Geriatric nutritional risk index as a possible predictor of decline in kidney function in older people.

Background: The Geriatric Nutritional Risk Index (GNRI) is associated with morbidity and mortality in older individuals. Our study explored the relationship between GNRI, decline in kidney function, and all-cause mortality in older individuals. Methods: This retrospective cohort study analyzed data from participants aged ≥60 years who underwent a general health checkup between 2002 and 2018. The primary exposure was the GNRI, divided into quartiles. The primary and secondary outcomes were a decline in kidney function assessed using the five-year estimated glomerular filtration rate (eGFR) and all-cause mortality, respectively. Results: The analysis included a total of 1,599 participants (median [interquartile range] age, 63 (61-67) years; 54% males). The mean ± standard deviation (SD) of GNRI was 114 ± 7. Compared with the highest GNRI quartile, the lower GNRI quartiles were associated with steeper five-year slopes in eGFR, with a fully adjusted beta coefficient and 95% confidence intervals (CIs) of -0.50 (-0.86. -0.14), -0.29 (-0.63. 0.05), and -0.19 (-0.53. 0.14) for the first, second, and third GNRI quartiles, respectively. The median follow-up duration was 7.4 (4.6-12.4) years. During this period, we identified 108 deaths (7.8 per 1000 person-years). The first GNRI quartile was associated with all-cause mortality compared to the highest GNRI quartile (hazard ratio and 95%CI 2.20 [1.23, 3.95]). Conclusion: Nutritional status, as evaluated using the GNRI, was associated with five-year changes in kidney function and all-cause mortality in older individuals.

Application of Double Piping Theory to Parallel-Arrayed Low-Pressure Membrane Module Header Pipe and Experimental Verification of Flow Distribution Evenness.

In this study, the improvement effect of flow distribution evenness is evaluated quantitatively by applying the double piping theory to a parallel-arrayed low-pressure membrane module header pipe structure, and its feasibility is discussed. Orifice inner pipes to be inserted into a full-scale membrane module header pipe are designed via the computational fluid dynamics (CFD) technique, and the flow rates into 10 membrane modules are measured in real time using a portable ultrasonic flowmeter during operation to verify the effect. Results of CFD simulation and actual measurements show that the outflow rate from the branch pipe located at the end of the existing header pipe is three times higher than the flow rate from the branch pipe near the inlet. By inserting two inner pipes (with an open end and a closed end into the existing header pipe) and applying the double pipe theory, the flow distribution evenness is improved. The CFD simulation and experimental results show that the flow uniformity can be improved by more than 70% and 50%, respectively.

A Study on the Evaluation of Flow Distribution Evenness in Parallel-Arrayed-Type Low-Pressure Membrane Module Piping.

The objectives of this study were to measure the flow rate distribution from a header pipe to each module installed in parallel for a water treatment membrane filtration process in operation and to investigate the reason for an uneven distribution of the flow rate via the CFD technique. In addition, this study attempted to propose the ratio of the branch pipe to the header pipe required to equalize the flow distribution for the same membrane filtration process. Finally, the relationship between the Reynolds number in the header pipe and the degree of the manifold flow distribution evenness was investigated. Mobile ultrasonic flow meter was used to measure the flow rate flowing from the membrane module pipe to each module, and the CFD technique was used to verify this. From the results of the actual measurement using ultrasonic flow meter and CFD simulation, it was confirmed that the outflow flow rate from the branch pipe located at the end of the header pipe was three times higher than that of the branch pipe near the inlet. The reason was that the differential pressure generated between each membrane module was higher toward the end of the header pipe. When the ratio of the sum of the cross-sectional area of the branch pipe and the cross-sectional area of the header pipe was reduced by about 30 times, it was confirmed that the flow rate flowing from each branch pipe to the membrane module was almost equal. Also, if the flow in the header pipe is transitional or laminar (Reynolds No. is approximately 4000 or less), the flow rate flowing from each branch pipe to the membrane module can be more even.

Improving flow distribution in influent channels using computational fluid dynamics.

Although the flow distribution in an influent channel where the inflow is split into each treatment process in a wastewater treatment plant greatly affects the efficiency of the process, and a weir is the typical structure for the flow distribution, to the authors' knowledge, there is a paucity of research on the flow distribution in an open channel with a weir. In this study, the influent channel of a real-scale wastewater treatment plant was used, installing a suppressed rectangular weir that has a horizontal crest to cross the full channel width. The flow distribution in the influent channel was analyzed using a validated computational fluid dynamics model to investigate (1) the comparison of single-phase and two-phase simulation, (2) the improved procedure of the prototype channel, and (3) the effect of the inflow rate on flow distribution. The results show that two-phase simulation is more reliable due to the description of the free-surface fluctuations. It should first be considered for improving flow distribution to prevent a short-circuit flow, and the difference in the kinetic energy with the inflow rate makes flow distribution trends different. The authors believe that this case study is helpful for improving flow distribution in an influent channel.

Arousal with iv epinephrine depends on the depth of anesthesia.

PURPOSE: To investigate whether the depth of anesthesia affects the change in the bispectral index (BIS) caused by iv epinephrine during propofol anesthesia. METHODS: Forty women undergoing elective lower abdominal surgery received a propofol target controlled infusion (TCI) to maintain a modified Observer's Assessment of Alertness/Sedation (OAA/S) score of 2 (sedation period). Subsequently anesthesia was induced with propofol TCI 5 mug.mL(-1) and rocuronium 0.9 mg.kg(-1), and propofol continued so as to maintain general anesthesia at a BIS of 50 (general anesthesia period). Intravenous epinephrine at a dose of 10 mug.5 mL(-1) in normal saline (epinephrine group, n = 20) or normal saline 5 mL (control group, n = 20) was administered during both periods. The BIS, mean arterial pressure (MAP) and heart rate (HR) were measured immediately before, and one, two, three, four, six, eight, and ten minutes after injection. The modified OAA/S scale was evaluated during the sedation period. RESULTS: There was no significant change in the modified OAA/S scale, BIS, or hemodynamic variables compared to preinjection values during either sedation or general anesthesia in the control group. Intravenous epinephrine increased the BIS and modified OAA/S scale during sedation, but there was no increase in BIS during general anesthesia. Increases in HR and MAP were observed during both periods after iv epinephrine. CONCLUSION: Intravenous epinephrine 10 mug resulted in an arousal effect and an increase in BIS during sedation, but did not change the BIS during general anesthesia. These results suggest that the arousal effect of iv epinephrine during propofol anesthesia depends on anesthetic depth.

Effects of botulinum toxin type A on the superior cervical ganglia in rabbits.

Sympathetic neurolysis is very important in treating chronic pain, especially sympathetically maintained pain. However, conventional neurolytic agents destroy nerve fibers nonselectively and may leave serious complications. Botulinum toxin type A (BTA) selectively acts on cholinergic nerves and inhibits the secretion of acetylcholines (Ach) at the involved nerve endings. Because cholinergic nerves also exist in autonomic ganglia, it is believed that BTA has pharmacological effects on sympathetic ganglia. In this study, after the administration of BTA into the superior cervical ganglion (SCG) in rabbits, the possible clinical use of BTA as a neurolytic agent was evaluated. In the normal saline-treated control group, miosis was not observed in all 12 rabbits. However, in the BTA-treated group, 15 cases of miosis were observed among 40 rabbits (37.5%). Furthermore, BTA induced miosis in a dose-dependent manner, though onset time and duration of miosis varied. Mean time of onset and duration were 1.8 days and 5.3 weeks, respectively. By eosin-hematoxylin (H&E) staining finding, no significant chronological and histological changes between the control and the experimental groups were observed. In conclusion, BTA was found to have a sympathetic ganglion blocking effect over a period of more than 1 month without causing considerable pathologic changes in the SCG, that is, this toxin may be used in the case of sympathetically maintained pain control as a sympatholytic.