotics if APN is clinically suspected because of poor clinical courses.

#1093 Remission rates and long-term outcomes of relapsed idiopathic nephrotic syndrome children treated with cyclophosphamide vs. cyclosporin A

Abstract Background and Aims Approximately seventy percent of nephrotic syndrome (NS) children experience relapse episodes which are classified as frequently-relapsing nephrotic syndrome (FRNS), steroid-dependent nephrotic syndrome (SDNS), or steroid-resistant nephrotic syndrome (SRNS). In such cases, immunosuppressive drugs are combined to reduce the steroid side effects and prolong the remission period. However, the benefit of immunosuppressants and their side effects should be balanced. Objectives This study aimed to determine the remission rates and long-term outcomes of FRNS, SDNS, and SRNS children treated with cyclophosphamide vs. cyclosporin A (Cy A). Methods A retrospective review of medical records of children (aged &amp;lt; 15 years) with relapsed idiopathic nephrotic syndrome at Prince of Songkla University Hospital, southern Thailand during 2010-2021 was conducted. Demographic data, treatment responses, and adverse events were recorded. The remission rates, incidences of infection and acute kidney injury (AKI) in FRNS/SDNS and SRNS were compared between oral cyclophosphamide and Cy A treatments. Results There were 148 relapsed NS children, 102 (68.9%) boys, with a median age of 4.6 (IQR 2.5-8.4) years. FRNS, SDNS, and SRNS accounted for 37 (25.0%), 50 (33.8%), and 61 (41.2%) children, respectively. The cyclophosphamide treatment group (N = 135) had significantly higher remission rates in FRNS/SDNS than SRNS (63/85 (74.1%) vs. 11/50 (22.0%), P &amp;lt; 0.001), while the difference in remission rates in the Cy A treatment group (N = 53) was not statistically significant between FRNS/SDNS and SRNS (14/20 (70.0%) vs. 18/33 (54.5%), P = 0.265). Patients who had the Cy A treatment had significantly higher proportions of infections and AKI than children in the cyclophosphamide treatment group (20/53 (37.7%) vs 10/95 (10.5%), P &amp;lt; 0.001 and 21/53 (39.6%) vs 9/95 (9.5%), P &amp;lt; 0.001, respectively). Of the 148 children, at a median follow-up time of 8.7 (IQR 5.2–12.2) years, 21 (14.2%) and 9 (6.1%) children had developed chronic kidney disease (CKD) stage III or end-stage kidney disease (ESKD), respectively. The mean duration from CKD stage III to ESKD was 5.0+5.5 months. Conclusions Seventy percent of FRNS/SDNS children achieved remission with either Cy A or cyclophosphamide, but the SRNS children achieved remission proportionately better with Cy A than cyclophosphamide. However, the Cy A-treated children had higher proportions of infections and AKI than the cyclophosphamide treatment group. Overall, one-fifth of the relapsed childhood NS children developed CKD.

#242 Incidence of postoperative acute kidney injury is twice as high in men than women following radical colorectal surgery—key findings from PROSACC

Abstract Background and Aims Acute kidney injury (AKI) affects approximately 8% of the general surgical population. Additionally, AKI increases the risk for morbidity and mortality by 8- and 3-fold respectively. It was earlier believed that women had a greater risk for postoperative AKI. However, recent literature indicates that the incidence of AKI is actually higher in hospitalized men than women (2.2 odds ratio). Hence the male sex is currently discussed to be a risk factor for AKI. We therefore hypothesized that the incidence of postoperative AKI will be higher amongst men than women after radical colorectal surgery. Method We conducted a post hoc analysis (PROSACC: Propofol or Sevoflurane Anesthesia in Colon Cancer, NCT05585866) on the database from the CAN-study (Cancer and Anesthesia: Survival After Radical Surgery, NCT01975064). The CAN-study included cancer patients undergoing radical surgery at several sites in China, Croatia, Poland, and Sweden. Patients included in PROSACC were those undergoing colorectal surgery at any predefined site. Primary outcome was incidence of AKI by changes in plasma creatinine, secondary outcome was AKI in association to gender (women/men). The KDIGO criteria was used for classifying AKI on postoperative days 1-3 and 4-10. Database management and statistical analysis was performed by Uppsala Research Centre. Men vs women AKI outcome at day 1-3 and 4-10 was statistically compared with the Pearson's chi-square test. Results A total of 3254 patients (n = 1900 men; n = 1354 women) were included in the analysis with their preoperative plasma creatinine. Demographics showed that of the women, 39% had hypertension, 12% had diabetes and 2% had pre-existing kidney disease. In comparison, amongst the men, 24% had hypertension, 9% had diabetes and 1% pre-existing kidney disease. Postoperative plasma creatinine values were obtainable from the database in 2741 patients (n = 1578 men; n = 1163 women) on postoperative day 1-3. One hundred and ninety patients (7%) of this group had developed AKI. Separated by gender, 6% of the women (n = 72) and 8% of the men (n = 118) had established AKI according to KDIGO (p = 0.190). Plasma creatinine values were obtainable in 986 patients (n = 582 men; n = 404 women) on postoperative day 4-10 whereas 87 patients (9%) in this group had developed AKI. Separated by gender, 6% of the women (n = 23) but 11% of the men (n = 64) had established AKI at this timepoint (p = 0.004). Conclusion With this post hoc analysis of a global, multicentre, randomized controlled trial we conclude that the incidence of postoperative AKI is twice as high in men compared with women after 4-10 postoperative days following radical colorectal surgery. Since the women had higher rate of pronounced preoperative risk factors yet still had lower incidence of AKI, this study aligns with the conclusion that the male sex is a risk factor for postoperative AKI.

#2999 Renal venous congestion as a predictor of poor prognosis in patients with acute decompensated heart failure

Abstract Background and Aims Systemic venous congestion in acute decompensated heart failure (ADHF) is associated with a risk of end-organ damage and high in-hospital mortality. We aimed to assess the prevalence and severity of renal venous congestion using venous excess ultrasound (VExUS) protocol in intensive care unit (ICU) patients with ADHF, and to evaluate the association between type of intra-renal venous blood flow, incidence of acute kidney injury (AKI), and in-hospital death. Method A prospective single-center study included 99 patients who were admitted to the ICU with ADHF (mean age 71.1 ± 12.54 years, 56 (56.6%) males). Inclusion criteria: age ≥18 years, ADHF II–IV, signed informed consent. Exclusion criteria: acute coronary syndrome, severe concomitant diseases, refusal to participate in the study. Upon admission, routine clinical, laboratory and instrumental examinations, lung ultrasound using the BLUE protocol, and assessment of venous congestion using the pulse-wave dopplerography were performed. The presence of continuous blood flow was regarded as the absence of renal venous congestion, while intermittent (biphasic and monophasic blood flow) indicated venous congestion. The diagnosis of ADHF and AKI was established based on generally accepted criteria in accordance with modern international recommendations. All patients received optimal drug therapy. The end point was defined as death from cardiovascular causes during hospitalization. Statistical analysis was performed using SPSS Statistics, version 26.0. Results Upon admission, continuous renal venous blood flow was detected in 17 (17.2%) patients, intermittent in 82 (82.8%): biphasic in 47 (47.5%) and monophasic in 35 (35.3%). The patient groups were comparable in gender, age, frequency of coronary heart disease, diabetes mellitus, anemia. Atrial fibrillation was more common in case of monophasic (p &amp;lt; 0.006), and arterial hypertension in patients with continuous venous blood flow (p &amp;lt; 0.001). Patients with renal venous congestion, compared with patients without signs of congestion, had more severe heart failure: swollen neck veins: 5 (29.4%) vs 21 (45%) vs 28 (60%), p &amp;lt; 0.001; hepatomegaly 12 (72.6%) vs 40 (85.1%) vs 31 (88.6%), p &amp;lt; 0.001; edema 8 (47.3%) vs 40 (85.1%) vs 24 (68.6%), p &amp;lt; 0.001; NYHA functional class IV 8 (47.1%) vs 32 (68.1%) vs 26 (74.6%), p &amp;lt; 0.001; more B-lines on lung ultrasound, M+SD 28.82 ± 8.91 vs 34.38 ± 9.64 vs 35.37 ± 8.72, p &amp;lt; 0.001, higher NTproBNP levels, pg/l, Ме(IQR) 2100 (1800;4560) vs 3418 (2300;8434) vs 4100 (2500;9282), p &amp;lt; 0.001, and albuminuria levels mg/g, Ме(IQR) 85 (29;145) vs 127 (49;248) vs 139 (64;245), p &amp;lt; 0.001. The incidence of AKI (4 (23.5%) vs 23 (49%) vs 31 (88.6%), p &amp;lt; 0.001), and in-hospital death (0 (0) vs 11 (23.4%) vs 12 (34.3%), p &amp;lt; 0.003) was also higher in the group of patients with monophasic renal blood flow. The presence of renal venous congestion on admission was associated with an increased risk of death due to heart failure during hospitalization with RR 1.32 (95% CI: 1.16-2.64), p &amp;lt; 0.001, and RR 1.64 (95% CI: 1.48-2.83), p &amp;lt; 0.001 in patients with biphasic and monophasic renal venous blood flow respectively, and with development of AKI RR 3.29 (95% CI: 1.50-7.24), p &amp;lt; 0.003 in patients with monophasic renal venous blood flow. Conclusion In ICU patients with ADHF, the presence of renal venous congestion, assessed on admission with Doppler ultrasound of the intrarenal veins using the VEXUS protocol, is associated with a high risk of developing AKI and in-hospital death.

Injury risk factors related to sport specialization in high school basketball: a prospective study.

Research that has examined the association between specialization and injury in basketball has been limited to cross-sectional or retrospective studies. To determine whether specialization is a risk factor for injury among high school basketball athletes. Prospective cohort study. Basketball players from 12 high schools participating in the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program (NATION-SP) were recruited prior to the 2022-2023 interscholastic basketball season. 130 athletes (mean age (SD) = 15.6 (1.3); girls' basketball: n=68 (52.3%)). Participants completed a questionnaire prior to the start of their school basketball season that had questions regarding participation in various specialized sport behaviors. During the basketball season, the school's athletic trainer reported all athletic exposures (AEs) and injuries (regardless of time loss) for participating athletes into NATION-SP. Injury incidence (IR) and incidence rate ratios (IRR) with 95% confidence intervals [95%CI] were calculated for the specialized sport behaviors previously described. There was no difference in injury risk between highly specialized and low specialized athletes (IRR [95%CI]: 1.9 [0.9, 3.7]). Players who participated in basketball year-round were twice as likely to sustain an injury compared to those who did not play year-round (IRR [95%CI]: 2.1 [1.1, 3.6]). Similarly, players who reported participating in basketball skills camps were at increased risk of injury compared to athletes who did not participate in basketball skill camps (IRR [95%CI]: 2.5 [1.2, 5.7]). Injury risk related to sport specialization in basketball may be specific to certain behaviors such as year-round play and participation in skills camps. Validated measures of comprehensive sport activity are needed to better measure specialization in youth sports to better determine injury risk related to sport specialization and develop injury prevention programs for basketball athletes.