Contrast media-induced nephropathy: clinical burden and current attempts for prevention]

Contrast media-induced nephropathy is the third most common cause of hospital acquired acute renal failure. With the increasing use of contrast media in diagnostic and interventional procedures it has become one of the major challenges encountered during routine cardiology practice. Despite clinical importance it is an under-recognized event with major morbidity and mortality. Risk of developing contrast media-induced nephropathy depends mainly on patients preexisting characteristics and physicochemical properties of the contrast agent. Primary attempts for the prevention of contrast media-induced nephropathy should include systematic review of patient's characteristics and risk stratification. Patients at the greatest risk for contrast media-induced nephropathy can be defined as those having preexisting impaired renal function, diabetes mellitus, and congestive heart failure. Other risk factors include; age above seventy years, female gender, dehydration and use of high volume contrast media. The more expeditious use of iso-osmolar non-ionic contrast media reduced the incidence of contrast media related renal dysfunction. Currently, the only widely proven method of reducing the risk of contrast-induced nephropathy is adequate pre and postprocedural hydration. In addition, prophylactic use of free radical scavenger N-acetylcysteine has been shown to prevent contrast media-induced nephropathy in some moderate-scale clinical trials and a meta-analysis. Despite the attempts to reduce the risk of contrast nephropathy, this clinical event affects over 25% of high risk patients and mortality remains to be high.     

Predictors of femoral hematoma in patients undergoing elective coronary procedure: a trigonometric evaluation

Vascular complications in the femoral artery puncture site are the most common complications of the coronary angiography. Femoral hematoma is the leading participant of the vascular complications. We investigated the femoral hematoma predictive value of angle of sheath to trochanter major in patients undergoing elective coronary procedures. In this prospective analysis, we evaluated the femoral hematoma predictive value of angle of sheath to trochanter major on 246 patients undergoing elective coronary procedures. In this prospective analysis, we evaluated the femoral hematoma predictive value of angle of sheath to trochanter major on 246 patients undergoing elective coronary procedures. Patients were divided into two as femoral hematoma (n?=?23) and control (n?=?223) groups according to post-procedure femoral hematoma status. Other independent predictors of femoral hematoma were also evaluated. In-hospital multivariable analysis revealed higher rates of femoral hematoma for patients with chronic renal failure (OR 24.97, 95% CI 3.04–78.88, p?=?0.003), with higher diastolic blood pressure after the procedure (OR 1.08 95% CI 1.00–1.16, p?=?0.037), with femoral vein puncture during procedure (OR 17.74, 95% CI 2.67–54.74, p?=?0.003) and with higher angle of sheath to trochanter major (OR 1.52, 95% CI 1.13–2.05, p?=?0.005). The best cut-off value of the angle of sheath to trochanter major to predict femoral hematoma was 15.6° with 74% sensitivity and 70% specificity (AUC: 0.75; 95% CI 0.63–0.86; p?<?0.001). The angle of sheath to trochanter major provides an independent predictor of femoral hematoma in patients undergoing elective coronary procedures. Our data suggests the importance of fluoroscopic guidance during femoral artery access with the predictive role of the angle of sheath to trochanter major.     

First-presentation with psychotic behavior to the Emergency Department: Meningitis or not,that is the question

Introduction

Meningitis is a potentially life threatening medical emergency. Psychotic behavior may be a presenting feature in patients with meningitis. We aimed to determine the value of various clinical and laboratory features at ruling-out meningitis in the patient presenting with a first-episode of psychotic behavior.

Protic ionic liquids with primary alkylamine-derived cations: the dominance of hydrogen bonding on observed physicochemical properties

Novel protic ionic liquids (PILs) were synthesized by neutralization of primary alkylamines with bis(trifluoromethanesulfonyl)amide acid. An extensive hydrogen bonding network in these PILs was observed via lower thermal stability, temperature dependent inversion from non-Newtonian to Newtonian fluidic behavior, and lower ionicity compared to their secondary and tertiary analogues.

The dominance of hydrogen bonds (networking) over the physicochemical features of primary alkylamine-PILs based on an amide acid.     

Relationships between cognitive appraisals of adolescents with OCD and their mothers

Objective

Our aim was to investigate cognitive models of OCD via the influence of mothers’ cognitive appraisals on children's cognitions and OCD symptoms.

Method

Our sample consisted of 21 adolescents with OCD, their mothers and 27 parent–child dyads for control group without OCD. Subjects with OCD and their mothers were administered The Beck Depression Inventory (BDI), The Thought–Action Fusion Scale (TAFS), The White Bear Suppression Inventory (WBSI), The Padua Inventory-Revised (PI-R) and The Penn Inventory of Scrupulosity (PIOS).

Results

While the BDI (t = 2.18, p < 0.05) and TAF Morality (t = 2.18, p < 0.05) scores of the mothers of OCD subjects were significantly higher than the mothers of control subjects, the comparisons for the PI, TAF likelihood and PIOS scores of groups were not significant. Intradyadic correlation revealed significant relationships for PI-Rumination, PI-Checking and WBSI scales between the scores of parent and child in OCD dyads, (respectively, r = 0.49, P = 0.11; r = 0.37, P = 0.045; and r = 0.47, P = 0.014). There was no significant relationship in the control group.

Conclusion

Our results partially supported that mothers’ cognitive appraisals are associated with the cognitive appraisal of adolescents. A cognitive intradyadic interaction between mother and child might be more likely in the presence of OCD in adolescents.     

Room-temperature graphitization in a solid-phase reaction

Graphitized carbon including graphene has recently become one of the most investigated advanced materials for future device applications, but a prerequisite for broadening its range of applications is to lower its growth temperature. Here we report a great decrease in graphitization temperature using the well-known catalyst Ni. Amorphous carbon films with Ni nanoparticles (NPs) were deposited, using a simple one-step magnetron sputtering method, onto microgrids and a SiO₂/Si substrate for transmission electron microscopy (TEM) and Raman spectroscopy analyses, respectively. The amorphous carbon surroundings and locations between the Ni NPs started to become graphitized during the film deposition even at room temperature (RT) and 50 °C. The graphitization was confirmed by both high-resolution TEM (HR-TEM) and Raman 2D peak analyses. The increase in the relative amount of Ni in the amorphous carbon film led to the partial oxidation of the larger Ni NPs, resulting in less graphitization even at an elevated deposition temperature. Based on the detailed HR-TEM analyses, a decreased oxidation of NPs and enhanced solubility of carbon into Ni NPs were believed to be key for achieving low-temperature graphitization.

The spontaneous graphitization for C films containing Ni NPs was attributed mainly to the increased solubility for metallic Ni NPs, and was enhanced at the deposition temperature of 50 °C.     

Fabrication of {198Au0} radioactive composite nanodevices and their use for nanobrachytherapy

We describe the simple fabrication of poly({198Au}) radioactive gold-dendrimer composite nanodevices in distinct sizes (diameter between 10 nm and 29 nm) for targeted radiopharmaceutical dose delivery to tumors in vivo. Irradiation of aqueous solutions of 197Au containing poly(amidoamine) dendrimer tetrachloroaurate salts or {197Au0} gold-dendrimer nanocomposites in a nuclear reactor resulted in the formation of positively charged and soluble poly{198Au0} radioactive composite nanodevices (CNDs). A mouse melanoma tumor model was used to test whether the poly{198Au0} CNDs can deliver a therapeutic dose. A single intratumoral injection of poly{198Au0}(d=22nm) CNDs in phosphate-buffered saline delivering a dose of 74 muCi resulted after 8 days in a statistically significant 45% reduction in tumor volume, when compared with untreated groups and those injected with the "cold" nanodevice. No clinical toxicity was observed during the experiments. This study provides the first proof of principle that radioactive CNDs can deliver therapeutic doses to tumors.     

A Modification to the Manouguian Aortoplasty for Biological Valve Implantation in Patients with Small (≤19 mm) Aortic Anuli—Rationale and Benefit

Enlargement of a small aortic root using the Manouguian technique for biological valve implantation can be challenging when rigid, severely calcified noncoronary parts of the aortic anulus are encountered in combination with outsized heights of interleaflet triangles. To maximize the efficacy of the Manouguian technique, we applied a modification—the rationale, technical details, and benefits of which we describe herein.Key words: Aortic valve/surgery, bioprosthesis, heart valve prosthesis, prosthesis design, prosthesis fittingThe posterior root enlargement as described by Manouguian and Seybold-Epting¹ remains an attractive and relatively simple method to avoid or alleviate patient–prosthesis mismatch for patients in whom the implantation of stentless or mechanical valves is inadvisable. In the Manouguian technique, the aortic anulus is divided in the area of the noncoronary cusp, and the incision is extended into the anterior mitral leaflet. The aortic root is then enlarged by inserting a wedge-shaped patch into the partially split anterior mitral leaflet and the ascending aorta.However, the semilunar shape of the aortic leaflet attachments—in combination with a calcified anulus and high interleaflet triangles—can create technical difficulties in terms of tensionless placement of the prosthetic valve. When the aortic anulus and sinus area are calcified and nonpliable, the surgeon can encounter considerable problems in adapting the anulus to the horizontal structure of the prosthetic ring; the solution, too often, is to use a prosthetic valve of a size smaller than the patient needs.As a remedy, we modified the Manouguian technique and applied this modification routinely in patients whose aortic anulus measured 19 mm or less in diameter.