Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide

The effect of compression ratio in constant load and speed conditions on engine characteristics

İçten yanmalı motorlarda yakıt ekonomisi ve egzoz emisyonlarının iyileştirilmesi ile ilgili araştırmalar günümüzde yoğunlaşmıştır. İşletme parametrelerinin motor performansı üzerindeki olumlu etkisini artırmak için çalışmalar yapılmaktadır. Bu çalışmada motor performansını etkileyen en önemli parametrelerden biri olan sıkıştırma oranının motor gücü, yakıt ekonomisi ve egzoz emisyonlarına olan etkileri deneysel olarak incelenmiştir. Deneyler; buji ile ateşlemeli, tek silindirli, dört zamanlı, hava soğutmalı, sıkıştırma oranı 4/1 ile 10/1 arasında ayarlanabilen değişken sıkıştırma oranlı bir motorda yapılmıştır. Sabit kısmi yük ve hızda sıkıştırma oranının artması ile birlikte motor gücünde % 29 artma, özgül yakıt tüketiminde % 23 azalma elde edilmiştir. Ayrıca CO emisyonlarında % 20 düşme kaydedilirken HC misyonlarının % 38 oranında arttığı gözlenmiştir.Studies on improving fuel economy and exhaust emissions in the internal combustion engines have been gained more importance day by day. Currently, the improvements of the effects of operating variables on the engine performance have been researched. In this study, the important operating variable that is compression ratio affecting on engine power, fuel economy and exhaust emissions were investigated. For the experiments, spark ignited, single cylinder, air-cooled and four stroke variable compression ratio engine was used. This engine's compression ratio is variable between 4/1 and 10/1. The results show that the increment on compression ratio increases 29 % engine power and decreases 23 % specific fuel consumption in constant load and speed conditions. In addition, the increment on compression ratio was provided almost 20 % decreases at CO and 38 % increases at HC emissions

The ballistic performance of SiC–AA7075 functionally graded composite produced by powder metallurgy

The potential of silicon carbide reinforced Functionally Gradient Material (FGM) to be used as armor material was investigated under the impact of armor piercing projectile. For this purpose, the SiC-Aluminum Alloy (AA) 7075 functionally graded composite at different thicknesses was produced from the metallic and ceramic powders via powder metallurgy method. Before the ballistic testing, the precipitation hardening behavior of the samples was determined. And also, the microstructural characterizations of the samples were done with the aid of microscopy techniques. Next, the FGM samples were tested using armor piercing projectile to analyze their impact behavior. In the produced samples, some pore formation was detected. The ballistic experiments showed that the investigated FGMs (up to a thickness of 25 mm) did not withstand the impact of the projectile. At the tested samples, some major cracks and plug formation were detected at macrolevel while there were some microcracks, deformed and elongated grains in the regions near to the deformation zone of the samples

Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide