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

Comparative study of the acidity of sulphated zirconia supported on alumina prepared by sol-gel and impregnation methods

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Effect of the evacuation mode of the solvent on the textural, structural and catalytic properties of sulfated zirconia doped with cerium

This work studies the evacuation mode of the solvent to optimise the catalytic properties of sulfated zirconia doped with cerium prepared by the sol-gel method. The xerogel solid obtained by ordinary gel drying and calcined at different temperatures exhibits a very low surface area. On the contrary, the aerogel obtained by solvent evacuation under supercritical conditions has a more developed surface. Both aerogel and xerogel exhibit the tetragonal phase of zirconia and/or the zirconium-cerium solid solution phase. Aerogel exhibits more developed superficial Ce4+ and higher acidity. The latter confers it a good reactivity in n-hexane isomerization in the whole temperature range investigated

Comparative study of the sulfur loss in the xerogel and aerogel sulfated zirconia calcined at different temperatures: effect on the n-hexane isomerization

Aerogel and xerogel sulfated zirconia exhibit different structure and texture at various calcination temperatures. At 560°C the aerogel develops only the tetragonal phase, whereas the xerogel contains both the monoclinic and the tetragonal phases. Heating at higher temperature causes the transition of the tetragonal phase into the monoclinic one for all the samples by loss of sulfur, but the tetragonal phase remains significantly more stable in the aerogel. Characterization indicates that the loss of sulfur at higher temperature is easier for the xerogel. The ability of the aerogel to retain sulfur at higher temperature explains its better stability and confers it a good catalytic performance in the n-hexane isomerization reactio

Lean NAFLD: A Distinct Entity Shaped by Differential Metabolic Adaptation

Background and Aims: Nonalcoholic fatty liver disease (NAFLD) affects a quarter of the adult population. A significant subset of patients are lean, but their underlying pathophysiology is not well understood. Approach and Results: We investigated the role of bile acids (BAs) and the gut microbiome in the pathogenesis of lean NAFLD. BA and fibroblast growth factor (FGF) 19 levels (a surrogate for intestinal farnesoid X receptor [FXR] activity), patatin-like phospholipase domain containing 3 (PNPLA3), and transmembrane 6 superfamily member 2 (TM6SF2) variants, and gut microbiota profiles in lean and nonlean NAFLD were investigated in a cohort of Caucasian patients with biopsy-proven NAFLD (n = 538), lean healthy controls (n = 30), and experimental murine models. Patients with lean NAFLD had a more favorable metabolic and histological profile compared with those with nonlean NAFLD (P < 0.05 for all). BA levels were significantly higher in NAFLD with advanced compared with earlier stages of liver fibrosis. Patients with lean NAFLD had higher serum secondary BA and FGF19 levels and reduced 7-alpha-hydroxy-4-cholesten-3-one (C4) levels (P < 0.05 for all). These differences were more profound in early compared with advanced stages of fibrosis (P < 0.05 for both). Lean patients demonstrated an altered gut microbiota profile. Similar findings were demonstrated in lean and nonlean murine models of NAFLD. Treating mice with an apical sodium-dependent BA transporter inhibitor (SC-435) resulted in marked increases in fgf15, a shift in the BA and microbiota profiles, and improved steatohepatitis in the lean model. Conclusions: Differences in metabolic adaptation between patients with lean and nonlean NAFLD, at least in part, explain the pathophysiology and provide options for therapy