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espanolEl fallo renal agudo es entendido como sindrome distinguido por el subito deterioro de la funcion renal que se sostiene por horas o dias, con la ulterior acumulacion de productos nitrogenados y pudiendo asociarse de oligoanuria y fracaso en la regulacion del equilibrio hidro-electrolitico y acido-base. Las causas de FRA en pacientes criticos son muchas, no obstan-te, entre las mas comunes se encuentran las causas pre-renales (deplecion de volumen, tercer espacio, deplecion de vo-lumen efectiva por insuficiencia cardiaca o cirrosis), o causas multifactoriales que conllevan fallo renal por necrosis tubular aguda como lo es el caso de la sepsis, entre otros. El objetivo del presente estudio es referir informacion actualizada con fundamento medico cientifico en base al cual exponer sobre el uso de la Cistatina C y la Creatinina Serica como predic-tores de la falla renal aguda en pacientes criticamente enfermos. En razon de ello, se escogio efectuar una investigacion de diseno bibliografico, adaptada a una metodologia de revision, a fines de exponer como evidencia diversos criterios expertos que explican la tematica planteada. En los resultados se hace referencia a definiciones actuales de falla renal aguda, asi como tambien a las exposiciones de algunos tratadistas que abordan lo referente al uso de los marcadores antes senalados como predictores de la falla renal aguda en pacientes criticamente enfermos. En conclusion, se destaca la importancia de tener claros los criterios unificados y estandarizados, no solo para el diagnostico adecuado del paciente, sino mas importante aun es lograr hacerlo precozmente. Entre las distintas disertaciones de expertos aqui revisadas, se ha percibido una tendencia a cuestionar la utilidad de la Creatinina Serica como predictor de FRA, en general; y en contraste, a reconocer la Cistatina C como un mejor predictor en terminos amplios. EnglishAcute renal failure is understood as a syndrome distinguished by the sudden deterioration of renal function that lasts for hours or days, with the subsequent accumulation of nitrogenous products and may be associated with oligoanuria and failure to regulate the hydro-electrolyte and acid balance. base. The causes of AKI in critically ill patients are many, howev-er, among the most common are prerenal causes (volume depletion, third space, effective volume depletion due to heart failure or cirrhosis), or multifactorial causes that lead to kidney failure. due to acute tubular necrosis such as sepsis, among others. The objective of this study is to provide updated information with a scientific medical basis on the basis of which to expose the use of Cystatin C and Serum Creatinine as predictors of acute renal failure in critically ill patients. For this reason, it was chosen to carry out a bibliographic design research, adapted to a review methodology, in order to expose as evidence various expert criteria that explain the issue raised. The results refer to current definitions of acute renal failure, as well as the expositions of some writers who address the use of the aforementioned markers as predictors of acute renal failure in critically ill patients. In conclusion, the importance of having clear unified and standardized criteria is highlighted, not only for the proper diagnosis of the patient, but even more important is to achieve it early. Among the different expert dissertations reviewed here, a tendency has been perceived to question the usefulness of Serum Creatinine as a predictor of ARF, in general; and in contrast, to recognize Cystatin C as a better predictor in broad terms.

Purpose Dysphagia occurs as a component of a wide variety of diseases and conditions. When unrecognized or poorly managed, dysphagia can result in malnutrition, volume depletion, and reduced quality of life, as well as aspiration, pneumonia, and death. This document focuses specifically on oropharyngeal dysphagia. The modified barium swallow study (MBSS) is a fluoroscopic motion study used to evaluate oropharyngeal anatomy and swallowing physiology in real time. It is typically performed by a speech-language pathologist together with a radiologist and often assisted by a radiologic technologist. Because oropharyngeal dysphagia has such a varied presentation, the guidance to diagnose and treat oropharyngeal dysphagia in the United States falls under the purview of several professional societies and organizations. However, a thorough review of available practice guidelines and appropriateness criteria issued to date reveals a deficit of up-to-date, comprehensive, evidence-based information on the diagnosis and evaluation of oropharyngeal dysphagia. Specifically, a lack of quality guidance on the ordering, performance, and reporting of the MBSS has hindered efforts to improve standardization and ensure quality continuity of care. Method In 2019, a group with expertise in oropharyngeal dysphagia (speech-language pathologists, radiologists, and referring physicians) convened with the goal of specifying a core set of expert recommendations/best practices to achieve a high-quality MBSS. Results Here, we present the results of the participants' discussions and provide consensus recommendations regarding ordering, performing, and reporting an MBSS. Conclusion The overarching goal of this summary is to emphasize the need for and encourage the development of MBSS practice guidelines to support clinicians and patients.

Background Vitamin K antagonists (VKAs) are still in use for oral anticoagulation, but not all indications allow their replacement by direct oral anticoagulants. Although formal dose reduction is not required in patients with impaired kidney function, case reports indicate that acute kidney injury (AKI) might be associated with derailment of VKA therapy. Methods The study retrospectively collected patients from a tertiary nephrology care centre who experienced AKI while being treated with VKA. In these individuals, the international normalized ratio (INR) as a measure of anticoagulant effect during renal failure was compared with a reference time point with stable kidney function. Results A total of 100 patients with AKI and ongoing VKA therapy met the inclusion criteria. The majority (76%) of patients had AKI with CKD. Volume depletion (n = 43), septic renal failure (n = 22), decompensated heart failure (n = 18) and toxic renal damage (n = 11) were the most important causes of AKI. The average INR values at the time of AKI were higher than at the reference time point [median 3.17 (range 1.10–13.0) versus 2.24 (1.07–5.17); P Conclusions The effect of AKI on anticoagulation by VKA has not been systematically described. This risk should be considered in patients at high risk for AKI.

The periorbital area is probably the most important aesthetic unit to show early signs of ageing due to volume depletion of soft tissues. Dermal filler injections have been increasingly used as a p...

In primary aldosteronism (PA), the occurrence of K+ loss and hypertension suggest alterations in renal tubular transport, but the molecular basis of these alterations in humans is unclear. In this study, urinary extracellular vesicles (uEVs) isolated from patients undergoing fludrocortisone suppression testing (FST, as a means of confirming or excluding PA) were analyzed using mass spectrometry-based proteomics to determine the combined effects of an aldosterone analogue, NaCl and KCl supplementation on renal tubular protein abundance. Of quantified proteins, the Cl−/HCO3− exchanger pendrin decreased by a median 37% [−15, 57] (P < 0.01) and the potassium channel ROMK increased by a median 31% [−10, 85] (P < 0.01) during FST among 10 PA subjects. The trends remained, but to a lesser degree, in two subjects cured of PA by unilateral adrenalectomy. In PA subjects, plasma K+ increased from median 3.6 to 4.2 mM (P < 0.01) and 24 h urine K+ from 101 to 202 mmol (P < 0.01), while 24 h urine Na+/K+ decreased from 2.3 to 0.8 (P < 0.01). At baseline, pendrin negatively correlated with plasma K+ (P < 0.05) and positively correlated with plasma aldosterone (P < 0.01). There were no clear correlations between Δ pendrin (Δ = D4–D0) and changes in blood or urine variables, and no correlations between ROMK in any of the blood or urine variables either at baseline or during FST. We conclude that oral co-administration of mineralocorticoid and KCl in PA patients is associated with reduced pendrin and enhanced ROMK in uEVs. Pendrin reduction during FST suggests that the suppressive effects of oral KCl may outweigh pendrin upregulation by mineralocorticoids.

The grain size effect is one of the fundamental characteristics of semiconductor gas sensors. However, it has not been fully understood due to the absence of studies on the volume-depleted grains. In this work, the gas-sensitive SnO2 quantum dots (QDs) from partial depletion to volume depletion are prepared to discuss the size effects. A facile aqueous-based method is used to prepare the size-controllable SnO2 QDs of 2.0–12.6 nm. The resistance shows a monotonically negative size effect while the response reaches the optimization when the grain radius is comparable to the depletion layer width. It is suggested that the design of highly sensitive gas sensors should consider the equal importance of the control of grain size and depletion layer width. The computational results illustrate size-dependent energy level of donors and number of quasi-free electrons, which are responsible for the negative size effect of resistivity in the volume-depleted SnO2 crystallites. This work provides a comprehensive understanding of grain size effects from partial depletion to volume depletion in semiconductor gas sensors.

Introduction The sodium-glucose cotransporter 2 (SGLT2) inhibitor ertugliflozin is approved for the treatment of adults with type 2 diabetes mellitus (T2DM). This analysis was conducted on safety data pooled from phase 3 studies using ertugliflozin 5 mg or 15 mg versus placebo or an active comparator. Methods The placebo pool (n = 1544) comprised data from three similarly designed 26-week placebo-controlled studies. The broad pool (n = 4849) comprised these three placebo-controlled studies plus four placebo- or active-controlled studies with treatment durations of up to 104 weeks. Results In the placebo pool, there were no notable differences across groups in the incidence of adverse events (AEs), serious AEs, or AEs resulting in discontinuation from study medication, while associations were observed with genital mycotic infection in both females (3.0%, 9.1%, and 12.2% in the placebo, ertugliflozin 5 mg, and ertugliflozin 15 mg groups, respectively) and males (0.4%, 3.7%, 4.2%), thirst (0.2%, 1.3%, 1.0%), and increased urination (1.0%, 2.7%, 2.4%). In the broad pool, volume depletion was increased with ertugliflozin in patients with estimated glomerular filtration rate

Hemorrhagic shock is one of the leading causes of prehospital death in the armed forces. The body begins to shut down due to volume depletion. A significant number of deaths due to hemorrhage occur in the first several hours after injury in both civilian and military trauma. Researchers all over the globe are working to develop products to prevent soldiers from going into a hemorrhagic shock, relatively inexpensive, and easy to transport. Much advancement has been made during the last several years towards the development of ideal hemostatic dressings that can be utilized in both military and civilian trauma. No current hemostatic agents meet all the requirements. Scientists are mainly focused on developing or achieving the specifications of an ideal hemostatic dressing. The ideal hemostatic dressing fulfils many important measures: minimize or stop blood flow within minutes, contain hemostatic agents to enhance blood clotting, is easy to apply, does not require pre-application preparation, has a reasonably long shelf life, is safe to use, prevents bacterial or viral transmission, is stable at extreme temperatures and is inexpensive. An extensive search of the academic scientific databases for relevant keywords was conducted and the results are assessed and summarized. This review will identify the recent advances in hemostatic wound dressings, summarize the currently available dressings such as Quikclot, Hemcon, Celox, Xstat, Floseal and their supporting literature, and discuss the compositions, mechanisms of action and clinical relevance of each category of dressing. In addition, case studies and future research into hemorrhage control with new hemostatic agents will also be discussed in this review.

This chapter introduces the PVT challenges of gas injection. First, the phase diagram of various gases, oil samples and mixtures of oil and gas are investigated. In the next part, the important PVT experiments are discussed in details. These experiments consist of CCE (constant composition expansion), DL (differential liberation), CVD (constant volume depletion), flash separation and swelling test. Some calculation must be considered for designing the gas injection process as it is discussed in Sect. 2.4. In Sects. 2.5, 2.6 and 2.7, three cases are studied about change of phase behavior due to gas injection, MMP calculation of gas injection and asphaltene precipitation due to gas injection, respectively. The optimum design of gas injection and PVT challenges associated with gas injection are presented in Sects. 2.8 and 2.9, respectively.

Dehydration and volume depletion describe two distinct body fluid deficit disorders with differing pathophysiology, clinical manifestations and treatment approaches. However, the two are often confused or equated with each other. Here, we address a number of commonly encountered misconceptions about body-fluid deficit disorders, analyse their origins and propose approaches to overcome them.

The orbital apex is an undefined but well understood concept of Orbital Surgeons. We sought to determine the surgical apex area specifically where the volume ratio decreases significantly impacting on the optic nerve. A retrospective analysis using PACS program processing, measured the right retrobulbar space volume changes in 100 randomly selected cases without orbital pathology where CT was performed for non-ophthalmic indications. Volume of the retrobulbar space was measured between two recognizable landmarks. The first landmark being the point of exit of the optic nerve from the eye and the second landmark the optic nerve's point of exit from the orbit. The measured length between these two points was divided into five equal segments, V1-V5. The volumes of all 5 segments were compared and the most significant area of volume depletion was established. The mean numeric value of measured orbital volumes was compared. A ratio difference of V1/V2 was less than 2, V2/V3 was 2.32 (± 0.27), V3/4 was 3.24 (± 0.39), and V4/V5 was 5.67 (± 1.66). The most remarkable difference in ratio was between V4 and V5 (mean 5.67 ± 1.66 with p

There are no relevant meta-analyses that have assessed the safety of the sodium-glucose transporter 2 (SGLT2) inhibitors in different chronic diseases. We aimed at evaluating the safety of four SGLT2 inhibitors in three chronic diseases by meta-analysis of the large randomized trials of SGLT2 inhibitors. We performed random-effects meta-analysis and carried out subgroup analysis according to type of underlying diseases and type of SGLT2 inhibitors. SGLT2 inhibitors versus placebo significantly reduced the risk of acute kidney injury (RR 0.75, 95% CI 0.66–0.85), and showed the reduced trend in the risk of severe hypoglycemia (RR 0.86, 95% CI 0.71–1.03). SGLT2 inhibitors significantly increased the risks of diabetic ketoacidosis (RR 2.57), genital infection (RR 3.75), and volume depletion (RR 1.14); and showed the increased trends in the risks of fracture (RR 1.07), amputation (RR 1.21), and urinary tract infection (RR 1.07). These effects exhibited by SGLT2 inhibitors were consistent across three chronic diseases (i.e. type 2 diabetes, chronic heart failure, and chronic kidney disease) and four SGLT2 inhibitors (i.e. dapagliflozin, empagliflozin, ertugliflozin, and canagliflozin) (all Psubgroup > 0.05). These findings will guide that specific adverse events are monitored when SGLT2 inhibitors are used in clinical practice.

Hyperkalemia is a life-threatening condition potentially leading to cardiac arrest. Here, we report a case of surprising severe hyperkalemia of 10.2 mmol/L in a diabetic patient with previously normal kidney function presenting without discernible clinical symptoms to our emergency department. The patient was admitted because of hyperglycemia of 32.8 mmol/L, which was detected during daily testing in her nursing home. The hyperkalemia was caused by prerenal failure due to hyperglycemic polyuria which led to volume depletion, and worsened by a combination of potassium-sparing drugs and potassium supplementation. The patient was treated conservatively. Eighteen hours later, the serum potassium concentration was 4.6 mmol/L. The patient could be released 6 days later. To our knowledge, this is the highest described hyperkalemia treated conservatively and survived without cardiopulmonary resuscitation.

In this work, we propose surface potential and subthreshold current models for a buried metal layer based junction-less transistor, for the first time, and the proposed models are verified with the simulation results using Sentaurus TCAD. The buried metal layer (BML) induces the bottom depletion layer and its workfunction is important for volume depletion in OFF-state. The buried metal layer workfunction (ϕ BML ) required for full depletion is derived and its impact on short channel effects (SCE) and drain induced barrier lowering (DIBL) is studied. The scalability of the buried metal layer technology is benchmarked against the existing double gate architecture, using its natural length (λ), electrostatic integrity (EI), Vth roll-off and subthreshold slope (SS) as the figure of merits. It is found that the buried metal layer based junctionless transistor (BML-JLT) can be scaled higher than double gate (DG) provided ϕ BML ≥ ϕ BML,FD however, its subthreshold slope needs to be improved further.

Background: Acute ischemic stroke patients are at risk of acute kidney injury (AKI) due to volume depletion, contrast exposure and pre-existing co-morbid diseases. We determined the incidence and identified predictors associated with AKI in acute ischemic stroke patients. Methods: Data from the Albumin in Acute Ischemic Stroke trial (ALIAS) - I and II and Interventional Management of Stroke (IMS) - III clinical trials were pooled and analyzed in which acute ischemic stroke patients were randomized into either IV albumin, placebo, endovascular or IV thrombolytic treatment groups. Serum creatinine levels from baseline and within day 5 or discharge along with the demographic and comorbidity information was collected. AKI classification was used to ascertain severity of renal dysfunction and based on increase in serum creatinine levels from baseline, stage 1 ≥ 0.3 mg/dl (≥ 26.4umol/L) or (>1.5 to 2-fold), stage 2 (>2 to 3-fold) and stage 3 (>3-fold) were identified. We analyzed the relationship between AKI and mortality at 3 months post randomization. Results: A total of 1931 acute ischemic stroke patients (mean age 66± 13 (SD) years; 1024 were men) were analyzed. Any increase in serum creatinine was seen in 691 (35.8%, 95% CI 30%-40%) and AKI was seen in 68 (3.5%, 95% CI 3%-4%) of 1931 patients. Severity of AKI was grade I, II, III in 2.1 %, 0.4%, and 0.1% patients, respectively. The risk of AKI was not higher between those who either underwent CT angiography (2% compared with 4.2%, RR 0.5, 95% CI 0.3-0.8, p=0.02) or endovascular treatment (1.9% compared with 4.1%, RR 0.4, 95% CI 0.2-0.8, p=0.0096). Patients with preexisting hypertension (4.3% compared to 1.5%, RR 2.8, 95% CI 1.3-5.7, p=0.006) and preexisting renal disease (9.1% compared to 3.0%, RR 3.1, 95% CI 1.8-5.3, p=0.006) had higher risk of AKI. Mortality at 3 months was significantly higher among patients with AKI (27% compared with 15%, RR 1.8, 95% CI 1.2-2.7, p=0.0083). Conclusions: The incidence of AKI in acute ischemic stroke patients was low and was not higher in patients who underwent CT angiogram or those who received endovascular treatment. Occurrence of AKI increased mortality at 3 months among acute ischemic stroke patients.

Contrast-induced acute kidney injury (CI-AKI) is a form of kidney damage by recent exposure of iodinated contrast media (CM) without another clear cause for AKI. Now serum creatinine-based definition is generally used; however, there are some problems on the definition and differentiation of CI-AKI. CM is known to induce a variety of alterations in the kidney. The new mechanism of direct tubular injury, specifically the role of inflammatory pathway, has recently been characterized to explain CI-AKI in clinical setting. This might lead to new therapeutic strategy. Both patient-related and procedure-related risk factors for CI-AKI have been identified, and volume depletion and chronic kidney disease (CKD) are known to be high risks for CI-AKI.

In this paper, the DBR all-visible mercury-free high-temperature and high-pressure multifunctional formation fluid PVT analyzer developed and produced by Schlumberger company is used to conduct an experimental study on phase behavior characteristics of one offshore high CO2 condensate gas wells. The experiments include two-phase flash experiment, constant composition expansion experiment (CCE experiment), and constant volume depletion experiment (CVD experiment). Experimental results show that the higher the CO2 content in the condensate gas system, the higher the gas-oil ratio of condensate gas, the greater the density of condensate oil, the higher the dew point pressure of condensate gas, the greater the relative volume of condensate gas, the smaller the amount of retrograde condensate oil. And the higher the CO2 content in the condensate gas system, the phase diagram is shifted to the left and up, the critical point of the phase diagram is shifted to the lower left, the smaller the area of the two-phase envelope, the lighter the condensate gas system, the condensate oil recovery is higher. The above experimental results revealed that CO2 is well soluble with condensate gas, the expansion capacity of the condensate gas system was slightly enhanced, and because CO2 has a good extraction capacity, the light components of condensate gas were constantly extracted, the retrograde condensate rate of condensate oil decreases, and the maximum retrograde condensate volume also decreased. However, the condensate oil was produced along with the natural gas, and the higher the CO2 content, the stronger the extraction, the more condensate oil was produced. It is mainly because CO2 has the strong gasification and extraction capacity, on the one hand, the retrograde condensation of condensate gas was inhibited, and on the other hand, reverse evaporation of condensate oil was enhanced. The above experimental results indicate the law of the effect of CO2 on the phase behavior characteristics of condensate gas reservoirs, providing theoretical basis and guidance for the efficient development of condensate gas reservoirs at sea.

Hyponatremia is the most commonly encountered dyselectrolytemia following head trauma. The two main mechanisms responsible for non-iatrogenic hyponatremia are cerebral salt wasting (CSW) syndrome and the syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH is the commonest dyselectrolytemia cause of hyponatremia following traumatic brain injury (TBI) whereas CSW is the most elusive and challenging diagnosis of the causes of hyponatremia from intracranial causes. The need to distinguish between CSW and SIADH is critical because the management of CSW is volume restitution and sodium restoration whereas for SIADH, the management is exact opposite - water restriction. Our recent experience with a 67-year old Caucasian female post-TBI illustrated very interesting observations. To our knowledge, this is the first case of the sequential development of symptomatic hyponatremia from SIADH followed by the development of hyponatremia from CSW in the same patient during the same admission. Furthermore, our case further highlighted the contrarian observation that with a high index of suspicion for CSW and its early diagnosis, volume depletion and hypovolemia from polyuria may not be a distinguishing presenting factor, when contrasted with SIADH.

Hydrolifting is a newly developed modality of skin rejuvenation, which enhances overall facial volume augmentation and recovers skin thickness through multi-pass HA injection. Although it is commonly performed, only a few articles have reported on the rejuvenating effects of hydrolifting. Moreover, clear protocols and possible mechanisms of the procedure have not been elucidated.To define a novel technique for injecting HA and to clarify how to choose an appropriate HA filler based on the procedural purpose.This article is based on a review of the medical literature and the authors' clinical experience in investigating and treating skin wrinkles with the hydrolifting method.In hydrolifting, HA filler serves as a hydration source, dermal volumizer, and stimulator of dermal collagen and antioxidants. Hydrolifting is frequently indicated in minor wrinkles, minor volume depletion and rough skin texture.The hydrolifting method is a newly introduced antiaging treatment modality. It effectively covers the blind spots of conventional HA injection, such as infraorbital, perioral and hand dorsal wrinkles. However, further investigations are needed to reach a consensus on the basic concepts of treatment, choice of appropriate fillers and optimal technique in hydrolifting.

Acute kidney injury (AKI) is an important part of renal diseases and a common clinical problem. AKI is an acute decline in renal function. Due to a lack of therapeutic options, prevention and optimal management of patients with AKI are the most important strategies. Although seldom the sole cause of patients' death, AKI is associated with a significant increase in mortality. Our objective is to draw the attention towards the prevention of AKI of non-renal causes.

Background: Loop diuretics (LD) are widely used in emergency and intensive care medicine. Summary: The substances increase the clearance of electrolytes and water; thus, they allow us to control hypervolemia and to prevent patients from pulmonary edema. LD are also frequently applied to patients with an acute decrease in glomerular filtration rate, namely, acute kidney injury (AKI). Nevertheless, volume depletion may be associated with reduced renal perfusion and possibly slower restitution or even aggravation of kidney dysfunction. Several trials on the preventive or therapeutic efficacy of LD have been published since the early 1970s. Our review article is intended to summarize the most important references related to this topic. In addition, we discuss the diagnostic value of the so-called furosemide stress test. The currently available data indicate that LD may act in a beneficial manner as long as euvolemia is maintained (matched hydration). Key Massages: LD are not beneficial for AKI treatment if kidney-related endpoints are considered. In certain situations, AKI prevention with LD can be associated with favorable outcomes as long as euvolemia is maintained. LD can help to identify AKI subjects at a higher risk of AKI progression, but the exact clinical consequences need to be determined.

Introduction: Swimming in cold water ("polar bear" swimming) is growing in popularity and attracting individuals of many ages and athletic backgrounds. Case Report: A case of 60-year-old woman swimmer who experienced near-syncope after swimming for 20 minutes in cold water (water temperature: 14°C) without a wetsuit. The patient did not have signs of clinically-relevant hypothermia but was brought to a sauna after swimming. Pre-existing volume depletion, with subsequent orthostatic hypotension made worse by swimming in cold water, was the most likely etiology of near-syncope in this patient. Clinical improvement was noted when the patient started shivering after being removed from the sauna, and all symptoms resolved after the administration of 1 L of normal saline. Conclusion: As cold-water swimming continues to gain in popularity, emergency medicine practitioners may see more cases of swimming-related syncope and near-syncope. Depending on the presentation, the priority of treatment may be the correction of volume depletion and orthostatic hypotension, rather than active rewarming.

Recurrent AKI is common among patients after hospitalized AKI and is associated with progressive CKD. In this study, we identified clinical risk factors for recurrent AKI present during index AKI hospitalizations that occurred between 2003 and 2010 using a regional Veterans Administration database in the United States. AKI was defined as a 0.3 mg/dl or 50% increase from a baseline creatinine measure. The primary outcome was hospitalization with recurrent AKI within 12 months of discharge from the index hospitalization. Time to recurrent AKI was examined using Cox regression analysis, and sensitivity analyses were performed using a competing risk approach. Among 11,683 qualifying AKI hospitalizations, 2954 patients (25%) were hospitalized with recurrent AKI within 12 months of discharge. Median time to recurrent AKI within 12 months was 64 (interquartile range 19-167) days. In addition to known demographic and comorbid risk factors for AKI, patients with longer AKI duration and those whose discharge diagnosis at index AKI hospitalization included congestive heart failure (primary diagnosis), decompensated advanced liver disease, cancer with or without chemotherapy, acute coronary syndrome, or volume depletion, were at highest risk for being hospitalized with recurrent AKI. Risk factors identified were similar when a competing risk model for death was applied. In conclusion, several inpatient conditions associated with AKI may increase the risk for recurrent AKI. These findings should facilitate risk stratification, guide appropriate patient referral after AKI, and help generate potential risk reduction strategies. Efforts to identify modifiable factors to prevent recurrent AKI in these patients are warranted.

The sum of the volumes of brain tissue, cerebrospinal fluid (CSF), and intracranial blood remain constant. This tenet of the Monroe-Kellie hypothesis is most often considered in the setting of intracranial hypertension, but it can also be applied in the setting of CSF volume depletion. We used this hypothesis to explain a case of failed caudal block in a patient with an iatrogenic CSF leak.A one-month-old baby (3 kg) born at 35 weeks' gestation presented for right inguinal hernia repair. His past medical history was significant for arthrogryposis (congenital joint contractures in two or more areas of the body) as well as ongoing apneic episodes that required continuous positive airway pressure therapy and neonatal intensive care. An ultrasound confirmed caudal block was completed and within five minutes of the procedure, the patient's heart rate increased, with an accompanying slight increase in T-wave amplitude. Pinch tests revealed anesthesia to the feet bilaterally but insufficient anesthesia to the abdomen. The surgery was delayed but successfully completed under general anesthesia the following week. Magnetic resonance imaging of the brain and spine following the surgery showed a significant CSF leak with engorgement of the epidural venous plexus along the entire spine. These findings were consistent with a CSF leak likely secondary to a prior lumbar puncture (at age 13 days) that was part of the investigation of his respiratory issues.The possible mechanism of this failed caudal block was high systemic absorption of anesthetic given the epidural venous plexus engorgement thus leaving less anesthetic acting within the CSF and on the exiting spinal nerves. Decreased CSF flow in the thecal sac might also have contributed, as might dilution of the remaining local anesthetic caused by large amounts of leaking CSF within the epidural space.

In this paper, we provide a simple and effective solution to realize efficient volume depletion and therefore, significantly reduce the OFF-state leakage current of a junctionless FET (JLFET) by replacing the SiO2 by HfO2 in the buried oxide (BOX). Using calibrated 2-D simulations, we show that the JLFET with a high-k BOX (HB JLFET) exhibits a considerably high ${\mathrm{ I}}_{\mathrm{ ON}} /{\mathrm{ I}}_{\mathrm{ OFF}} $ ratio of $\sim 10^{6}$ even for a channel length of 20 nm. Further, we demonstrate that the use of a high-k BOX leads to a reduction in both gate capacitance ${\mathrm{ C}}_{\mathrm{ g}} $ and gate-to-drain feedback (Miller) capacitance ${\mathrm{ C}}_{\mathrm{ gd}} $ .

We report a case of severe hypokalemia and volume depletion complicated by chronic watery diarrhea resulting from chronic alcoholism in a 57-year-old man. Prompt replacement of normal saline with potassium chloride and cessation of alcohol intake resulted in a favorable outcome. We discuss the pathophysiology of the case, emphasizing the response of aldosterone in both hypokalemia and volume depletion, and provide a review of recent research.

Pituitary apoplexy is characterized by the acute ischemic or hemorrhagic infarction of the pituitary gland. Acute kidney injury is a less recognized complication associated with pituitary apoplexy but occasionally can be a presenting condition in patients with pituitary apoplexy. Here we discuss the case of a patient who presented with significant volume depletion, admitted with acute kidney injury, and was later diagnosed with pituitary apoplexy.

Background Worldwide, the brow is the most common facial site to receive aesthetic treatment. However, the forehead above the brows has been comparatively less well studied with respect to both neuromodulators and fillers. Age-related remodeling of the forehead with loss of facial bone has been demonstrated on detailed radiographic studies. Concurrent loss of facial fat deposits also adds to the volume depletion. The resulting shallow scalloped depressions in the central 2/3 of the forehead give a tired and aged appearance as do the deep etched horizontal forehead lines which are often associated. Temporal hollowing may be an important associated feature. Methods Combination treatment of the upper face with neuromodulators to elevate the brows and diluted hyaluronic acid (HA) fillers to smooth the medial glabellar complex and reflate the forehead and temple has recently become a desired and popular treatment. Several techniques have been described in the literature. All these techniques are designed to allow forehead reflation with reduction of the possibility of vascular compromise. Conclusion Avoidance of the supratrochlear and supraorbital vasculature with cosmetic filler injections is possible by insertion of needle or cannula into the subgaleal space above their transition from preperiosteal to subcutaneous level. Using this technique we have so far not seen any vascular compromise and we present this technique in the interest of patient safety.

CANA is an SGLT2 inhibitor that was generally well tolerated in 12 placebo (PBO) and active-controlled phase 3/4 trials (non-CANVAS studies [NCS]) for ≤104 weeks in a broad range of patients with type 2 diabetes (T2D). Here we report the longest-term safety data to date (up to 6.5 years) with CANA in patients with T2D and high CV risk from the CANVAS Program vs. the NCS. Amputation and fracture were novel safety signals in the CANVAS Program (HR [95% CI]: 1.97 [1.41, 2.75] and 1.26 [1.04, 1.52]) that were not seen in the NCS (RR [95% CI]: 0.23 [0.06, 0.89] and HR [95% CI]: 1.13 [0.74, 1.72]). The incidence of labeled AEs (i.e., osmotic diuresis [OD]- and volume depletion [VD]-related AEs, hypoglycemia, urinary tract infection, genital mycotic infection [GMI], renal-related AEs, hypersensitivity, diabetic ketoacidosis) and those that were serious or led to discontinuation in the CANVAS Program and the NCS are reported. In the CANVAS Program, incidence of OD- and VD-related AEs and GMI was higher with CANA vs. PBO, consistent with NCS (Table). There were no imbalances in other labeled AEs including hypoglycemia and renal-related AEs. The rate of serious and discontinuation-related labeled AEs was similar with CANA and PBO. CANA was generally well tolerated for up to 6.5 years in the CANVAS Program with an AE profile (excluding amputation and fracture) consistent with NCS, which included a more general T2D population. Disclosure P. Hollander: Advisory Panel; Self; Novo Nordisk Inc., Eli Lilly and Company, Merck & Co., Inc.. V. Mohan: None. V.C. Woo: Advisory Panel; Self; Janssen Pharmaceuticals, Inc., AstraZeneca, Novo Nordisk Inc., Sanofi, Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc. R. Oh: Employee; Self; Janssen Research & Development. G. Fulcher: Other Relationship; Self; Novo Nordisk Inc., Janssen Scientific Affairs, LLC., Boehringer Ingelheim GmbH, Merck Sharp & Dohme Corp..

Ertugliflozin (ERTU) is an SGLT2 inhibitor for the treatment of T2DM. Osmotic diuresis (OD), volume depletion (VD) and change in renal function were assessed in adults with T2DM. Pooled analyses were performed on data from 7 randomized, double blind, Phase 3 trials in patients receiving ERTU or non-ERTU (placebo [PBO] or active comparator) for at least 26 weeks, including a PBO pool (subset; n=1544) and a broad pool (all studies; N=4859; ERTU 5 mg: n=1716; ERTU 15 mg: n=1693; non-ERTU: n=1450). Mean age was 57.8 years, 25.8% were ≥65 years old, 51.8% were male and 27.7% were on diuretics. Mean eGFR was 85.3 mL/min/1.73 m2. Mean duration of T2DM was 7.9 years and mean baseline (BL) A1C was 8.2%. BL characteristics were similar in the PBO pool. In the broad pool, the incidence of OD events was 2.7%, 2.2%, and 1.4% with ERTU 5 mg, ERTU 15 mg, and non-ERTU, respectively; none were serious and ≤0.2% led to treatment discontinuation. The incidence of VD events was 1.9%, 1.4%, and 1.2% with ERTU 5 mg, ERTU 15 mg and non-ERTU, respectively; 0.2%, 0% and 0%, respectively, were serious and ≤0.1% led to treatment discontinuation. In patients with moderate renal impairment (RI; n=575, ∼12%), ≥65 years old, or on diuretics, ERTU led to a higher incidence of VD events than non-ERTU. In the PBO pool, the incidence of OD events was 2.9%, 2.4%, and 1.0% and the incidence of VD events was 0.8%, 1.0%, and 1.7% with ERTU 5 mg, ERTU 15 mg and PBO, respectively. There was no increase in the proportion of patients with orthostatic hypotension with ERTU treatment. ERTU was associated with small, early decreases in eGFR that returned to or towards BL during treatment. Mean decreases in eGFR were larger in patients with BL moderate RI and returned to BL after treatment discontinuation (recently published). ERTU is associated with OD, but does not generally lead to VD events or orthostatic hypotension. Consistent with this, observed decreases in eGFR were reversible during treatment or after discontinuation. Disclosure S.M. Patel: Employee; Self; Merck & Co., Inc.. Employee; Spouse/Partner; GlaxoSmithKline plc.. Stock/Shareholder; Self; Merck & Co., Inc.. Stock/Shareholder; Spouse/Partner; GlaxoSmithKline plc. M.A. Hickman: Employee; Self; Pfizer Inc.. Stock/Shareholder; Self; Pfizer Inc. R. Frederich: Employee; Self; Pfizer Inc.. Stock/Shareholder; Self; Pfizer Inc., Bristol-Myers Squibb Company. B. Lauring: Employee; Self; Merck & Co., Inc. S. Terra: Employee; Self; Pfizer Inc. S.L. Johnson: Employee; Self; Pfizer Inc. S. Huyck: Employee; Self; Merck & Co., Inc. J.P. Mancuso: Employee; Self; Pfizer Inc.. Stock/Shareholder; Self; Pfizer Inc.. Employee; Spouse/Partner; Pfizer Inc.. Stock/Shareholder; Spouse/Partner; Pfizer Inc..

We thank Dr Grocott for his comments on our recent review of sodium-glucose cotransporter-2 (SGLT2) inhibitors in Circulation .1 We fully agree that, although rare, there is a potential increased risk for the development of serious adverse effects with SGLT2 inhibitors such as diabetic ketoacidosis and issues related to volume depletion that warrant special attention and monitoring in the perioperative setting.1 As outlined elsewhere, we have discussed possible contributory mechanisms and have suggested management approaches for patients taking SGLT2 inhibitors perioperatively to avoid these rare but potentially serious adverse …

Spontaneous intracranial hypotension (SIH) is a rare and potentially serious condition in childhood. Cerebrospinal fluid (CSF) volume depletion is thought to be the main causative feature for intracranial hypotension and results from a spontaneous CSF leak, often at the spine level. SIH is increasingly diagnosed in clinical practice, although it manifests a varied symptomatology. The downward displacement of the brain, sometimes mimicking a Chiari I malformation, has rarely been reported. We present a case of a SIH with Chiari I malformation accompanied by an unusual clinical presentation of persistent hypoglycemia.

Introduction Volume depletion is a common problem in pediatrics. Interns need to be able to recognize critical illness such as hypovolemic shock, obtain access, and manage complications. This simulation case involves a child with hypovolemic shock who requires intraosseous (IO) needle placement. While designed for subinterns in pediatrics, it is relevant for clerkship students and interns in family medicine and emergency medicine. Methods In this case, a 3-year-old child presents with vomiting, diarrhea, and lethargy, and is in hypovolemic shock. As IV access cannot be obtained, he requires IO access. Laboratory results reveal hypoglycemia, hypernatremia, and acute kidney injury. Required equipment includes an IV arm task trainer and a child mannequin with IO capacity (or a child mannequin plus a separate IO task trainer). Learning objectives include recognizing and managing hypovolemic shock, hypoglycemia, and electrolyte disturbances; obtaining IO access; and communicating with a distraught parent. Critical actions include attempting IO access, requesting labs, and administering fluids. Students complete a selfassessment survey following the case. Results A pilot study was conducted in 2017 with all subinterns (N = 16) on the pediatric service. Students' perceived competence in assessment and management of volume depletion and procedural skills such as IO placement were high following the session, and students rated the case as a highly beneficial learning experience. Discussion This clinical simulation case allows students to demonstrate clinical reasoning skills, procedural skills, and management skills regarding hypovolemic shock. It may be used as part of a curriculum for fourth-year students entering pediatric residency.

ObjectiveHurricane Sandy, one of the most destructive natural disasters in New Jersey history, made landfall on October 29, 2012. Prolonged loss of electrical power and extensive infrastructure damage restricted access for many to food and water. We examined the rate of dehydration in New Jersey residents after Hurricane Sandy.MethodsWe obtained data from 2008 to 2012 from the Myocardial Infarction Data Acquisition System (MIDAS), a repository of in-patient records from nonfederal New Jersey hospitals (N=517,355). Patients with dehydration had ICD-9-CM discharge diagnosis codes for dehydration, volume depletion, and/or hypovolemia. We used log-linear modeling to estimate the change in in-patient hospitalizations for dehydration comparing 2 weeks after Sandy with the same period in the previous 4 years (2008–2011).ResultsIn-patient hospitalizations for dehydration were 66% higher after Sandy than in 2008–2011 (rate ratio [RR]: 1.66; 95% confidence interval [CI]: 1.50, 1.84). Hospitalizations for dehydration in patients over 65 years of age increased by nearly 80% after Sandy compared with 2008–2011 (RR: 1.79; 95% CI: 1.58, 2.02).ConclusionSandy was associated with a marked increase in hospitalizations for dehydration. Reducing the rate of dehydration following extreme weather events is an important public health concern that needs to be addressed, especially in those over 65 years of age. (Disaster Med Public Health Preparedness. 2016;10:188–192)

The use of facial fillers has been rapidly increased as the range of injectable products and indications continues to expand. Complications may arise from improper placement or technique. This article highlights the importance of anatomic knowledge when using injectable fillers in the face.A detailed review of the clinical anatomy of the upper face is performed. Regional approaches are described using the applied anatomy to efficiently and safely augment the different subunits of the upper face.Key aspects of safe and successful injection of fillers in the upper face include a thorough knowledge of the location of fat compartments and neurovascular structures. Awareness of these structures enables the practitioner to maximize injections, while avoiding damage to important nerves and vessels.A detailed knowledge of the anatomy and properties of the product is paramount to maximize the efficacy while minimizing the risk of complications.

Introduction Sodium glucose co-transporter 2 inhibitors decrease hemoglobin A1c (HbA1c) and blood pressure (BP) and slightly increase low-density lipoprotein cholesterol (LDL-C) in patients with type 2 diabetes mellitus (T2DM). The effects of baseline BP and LDL-C on the safety and efficacy of canagliflozin in patients were analyzed post hoc in a phase III study. Methods Japanese patients with T2DM were classified by baseline systolic BP (SBP) of

SummaryBackgroundFrom developing countries, there is paucity of information regarding epidemiological characteristics of acute-on-chronic renal failure (ACRF) that differs from acute kidney injury (AKI).MethodsIn this prospective study, we analyzed and compared clinical characteristics and outcome of ACRF with AKI from January 2007 to August 2012.ResultsA total of 1117 patients with community-acquired AKI were included in study (AKI = 835; ACRF = 282). Patients with ACRF were older than patients with AKI (p < 0.001). Sepsis was the main cause of acute decline in renal functions in patients with ACRF in comparison to AKI (p < 0.001). Volume depletion/renal hypoperfusion was the most common cause of AKI and the difference was statistically significant as compared to ACRF (33.9% vs. 17.7%; p < 0.001). Need for dialysis was significantly less in patients with ACRF as compared to AKI (68% vs. 77.4%; p 0.002). Lower inhospital mortality was observed in ACRF in comparison to AKI (5% vs. 8.9%, p = 0.04), while no significant difference was noted in terms of duration of hospital stay between the two groups (p = 0.67). However, a significantly higher proportion of patients with ACRF did not recover and progressed to end-stage renal disease as compared to AKI (20% vs. 7.8%; p < 0.001).ConclusionACRF constituted an important cause (25%) of AKI. An episode of superimposed AKI is associated with significantly increased risk of progression to end-stage renal disease in patients with chronic kidney disease.背景慢性腎病合併急性腎衰竭 (ACRF) 不同於急性腎損傷 (AKI)，然而在發展中國家，ACRF 的流行病學數據仍然相當有限。方法在 2007 年 1 月至 2012 年 8 月期間，我們進行了一項前瞻性研究，分析並比較了 ACRF 與 AKI 的臨床特徵和治療後果。結果研究對象為 1117 位社區性 AKI 患者 (AKI = 835；ACRF = 282)，其中 ACRF 患者較 AKI 患者年老 (p < 0.001)。相比於 AKI，ACRF 的急性腎功能下降較常歸因於敗血症 (p < 0.001)；相比於 ACRF，AKI 則較常歸因於容積匱乏/腎灌流不足 (33.9% vs. 17.7%；p < 0.001)；ACRF 患者比 AKI 患者較少需要接受透析療法 (68% vs. 77.4%；p = 0.002)；ACRF 患者的院內死亡率低於 AKI 患者 (5% vs. 8.9%；p = 0.04)，兩組間的住院期則無明顯差別 (p = 0.67)；然而，相比於 AKI 患者，明顯較多的 ACRF 患者無法康復並惡化成末期腎病 (ESRD) (20% vs. 7.8%；p < 0.001)。結論慢性腎病合併急性腎衰竭是急性腎損傷的重要病因 (25%)；在慢性腎病患者間，AKI 的發生明顯增加惡化為 ESRD 的風險。

1. Michael L. Moritz, MD, FAAP* 2. Juan C. Ayus, MD, FACP, FASN† 1. *Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, The University of Pittsburgh School of Medicine, Pittsburgh, PA. 2. †Renal Consultants of Houston, Houston, TX. In the July issue of Pediatrics in Review , Dr Powers discusses the recognition and management of various forms of dehydration: isotonic, hypotonic, and hypertonic. (1) We would like to draw attention to certain aspects of her recommendations that are incorrect and could pose serious complications if followed, that is, the use of hypotonic fluids with the addition of 40 mEq/L (40 mmol/L) of potassium chloride for the treatment of dehydration and the use of isotonic fluids for the treatment of hyponatremic encephalopathy. Our main contentions are: The term “dehydration” is frequently employed in children with gastroenteritis who have normal or low plasma sodium concentrations. The term dehydration means the loss of total body water and in the strict sense can only be applied to children who have hypernatremia. The more appropriate terminology is volume depletion, which refers to extracellular fluid loss. (2)(3) We, therefore, use the term volume depletion for children with gastroenteritis and signs of hypovolemia. Dr …

A prospective study of 82 patients with acute renal failure was carried out over the last 2 years. Mean age of the patients was 35.6 years (8-82 years). Male to female ratio was 3.5:1. The etiological factors were septicaemia in 18 patients (21.95%), aminoglycoside toxicity in 16 patients (19.51%), open heart surgery in 8 patients (9.76%), volume depletion and blood loss in 12 patients (14.63%), glomerulonephritis in 4 patients (4.88%), renal allograft dysfunction in 4 patients (4.88%), and miscellaneous causes in 20 patients (24.39%). Non-oliguric renal failure was observed in 39.02 per cent cases. Dialysis support was required in 65.8 per cent of the cases; with average 5.6 (4 to 11) dialysis sessions. Four patients of acute renal failure following open heart surgery were given continuous arterio-venous haemofiltration. Overall mortality was 32.5 per cent, septicaemia accounting for 60 per cent of the deaths.

This chapter presents an introduction to fluid sampling concepts and how it effects on the oil and gas reservoir management. Furthermore, this chapter demonstrates the sampling methods including bottom-hole samples, surface sampling, formation testers, and wellhead sampling. In addition, it presents the advantages and drawbacks of surface and subsurface sampling methods. Next, this chapter provides the full description of recombination methods along with several real oil and gas field examples. Moreover, a thorough explanation of pressure–volume–temperature (PVT) tests (differential test, swelling test, separator test, constant composition test, constant volume depletion, and differential liberation test) along with advantages, drawbacks, and calculation procedures is given. Also, it provides which PVT test provides which information and how to calculate them from raw data samples. Finally, this chapter explains the flash calculation procedure. In this regard, several real field examples are provided. Finally, at the end of the chapter, several useful problems are provided.

Background Little is known about the adverse drug reaction (ADR) related admissions among heart failure (HF) patients. Objective The aim of this study was to determine the rate, factors, and medications associated with ADR-related hospitalisations among HF patients. Setting Two government hospitals in Dubai, United Arab Emirates. Methods This was a prospective, observational study. Consecutive adult HF patients who were admitted between December 2011 and November 2012 to the cardiology units were included in this study. The circumstances of their admission were analysed. Main outcome measures ADRs-related admissions of HF patients to cardiology units were identified and further assessed for their nature, causality, and preventability. Results Of 511 admissions, 34 were due to ADR-related hospitalisation (6.65, 95 % confidence interval 4.8–8.5 %). Number of medications taken by HF patients was the only predictors of ADR-related hospitalisations, where higher number of medications was associated with the odd ratio of 1.11 (95 % CI, 1.03–1.20, P = 0.005). More than one-third of ADR-related hospitalisations (35 %) were preventable The most frequent drugs causing ADR-related hospitalisation were diuretics (32 %), followed by non-steroidal anti-inflammatory drugs (15 %), thiazolidinediones (9 %), anticoagulants (9 %), antiplatelets (6 %), and aldosterone blockers (6 %). Conclusion ADR-related hospitalisations account for 6.7 % of admissions of HF patients to cardiac units, one-third of which are preventable. Number of medications taken by HF patients is the only predictors of ADR-related hospitalisations. Diuretic induced volume depletion, and sodium and water retention caused by thiazolidinediones and NSAIDs medications are the major causes of ADR-related hospitalisations of HF patients.

No abstract available. Article truncated at 150 words. A 68-year-old woman was admitted to the ICU due to acute renal failure in setting of ovarian cancer recurrence. She reports a two week history of abdominal pain with increased, loose ileostomy output, nausea, one episode of vomiting of food returns, and profound increasing generalized weakness. She states she has been voiding urine in normal frequency. She took her most recent dose of Xarelto 20mg the evening prior to presentation. On ICU arrival, she was alert and oriented but pale and underweight with dry mucous membranes. She reported 2/10 generalized abdominal pain. Her blood pressure was stable. PMH: March 2013: Diagnosed with stage IIIC metastatic ovarian cancer. She underwent extensive abdominal surgery including radical hysterectomy, diverting loop ileostomy and cholecystectomy. Final pathology: grade 3 serous carcinoma involving omentum, descending colon, cecum and terminal ileum, both ovaries with implants on bilateral tubes and uterine serosa, right pelvic side wall, right diaphragm ...

Prevention of contrast-induced nephropathy is founded on minimizing the pathophysiologic consequences of contrast media (CM) interacting with a vulnerable kidney. In this article, the rationale for administering fluid (oral or intravenous) is discussed, and the clinical trials exploring different protocols are reviewed. A benefit from administration of fluids before CM exposure, which corrects volume depletion and increases urine output, can be expected. Forced diuresis without adequate volume replacement is deleterious.

The depletion experiments about practical condensate gas samples were carried out with the three full diameter cores from X volcanic condensate gas reservoir in the laboratory. The depletion behavior of condensate gas in cores was studied under the circumstances of existing bottom water, and the results were compared with that of constant volume depletion in a pressure-volume-temperature (PVT) cell. The experimental results were simulated by the ECLIPSE software afterward. The results indicate that the condensate gas depletion performance is different from that of PVT test regardless of existing bottom water, and there is only a little difference for natural gas recovery in cores whether the bottom water is existing, but bottom water has significant effect on condensate oil recovery; the higher the permeability of cores is, the faster water influx rate is, the earlier water breakthrough in production outlet is; the variation laws of the recovery of gas and condensate oil and gas oil ratio obtained by nume...

Diabetes Insipidus (DI) is either due to deficient secretion of arginine vasopressin (central) or to tubular unresponsiveness (nephrogenic). Drug induced DI is a well-known entity with an extensive list of medications. Polyuria is generally defined as urine output exceeding 3 liters per day in adults. It is crucial to identify the cause of diabetes insipidus and to implement therapy as early as possible to prevent the electrolyte disturbances and the associated mortality and morbidity. It is very rare to have an idiosyncratic effect after a short use of a medication, and physicians should be aware of such a complication to avoid volume depletion. The diagnosis of diabetes insipidus is very challenging because it relies on laboratory values, urine output, and the physical examination of the patient. A high clinical suspicion of diabetes insipidus should be enough to initiate treatment. The complications related to DI are mostly related to the electrolyte imbalance that can affect the normal physiology of different organ systems.

A noninvasive method for quantifying hydration status would be helpful for clinical management and for research applications in dogs. This prospective, experimental, pilot study aimed to assess the feasibility of ultrasonographic measurement of the caudal vena cava to aorta ratio as a method for quantifying volume depletion in dogs. In 12 normal beagle dogs, furosemide was administered intravenously at a dose of 1 mg/kg, every 2 h, for 8 h, to induce consecutive volume depletion. Every 30 min after administration, ultrasonographic images of the caudal vena cava and aorta, and physical and biological parameters related to dehydration were acquired. On transverse and longitudinal planes of caudal vena cava and aorta images, the height and area of the caudal vena cava and aorta were measured to calculate the caudal vena cava/aorta ratios. All images were acquired by approaching from the right intercostal space with the dogs in left lateral recumbency. A negative correlation was present between the percentage of weight loss in dogs and all four investigated caudal vena cava/aorta ratios (transverse plane width of the caudal vena cava [TW]/aorta; transverse plane height of caudal vena cava [TH]/aorta; longitudinal plane area of the caudal vena cava [TA]/aorta; and longitudinal plane maximal height of the caudal vena cava [L]/aorta). Significant differences (P

Background The earlobe demonstrates stereotypical signs of aging, including wrinkles and volume depletion. Objectives The purpose of this study is to review the outcome of the earlobe rejuvenation developed by the senior author. Methods We describe our earlobe rejuvenation technique refined over 10 years that uses fat grafting to the earlobe. Three raters assessed preoperative and postoperative photographs of 40 earlobes in 20 patients. Each earlobe was evaluated for volume deficiency, number of deep creases, depth of creases, and number of fine wrinkles. Inter-rater reliability was calculated. Earlobe length was also measured. Results Seventeen females and 3 males with average age of 63 years were followed for an average of 26 months. Postoperative improvements were observed in earlobe volume deficiency and number of fine wrinkles ( P .05). No complications relating to the earlobe were observed in these patients. Conclusions Fat grafting can be an effective means for earlobe rejuvenation. Level of Evidence 4![Graphic][1] Therapeutic [1]: /embed/inline-graphic-1.gif

Prerenal acute kidney injury (AKI) is thought to be a reversible loss of renal function without structural damage. Although prerenal and intrinsic AKI frequently coexist in clinical situations, serum creatinine and urine output provide no information to support their differentiation. Recently developed biomarkers reflect tubular epithelial injury; therefore, we evaluated urinary biomarker levels in an adult mixed intensive care unit (ICU) cohort of patients who had been clinically evaluated as having prerenal AKI. Urinary L-type fatty acid–binding protein (L-FABP), neutrophil gelatinase–associated lipocalin (NGAL), interleukin-18 (IL-18), N -acetyl-β-D-glucosaminidase (NAG), and albumin in patients with prerenal AKI showed modest but significantly higher concentrations than in patients with non-AKI. We also conducted a proof-of-concept experiment to measure urinary biomarker excretion in prerenal AKI caused by volume depletion. Compared with cisplatinum and ischemia–reperfusion models in mice, volume depletion in mice caused a modest secretion of L-FABP and NGAL into urine with more sensitive response of L-FABP than that of NGAL. Although no histological evidence of structural damage was identified by light microscopy, partial kidney hypoxia was found by pimonidazole incorporation in the volume depletion model. Thus, our study suggests that new AKI biomarkers can detect mild renal tubular damage in prerenal acute kidney injury.

Acute kidney injury (AKI) is common in hospitalized patients and is an important cause of mortality. This is a descriptive study of AKI in patients from Himachal Pradesh, India, located in Western Himalayan region. Over a period of 1 year, 102 patients with clinical and laboratory evidence of azotemia were included. Out of 102 patients, 84.3% had community acquired AKI and 15.7% had hospital acquired AKI. Medical causes were leading contributors (85.3%), with septicemia being the main factor (33.3%). Multiorgan failure was present in 59.8% patients. The overall mortality was 29.2%, and community acquired AKI was associated with higher mortality as compared to hospital-acquired AKI (22.5% vs 6.7%). AKI is still common in community and associated with high mortality. Septicemia, volume depletion and nephrotoxins were the leading cause of AKI in our study. Our study highlights the presence of hypotension, multiorgan failure and oliguria with mortality. Community-acquired AKI had higher mortality than hospital-acquired AKI.

Although often used interchangeably, dehydration and volume depletion are not synonyms. Dehydration refers to loss of total-body water, producing hypertonicity, which now is the preferred term in lieu of dehydration, whereas volume depletion refers to a deficit in extracellular fluid volume. In particular, hypertonicity implies intracellular volume contraction, whereas volume depletion implies blood volume contraction. Using a case of hyperglycemic hypertonic nonketosis as an example, we examine the changing composition of body fluid spaces to explore the distinction between dehydration and hypertonicity from volume depletion.