Renal Athersosclerotic reVascularization Evaluation (RAVE Study): Study protocol of a randomized trial [NCT00127738]

BACKGROUND: It is uncertain whether patients with renal vascular disease will have renal or mortality benefit from re-establishing renal blood flow with renal revascularization procedures. The RAVE study will compare renal revascularization to medical management for people with atherosclerotic renal vascular disease (ARVD) and the indication for revascularization. Patients will be assessed for the standard nephrology research outcomes of progression to doubling of creatinine, need for dialysis, and death, as well as other cardiovascular outcomes. We will also establish whether the use of a new inexpensive, simple and available ultrasound test, the renal resistance index (RRI), can identify patients with renal vascular disease who will not benefit from renal revascularization procedures[1]. METHODS/DESIGN: This single center randomized, parallel group, pilot study comparing renal revascularization with medical therapy alone will help establish an infrastructure and test the feasibility of answering this important question in clinical nephrology. The main outcome will be a composite of death, dialysis and doubling of creatinine. Knowledge from this study will be used to better understand the natural history of patients diagnosed with renal vascular disease in anticipation of a Canadian multicenter trial. Data collected from this study will also inform the Canadian Hypertension Education Program (CHEP) Clinical Practice Guidelines for the management of Renal and Renal Vascular Disease. The expectation is that this program for ARVD, will enable community based programs to implement a comprehensive guidelines based diagnostic and treatment program, help create an evidence based approach for the management of patients with this condition, and possibly reduce or halt the progression of kidney disease in these patients. DISCUSSION: Results from this study will determine the feasibility of a multicentered study for the management of renovascular disease

A CT-based revised description and phylogenetic analysis of the skull of the basal maniraptoran Ornitholestes hermanni Osborn 1903

Ornitholestes hermanni was one of the first small-bodiedtheropods named in the 1900s. It is known from a singlespecimen discovered during the American MuseumExpedition of 1900, at the Jurassic Morrison Formationsite known as Bone Cabin Quarry, in Wyoming. It haslong been a critical taxon in understanding the evolutionof the Coelurosauria, the clade that includestyrannosauroids, living birds, and their commonancestors. The holotype specimen comprises a nearlycomplete skull and most of a postcranial skeleton. Despitethis abundant material, its precise phylogeneticrelationships have been difficult to determine. This is inpart due to the intense mediolateral crushing of the skulland the relatively generalized postcranial anatomy. Herewe present the results of a micro- computed tomographybasedinvestigation of the cranial anatomy and subsequentincorporation of these data into a phylogenetic data matrixdesigned to test coelurosaurian interrelationships. We findrobust evidence across different optimality criteria thatOrnitholestes is the earliest-branching oviraptorosaurianspecies. Using parsimony as an optimality criterion, thisphylogenetic position is supported by 14 unambiguoussynapomorphies, including: a short frontal process of thepostorbital; short, deep, and pendant paroccipitalprocesses; a large mandibular foramen; an anterodorsallyoriented dentary symphysis; a surangular that is longerthan the dentary; short maxillary and dentary tooth rows;and procumbent dentary and premaxillary teeth. UsingBayesian fossilized birth-death models, we find highposterior probabilities (>.99) that Ornitholestes is theearliest-branching oviraptorosaurian species. Weadditionally find strong support in both analyses that thesuperficially bat-like and possibly arborealscansoriopterygids are an early branching lineage withinOviraptorosauria. This new phylogenetic position fills in apersistent ghost lineage in Oviraptorosauria and confirmsthat scansoriopterygids are basally branchingoviraptorosaurians that represent an independent origin ofaerial habits, separate from those of dromaeosaurs andavialans.Fil: Chapelle, Kimberley E.. American Museum of Natural History; Estados UnidosFil: Norell, Mark. American Museum of Natural History; Estados UnidosFil: Ford, David P.. University of the Witwatersrand; SudáfricaFil: Hendrickx, Christophe. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico - Tucumán. Unidad Ejecutora Lillo; ArgentinaFil: Radermacher, Viktor J.. University of Minnesota; Estados UnidosFil: Balanoff, Amy. University Johns Hopkins; Estados UnidosFil: Zanno, Lindsay E.. North Carolina Museum of Natural Sciences; Estados UnidosFil: Choiniere, Jonah N.. University of the Witwatersrand; Sudáfrica81st Annual Meeting of the Society of Vertebrate PaleontologyMc LeanEstados UnidosSociety of Vertebrate Paleontolog

Hemodynamic support in the early phase of septic shock: a review of challenges and unanswered questions

BACKGROUND: Improving sepsis support is one of the three pillars of a 2017 resolution according to the World Health Organization (WHO). Septic shock is indeed a burden issue in the intensive care units. Hemodynamic stabilization is a cornerstone element in the bundle of supportive treatments recommended in the Surviving Sepsis Campaign (SSC) consecutive biannual reports. MAIN BODY: The "Pandera\u27s box" of septic shock hemodynamics is an eternal debate, however, with permanent contentious issues. Fluid resuscitation is a prerequisite intervention for sepsis rescue, but selection, modalities, dosage as well as duration are subject to discussion while too much fluid is associated with worsen outcome, vasopressors often need to be early introduced in addition, and catecholamines have long been recommended first in the management of septic shock. However, not all patients respond positively and controversy surrounding the efficacy-to-safety profile of catecholamines has come out. Preservation of the macrocirculation through a "best" mean arterial pressure target is the actual priority but is still contentious. Microcirculation recruitment is a novel goal to be achieved but is claiming more knowledge and monitoring standardization. Protection of the cardio-renal axis, which is prevalently injured during septic shock, is also an unavoidable objective. Several promising alternative or additive drug supporting avenues are emerging, trending toward catecholamine\u27s sparing or even "decatecholaminization." Topics to be specifically addressed in this review are: (1) mean arterial pressure targeting, (2) fluid resuscitation, and (3) hemodynamic drug support. CONCLUSION: Improving assessment and means for rescuing hemodynamics in early septic shock is still a work in progress. Indeed, the bigger the unresolved questions, the lower the quality of evidence