Daily Archives: May 18, 2021

Small Island Developing States (SIDS) face particularly acute health risks as a result of the climate crisis. Warming temperatures, changing precipitation patterns, rising sea levels and extreme weather events lead to increased risks of injuries, deaths, food insecurity and the spread of vector-borne, waterborne and foodborne diseases.

Despite these growing challenges, island states are leading in the global response to climate change by advocating for limiting global temperature rise to 1.5C; implementing adaptation actions; and establishing climate-resilient and environmentally sustainable health systems.

A new SIDS dynamic data dashboard, launched today, illustrates the progress made by island states to date in responding to the health threats of climate change. The interactive dashboard, presenting data from the WHO UNFCCC Health and Climate Change Country Profiles, visualises key health and climate change indicators to empower SIDS policy makers to:

Alongside the dynamic SIDS dashboard WHO is also publishing a series of SIDS Health and Climate Change Country Profiles, adding to the existing library of these national outputs.

WHO is publishing new country profiles for the Dominican Republic, Mauritius, and Sao Tome and Principe. The country profiles present national climate projections; indicators on health vulnerabilities to and health impacts of climate change; policy responses to health and climate change; and recommendations to address the national health threats posed by climate change. Additional SIDS country profiles will be published in 2021.

The WHO SIDS dynamic data dashboard and country profiles complement each other, and are part of the WHO Special Initiative on Climate Change and Health in SIDS. The SIDS Special Initiative aims to provide health authorities from island states with the political, technical, scientific and financial support to improve understanding and address the health impacts of climate change.

The data presented in the dynamic dashboard allows readers to view data at the global, regional or national level, while the SIDS country profiles provide detailed information on specific health and climate challenges in a given country. Together, the SIDS interactive report and SIDS country profiles are therefore invaluable tools in showing the global, regional and national progress SIDS are making in tackling health and climate change challenges.

Originally posted here:

Dynamic WHO dashboard for island states highlights barriers and progress on climate change and health - World Health Organization

Britain wants to see progress soon in talks with the European Union on solving the post-Brexit Northern Irish border riddle, with its minister in charge of ties with the bloc urging member states to meet their obligations.

After the United Kingdom left the European Union's orbit at the end of last year, checks were introduced on some goods moving from mainland Britain to Northern Ireland, which has a land border with EU member Ireland.

The checks triggered anger and a perception among pro-British unionists in Northern Ireland that the Brexit deal divides them from the rest of the United Kingdom, a shift they say could sink the 1998 peace deal that brought an end to three decades of violence there.

British Prime Minister Boris Johnson, who had promised there would be unfettered trade between Northern Ireland and the rest of the United Kingdom, unilaterally extended a grace period on certain checks to minimise supply disruption, a move Brussels said breached the Brexit divorce deal.

David Frost, the minister in charge of ties with the EU, said he wanted the bloc to meet its obligations under the Brexit deal to try to minimise barriers in trade between Britain and the province, but had yet to have the conversation. read more

He also said there should be progress before July 12, when Northern Irish loyalists gather to mark the 1690 victory at the Battle of the Boyne by Protestant King William of Orange over Catholic King James of England and Scotland.

"I would like to feel that we will be making progress with the EU in good time before that date," he told a parliamentary committee.

Earlier, the BBC said Britain was asking the EU to introduce checks slowly. From October, checks on fresh meat products could begin, extending to dairy products, plants and wine from the end of Jan. 2022, the BBC reported.

Irish Prime Minister Michel Martin said separately he wanted the deal to work, adding he did not get an immediate sense from his meeting with Johnson that London wanted to rewrite the trading arrangements, as reported this week in the Irish media. read more

"We were very clear and are very clear that this is an international agreement, commitments have been made and it needs to be worked, and the processes that are in it need to be worked also," Martin told an online event when asked about the Irish national broadcaster RTE report.

Preserving the delicate peace without allowing the United Kingdom a back door into the EU's single market via the Irish border was one of the most difficult issues of nearly four years of tortuous talks on the terms of Britain's exit from the bloc.

Some fear the dispute over the Northern Ireland protocol, designed to prevent a "hard" border, could spill over into violent protest in the province in the coming months.

Britain's retail industry lobby group on Monday called for urgent talks between the major supermarket groups it represents and European Union and British officials to discuss proposed new post-Brexit Irish Sea border checks for food products.

Our Standards: The Thomson Reuters Trust Principles.

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Britain calls for progress with EU on post-Brexit Northern Irish trade - Reuters UK

Dive Brief:

CDP provides a platform for cities to disclose, measure and manage their environmental data to build resilience and sustainable economies. It reportedly has the most comprehensive global collection of self-reported environmental data from cities, corporations and investors.

Some of the climate-related hazards that cities say put citizens at risk are extreme heat, increasing extreme storms,flooding,drought and air pollution. Sixty percent of cities are facing risks to their water security. In fact, water supply and sanitation is the city services category most reported to be affected by climate change, followed by public health, environment/forestry, residential and transportation.

Neglecting to properly address these areas with a climate adaptation plan comes with a financial cost as well.The U.S. sustained 22 distinct billion-dollar weather and climate disasters in 2020 that collectively racked up $95 billion in damage to homes, businesses and infrastructure,the American Jobs Plannotes.

Those costs are vexing to cities, particularly as they regularly cite funding shortfalls even without climate adaptation projects. The Biden administration's $2.3 trillion American Jobs Plan, however, could provide a major boost not only for cities' infrastructure, but also for their sustainability and resilience plans. The plan includes $174 billion for electric vehicle infrastructure, $100 billion for power grid improvements, $46 billion in clean energy manufacturing and $35 billion for research into technology that addresses climate change.

"They can't do it alone. It will come down to engagement and support... and it's going to need to be a coordinated effort," Walsh said.

CDP's data disclosure work also helps identify the projects for which cities are seeking financing. In 2020, 97 U.S. cities identified 304 projects worth $25 billion. Transportation was the top sector. About half of the project costs were $5 million or under, which indicates that with just a little help,cities can make critical interventions and investments to tackle climate risk and adaptation,Walsh said.

"These projects showcase a huge opportunity for sustainable infrastructure investment," she said."If we are going to be putting dollars forward, let's not further lock in highly carbon-intensive projects. Let's use these dollars for green infrastructure opportunities... We can accelerate investment in the green economy."

The report notes that buildings, transportation, energy and waste are key areas that have the greatest potential for emissions reductions in most cities.But as of last year, only 50% of cities are optimizing building energy use;42% are addressing transportation emissions; 34% are working to decarbonize the electricity grid and 33% are improving waste operations."Our data shows there is still a gap between what is needed and what cities are doing," the report says.

Meanwhile, the top five actions cities are taking to increase their resilience are tree planting/creating green space, flood mapping, community engagement/education, developing crisis management plans and developing hazard-resistant infrastructure.

Despite the progress, only 169 of the thousands of U.S. cities currently disclose their data to CDP, which is a sign that "we have many more cities and counties to engage with to make sure they're adapting to climate change," Walsh said.

New city climate plans have been coming at a quick pace over the last five years, though.This month Jersey City, New Jersey,and Charleston,South Carolina,joined the pack, while Honolulu did so last year. Walsh also highlighted collaborative action in Florida,where Tampa, St. Petersburg and Orlando committed to climate action plans, waging a friendly competition and sharing best practices on a race to net-zero emissions.

San Diego is also in the process of developing a climate resilience plan to build on its climate action plan from six years ago. One goal of San Diego's resilience plan is to prioritize adaptation strategies in areas where residents are more vulnerable to the effects of climate change but have fewer resources.

As far as holding cities to their climate commitments, Walsh said CDP's reporting process serves as that accountability and transparency measure by presenting a standardized comparison and tracking resource.

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Funding is a key barrier to cities' climate plan progress: report - Smart Cities Dive

With so much rainfall throughout the metroplex, NBC 5 wanted an update on a project expected to mitigate flooding in East Dallas. A solution for East Dallas well-documented flood problems has been a long time coming.

Weeks and days where we have large rainfall in a short amount of time, the system is going to struggle, said Sarah Standifer with Dallas Water Utilities. There were some major flood events that were catastrophic where lives and property were lost, and that really set the city forward.

A few years ago, work started on the Mill Creek Drainage Relief Tunnel. Were told during a week like the one were having now, it would make a huge difference.

The latest news from around North Texas.

The tunnel would provide an alternate outfall and would decrease the amount of flooding in some of those areas where the rain was, said Milton Brooks, Project Manager for Dallas Water Utilities.

Its a massive multimillion-dollar project that is under construction some 170 feet below ground. The tunnel is expected to protect more than 2,000 commercial and residential properties. Throughout East Dallas, we see signs of progress being made. Feasibility studies started decades ago, and were now looking at the tunnels completion by Fall 2023.

City officials say the tunnel will have a noticeable impact on areas immediately surrounding the tunnel and south of the tunnel. More capital improvement should be expected beyond its completion date.

We dont say that its going to be dry ground, said Brooks. We dont say that its going to remove all the flooding, its going to reduce the flooding.

For more information on the Mill Creek Drainage Relief Tunnel, click here.

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Progress Update on East Dallas Tunnel Project to Address Flooding Problems - NBC 5 Dallas-Fort Worth

Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, Peoples Republic of China

Correspondence: Yuan GaoDepartment of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 of Pujian Street, Pudong New Area, Shanghai, 200127, Peoples Republic of ChinaTel +86 21 58752345Fax +86 21 58752345Email [emailprotected]

Abstract: Acute kidney injury (AKI) is a critical illness in clinic. The guideline recommendation of kidney disease for improving global outcomes regards urine volume and creatinine as standards to evaluate kidney functions. However, urine volume and creatinine have a certain delay for kidney function evaluation, and these would be interfered by many factors. Whether the renal function of AKI patients can recover is very important, which affects the quality of life of patients. Therefore, the present study reviews the application situation and research progress of the recoverability evaluation of AKI patient kidney function from three aspects: conventional indexes, biomarkers, and imaging methods of kidney function.

Acute kidney injury (AKI) is a common critical illness in clinic. According to a domestic research report, the 90-day fatality rate of AKI patients can reach up to 34%.1,2 According to the follow-up data, it was found that patients with AKI, who have been discharged for 10 years, have a higher fatality rate.3 For surviving AKI patients, 2050% of these patients develop chronic kidney disease, and 5% of these patients develop end-stage kidney disease.4 AKI leads to poor prognosis, and even death.5

The AKI diagnostic standards recommended by KDIGO are as follows: (1) kidney function suddenly decreases within 48 hours, and the absolute value of serum creatinine (SCr) increases 26.5 mol/L (0.3 mg/dL); (2) SCr increases by 1.5 times of the base value; (3) urine volume <0.5 mL/kg.h and time of duration >6 hours.6 Recovery standard within seven days after AKI: (1) complete recovery: the last time SCr within seven days was <1.2 times of baseline; (2) partial recovery: the last time SCr in seven days was >1.2 times of baseline and <1.5 times; (3) no recovery: the last time SCr in seven days was 1.5 times of the diagnosis, or continued renal replacement therapy; (4) non-detection: no duplicate detection was carried out within seven days after diagnosing AKI.7 Its evaluation means include the SCr level, glomerular filtration rate, changes in kidney injury, relevant biological indicators related to kidney function recovery, and (or) other methods to evaluate kidney reserve function and kidney blood perfusion. Therefore, the present study proposes to review the application situation and research progress of the recoverability evaluation of AKI and AKD patient kidney function from three aspects: regular monitoring indicators, biomarkers, and imaging examination.

At present, the conventional indexes to inspect kidney functions in clinic mainly include creatinine, urine volume, glomerular filtration rate, etc. Since it is not suitable to adopt inulin, 51Cr-EDTA, 99TmDTPA, or iodohydrin to measure the glomerular filtration rate for critically ill patients received by the intensive care unit (ICU), the kidney function evaluation for critically ill patients was limited to serum creatinine and urine volume. Creatinine and urine volume are influenced by various reasons, such as gender, age, weight, nutrient status and so on.8 When SCr increases and exceeds the normal range, and the glomerular filtration rate decreases by >50%, this indicates that renal parenchyma damage actually occurred. The creatinine concentration is influenced by body fluid volume change. If the volume is overloaded, the AKI diagnosis may be postponed.9 Furthermore, the urine volume is influenced by the volume state, fluid ADI, diuretic and other factors, and the urine volume decrease may be the reaction of decrease of normal renal perfusion pressure or kidney injury. Therefore, AKI diagnosis, with creatinine and urine volume as the measurement criteria, lacks the ideal sensibility and specificity.10

At present, the biomarkers to evaluate kidney function damage in clinic mainly include the following: neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), interleukin-18 (IL-18), cystatin C CysC, urinary total protein, matrix metalloproteinase-9, retinol conjugated protein, etc. However, different biomarkers have different advantages and disadvantages. Various previous studies have indicated that the increase in biomarkers, such as IL-18, KIM-1, NGAL and CysC, occurs earlier, when compared to creatinine, urea nitrogen and urine volume, and the combination of these is expected to increase the sensibility of AKI diagnosis.6,11 Although it remains unclear whether there is a factor to stimulate the continuous increase in biomarker level when the kidney injury biomarker level is continuously increased at present, the above biomarker level increase is still considered as a signal of continuous kidney injury. The decrease in kidney injury biomarkers has been used to predict the AKI and AKI recovery after a kidney transplant. These biomarkers did not decline, which may reflect the risk of AKI progressing to AKD or CKD, in addition to indicating irrecoverable.12 Common biomarkers that can be used to evaluate AKI recoverability would be respectively introduced.

NGAL is an apolipoprotein associated with the neutrophil gelatinase, and it is mainly expressed in the epithelial cells of renal proximal tubular cells. After kidney injury, the main sources of urinary NGAL are the renal collecting duct and the ascending branch of the medullary loop.13 Increased NGAL could be detected in early (within two hours) urine of AKI. NGAL is the most valuable biomarker for the diagnosis of AKI, and could be used to predict the severity and duration of AKI. The specificity and sensitivity of NGAL is 81% and 68%, respectively.14 NGAL detected in urine or serum can give a good prediction for kidney injury, but is liable to be influenced by AKI complication, such as sepsis, chronic renal failure, malignant tumor, inflammatory diseases, etc.15 Urine NGAL decreases oxidative stress by adjusting the iron concentration in cells, but this has little significance in AKI patient clinical prognosis as the kidney tissue damage maker.16 In present clinical practice, there is no unified NGAL threshold prediction and evaluation for AKI.

KIM-1 is a I transmembrane glycoprotein, which is mainly expressed on the surface of T cells, but has little expression on healthy kidneys or urine.17 KIM-1 expression in kidney tubular epithelial cells significantly increase after kidney injury.18 Han et al19 conducted a prospective study on clinical cases, and revealed that KIM-1 was detected in urine after 12 hours of kidney ischemic injury. The increase in level is apparently higher than other types of kidney injury. When KIM-1 increases by 1 U, the probability of acute kidney failure would increase by 12 times. Hence, KIM-1 can not only be used for the early diagnosis of AKI, its value can be used for evaluating and monitoring the disease status. Urine KIM-1 level is significantly higher in acute tubular necrosis patients than in patients with chronic kidney disease and contrast nephropathy.20 For the operation of patients, the area under the curve (AUC) values of AKI in children and adult urine KIM-1 is 0.83 and 0.78, respectively.21 KIM-1 in urine can reflect the damage of proximal renal tubular epithelial cells. In acute kidney injury patients, urine KIM-1 begins to increase after two hours of injury, and reaches a peak value within 48 hours. Hence, urine KIM-1 determination is an important biological marker to diagnose AKI, and evaluate the disease status and prognosis.

IL-18 is the proinflammatory factor secreted by kidney tubular cells, macrophages and other antigen-presenting cells. IL-18 kidney tubular cells and macrophages synthesize the IL-18 inactive precursor, and is cracked by cysteine-aspartic protease-1 or released in blood after the secretion of monocytes/macrophages.22 Cleaved IL-18 plays an inflammatory role through receptor and receptor heterodimer signaling pathways. During the ischemic injury, sepsis and malignant tumor period, IL-18 is released in the urine. Then, the urine IL-18 begins to increase within six hours of kidney injury, and reaches a peak within 1218 hours. In a study, within the first three days after cardiac surgery, urine IL-18 is the best predictor of AKI progression or stage I patient AKI death.23 One meta-analysis revealed that the AUC of AKI predicted by the urine IL-18 level was 0.77. This indicates that IL-18 has a moderate or above value in the early diagnosis AKI.24 Furthermore, it is found that urine IL-18 level in patients with cirrhosis can be used to distinguish ischemic acute tubular necrosis and other types of renal damage, and predict the short-term mortality in such patients.25 The increase of IL-18 in urine is liable to be influenced by sepsis, inflammation, lung injury, heart failure, immune injury and other factors, causing this to poorly predict the long-term prognosis of AKI patients.26 However, IL-18 therapy may be used as an AKI therapeutic method in the future.

CysC is mainly generated by karyotes, and this can almost be completely filtered by glomeruli, and finally completely reabsorbed in proximal tubules.27 Hence, there is no CysC in urine. CysC is not influenced by gender, age and muscle content. Furthermore, its distribution volume is 1/3 of creatinine, and it could more quickly reflect the kidney function injury, when compared to serum creatinine. An increase in urine CysC suggests that there is renal kidney injury. Therefore, CysC has certain advantages in the early diagnosis AKI and prognosis evaluation.28 A study revealed that in acute respiratory distress in premature newborns, when the CysC threshold is >1.3 mg/L, the sensitivity and specificity for AKI diagnosis is 92.3% and 96%, respectively. This can earlier predict the occurrence of AKI, when compared to creatinine and the glomerular filtration rate.29 For the early diagnosis of AKI, CysC can diagnose AKI at 2448 hours earlier, when compared to SCr.30 However, for serious kidney injury, since the glomerular filtration rate is significantly decreased, serum CysC has no advantages, when compared to SCr.31

White cartilage glycoprotein 39 is a glycoprotein involved in inflammation, cell protection and repair, and is produced by a variety of cells, which include kidney macrophages. The high urine level of human cartilage glycoprotein-39 in dead kidney donors is not only correlated to AKI, but also correlated to the improvement of graft function and the glomerular filtration rate at six months. This may indicate that the increase of this marker may represent the beginning of an effective repair.12 Hence, human cartilage glycoprotein 39 is a potential biomarker that may be used to predict the severity and recovery of AKI.

In summary, there is no consensus on when to use biomarkers to predict renal recovery time. The reason is correlated to the confounding factors (sepsis, fluid status, etc.) and severity of AKI or AKD, and the determination on whether to accept renal replacement therapy.14 Unlike the use of troponins for confirmation of myocardial infarction, identification of a single marker for AKI seems unlikely.

Since kidney function is significantly correlated with the blood perfusion of renal parenchyma, the dynamic detection of renal blood perfusion may sensitively reflect the changes in kidney function. At present, the common imaging methods for evaluating renal function through clinical application are radionuclide renal dynamic imaging, spiral computed tomography (CT) enhancement scan, magnetic resonance imaging (MRI), and ultrasound.

Radionuclide renal dynamic imaging is the clinical standard of determining the glomerular filtration rate at present, with the classic method of 99mTc-DTPA renal dynamic imaging, Gates. The test method is performed to conduct the radioactive counting of the drug in the kidneys after the intravenous injection of 99mTcDTPA for a period of time, in order to calculate the glomerular filtration rate and the corresponding imaging of urinary system.32 This may provide the information on the morphology of double kidneys, the function of the renal parenchyma, and the unobstructed urinary tract and renal blood perfusion, using the 99mTc-DTPA renal dynamic imaging Gates method. At present, the method applied is the imaging method for obtaining the split-renal function for non-invasive quantification, and this is used to evaluate the severity and prognosis of renal disease in clinic, and the change in illness before and after treatment, and guide the dialysis treatment of patients with renal failure, or evaluate the timing of the renal transplantation.23 However, when the glomerular filtration rate of the patient is decreases to a certain degree, the determination results with this method would no longer be accurate, which may have a certain effect on the evaluation of kidney function and guidance of clinical treatment.33,34 Hence, there are many disputes for the accuracy of renal dynamic imaging through the Gates method.

Iopromide or iohexol is the commonly used CT contrast agent, which would not be secreted or reabsorbed in the kidney tubule.35 This may be used as a tracer agent to determine the kidney function. There is a good linear relation between the concentration of renal CT contrast agent and CT attenuation value. Therefore, the product of kidney volume and CT enhancement value may be used for evaluating kidney function.36 Hence, spiral CT is a reliable tool to determine whether the contrast agent is filtered by the kidney. Renal blood perfusion and renal filtration effect the CT enhancement at different stages, and have different effects on renal CT value.35,36 Therefore, contrast media can cause renal injury, which limits the application of enhanced CT.. The accuracy of kidney function by the CT enhancement scan remains to be improved.

MRI techniques that are applied more in the evaluation of kidney function are diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI). The principles are to reflect the changes in the pathophysiology of renal tissues through the measurement of diffusion of water molecules and tissue perfusion in the kidney. DTI was developed and deepened from DWI, which has quantified the directional preference of water molecule diffusion. The movement characteristics of water molecules can be expressed by the apparent diffusion coefficient (ADC). ADC combines the parameters of dispersion and perfusion to reflect the diffusibility in the whole tissue. The diffusion characteristics of water molecules in the kidney may reflect the kidney function. Some previous studies speculate that the ADC value may directly reflect the damage degree of kidney function, based on the correlation between the ADC value and renal function indicator.37 However, ADC is a semi-quantitative indicator, and can indirectly reflect the kidney function. A large number of studies are still needed to further confirm the sensitivity and specificity of renal function impairment diagnosed by ADC.

Although the information of renal structure and renal blood perfusion can be obtained with the imaging examination methods above, this is not suitable for evaluating the kidney function of patients with kidney injury due to limitations, such as the renal toxicity of contrast agent, expensive examination price, radiation failure of point-of-care, dynamic and bedside testing, etc. Point of care ultrasound has rapidly been developed in recent years. At present, the main ultrasonic methods for evaluating renal perfusion are two-dimensional ultrasound and Doppler ultrasound resistance index determination with ultrasound contrast. For two-dimensional ultrasound, the normal kidney is oval, the renal parenchyma has a low-level echo, which is lower than that of the liver and spleen, under this kind of ultrasound, and the renal sinus presents a high-level echo. The long diameter of the normal kidney was 912 cm, the transverse diameter was 57 cm, and the thickness was 46 cm. The thickness of the renal parenchyma was 1.41.8 cm. The renal long diameter was the most useful parameter to identify acute and chronic renal diseases, and evaluate the kidney function in the two-dimensional measurement parameters of kidneys. At the same time, two-dimensional ultrasound may screen the renal insufficiency that resulted from the cause of obstruction. The renal parenchyma is thickened and kidney volume is increased at different degrees in the case of acute renal insufficiency.38 The acute renal insufficiency, which resulted from the renal venous thrombosis, acute tubular necrosis and acute interstitial nephritis, may lead to the increase of kidney volume. Among the patients who have renal failure that resulted from chronic glomerulonephritis, with the progression of disease, the kidney volume is gradually reduced, the cortex echo is enhanced, and the corticomedullary differentiation is vague.39

Renal blood flow is mainly determined by kidney vessel (including the afferent arteriole, efferent arteriole and interlobar artery) resistance. The changes in renal blood perfusion can be evaluated half-quantitatively through the positioning of the vessels above. Lerolle reported that for critical patients diagnosed with AKI, there was a significant correlation between the increase in resistant index (RI) and occurrence of AKI through the repeated measurement of RI of the interlobar artery or arcuate artery.40 Renal RI has no normal value at present. In general, a healthy persons RI is approximately 0.6, with a high limit of 0.7.41 Radermacher found that the changes in RI of patients after the renal transplantation correlated with the prognosis.42 Some studies have revealed that RI obviously increased at the AKI oliguria stage and migratory stage, and that this was more than 0.7 in general. Furthermore, 23 times of monitoring was conducted every week at the AKI oliguria stage and recovery stage. If RI processivity was reduced, the prognosis would be better, while if RI continued to grow or had no significant decline, this suggested that the prognosis was poorer.43 Measuring RRI immediately after major surgery and using a cut-off value 0.715 may provide an excellent tool in the detection of the onset of AKI.44 However, RI is closely related to cardiac function, vascular elasticity and renal interstitial condition, and is not a good indicator of renal perfusion,45 the measurement of kidney RI by ultrasound are affected by factors, such as the patients breathing activity, body position, arterial compliance and intra-abdominal pressure, etc. Hence, ultrasound cannot accurately quantify the renal blood flow velocity. In recent years, studies on the use of renal RI to determine and evaluate AKI have been steadily decreasing. The investigators consider that for patients with AKI that resulted from different diseases, more studies are needed to evaluate the value of renal RI to AKI in evaluating the critical degree and predicting the prognosis.

Among AKI patients, the changes in renal blood perfusion was significant.44 Furthermore, 90% of the renal blood perfusion is concentrated on the renal cortex, and all or the local renal blood perfusion of the renal cortex have various degrees of changes at the early stage of renal injury.45 The microbubble contrast agent completely cycles in the blood vessel after being injected into the peripheral vein, which belongs to the hemodynamic change, and is similar to red blood cell (RBC) movement. The renal ultrasound contrast imaging successively revealed that the renal-artery-renal cortex-renal medulla was rapidly enhanced. Hence, the early diagnosis of the renal lesion and renal perfusion should be conducted using the ultrasonic contrast value and time intensity curve (TIC) at different time points. In a study on the ultrasound contrast of an AKI rabbit model induced by cis-platinum,46 SCr was found earlier than AKI by the ultrasound contrast, and the severity was evaluated. Cao et al47 reported that the renal ultrasound contrast may dynamically and non-invasively monitor the renal ischemic reperfusion injury and early predict the progression of AKI-CKD. The clinical application of the ultrasound contrast is increasing, but there is still has no accepted renal perfusion standard.48 This limits quantitative renal blood perfusion to some extent.

Even though the biomarker may judge the severity of kidney injury and suggest the patients prognosis to some extent, there is still no standard for diagnosing kidney injury at present. This category is likely to be the diagnosis and evaluation standards for kidney injury when the new biomarker is studied at the same time. For the imaging, bedside ultrasound is a good method for the early evaluation of AKI and renal perfusion, and prediction of the patients prognosis. The dynamic changes in RI may have a certain value to the prognosis of AKI patients. Although there have been few studies, the contrast-enhanced ultrasound technique has exhibited the characteristics of real-time evaluation, no damage and high accuracy to the renal perfusion. In addition, this allows for the more accurate evaluation of the situation of the local and overall kidney of AKI patients, in combination of the targeted drug and contrast agent, using the microbubble technique.

In conclusion, although there are many limitations and disadvantages for evaluating the kidney function of critical patients by creatinine and urine volume, creatinine and urine volume are still the important indicators for diagnosing and evaluating kidney injury.

The authors declare that there are no conflicts of interest.

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16. Biernawska J, Bober J, Kotfis K, Bogacka A, Barnik E, ukowski M. Cardiac surgery related cardio-renal syndrome assessed by conventional and novel biomarkers under or overestimated diagnosis? Arch Med Sci. 2017;13(5):11111120. doi:10.5114/aoms.2017.69328

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Progress of kidney function recoverability - IJGM | IJGM - Dove Medical Press

Its been more than six months since Sen. Cheryl C. Kagan (D-Montgomery) raised a red flag over a lack of 911 fee audits from the Maryland Comptrollers office but she says shes yet to receive any data.

Comptroller Peter V.R. Franchot (D) had paused audits due to the pandemic, but agreed to resume 911 fee audits after Kagan warned of a lack of oversight last November. Although those audits have since resumed, Kagan said in a Thursday letter to Franchot that the states Next Generation 911 Commission hasnt received any information from the comptrollers office.

Kagan is the chair of that commission, which oversaw a revamp of the states 911 fee system. She also sponsored legislation to require comptroller audits of telephone companies that collect 911 fees, warning in 2019 that T-Mobile had overcharged Marylanders for 911 fees for more than a decade.

The commission recommended audits of 911 fees in 2019 after those overcharges came to light, and the General Assembly passed a bill in 2020 requiring regular audits of 911 fee collections. Now in its final year, Kagan wrote that her commission needs those audits to finish their work.

I convened the NG911 Commission last week for our 4th and final year, Kagan wrote. We have an ambitious agenda that will support the counties as they transition to Next Generation 911 in order to save lives. Without your audits, we simply cannot complete our mission.

But Kagan and other commission members might be looking at a long wait to get information. In a letter responding to Kagan on Thursday, Franchot said much of the information in those audits is confidential, and that a full report on those audits isnt due until Dec. 1.

Franchot wrote that Kagans own legislation requiring the audits mandates that information given to his office be confidential, privileged or proprietary, and may not be disclosed to any person other than the telephone company or [commercial mobile radio service] provider.

I hope you did not expect my agency to disclose specific taxpayer information relating to ongoing audits with you or members of the [commission], Franchot wrote. It is not the practice of my agency to publicly disclose which taxpayers or entities are under audit, nor is it permissible by law.

He also attached an email sent to Kagans office in December providing an update on the audit process.

Franchot said Kagans legislation requires his agency to submit an annual report about the 911 fee audits conducted during the immediately preceding year. Since Kagans legislation was enacted in 2020, Franchot wrote, the report on 911 fees for that year is not due until Dec. 1, 2021.

Kagan said late Thursday that she isnt looking for granular, specific data involving individual taxpayers, but rather general information about whether telephone companies are playing by the rules. She said that will help the commissions work and help local governments plan ahead for costs associated with the 911 system.

We just need to know that theyre on it, that theyre addressing it with the company, that the company will fix it, Kagan said.

Franchot blasted the tone of Kagans letter, which he described as patently false and offensive. In her letter, Kagan urged Franchot, who is running for governor, to take time away from the campaign trail to ensure that your taxpayer-paid employees are fulfilling these responsibilities.

Franchot said Kagan was dragging nonpartisan state employees into the argument and listed work his employees have done during the pandemic, including conducting the audits of telephone companies and issuing speedy state stimulus checks after the passage of the RELIEF Act.

Kagan said her concerns were aimed only at Franchot, and not comptrollers office staff. She said she found Franchots response patronizing and dismissive, and feels that the long list of work done was filler that didnt address the issue of 911 fee oversight.

The buck stops here is what Harry Truman said, she said. It would be nice if we thought that the buck stops with the Comptroller.

Franchot called Kagans letter a campaign press release multiple times in his response.

Kagan said she was writing in her capacity as commission chair about a legislative matter. For him to take a pot shot and accuse me of sending out a campaign press release, and say that five times, is ridiculous, Kagan said.

Kagan distributed the letter, written on Senate letterhead, through Constant Contact, which is paid for by her campaign finance entity, and the message said PRESS RELEASE in the subject line. The email also included the line By Authority: Citizens Helping Elect Cheryl Kagan (C.H.E.C.K.).

Franchot pledged in his response to Kagan to continue 911 fee audits to determine if telephone companies are remitting the proper fees to the state.

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Editors Note: This story was updated to include additional details from the letters sent Thursday and to correct the political affiliation of Comptroller Peter V.R. Franchot.

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In Sharply Worded Letters, Franchot and Kagan Spar Over Progress on 911 Fee Audits Maryland Matters - Josh Kurtz