Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Regular transient loading response in a vapor-phase flow-direction-switching biofilter

The principal objective of this study was determination of the response of a laboratory-scale vapor-phase flow-direction-switching biofilter to loading changes associated with normal operations such as lunch breaks, overnight shutdowns, and single-shift operation of commercial and industrial facilities. Three regular transient loading cases were considered: (a) variable flow-reversal interval lenghts, (b) variable feed-on/off interval lengths, and (c) variable inlet concentration during a repeating feed-on/off cycle. Toluene was used as the model contaminant compound. The most significant findings of the study were: (1) Relative to unidirectional mode of operation, periodic flow reversal produced a more uniform distribution of reaction capacity along the length of the packed bed; (2) a 12 h flow reversal interval was sufficiently short to maintain the toluene-degrading microbial community in a near-fully active state throughout the unit whereas a 2 day flow reversal interval resulted in diminished removal rates in the first half of the bed and (3) Increasing off-period length resulted in greater penetration of contaminant into the bed and more uniform removal rates along the length of the bed. Information developed in this study should provide a more complete basis for establishing operating protocols and monitoring regulations for vapor-phase biofiltration systems

Microwave Plasma Conversion of Volatile Organic Compounds

A microwave-induced, steam/Ar/O-2, plasma "torch" was operated at atmospheric pressure to determine the feasibility of destroying volatile organic compounds (VOCs) of concern. The plasma process can be coupled with adsorbent technology by providing steam as the fluid carrier for desorbing the VOCs from an adsorbent. Hence, N-2 can be excluded by using a relatively inexpensive carrier gas, and thermal formation of oxides of nitrogen (NO.) is avoided in the plasma. The objectives of the study were to evaluate the technical feasibility of destroying VOCs from gas streams by using a commercially available microwave plasma torch and to examine whether significant byproducts were produced. Trichloroethene (TCE) and toluene (TOL) were added as representative VOCs of interest to a flow that contained Ar as a carrier gas in addition to O-2 and steam. The O-2 was necessary to ensure that undesirable byproducts were not formed in the process. Microwave power applied at 500-600 W was found to be sufficient to achieve the destruction of the test compounds, down to the detection limits of the gas chromatograph that was used in the analysis. Samples of the postmicrowave gases were collected on sorbent tubes for the analysis of dioxins and other, byproducts. No hazardous byproducts were detected when sufficient O-2 was added to the flow. The destruction efficiency at a fixed microwave power improved with the addition of steam to the flow that passed through the torch