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Injured patients are at risk of developing acute kidney injury (AKI), which is associated with increased morbidity and mortality. The aim of this study is to describe the incidence, timing, and severity of AKI in a large trauma population, identify risk factors for AKI, and report mortality outcomes. A prospective observational study of injured adults, who met local criteria for trauma team activation, and were admitted to a UK Major Trauma Centre. AKI was defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Multivariable logistic regression and Cox proportional hazard modelling was used to analyse parameters associated with AKI and mortality. Of the 1410 patients enrolled in the study, 178 (12.6%) developed AKI. Age; injury severity score (ISS); admission systolic blood pressure, lactate and serum creatinine; units of Packed Red Blood Cells transfused in first 24 hours and administration of nephrotoxic therapy were identified as independent risk factors for the development of AKI. Patients that developed AKI had significantly higher mortality than those with normal renal function (47/178 [26.4%] versus 128/1232 [10.4%]; OR 3.09 [2.12 to 4.53]; p<0.0001). After adjusting for other clinical prognostic factors, AKI was an independent risk factor for mortality. AKI is a frequent complication following trauma and is associated with prolonged hospital length of stay and increased mortality. Future research is needed to improve our ability to rapidly identify those at risk of AKI, and develop resuscitation strategies that preserve renal function in trauma patients.

Background Extracorporeal cardiopulmonary resuscitation (ECPR) is considered infeasible in patients with traumatic cardiac arrest (TCA). Methods We conducted a systematic literature review applying a multi-layered search strategy to summarise and meta-analyse published evidence on the use of ECPR in TCA patients. We focused on TCA occurring during the pre-hospital and early in-hospital phase approximately corresponding to the first six hours following injury. Results Nine studies (retrospective study, n  = 4; case series, n  = 2; case report, n  = 3) including 84 TCA patients undergoing ECPR were identified. All ECPR procedures were performed in-hospital. The median age was 39 (29–51) years. Two patients (2%) were < 18 years. Sixty-seven (80%) patients were male. The injury mechanism was blunt in 54% and penetrating in 46%. Thirty-three (39%) patients survived to hospital discharge. All survivors recovered completely or with minor to moderate neurological disability. Survivors more frequently sustained TCA due to respiratory failure (56 vs. 18%, p  = 0.008), experienced TCA out-of-hospital (36 vs. 14%, p  = 0.04), had a shorter duration of cardiopulmonary resuscitation before ECPR [43 (25–71) vs. 78 (54–103) minutes, p  = 0.02] and underwent surgery following ECPR more often (100 vs. 0%, p  = 0.001) than non-survivors. While all survivors sustained chest injuries, no patient with traumatic brain injuries survived. The median initial extracorporeal blood flow reported in twenty-six patients was 3.6 (2.8–4.0) L/min. One study reported infeasibility to maintain adequate extracorporeal blood flows in four of eleven (36%) patients. While 21 of 27 patients (74%) received no initial anticoagulation, unfractionated heparin was administered in the remaining six patients. Of the 32 patients, in whom complications were reported, 18 subjects (56%) experienced one or more complications. Complications related to the extracorporeal circuit (25%) and neurological (22%), renal (16%), haemorrhagic (16%) and cardiovascular (16%) complications were reported most frequently. Conclusions This comprehensive systematic review of the literature identified 84 patients, who were treated with ECPR because of a TCA during the acute phase following injury. The results of this meta-analysis are hypothesis-generating and suggest that ECPR may be feasible and potentially beneficial in selected patients with TCA. Future research on ECPR in TCA is warranted. Entry of respective cases into international registries appears essential.

Survival from out-of-hospital cardiac arrest (OHCA) has remained low despite advances in resuscitation science. Hospital-based extra-corporeal cardiopulmonary resuscitation (ECPR) is a novel use of an established technology that provides greater blood flow and oxygen delivery during cardiac arrest than closed chest compressions. Hospital-based ECPR is currently offered to selected OHCA patients in specialized centres. The interval between collapse and restoration of circulation is inversely associated with good clinical outcomes after ECPR. Pre-hospital delivery of ECPR concurrent with conventional resuscitation is one approach to shortening this interval and improving outcomes after OHCA. This article examines the background and rationale for pre-hospital ECPR; summarises the findings of a literature search for published evidence; and considers candidate selection, logistics, and complications for this complex intervention.

It was during the teens that filmmaking truly came into its own. Notably, the migration of studios to the West Coast established a connection between moviemaking and the exoticism of Hollywood. The essays inAmerican Cinema of the 1910sexplore the rapid developments of the decade that began with D. W. Griffith's unrivaled one-reelers. By mid-decade, multi-reel feature films were profoundly reshaping the industry and deluxe theaters were built to attract the broadest possible audience. Stars like Mary Pickford, Charlie Chaplin, and Douglas Fairbanks became vitally important and companies began writing high-profile contracts to secure them. With the outbreak of World War I, the political, economic, and industrial groundwork was laid for American cinema's global dominance. By the end of the decade, filmmaking had become a true industry, complete with vertical integration, efficient specialization and standardization of practices, and self-regulatory agencies.

Mitigation and adaptation projects will lead to increased population displacement, calling for new research and attention to past lessons. Although there is agreement that climate change will result in population displacements and migration, there are differing views on the potential volume of flows, the likely source and destination areas, the relative role of climatic versus other factors in precipitating movements, and whether migration represents a failure of adaptation ( 1 , 2 ). We argue that climate change mitigation and adaptation (M&A) actions, which will also result in significant population displacements, have not received sufficient attention. Given the emergence of resettlement as an adaptation response, it is critical to learn from research on development-forced displacement and resettlement (DFDR). We discuss two broad categories of potential displacement in response to (i) climate impacts themselves and (ii) large-scale M&A projects. We discuss policy approaches for facilitating migration and, where communities lack resources to migrate, suggest guidelines for organized resettlement.

Community-acquired pneumonia is a major cause of morbidity and mortality globally. Specific molecular endotypes are currently not well defined, and different viral or bacterial pathogens may trigger specific host responses and pathogenic mechanisms. We performed longitudinal proteomic profiling of bronchoalveolar lavage fluid and plasma from bacterial, influenza, and SARS-CoV-2-driven pneumonia. Our analysis revealed highly pneumonia type-specific proteomic signatures, including COVID-19-specific antibodies locally produced in the lung. These antibodies showed biased immunoglobulin V-domain usage, linked to a CD69/CD83 plasma cell state associated with disease severity and degree of autoimmunity. Using mass spectrometry-driven autoantibody profiling in 2 independent COVID-19 cohorts, we identified 177 putative autoantibodies targeting extracellular matrix, nuclear, and immune-related proteins. Of note, temporal changes in autoantibody profiles correlated with clinical markers of inflammation, organ dysfunction, and duration of hospitalization. These findings highlight the autoimmune aspects of COVID-19 and provide potential biomarkers and therapeutic targets to help improve patient outcomes.