Prevention of acute kidney injury and protection of renal function in the intensive care unit

Acute renal failure on the intensive care unit is associated with significant mortality and morbidity. To determine recommendations for the prevention of acute kidney injury (AKI), focusing on the role of potential preventative maneuvers including volume expansion, diuretics, use of inotropes, vasopressors/vasodilators, hormonal interventions, nutrition, and extracorporeal techniques. A systematic search of the literature was performed for studies using these potential protective agents in adult patients at risk for acute renal failure/kidney injury between 1966 and 2009. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, and use of potentially nephrotoxic drugs and radiocontrast media. Where possible the following endpoints were extracted: creatinine clearance, glomerular filtration rate, increase in serum creatinine, urine output, and markers of tubular injury. Clinical endpoints included the need for renal replacement therapy, length of stay, and mortality. Studies are graded according to the international Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) group system Several measures are recommended, though none carries grade 1A. We recommend prompt resuscitation of the circulation with special attention to providing adequate hydration whilst avoiding high-molecular-weight hydroxy-ethyl starch (HES) preparations, maintaining adequate blood pressure using vasopressors in vasodilatory shock. We suggest using vasopressors in vasodilatory hypotension, specific vasodilators under strict hemodynamic control, sodium bicarbonate for emergency procedures administering contrast media, and periprocedural hemofiltration in severe chronic renal insufficiency undergoing coronary intervention

Hot‐pressing platelet alumina to transparency

Alumina powder with a platelet morphology was hot‐pressed to transparency with preload pressures of 0‐8 MPa, maximum temperatures of 1750‐1825°C, maximum pressures of 2.5‐80 MPa, and isothermal hold times of 1‐7 hours. Optical transmission (in‐line and total), as well as optical losses (backward/forward scattering and absorption), of the hot‐pressed samples were measured and related to the microstructure. Higher hot‐pressing temperatures increase the in‐line transmission. A gray discoloration of the samples (indicative of high absorption) was minimized by heat treating the powder in air prior to hot pressing and reducing the preload pressure. Maximum pressures above/below 10 MPa increased porosity, which decreased in‐line transmission and increased backward/forward scattering. Lower densities at higher pressures are attributed to a pore‐swelling phenomenon. Increasing isothermal hold time decreased porosity, which increased in‐line transmission and reduced backward/forward scattering. Best optical properties with an in‐line transmission of 65.3% at 645 nm (0.8 mm thick) were achieved by hot‐pressing heat‐treated platelet alumina powder with a preload pressure of 0 MPa, maximum temperature of 1800°C, maximum pressure of 10 MPa, and an isothermal hold time of 7 hours. This high in‐line transmission, despite its large grain size (65 µm), is attributed to crystallographic orientation of the platelets during hot pressing

Coronary angiography after cardiac arrest: Rationale and design of the COACT trial

Background Ischemic heart disease is a major cause of out-of-hospital cardiac arrest. The role of immediate coronary angiography (CAG) and percutaneous coronary intervention (PCI) after restoration of spontaneous circulation following cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains debated. Hypothesis We hypothesize that immediate CAG and PCI, if indicated, will improve 90-day survival in post cardiac arrest patients without signs of STEMI. Design In a prospective, multicenter, randomized controlled clinical trial, 552 post cardiac arrest patients with restoration of spontaneous circulation and without signs of STEMI will be randomized in a 1:1 fashion to immediate CAG and PCI (within 2 hours) versus initial deferral with CAG and PCI after neurological recovery. The primary end point of the study is 90-day survival. The secondary end points will include 90-day survival with good cerebral performance or minor/moderate disability, myocardial injury, duration of inotropic support, occurrence of acute kidney injury, need for renal replacement therapy, time to targeted temperature control, neurological status at intensive care unit discharge, markers of shock, recurrence of ventricular tachycardia, duration of mechanical ventilation, and reasons for discontinuation of treatment. Summary The COACT trial is a multicenter, randomized, controlled clinical study that will evaluate the effect of an immediate invasive coronary strategy in post cardiac arrest patients without STEMI on 90-day survival

Recommendations of generic names in Diaporthales competing for protection or use

In advancing to one name for fungi, this paper treats generic names competing for use in the order Diaporthales (Ascomycota, Sordariomycetes) and makes a recommendation for the use or protection of one generic name among synonymous names that may be either sexually or asexually typified. A table is presented that summarizes these recommendations. Among the genera most commonly encountered in this order, Cytospora is recommended over Valsa and Diaporthe over Phomopsis. New combinations are introduced for the oldest epithet of important species in the recommended genus. These include Amphiporthe tiliae, Coryneum lanciforme, Cytospora brevispora, C. ceratosperma, C. cinereostroma, C. eugeniae, C. fallax, C. myrtagena, Diaporthe amaranthophila, D. annonacearum, D. bougainvilleicola, D. caricae-papayae, D. cocoina, D. cucurbitae, D. juniperivora, D. leptostromiformis, D. pterophila, D. theae, D. vitimegaspora, Mastigosporella georgiana, Pilidiella angustispora, P. calamicola, P. pseudogranati, P. stromatica, and P. terminaliae