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

Spektroskopische Untersuchung der dreidimensionalen topologischen Isolatoren (MnBi2_2Te4_4)(Bi2_2Te3_3)n_n und HgTe: Bandstruktur, orbitale Symmetrien und Einfluss der kationischen dd-Zustände

This thesis examines the electronic properties of two materials that promise the realization and observation of novel exotic quantum phenomena. For this purpose, angle-resolved photoemission forms the experimental basis for the investigation of the electronic properties. Furthermore, the magnetic order is investigated utilizing X-ray dichroism measurements. First, the bulk and surface electronic structure of epitaxially grown HgTe in its three-dimensional topological insulator phase is investigated. In this study, synchrotron radiation is used to address the three-dimensional band structure and orbital composition of the bulk states by employing photon-energy-dependent and polarization-dependent measurements, respectively. In addition, the topological surface state is examined on in situ grown samples using a laboratory photon source. The resulting data provide a means to experimentally localize the bulk band inversion in momentum space and to evidence the momentum-dependent change in the orbital character of the inverted bulk states. Furthermore, a rather new series of van der Waals compounds, (MnBi$_2$Te$_4$)(Bi$_2$Te$_3$)$_n$, is investigated. First, the magnetic properties of the first two members of the series, MnBi$_2$Te$_4$ and MnBi$_4$Te$_7$, are studied via X-ray absorption-based techniques. The topological surface state on the two terminations of MnBi$_4$Te$_7$ is analyzed using circular dichroic, photon-energy-dependent, and spin-resolved photoemission. The topological state on the (MnBi$_2$Te$_4$)-layer termination shows a free-standing Dirac cone with its Dirac point located in the bulk band gap. In contrast, on the (Bi$_2$Te$_3$)-layer termination the surface state hybridizes with the bulk valences states, forming a spectral weight gap, and exhibits a Dirac point that is buried within the bulk continuum. Lastly, the lack of unambiguous evidence in the literature showing a temperature-dependent mass gap opening in these magnetic topological insulators is discussed through MnBi$_2$Te$_4$.In dieser Arbeit werden die elektronischen Eigenschaften zweier Materialien untersucht, welche die Realisierung und Beobachtung neuartiger exotischer Quantenphänomene versprechen. Hierbei bildet die winkelaufgelöste Photoemission die experimentelle Grundlade für die Untersuchung der elektronischen Eigenschaften. Zudem wird die magnetische Ordnung mittels Röntgendichroismusmessungen untersucht. Zunächst wird die elektronische Volumen- und Oberflächenstruktur von epitaktisch gewachsenem HgTe in der Phase eines dreidimensionalen topologischen Isolators untersucht. In dieser Studie wird Synchrotronstrahlung verwendet, um die dreidimensionale Bandstruktur und die orbitale Zusammensetzung der Volumenzustände durch photonenenergieabhängige bzw. polarisationsabhängige Messungen zu bestimmen. Darüber hinaus wird der topologische Oberflächenzustand an in situ gewachsenen Proben mit einer Laborphotonenquelle untersucht. Die daraus resultierenden Daten ermöglichen eine Lokalisierung der Bandinversion im Impulsraum und den Nachweis der impulsabhängigen Veränderung des Orbitalcharakters der invertierten Volumenzustände. Zusätzlich wird eine relativ neue Reihe von van-der-Waals-Verbindungen, (MnBi$_2$Te$_4$)(Bi$_2$Te$_3$)$_n$, untersucht. Zunächst werden die magnetischen Eigenschaften der ersten beiden Mitglieder der Reihe, MnBi$_2$Te$_4$ und MnBi$_4$Te$_7$, mittels Röntgenabsorptionsverfahren bestimmt. Der topologische Oberflächenzustand auf den beidem Terminierungen von MnBi$_4$Te$_7$ wird unter der Verwendung von zirkularem Dichroismus, photonenenergieabhängiger sowie spinaufgelöster Photoemission analysiert. Der topologische Zustand auf der (MnBi$_2$Te$_4$-Terminierung zeigt dabei einen freistehenden Dirac-Zustand mit einem in der Volumenbandlücke liegendem Dirac-Punkt. Im Gegensatz dazu hybridisiert der Oberflächenzustand auf der (Bi$_2$Te$_3$)$_n$-Terminierung mit den Volumenzuständen, wodurch eine Lücke im spektralen Gewicht entsteht, und weist einen Dirac-Punkt auf, der vom Volumenkontinuum überlagert ist. Abschließend wird das Fehlen einer eindeutigen Beweislage in der Literatur, die eine temperaturabhängige Öffnung einer Energielücke in diesen Materialien zeigt, anhand von (MnBi$_2$Te$_4$ diskutiert

Non-local effect of impurity states on the exchange coupling mechanism in magnetic topological insulators

Since the discovery of the quantum anomalous Hall (QAH) effect in the magnetically doped topological insulators (MTI) Cr:(Bi,Sb)2Te3 and V:(Bi,Sb)2Te3, the search for the magnetic coupling mechanisms underlying the onset of ferromagnetism has been a central issue, and a variety of different scenarios have been put forward. By combining resonant photoemission, X-ray magnetic circular dichroism and density functional theory, we determine the local electronic and magnetic configurations of V and Cr impurities in (Bi,Sb)2Te3. State-of-the-art first-principles calculations find pronounced differences in their 3d densities of states, and show how these impurity states mediate characteristic short-range pd exchange interactions, whose strength sensitively varies with the position of the 3d states relative to the Fermi level. Measurements on films with varying host stoichiometry support this trend. Our results explain, in an unified picture, the origins of the observed magnetic properties, and establish the essential role of impurity-state-mediated exchange interactions in the magnetism of MTI

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

Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial

Purpose: Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery. Methods: We conducted an international prospective, observational, multi-center study among patients undergoing major surgery. The primary study endpoint was the incidence of AKD (defined as new onset of estimated glomerular filtration rate (eCFR) < 60 ml/min/1.73 m2 present on day 7 or later) among survivors. Secondary endpoints included the relationship between early postoperative acute kidney injury (AKI) (within 72 h after major surgery) and subsequent AKD, the identification of risk factors for AKD, and the rate of chronic kidney disease (CKD) progression in patients with pre-existing CKD. Results: We studied 9510 patients without pre-existing CKD. Of these, 940 (9.9%) developed AKD after 7 days of whom 34.1% experiencing an episode of early postoperative-AKI. Rates of AKD after 7 days significantly increased with the severity (19.1% Kidney Disease Improving Global Outcomes [KDIGO] 1, 24.5% KDIGO2, 34.3% KDIGO3; P < 0.001) and duration (15.5% transient vs 38.3% persistent AKI; P < 0.001) of early postoperative-AKI. Independent risk factors for AKD included early postoperative-AKI, exposure to perioperative nephrotoxic agents, and postoperative pneumonia. Early postoperative-AKI carried an independent odds ratio for AKD of 2.64 (95% confidence interval [CI] 2.21-3.15). Of 663 patients with pre-existing CKD, 42 (6.3%) had worsening CKD at day 90. In patients with CKD and an episode of early AKI, CKD progression occurred in 11.6%. Conclusion: One in ten major surgery patients developed AKD beyond 7 days after surgery, in most cases without an episode of early postoperative-AKI. However, early postoperative-AKI severity and duration were associated with an increased rate of AKD and early postoperative-AKI was strongly associated with AKD independent of all other potential risk factors

First Measurement of the Total Inelastic Cross-Section of Positively-Charged Kaons on Argon at Energies Between 5.0 and 7.5 GeV

International audienceProtoDUNE Single-Phase (ProtoDUNE-SP) is a 770-ton liquid argon time projection chamber that operated in a hadron test beam at the CERN Neutrino Platform in 2018. We present a measurement of the total inelastic cross section of charged kaons on argon as a function of kaon energy using 6 and 7 GeV/$c$ beam momentum settings. The flux-weighted average of the extracted inelastic cross section at each beam momentum setting was measured to be 380$\pm$26 mbarns for the 6 GeV/$c$ setting and 379$\pm$35 mbarns for the 7 GeV/$c$ setting

First Measurement of the Total Inelastic Cross-Section of Positively-Charged Kaons on Argon at Energies Between 5.0 and 7.5 GeV

International audienceProtoDUNE Single-Phase (ProtoDUNE-SP) is a 770-ton liquid argon time projection chamber that operated in a hadron test beam at the CERN Neutrino Platform in 2018. We present a measurement of the total inelastic cross section of charged kaons on argon as a function of kaon energy using 6 and 7 GeV/$c$ beam momentum settings. The flux-weighted average of the extracted inelastic cross section at each beam momentum setting was measured to be 380$\pm$26 mbarns for the 6 GeV/$c$ setting and 379$\pm$35 mbarns for the 7 GeV/$c$ setting

The hypothetical track-length fitting algorithm for energy measurement in liquid argon TPCs

International audienceThis paper introduces the hypothetical track-length fitting algorithm, a novel method for measuring the kinetic energies of ionizing particles in liquid argon time projection chambers (LArTPCs). The algorithm finds the most probable offset in track length for a track-like object by comparing the measured ionization density as a function of position with a theoretical prediction of the energy loss as a function of the energy, including models of electron recombination and detector response. The algorithm can be used to measure the energies of particles that interact before they stop, such as charged pions that are absorbed by argon nuclei. The algorithm's energy measurement resolutions and fractional biases are presented as functions of particle kinetic energy and number of track hits using samples of stopping secondary charged pions in data collected by the ProtoDUNE-SP detector, and also in a detailed simulation. Additional studies describe impact of the dE/dx model on energy measurement performance. The method described in this paper to characterize the energy measurement performance can be repeated in any LArTPC experiment using stopping secondary charged pions