Beating heart coronary surgery and renal function: a prospective randomised study (Presented at 18th Spring Meeting of the Association of Cardiothoracic Anaesthetists: Selected abstracts, Cambridge, UK. 22 June 2001)

Introduction Cardiopulmonary bypass (CPB) is widely regarded as an important contributor to renal failure, a well recognised complication, following coronary artery surgery (CABG). Off-pump coronary surgery (OPCAB) is intuitively considered renoprotective. We examine the extent of renal glomerular and tubular injury in low-risk patients undergoing either OPCAB or on-pump coronary artery bypass (ONCAB).Methods Forty patients awaiting elective CABG were prospectively randomized into those undergoing OPCAB (n = 20) and ONCAB (n = 20). Table 1 illustrates the exclusion criteria. Glomerular and tubular injury were assessed, respectively, by urinary excretion of microalbumin and retinol binding protein (RBP) indexed to urinary creatinine [1]. Daily measurements were made from admission to postoperative day 5. Fluid balance, serum creati-nine and blood urea were also monitored. Results No mortality or renal complication was observed. Both groups had similar demographic make-up. The OPCAB group received fewer coronary grafts than their counterparts (1.8 versus 2.8; P = 0.002). Serum creatinine and blood urea remained normal in both groups throughout the study. A dramatic and similar rise in mean ± 2SD urinary RBP:creatinine ratio occurred in both groups peaking on day 1 (3183 ± 2534 versus 4035 ± 4078; P = 0.43) before returning to baseline levels. These trends were also observed with the urinary microalbumin:creatinine ratio (5.05 ± 2.66 versus 6.77 ± 5.76; P = 0.22). ONCAB patients had a significantly more negative fluid balance on postoperative day 2 (-183 ± 1118 versus 637 ± 847 ml; P < 0.05). Conclusions Although renal dysfunction did not clinically occur in any patient, sensitive indicators revealed significant and similar injury to both renal tubules and glomeruli following either OPCAB or ONCAB. These suggest that avoidance of CPB per se does not offer additional renoprotection to patients at low risk of perioperative renal insult during CABG

A model for dynamic communicators

We develop and test an intuitively simple dynamic network model to describe the type of time-varying connectivity structure present in many technological settings. The model assumes that nodes have an inherent hierarchy governing the emergence of new connections. This idea draws on newly established concepts in online human behaviour concerning the existence of discussion catalysts, who initiate long threads, and online leaders, who trigger feedback. We show that the model captures an important property found in e-mail and voice call data – ‘dynamic communicators’ with sufficient foresight or impact to generate effective links and having an influence that is grossly underestimated by static measures based on snaphots or aggregated data

Sphaleron transition rate in the classical 1+1 dimensional abelian Higgs model at finite temperature

We compute the sphaleron transition rate in the 1+1 dimensional abelian Higgs model at finite temperature, by real time simulation using the classical canonical ensemble.Comment: 3 pages to appear in the Proceedings of Lattice '93, Dallas, Texas, 12-16 October 1993, comes as a single postscript file (LaTeX source available from the authors), ITFA 93-3

A co-operating solver approach to building simulation

This paper describes the co-operating solver approach to building simulation as encapsulated within the ESP-r system. Possible adaptations are then considered to accommodate new functional requirements