EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Characterization of LIL laser UV focal spot

One way to get the fusion of hydrogen in laboratory consists in heating and compressing a DT fuel capsule by using a laser. To reach this aim requires a new generation of high power laser facility. CEA is developing for this purpose a new 240 laser line facility, the LMJ facility. The LIL which is the prototype of four LMJ laser lines is operational now. In order to confirm the technical choices, a systematic characterization of LIL was carried out. A particular effort has been provided to measure the 3$\omega$ high energy laser focal spot (1.5 kJ/700 ps and 5 ns for one beam) and the synchronization of laser beams onto the target, which are key issues for the plasma production. We present the experimental device designed to perform these measures: the SAT $3\omega$ (a $3\omega$ laser focal spot analysis system). That diagnostic which is located at the end of the laser lines supplied its first results during the 2004 quadruplet qualification campaigns. We will display and analyze caustic and focal spot results

VISAR diagnostic at LIL facility

A Velocity Interferometer for Any Reflector (VISAR) [1, 2] and a Streaked Optical Pyrometer (SOP) [3] were implemented on the “Ligne integration Laser” (LIL) facility. Spatial resolution as good as 10  μm in the target plane and velocity resolution as good as 0.1 km/s can be achieved. Several campaigns were performed in 2010 involving various experimental setups and physical processes: Boron EOS, Pre-compress H2 with special setup of diamond anvil cell and Shock coalescence. This feedback will be of a great help for the Laser Mégajoule facility (LMJ) VISAR design

VISAR diagnostic at LIL facility

A Velocity Interferometer for Any Reflector (VISAR) [1, 2] and a Streaked Optical Pyrometer (SOP) [3] were implemented on the “Ligne integration Laser” (LIL) facility. Spatial resolution as good as 10  μm in the target plane and velocity resolution as good as 0.1 km/s can be achieved. Several campaigns were performed in 2010 involving various experimental setups and physical processes: Boron EOS, Pre-compress H2 with special setup of diamond anvil cell and Shock coalescence. This feedback will be of a great help for the Laser Mégajoule facility (LMJ) VISAR design

The LIL facility quadruplet commissioning

Following LIL single beamline commissioning in 2003, where performance in terms of power and energy required for LMJ was demonstrated, we spent year 2004 to qualify the quadruplet (or quad) performance at 1$\omega$/3$\omega$. Over that year, the first quad high power and high energy laser experiments took place on LIL facility. A careful set of test campaigns were conducted to safely ramp up laser performance. The main goal was to measure quad-specific features such as beam synchronization and focal spot (size, smoothing contrast ratio or irradiation nonuniformity $\sigma _{\rm rms})$ versus the LMJ requirements. LIL Quad beam waist was recorded for various pulse durations, smoothing techniques and for a wide range of laser intensities up to LMJ-nominal ones. Now, LIL quad has been commissioned to the center of the target chamber and the first plasma experiments are made

115 PW–850 J compressed beam demonstration using the PETAL facility

International audienceThe Petawatt Aquitaine Laser (PETAL) facility was designed and constructed by the French Commissariat à l'énergie atomique et aux énergies alternatives (CEA) as an additional PW beamline to the Laser MegaJoule (LMJ) facility. PETAL energy is limited to 1kJ at the beginning due to the damage threshold of the final optics. In this paper, we present the commissioning of the PW PETAL beamline. The first kJ shots in the amplifier section with a large spectrum front end, the alignment of the synthetic aperture compression stage and the initial demonstration of the 1.15 PW @ 850 J operations in the compression stage are detailed

Overview of on-going LIL experiments

The Ligne d'Integration Laser (LIL) facility has been designed as a prototype for the Laser MegaJoule (LMJ) which is a cornerstone of the French 'Simulation Program'. This laser has been intensively used to test and improve the LMJ components. In addition, a large panel of plasma diagnostics has been installed and is currently used to perform laser-plasma experiments. After a brief discussion about the LIL design, we present the last results in various plasma physics domains.</p

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI): Study protocol for a multicentre, observational trial

Introduction More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. Methods and analysis EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. Ethics and dissemination EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369.