Combination of Inferior Vena Cava Diameter, Hepatic Venous Flow, and Portal Vein Pulsatility Index: Venous Excess Ultrasound Score (VEXUS Score) in Predicting Acute Kidney Injury in Patients with Cardiorenal Syndrome: A Prospective Cohort Study.

BACKGROUND: Fluid overload is deleterious in critically ill patients. It can lead to venous congestion, thereby increasing venous pressure, theoretically increasing the backpressure, and thereby reducing renal blood flow. Venous congestion thus can be an important contributor to acute kidney injury (AKI), with no validated tools to objectively identify venous congestion bedside. MATERIALS AND METHODS: Patients above 18 years admitted in ICU with a provisional diagnosis of cardiorenal syndrome were included in the study. Those with inadequate window, inferior vena cava (IVC) thrombus, and known case of cirrhosis with portal hypertension were excluded from the study. Patients underwent ultrasound examination with serial determination till AKI resolved or patient is initiated on dialysis. Venous excess ultrasound score (VEXUS) comprising inferior vena cava, hepatic vein waveform, and portal vein pulsatility was assessed. RESULTS: Thirty patients were enrolled for the study. The mean age was 59.53 ± 16.47 with 21 (70%) males. Mean sequential organ failure assessment (SOFA) score was 5.03 ± 1.97. Fourteen patients (46.7%) were in AKI stage 1, while eight patients (26.7%) were in AKI stage 2 and stage 3 each. Twenty patients (66.7%) had VEXUS grade III. Resolution of AKI injury showed significant correlation with improvement in VEXUS grade (p value 0.003). Similarly, there was significant association between changes in VEXUS grade and fluid balance (p value 0.006). There was no correlation between central venous pressure (CVP), left ventricular function, and right ventricular function with change in VEXUS grade. CONCLUSION: The study shows that a combined grading of IVC, hepatic vein, and portal vein might reliably demonstrate venous congestion and aid in the clinical decision to perform fluid removal. HOW TO CITE THIS ARTICLE: Bhardwaj V, Vikneswaran G, Rola P, Raju S, Bhat RS, Jayakumar A, et al. Combination of Inferior Vena Cava Diameter, Hepatic Venous Flow, and Portal Vein Pulsatility Index: Venous Excess Ultrasound Score (VEXUS Score) in Predicting Acute Kidney Injury in Patients with Cardiorenal Syndrome: A Prospective Cohort Study. Indian J Crit Care Med 2020;24(9):783-789.

A Comprehensive Review on Printed Electronics: A Technology Drift towards a Sustainable Future.

Printable electronics is emerging as one of the fast-growing engineering fields with a higher degree of customization and reliability. Ironically, sustainable printing technology is essential because of the minimal waste to the environment. To move forward, we need to harness the fabrication technology with the potential to support traditional process. In this review, we have systematically discussed in detail the various manufacturing materials and processing technologies. The selection criteria for the assessment are conducted systematically on the manuscript published in the last 10 years (2012-2022) in peer-reviewed journals. We have discussed the various kinds of printable ink which are used for fabrication based on nanoparticles, nanosheets, nanowires, molecular formulation, and resin. The printing methods and technologies used for printing for each technology are also reviewed in detail. Despite the major development in printing technology some critical challenges needed to be addressed and critically assessed. One such challenge is the coffee ring effect, the possible methods to reduce the effect on modulating the ink environmental condition are also indicated. Finally, a summary of printable electronics for various applications across the diverse industrial manufacturing sector is presented.

Dominance of Fossil Fuels in Japan's National Energy Mix and Implications for Environmental Sustainability.

Despite the drive for increased environmental protection and the achievement of the Sustainable Development Goals (SDGs), coal, oil, and natural gas use continues to dominate Japan's energy mix. In light of this issue, this research assessed the position of natural gas, oil, and coal energy use in Japan's environmental mitigation efforts from the perspective of sustainable development with respect to economic growth between 1965 and 2019. In this regard, the study employs Bayer and Hanck cointegration, fully modified Ordinary Least Square (FMOLS), and dynamic ordinary least square (DOLS) to investigate these interconnections. The empirical findings from this study revealed that the utilization of natural gas, oil, and coal energy reduces the sustainability of the environment with oil consumption having the most significant impact. Furthermore, the study validates the environmental Kuznets curve (EKC) hypothesis in Japan. The outcomes of the Gradual shift causality showed that CO2 emissions can predict economic growth, while oil, coal, and energy consumption can predict CO2 emissions in Japan. Given Japan's ongoing energy crisis, this innovative analysis provides valuable policy insights to stakeholders and authorities in the nation's energy sector.

A Comprehensive Review on Bio-Nanomaterials for Medical Implants and Feasibility Studies on Fabrication of Such Implants by Additive Manufacturing Technique.

Nanomaterials have allowed significant breakthroughs in bio-engineering and medical fields. In the present paper a holistic assessment on diverse biocompatible nanocomposites are studied. Their compatibility with advanced fabrication methods such as additive manufacturing for the design of functional medical implants is also critically reviewed. The significance of nanocomposites and processing techniques is also envisaged comprehensively in regard with the needs and futures of implantable medical device industries.

Manufacturing the Gas Diffusion Layer for PEM Fuel Cell Using a Novel 3D Printing Technique and Critical Assessment of the Challenges Encountered.

The conventional gas diffusion layer (GDL) of polymer electrolyte membrane (PEM) fuel cells incorporates a carbon-based substrate, which suffers from electrochemical oxidation as well as mechanical degradation, resulting in reduced durability and performance. In addition, it involves a complex manufacturing process to produce it. The proposed technique aims to resolve both these issues by an advanced 3D printing technique, namely selective laser sintering (SLS). In the proposed work, polyamide (PA) is used as the base powder and titanium metal powder is added at an optimised level to enhance the electrical conductivity, thermal, and mechanical properties. The application of selective laser sintering to fabricate a robust gas diffusion substrate for PEM fuel cell applications is quite novel and is attempted here for the first time.