Acute kidney injury after arterial switch operation: incidence, risk factors, clinical impact - a retrospective single-center study.

BACKGROUND: This retrospective study aimed to determine the incidence, risk factors, and outcomes of acute kidney injury (AKI) in neonates following the arterial switch operation (ASO) for transposition of great arteries (TGA). METHODS: Retrospective review of medical data of children who underwent ASO in 2019-2020 in the Ukrainian Children's Cardiac Center. RESULTS: 76 consecutive neonatal patients were included, 48 developed AKI after ASO (51.7%), and 24 - had severe AKI (25.8%). Severe AKI development was associated with longer cross-clamp time: 82 (61-127) versus 73.5 (53-136) in the non-severe AKI group (p = 0.02). 76 min of cross-clamp time were defined as a threshold value for increased severe AKI risk, OR 4.4 (95% CI: 1.5 - 13, p = 0.01). Higher lactate levels during cardiopulmonary bypass (CPB) increased severe AKI development risk, OR 1.5 (95% CI: 1.0 - 2.0, p = 0.03). Children with severe AKI had prolonged mechanical ventilation, longer time to negative fluid balance, and higher postoperative day 3 (POD3) Inotropic Score (IS). Only one patient required peritoneal dialysis. CONCLUSIONS: In our study, 51.7% of patients developed AKI after ASO, 25.8%-severe AKI. Prolonged cross-clamp time and higher lactate levels during cardiopulmonary bypass increased the risk for severe AKI development. The development of AKI was associated with prolonged mechanical ventilation, longer time to negative fluid balance, higher POD 3 Inotropic Score.

Assessment of beta particle flux from surface contamination as a relative indicator for radionuclide distribution on external surfaces of a multistory building in Pripyat.

Several issues should be considered when assessing the feasibility of remediation following the detonation of a radiological dispersion device (e.g., dirty bomb) or improvised nuclear device in a large city. These issues include the levels and characteristics of the radioactive contamination, the availability of resources required for decontamination, and the planned future use of the city's structures and buildings. Presently, little is known about the distribution, redistribution, and migration of radionuclides in an urban environment. However, Pripyat, a city substantially contaminated by the Chernobyl Nuclear Power Plant accident in April 1986, may provide some answers. The main objective of this study was to determine the radionuclide distribution on a Pripyat multistory building that had not been decontaminated and, therefore, could reflect the initial fallout and its further natural redistribution on external surfaces over 23 y. The seven-story building selected was surveyed from the ground floor to the roof on horizontal and vertical surfaces along seven ground-to-roof transections. Some results from this study indicate that the upper floors of the building had higher contamination levels than the lower floors. Consequently, the authors recommend that thorough decontamination should be considered for all the floors of tall buildings (not just lower floors).