BACKGROUND: Although the present diagnosis of acute kidney injury (AKI) involves measurement of acute increases in serum creatinine (SC) and reduced urine output (UO), measurement of UO is underutilized for diagnosis of AKI in clinical practice. The purpose of this investigation was to conduct a systematic literature review of published studies that evaluate both UO and SC in the detection of AKI to better understand incidence, healthcare resource use, and mortality in relation to these diagnostic measures and how these outcomes may vary by population subtype.
METHODS: The systematic literature review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Data were extracted from comparative studies focused on the diagnostic accuracy of UO and SC, relevant clinical outcomes, and resource usage. Quality and validity were assessed using the National Institute for Health and Care Excellence (NICE) single technology appraisal quality checklist for randomized controlled trials and the Newcastle-Ottawa Quality Assessment Scale for observational studies.
RESULTS: A total of 1729 publications were screened, with 50 studies eligible for inclusion. A majority of studies (76%) used the Kidney Disease: Improving Global Outcomes (KDIGO) criteria to classify AKI and focused on the comparison of UO alone versus SC alone, while few studies analyzed a diagnosis of AKI based on the presence of both UO and SC, or the presence of at least one of UO or SC indicators. Of the included studies, 33% analyzed patients treated for cardiovascular diseases and 30% analyzed patients treated in a general intensive care unit. The use of UO criteria was more often associated with increased incidence of AKI (36%), than was the application of SC criteria (21%), which was consistent across the subgroup analyses performed. Furthermore, the use of UO criteria was associated with an earlier diagnosis of AKI (2.4-46.0 h). Both diagnostic modalities accurately predicted risk of AKI-related mortality.
CONCLUSIONS: Evidence suggests that the inclusion of UO criteria provides substantial diagnostic and prognostic value to the detection of AKI.

Current legislation in the United Kingdom stipulates that horses should not be slaughtered within sight of one another. However, abattoir personnel anecdotally report that, for semi-feral horses unused to restraint, co-slaughtering alongside a conspecific could reduce distress through social buffering and improve safety, but there is a lack of evidence to support this. CCTV footage from an English abattoir was assessed retrospectively with welfare indicators from when horses entered the kill pen until they were killed. Of 256 horses analysed, 12% (32/256) were co-slaughtered (alongside a conspecific) and 88% (224/256) individually. Co-slaughtered horses moved more in the pen, but individually slaughtered horses showed more agitated behaviour, required more encouragement to enter the kill pen, and experienced more slips or falls. Unrestrained horses (40%; 102/256) showed increased agitation, movement, and agonistic behaviour towards the operator and resisted entry to the kill pen compared to restrained horses (60%; 154/256). Positive interactions between conspecifics were seen in 94% (30/32) of co-slaughtered horses, and only 6% (1/16) showed a startled response to the first horse being shot, with a median time of 15 s between shots. This study highlights the impact that both conspecific and human interactions can have on equine welfare at slaughter. Semi-feral or unrestrained horses appear to experience increased distress compared to horses more familiar with human handling, and the presence of a conspecific at slaughter mitigated this.

This paper explores the unconscious symbolism of the battlefield cross memorial, which is comprised of combat boots and a rifle, often with dog tags attached, topped by a helmet. While the memorial\'s manifest function is to provide solace, build solidarity, and convey respect for patriotic sacrifice in response to grief, the battlefield cross also exalts masculinity at a subliminal level. Because of the latent ways in which the components of the battlefield cross reinforce fallen soldiers\' masculinity, the memorial provides an outlet for bereavement according to a masculine script that treats virility as sacrosanct. The resonance of the battlefield cross and its synergism with unrecognized gender coding in broader society illustrate how a powerful symbol intended to honor members of the military also valorizes machismo. This qualitative interpretation could help explain impediments to women achieving parity with men in the military.

UNASSIGNED: There is limited information on return to shooting following shoulder surgery. The purpose of this study is to determine the rate and timing for resuming shooting a rifle following shoulder surgery.
UNASSIGNED: We performed a retrospective review of prospectively collected data. The study included patients undergoing arthroscopic and open shoulder stabilization for unidirectional shoulder instability, and arthroscopic surgery for rotator cuff tears, SLAP lesions, biceps tendinopathy, and acromioclavicular pathology. Data collected included the laterality of surgery, shooting dominance, and patient-reported outcome measures at the preoperative and postoperative visits. Starting at the 4.5-month clinic visit, patients were asked if they could shoot a military rifle.
UNASSIGNED: One hundred patients were identified with arthroscopic and open shoulder surgery with a mean age of 30 years (range, 18-45) and a mean follow-up of 24 months (range, 12-32). The cohort consisted of patients undergoing arthroscopic Bankart repair (n = 23), arthroscopic posterior labral repair (n = 18), open Latarjet (n = 16), mini-open subpectoral biceps tenodesis (OBT) (n = 25), OBT with open distal clavicle resection (DCR) (n = 10), open DCR (n = 4), and arthroscopic rotator cuff repair with concomitant OBT (n = 4). Significant improvement in SSV, VAS, ASES, and WOSI was shown at 1-year postoperative, SSV 85, VAS 2, ASES 85, WOSI 239, P = .001. The percentage of patients reporting the ability to shoot a military rifle postoperatively were 47%, 63%, 85%, and 94% at 4.5 months, 6 months, 1 year, and 2 years, respectively. At 4.5 months postoperatively, patients who underwent surgery ipsilateral to their shooting dominance (n = 59) had a rate of return to shooting (33%) versus shoulder surgery on the contralateral side of shooting dominance (n = 41) (60%), P = .04. However, there was no significant difference in the groups at 6 months and 1 year. Additionally, there was a significant difference in the rate of return to shooting at 6 months in patients undergoing arthroscopic posterior labral repair versus the remainder of the cohort (posterior instability (33%) vs. (69%), P = .016), and a significant difference between posterior shoulder stabilization and anterior shoulder stabilization (70%), P = .03.
UNASSIGNED: Patients undergoing arthroscopic and open shoulder surgery have a high rate of return to shooting. Approximately 60% of patients resume shooting at 6 months postoperatively and 85% return at 1 year. Patients undergoing shoulder surgery on the contralateral side of their shooting dominance return to shooting significantly faster than those with shoulder surgery ipsilateral to their shooting dominance. Additionally, those undergoing arthroscopic posterior shoulder stabilization return to shooting at a slower rate than anterior stabilization surgery.

OBJECTIVE: Acute Kidney Injury (AKI) affect mortality and morbidity in critically ill patients. There have been few studies examining the prevalence of AKI and mortality after successful cardiopulmonary resuscitation. In the present study, we investigated the association between AKI and mortality in post-cardiac arrest patients admitted to the Intensive Care Unit (ICU).
METHODS: Our retrospective analysis included 109 patients, admitted to the ICU following successful cardiopulmonary resuscitation between 2014 and 2016. We compared two scoring systems to estimate mortality.
CONCLUSIONS: AKI were diagnosed in 46.7% (n = 51) of the patients based on the RIFLE criteria and 66.1% (n = 72) using the KDIGO. Mortality rate was significantly higher among patients with AKI diagnosed according to the RIFLE criteria (p = 0.012) and those with AKI diagnosed using KDIGO criteria (p = 0.003). Receiver Operating Characteristic (ROC) analysis showed that both scoring systems were able to successfully detect mortality (Area under the ROC curve = 0.693 for RIFLE and 0.731 for KDIGO).
CONCLUSIONS: AKI increases mortality and morbidity rates after cardiac arrest. Although more renal injury and mortality were detected with KDIGO, the sensitivity and specificity of both scoring systems were similar in predicting mortality in patients with Return of Spontaneous Circulation (ROSC).

Acute kidney injury is one of the severe complications after burns. The purpose of this study was to identify prevalence, risk factors to the development of acute kidney injury (AKI) in burn patients and mortality, using RIFLE classification: risk (R), injury (I), failure (F), loss (L), and end-stage kidney disease (E). This 3-year retrospective study was conducted in burn patients admitted to the Dr. Soetomo Hospital Burn Center between January 2018 and September 2020. Burn patients aged >18 years old and diagnosed with acute kidney injury during hospitalization were enrolled in this study. Factors influencing AKI and its mortality were assessed using bivariate and multivariate logistic regression analysis. Eighty-nine burn patients were available for analysis, and 18 (20%) of them developed AKI according to the RIFLE classification: risk in 6 (33%), injury in 7 (39%) and failure in 5 (28%). Patients with AKI had a significantly higher age and % of TBSA than those without AKI (p-value <0.05). Age more than 60 years old was significantly associated as a risk factor to develop AKI (OR=25.553, p value=0.014). The mortality rate of patients with AKI was 83% (15 deaths from 18 patients), with the overall mortality of patients 16.8%. Chi-square analysis indicated inhalation injury, % of TBSA, and age as risk factors for mortality (p-value < 0.05). The conclusion of our study was that the incidence of AKI in burn patients was relatively high. Older age as a risk factor to develop AKI and inhalation injury, TBSA, and age were associated with mortality.
La défaillance rénale aiguë (DRA) est une des complications graves des brûlures. Cette étude a pour d’évaluer sa prévalence, les facteurs de risque de sa survenue et sa mortalité, en utilisant la classification RIFLE : R (Risk- Risque), I (Injury- Lésion), F (Failure- Défaillance), L (Loss- Perte de fonction), E (End stage- Terminale). Cette étude rétrospective a concerné les patients hospitalisés dans le CTB de l’hôpital Dr Soetomo durant 3 ans (janvier 2018- décembre 2020). Elle a concerné tous les patients de plus de 18 ans ayant subi une DRA. Les facteurs de risque ont été évalués par analyses uni- et multivariées. Quatre- vingt- dix- neuf patients étaient éligibles, dont 18 ont développé une DRA (6- 33%- R ; 7- 39%- I et 5- 28%- F). Les patients avec DRA étaient plus âgés et brûlés plus extensivement, en particulier, l’âge de plus de 60 ans avait un OR de 25,553 ; p= 0,014). La mortalité des patients avec DRA était de 83% (15 morts sur 18) alors que la mortalité globale était de 16,8%. L’analyse par C² montrait que l’âge, la surface brûlée et l’inhalation de fumée étaient des facteurs de mortalité (p<0,05). L’incidence de DRA est relativement élevée et corrèle avec l’âge quand la mortalité globale reste liée à l’âge, la surface brûlée et l’inhalation de fumées.

BACKGROUND: The main objective of this study was to evaluate the differences between cisplatin and paclitaxel in the development of postoperative renal toxicity, using as a reference the RIFLE (Risk, Injury, Insufficiency, Loss, and End-stage renal function) and AKIN (Acute Kidney Injury Network) criteria in patients with primary or recurrent ovarian cancer with peritoneal dissemination treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC).
METHODS: One hundred fifty-two patients who were treated between December 2007 and June 2017 were analyzed.
RESULTS: Patients who received previous platinum-based chemotherapy had higher baseline creatinine levels than those who had not (p = 0.05). A total of 11 (7.2%) and 4 (2.6%) patients developed an acute renal dysfunction (ARD) during the postoperative period of cytoreduction and HIPEC according to the RIFLE and AKI criteria respectively. RIFLE detects a higher rate of ARD due to different parameters such as GFR (7.2% versus 2.6%, p = 0.016). Performing ostomy (p = 0.007; OR: 39.320; 95% CI = 2.74-56.13) and using of cisplatin during HIPEC treatment (p = 0.017; OR = 13.619; 95% IC = 1.600-25.95) were factors independently related to a higher rate of ARD.
CONCLUSIONS: ARD has a multifactorial origin. Cisplatin was associated with the development of a higher rate of ARD than paclitaxel. Diagnosis of ARD did not correlate with worse survival figures.

UNASSIGNED: Three consensus classifications of acute kidney injury have been published. These are RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease published by the Acute Dialysis Quality Initiative workgroup), AKIN (published by the Acute Kidney Injury Network) and KDIGO (published by the Kidney Disease Improving Global Outcome workgroup). Acute kidney injury has been reported consistently as associated with worsened outcomes. However, toxicant-related acute kidney injury has been excluded from the studies used to validate the classifications of acute kidney injury.
UNASSIGNED: To study whether poisoned patients who develop acute kidney injury, as defined by consensus definitions/classifications, have higher mortality compared to those who did not.
UNASSIGNED: Databases were searched from 2004 to 2019 using the following keywords (KDIGO OR \"Kidney Disease: Improving Global Outcomes\" OR \"Kidney Disease Improving Global Outcomes\" OR AKIN OR \"AKI network\" OR \"Acute kidney Injury Network\" OR ADQI OR RIFLE OR \"Acute dialysis quality initiative\") AND (intoxication OR poisoning OR overdose OR ingestion) AND (AKI OR kidney OR renal OR ARF). If data were available, we used a random-effects meta-analysis model and Fisher\'s exact test to compare mortality in patients according to kidney function definitions (acute kidney injury vs not) and stages (stages vs no acute kidney injury), respectively. If data were available, we assessed the correlation between mortality and renal function (no acute kidney injury, risk/stage 1, injury/stage 2 and failure/stage 3) using the Spearman correlation. If available, we collected the results of statistical analyses in studies that have used acute kidney injury to predict mortality.
UNASSIGNED: Study selection. Thirty-three relevant studies were found, 22/33 retrospective studies (67%) and 11/33 prospective studies (33%). Paraquat was the most frequent toxicant involved (13/33, 39%). We found a disparity between studies regarding the timeframe during which mortality was assessed, the temporality of the renal function considered to predict mortality (initial/worst) and the criteria used to define/grade acute kidney injury across studies. Univariate association between acute kidney injury definitions/stages and mortality. Consensus definitions/staging of acute kidney injury were associated with higher mortality, using univariate analyses, in twenty-eight (RIFLE = 7; AKIN = 12; KDIGO = 9) studies included but not in five (AKIN = 4, KDIGO = 1). When available data were pooled, RIFLE (5 studies), AKIN (16 studies) and KDIGO definitions (8 studies) of acute kidney injury were associated with a higher mortality (Log unadjusted Odds ratios [95%-confidence interval], 2.60 [2.23; 2.97], 2.02 [1.48; 2,52] and 3.22 [2,65; 3.78], respectively). However, we found high heterogeneity (I2=54,7%) and publication bias among studies using AKIN. In ten studies with available data, the correlation between renal function (no acute kidney injury, risk/stage 1, injury/stage 2, failure/stage 3) and mortality was significant in 5 studies (RIFLE = 2; AKIN = 3), but not in five studies (RIFLE = 1; AKIN = 3; KDIGO = 1).Multivariate association between acute kidney injury definitions/stages and mortality. The definitions of acute kidney injury were associated with higher mortality in two studies (RIFLE = 2), but not in four studies (AKIN = 1 and KDIGO = 3. The stages of acute kidney injury (including one or more stages) were associated with higher mortality in four (RIFLE = 1, AKIN = 1 and KDIGO = 2).
UNASSIGNED: All three consensus definitions/classifications were associated independently with increased mortality in poisoning but with disparity between studies reporting acute kidney injury.

Psychological aspects like anxiety, injuries\' effects, professional psychological support (PPS), psychological training (PT), or athlete-coach relationships could influence shooters\' performance. This study tried to determine which aspects were critical from the shooters\' perspective. Eight elite shooters were interviewed. After using qualitative methods, the following categories were obtained: importance of PT; anxiety and competition relationship; mental preparation; PPS; stress during training; injuries\' psychological effects and coach\'s influence. PT is important for shooter\'s performance, being PPS a key aspect. Moreover, anxiety levels are critical, raising during the pre-competitive period and oscillating during competition. Furthermore, shooters considered more effective the stress placed on training by the coach than by themselves. Accordingly, the coach plays a key role. Surprisingly, injuries did not affect shooters psychologically, nor in their competitive performance. We conclude that the combination of PPS, shooter competitive experience and the optimal coach\'s work can promote a greater performance in Olympic shooting.

Olympic shooting is a sport with high demands of accuracy. Minimal visual errors could be related to performance losses. However, not all visual skills have been studied in depth in this sport. The main objectives of this study were to compare differences in shooters\' visual skills by level and to analyze the competition effect on them. Sixty-six participants were distributed in three groups (non-athletes, elite and non-elite). Eleven visual variables were tested in four skills groups (visual acuity, heterophoria, accommodation functions and other visual skills). The data were collected through a pre- and post-competition simulation test. The results of the study showed differences between groups by shooting sport level. In general, shooters had higher visual acuity values than non-athletes p < .001 with large size effects (d between 1.01 and 2.35), and elite shooters presented higher values of accommodation than non-elite shooters p < .05 with large size effects (d between 0.88 and 0.97). Furthermore, different visual skills were modified after competition depending on the shooting level. Specifically, visual accommodation skills were only improved in elite shooters. Finally, our study suggests that elite shooters employ different visual strategies or skills to non-elite shooters and that shooting activity is closely related to some specific visual skills. This aspect should be considered by coaches in the design of optimal visual trainings and improve the shooters\' performance.Highlights Shooters showed better acuity skills than non-athletes.Shooting activity seems to improve visual acuity skills, binocular visual time and eye-hand coordination in non-elite shooters, and accommodation and eye-hand coordination in elite shooters immediately after the competition simulation.Elite shooters employ different visual strategies or skills to non-elite shooters.Non-dominant eye occlusion may benefit binocular vision recovery by inhibiting aiming action and the use of accommodative flexibility could be related to the QE during the shot.