Prevention of contrast‐induced acute kidney injury in patients with stable chronic renal disease undergoing elective percutaneous coronary and peripheral interventions: Randomized comparison of two preventive strategies

Objective : We compared use of intravenous (IV) normal saline (NS) to sodium bicarbonate (NaHCO₃) with or without oral N‐acetylcysteine (NAC) for prevention of contrast‐induced acute kidney injury (CI‐AKI). Background : CI‐AKI is associated with significant adverse clinical events. Use of NAC has produced variable results. Recently, intravenous hydration with NaHCO₃ for CI‐AKI prophylaxis has been adopted as standard treatment for patients with stable chronic renal disease undergoing catheterization procedures. Methods : We prospectively enrolled 320 patients with baseline renal insufficiency scheduled to undergo catheterization. Patients were randomly assigned to receive either IV NS ± NAC (n = 161) or IV dextrose 5% in water containing 154 mEq/l of NaHCO₃ ± NAC (n = 159). IV NS was administered at 1 ml/kg body weight for 12 hr preprocedure and 12 more hr postprocedure. IV NaHCO₃ was administered at 3 ml/kg body weight for 1 hr preprocedure followed by 1 ml/kg body weight postprocedure. A 1,200 mg oral dose of NAC was given 2–12 hr preprocedure and 6–12 hr postprocedure in 50% of patients in each study arm. CI‐AKI was defined as an increase of >0.5 mg/dl or >25% above baseline creatinine. Results : Overall incidence of CI‐AKI was 10.3%. There was no significant difference in incidence among the two groups (NS ± NAC 11.8% vs. NaHCO₃ ± NAC 8.8%, p = ns). Incidence of CI‐AKI increased with increasing age (p = 0.001), contrast agent use >3 ml/kg body weight (p = 0.038) and diuretic use (p = 0.005). Conclusion : Incidence of CI‐AKI was no different in the NaHCO₃ group compared to NS group, and NAC did not reduce CI‐AKI in the two study arms. © 2011 Wiley Periodicals, Inc.     

The Effect of Tropical Environment on Fatigue Failure in Royal Malaysian Airforce (RMAF) Aircraft Structure and Operational Readiness

The environmental condition in which the Royal Malaysian Airforce is currently operating its aircraft is prone to corrosion. This is due to the high relative humidity and temperature. With most of its aircraft being in the legacy aircraft era, the aircraft’s main construction consists of the aluminium 2024 material. However, this material is prone to corrosion, thus reducing fatigue life and leading to fatigue failure. Using the concept of either Safe Life or Damage Tolerance as its fatigue design philosophy, the RMAF adopts the Aircraft Structure Integrity Program (ASIP) to monitor its structural integrity. With the current problem of not having the structural limitation on corrosion-damaged structure, the RMAF has embarked on its fatigue testing method. Finite Element (FE) studies and flight tests were conducted, and the outcome is summarized. The conclusion is that the longeron tested on the aircraft can withstand the operational load, and its yield strength is below the ultimate yield strength of the material. These research outcomes will also enhance the ASIP for other aircraft platforms in the RMAF fleet for its structure life assessment or service life extension program.     

Transseptal use of high-density grid catheter for VT mapping and retrograde hemodynamic support with Impella pump in presence of Mitraclips

Journal of Interventional Cardiac Electrophysiology - We sought to establish the technical feasibility of VT-mapping with high-density catheters in patients with Mitraclips, requiring a hemodynamic...     

A new method for computer-assisted detection,definition and differentiation of the urinary calculi

Purpose: Urinary stones are common and can be diagnosed with computed tomography (CT) easily. In this study, we aimed to specify the opacity characteristics of various types of calcified foci that develop through the urinary system by using an image analysis program. With this method, we try to differentiate the calculi from the non-calculous opacities and also we aimed to present how to identify the characteristic features of renal and ureteral calcules. Materials and methods: We obtained the CT studies of the subjects (n?=?48, mean age?=?41 years) by using a dual source CT imaging system. We grouped the calculi detected in the dual-energy CT sections as renal (n?=?40) or ureteric (n?=?45) based on their locations. Other radio-opaque structures that were identified outside but within close proximity of the urinary tract were recorded as calculi “mimickers”. We used ImageJ program for morphological analysis. All the acquired data were analyzed statistically. Results: According to thorough morphological parameters, there were statistically significant differences in the angle and Feret angle values between calculi and mimickers (p?p?=?0.003) and kidney (p?=?0.001) stones. Conclusions: Computer-based morphologic parameters can be used simply to differentiate between calcular and noncalcular densities on CT and also between renal and ureteric stones.     

Tacrolimus exposure in the real world: an analysis from the Mycophenolic acid Observational REnal transplant study

Tacrolimus exposure and renal function data to 36 months post‐transplant were analyzed from the prospective, observational Mycophenolic acid Observational REnal transplant (MORE) registry in which de novo kidney transplant patients were managed according to local practice. Tacrolimus trough (C₀) concentration at month 12 was stratified as low (<6 ng/mL), moderate (6–8 ng/mL), or high (>8 ng/mL) in 724 patients. Estimated glomerular filtration rate (eGFR) was stratified as low (<60 mL/min/1.73 m²) or high (≥60 mL/min/1.73 m²). High tacrolimus C₀ (>8 ng/mL) was observed in 47.7%, 34.1%, 26.8%, and 26.7% of patients at baseline and months 12, 24, and 36, respectively. Biopsy‐proven acute rejection was similar to month 36 regardless of tacrolimus C₀ category at month 12. Tacrolimus C₀ >8 ng/mL vs. <6 ng/mL at month 12 was predictive of low eGFR at month 24 (p = 0.023) with a nonsignificant trend at month 36 (p = 0.085). Infections (p < 0.013) and BK virus infection (p < 0.001) were most frequent in the low tacrolimus C₀ cohort. Neutropenia was most frequent in the high tacrolimus C₀ category (p = 0.010). In conclusion, over a quarter of patients were exposed to high tacrolimus C₀ to 36 months post‐transplant. Tacrolimus exposure did not affect rejection risk, but tacrolimus C₀ >8 ng/mL at month 12 was predictive of subsequent low eGFR compared to C₀ <6 ng/mL.