Semiquantitative Power Doppler Ultrasound Score to Predict Acute Kidney Injury in Patients With Sepsis or Cardiac Failure: A Prospective Observational Study.

BACKGROUND: Diagnosing acute kidney injury (AKI) stage 3 in critically ill patients may help physicians in making treatment decisions. This diagnosis relies chiefly on urinary output and serum creatinine, which may be of limited value. This study aimed to explore the diagnostic performance of renal resistive index (RRI) and semiquantitative power Doppler ultrasound (PDU) scores in predicting AKI stage 3 in patients with sepsis or cardiac failure. METHODS: This study is a prospective observational study that included 83 patients (40 with sepsis and 43 with cardiac failure). Renal resistive index and semiquantitative PDU scores were measured within 6 hours following admission to the intensive care unit. Acute kidney injury was defined according to the criteria set by Kidney Disease Improving Global Outcomes. RESULTS: The predictive values of RRI (area under the curve [AUC] = 0.772, 95% confidence interval [CI] = 0.658-0.886) and PDU score (AUC = 0.780, 95% CI = 0.667-0.892) were similar in all patients. Power Doppler ultrasound score (AUC = 0.910, 95% CI = 0.815-1.000) could effectively predict AKI stage 3 in the cardiac failure subgroup, and the optimal cutoff for this parameter was ≤ 1 (sensitivity = 87.5%, specificity = 92.6%, Youden index = 0.801, accuracy in our population = 90.7%). However, PDU scores (AUC = 0.620, 95% CI = 0.425-0.814) could not predict AKI stage 3 in the sepsis subgroup. The predictive values of RRI for AKI stage 3 in the cardiac failure (AUC = 0.820, 95% CI = 0.666-0.974) and sepsis (AUC = 0.724, 95% CI = 0.538-0.910) subgroups were similar. CONCLUSIONS: Power Doppler ultrasound scores could effectively predict AKI stage 3 in patients with cardiac failure but not in patients with sepsis. Renal resistive index is a poor predictor of AKI stage 3 in patients with sepsis or cardiac failure.

Proton pump inhibitor use increases hepatic encephalopathy risk: A systematic review and meta-analysis.

BACKGROUND: Several studies have been conducted to explore the association between the use of proton pump inhibitors (PPIs) and hepatic encephalopathy (HE) risk in patients with liver cirrhosis. However, their results are controversial. AIM: To perform a systematic review and meta-analysis to evaluate the HE risk among PPI users. METHODS: A systematic search on PubMed, Web of Science, EMBase, and ScienceDirect databases was conducted up to December 31, 2018 for eligible studies involving PPI use and HE risk. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the fixed or random effects model. Publication bias was evaluated using Begg's test, Egger's test, and trim-and-fill method. RESULTS: Seven studies with 4574 patients were included in the present meta-analysis. The meta-analysis results indicated a significant association between the PPI use and HE risk (OR = 1.50; 95%CI: 1.25-1.75) with low heterogeneity (I 2 = 14.2%, P = 0.321). Although publication bias existed when Egger's tests were used (P = 0.005), the trim-and-fill method verified the stability of the pooled result. Sensitivity analyses suggested that the results of this meta-analysis were robust. CONCLUSION: The current evidence indicates that PPI use increases HE risk in patients with liver cirrhosis. Further studies with a large data set and well-designed models are needed to validate our findings.

Prediction of acute kidney injury: the ratio of renal resistive index to semiquantitative power Doppler ultrasound score-a better predictor?: A prospective observational study.

This study aimed to explore the diagnostic performance of the ratio of renal resistive index (RRI) to semiquantitative power Doppler ultrasound (PDU) score in predicting acute kidney injury (AKI) 3 in critically ill patients.This study was a prospective, observational study that included 101 critically ill patients. RRI and semiquantitative PDU score were measured within 6 hours following admission to the intensive care unit (ICU). The ratio of RRI to PDU (RRI/PDU) was calculated as follows: RRI / PDU. If PDU score was 0, the RRI/PDU was 1. Meanwhile, AKI was defined according to the Kidney Disease Improving Global Outcomes criteria.Median RRI/PDU was 0.234 (0.190, 0.335) in patients with AKI 0-2 and 0.636 (0.411, 0.738) in patients with AKI 3 (P < .001). As assessed by the area under the receiver operator characteristic curves (AUC), RRI/PDU performed best in diagnosing AKI 3 [AUC = 0.935 (95% CI: 0.868-0.974)]. Optimal cuto for RRI/PDU was > 0.37, and the sensitivity and specificity were 90.5% and 90.0%, respectively. In 93 patients, except for 8 patients with a PDU score of 0, the AUC of RRI/PDU [0.938 (95% CI: 0.868-0.977)] was superior to the PDU score (0.905 [95% CI: 0.826-0.956], P = .133), RRI [0.782 (95% CI: 0.684-0.861), P = .016], serum creatinine [0.801 (95% CI: 0.705-0.877), P = .017], or 6 hours AKI stage (0.876 [95% CI: 0.791-0.935], P = .110) in predicting AKI 3 on D5.In our study, RRI, PDU score, RRI/PDU, and 6 hours AKI stage were useful in predicting AKI 3. Furthermore, RRI/PDU may be a better predictor of AKI 3.

Applying rheological analysis to better understand the mechanism of acid conditioning on activated sludge dewatering.

The pH value is a key parameter and affects sludge dewatering. Comprehensive understanding of the effects and mechanism of pH is important for sludge treatment process and sludge dewatering. The goal of this study was to evaluate the proposed mechanism of acid conditioning on sludge dewatering based on rheological analysis. At lower sludge pH, changes in floc structure, surface properties, and flocculation improved the performance of dewatering. Additionally, lower sludge pH caused the hydrolysis of EPS and intracellular materials, which released greater amounts of bound water. These changes resulted in altered rheological properties, weakening network strength and shrinking the linear viscoelastic regime, making the sludge system sensitive to shear. Thus, both the sludge dewatering rate and moisture reduction efficiency were improved by lowering the pH. These factors demonstrate that rheological analysis can understand the mechanism of acid conditioning on activated sludge dewatering better.

A novel approach for phosphorus recovery and no wasted sludge in enhanced biological phosphorus removal process with external COD addition.

In enhanced biological phosphorus removal (EBPR) process, phosphorus (P) in wastewater is removed via wasted sludge without actual recovery. A novel approach to realize phosphorus recovery with special external chemical oxygen demand (COD) addition in EBPR process was proposed. During the new operating approach period, it was found that (1) no phosphorus was detected in the effluent; (2) with an external addition of 10 % of influent COD amount, 79 % phosphorus in the wastewater influent was recovered; (3) without wasted sludge, the MLVSS concentration in the system increased from 2,010 to 3,400 mg/L and kept stable after day 11 during 24-day operating period. This demonstrates that the novel approach is feasible to realize phosphorus recovery with no wasted sludge discharge in EBPR process. Furthermore, this approach decouples P removal and sludge age, which may enhance the application of membrane bioreactor for P removal.

A rheological approach to analyze aerobic granular sludge.

Aerobic granular sludge is one promising biotechnology in wastewater treatment. Despite intensive researches on granular architecture and strategies to improve treatment efficiency, there are still some elusive material parameters needed to stimulate the granulation process. The main aim of this study was to evaluate aerobic granular sludge innovatively using the universal rheology methodology, in terms of processability or quality and texture. Steady shear and oscillatory measurements were performed. Basic rheological characterization showed that aerobic granular sludge was a shear-thinning Herschel-Bulkley fluid with yield pseudoplasticity. Meanwhile, granular sludge presented characterized viscoelastic behaviors in dynamic sweeps highlighting its superiority to flocculent sludge. Furthermore, a Wagner-type constitutive model incorporating a relaxation and damping function was introduced and able to describe the time-dependent and non-linear viscoelastic behaviors. This study could make a further step on predicting rheological properties, helping improve the actual sludge treatment process and the operation of sludge dewatering.