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Contrast media-associated acute renal failure represents the third most common cause of in-hospital renal function deterioration after decreased renal perfusion and post-operative renal insufficiency. Although generally benign, this complication is associated with a mortality rate ranging from 3.8 to 64%, depending on the increase of creatinine concentration. Multiple drugs have been tested in an attempt to prevent this complication. Central to the pathophysiology of contrast-induced nephrotoxicity (CIN) is an alteration in renal hemodynamics. In an effort to reverse these hemodynamic changes, vasodilators and diuretics have been tested as prophylactic drugs. However, their effectiveness has not been confirmed. Recently, considerable interest has resulted from the initial positive data on the effectivess of prophylactic administration of antioxidant compounds, such as acetylcysteine and ascorbic acid. In this review, we focus on the effectiveness of pharmacologic therapies for preventing CIN. [ABSTRACT FROM AUTHOR]

Contrast media-associated acute renal failure represents the third most common cause of in-hospital renal function deterioration after decreased renal perfusion and post-operative renal insufficiency. Although generally benign, this complication is associated with a mortality rate ranging from 3.8 to 64%, depending on the increase of creatinine concentration. Multiple drugs have been tested in an attempt to prevent this complication. Central to the pathophysiology of contrast-induced nephrotoxicity (CIN) is an alteration in renal hemodynamics. In an effort to reverse these hemodynamic changes, vasodilators and diuretics have been tested as prophylactic drugs. However, their effectiveness has not been confirmed. Recently, considerable interest has resulted from the initial positive data on the effectivess of prophylactic administration of antioxidant compounds, such as acetylcysteine and ascorbic acid. In this review, we focus on the effectiveness of pharmacologic therapies for preventing CIN.Kidney International (2006) 69, S30–S38. doi:10.1038/sj.ki.5000372 [ABSTRACT FROM AUTHOR]

An abstract of the article "Preliminary report on the effects of ultrafiltration in severe heart failure: the Continuous Ultrafiltration for cOngestive heaRt failure (CUORE) trial," by M. Muratori and colleagues is presented.

Background Observational studies suggest that low levels of antioxidants are associated with high risk for coronary artery disease (CAD). We investigated whether the biomarkers of oxidative balance undergo the same modifications in all CAD patient groups, regardless of gender and age. Materials and methods One hundred sixty-eight CAD patients and 107 healthy controls were assayed for plasma levels of reduced glutathione (GSH), α- and γ-tocopherol (α- and γ-T) as endogenous antioxidants. A damage score (DS), representative of oxidative stress status, was calculated.ancova models were used to test the association between antioxidants, DS and CAD and its modulation by age and gender. Results The DS was higher in CAD than in controls. GSH levels, were lower in CAD patients (mean ± SEM: 57·61 ± 1·87 μmol 10 g−1 haemoglobin vs. 68·55 ± 2·23 in controls, P < 0·0006) in males and in older subjects. Levels of other antioxidants exhibited a complex pattern. Overall, no difference was found in α- and γ-T contents between CAD and controls, but lower α-T values were observed in CAD females. A significant interaction between CAD status and gender was observed ( P = 0·003). Conclusions Our study shows that the involvement of antioxidants in CAD is related to patients’ characteristics. These findings may be relevant in planning antioxidant therapies. [ABSTRACT FROM AUTHOR]

Background: In Italy there is evidence of a large variability in health care services and health outcomes. This multi-regional project is funded on Ministry of Health and Health Regional Authorities (code NET-2016-02364191). The aims are: 1) To test the effectiveness of Audit and Feedback (A&F) interventions in improving health professional practices and patients’ outcomes in different settings using both a quantitative and a qualitative approach. 2) To examine factors that may explain variations in the effectiveness of A&F. 3) To evaluate the impact of A&F in reducing avoidable differences in access to effective health care interventions in socioeconomically disadvantaged populations. Methods: In the 7 participating Regions (about 33 million inhabitants) experimental study designs have been implemented in different clinical areas (e.g. before-after controlled study, cluster randomized trial): in Lazio emergency care and chronic diseases care, in Friuli Venezia Giulia emergency care, in Piemonte oncology care, in Emilia Romagna chronic disease care, in Lombardia cardiovascular care, in Calabria deliveries and maternal health, in Sicilia emergency care. The effectiveness of different types of A&F are compared in term of outcomes using health information system databases. Results: Preliminary results show large heterogeneity in developing and conducting A&F, in term of team project composition, type of intervention, clinicians’ behavior to be changed, outcomes indicators, professionals involved, structure and timing of data reporting, actions to be implemented after the intervention. Limited awareness and interest of clinicians in A&F interventions was found. Conclusions: The project represents a unique opportunity to explore how A&F interventions could be better designed. Different A&F strategies will be compared in term of clinical outcomes. The identification of barriers/facilitating factors will supply knowledge on mechanisms and tools to enhance A&F effectiveness. Key messages: The project supports providers in reducing gap between knowledge and practice. The project promotes culture of interprofessional collaboration as a key point for high quality care. [ABSTRACT FROM AUTHOR]

Background: The contrast medium (CM) dose-to-eGFR (estimated glomerular filtration rate) ratio has recently been advocated to express systemic exposure to CM in assessing the risk of contrast medium-induced nephropathy (CIN). Purpose: To evaluate how CIN risk might vary with decreasing eGFR at fixed CM-dose/eGFR ratios and other CIN risk factors, and to find a relatively safe CM-dose/eGFR ratio. Material and Methods: 391 patients underwent primary coronary angioplasty for ST-segment elevation acute myocardial infarction. CM dose (grams iodine; g I), eGFR (ml/min), and preprocedural CIN risk factors were entered into a multiple logistic regression model. From the established statistical model, the probability of CIN (≥44.2 µmol/l serum creatinine rise or oliguria/anuria) was calculated at various eGFR levels based on g-I/eGFR ratios of 1:2, 1:1, 2:1, and 3:1. Results: At a g-I/eGFR ratio <1 the risk of CIN was 3%, while it was 25% at a g-I/eGFR ratio ≥1. Independent predictors of CIN were CM dose, eGFR, left ventricular ejection fraction (LVEF) and cardiogenic shock (ROC area =0.87). An estimated CIN risk of 10% would for example occur at a g-I/eGFR ratio of 1.5:1 in patients with 50% LVEF without shock. At a 1:2, 1:1, 2:1, and 3:1 g-I/eGFR ratio with 50% LVEF without shock, the CIN risk was about 2, 6, 18, and 30%, respectively, over a wide range of eGFR values (30-90 ml/min). At a 1:1 g-I/eGFR ratio with 50% LVEF+shock, 25% LVEF without shock, or 25% LVEF+shock, the CIN risk was 20, 55, and 80%, respectively. Conclusion: Relating CM dose to eGFR appears to be an attractive pharmacotoxic model to assess CIN risk. At fixed CM-dose/eGFR ratios, CIN risk increased marginally with decreasing eGFR. Limiting the CM dose in g I numerically to the eGFR value in ml/min or less may be relatively safe with regard to CIN, unless multiple risk factors are present. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the preventive effect of the antioxidant N-acetylcysteine on postoperative acute renal failure in patients with renal insufficiency undergoing cardiac surgery. DESIGN: Randomized, placebo-controlled, prospective study. SETTING: University cardiology center. PATIENTS: Two hundred fifty-four consecutive patients with chronic renal insufficiency (estimated creatinine clearance < or = 60 mL/min) undergoing elective cardiac surgery. INTERVENTIONS: Patients were randomized to receive N-acetylcysteine (n = 129) or placebo (n = 125). Patients of the N-acetylcysteine group received four boluses of intravenous N-acetylcysteine (1200 mg every 12 hrs, starting immediately before cardiac surgery). MEASUREMENTS AND MAIN RESULTS: The incidence of postoperative acute renal failure (> 25% increase in serum creatinine from baseline) and the in-hospital clinical course were evaluated. Acute renal failure occurred in 46% of patients and was associated with increased in-hospital mortality (7% vs. 0.7%; p = .024). It occurred in 52% of control patients and 40% of N-acetylcysteine-treated patients (p = .06). In-hospital mortality and need for renal replacement therapy were not affected by N-acetylcysteine, but a lower percentage of N-acetylcysteine-treated patients required mechanical ventilation prolonged for > 48 hrs (3% vs. 18%; p < .001) and had an intensive care unit stay > 4 days (13% vs. 33%; p < .001). CONCLUSIONS: Intravenous administration of N-acetylcysteine does not clearly prevent postoperative acute renal failure in patients with renal insufficiency undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]

Abstract: New polymeric composite materials containing a nanohybrid to be used for the controlled release of an antibiotic molecule, chloramphenicol succinate, have been formulated, prepared and characterised. The nanohybrid consists of a layered double hydroxide of Mg–Al hydrotalcite-type, in which the nitrate anions present in the host galleries were replaced with chloramphenicol succinate anions (CFS−) by a simple ion-exchange reaction. Different amounts of the hybrid material were incorporated in polycaprolactone and processed as films of 0.15mm thickness. The composite materials were analysed by X-ray diffractometry and thermogravimetry and their mechanical properties were determined. They showed properties even better than those of the pristine polymer. The release process of the antibiotic molecules was found to be very interesting and promising for tuneable drug delivery. It consists of two stages: an initial stage of a very rapid burst, in which a small fraction of drug is released; and a second stage that is much slower, extending for a longer and longer time. This behaviour is profoundly different and much slower than that of a sample in which the antibiotic molecule is directly incorporated into the polymeric matrix. The parameters influencing drug release have been individuated and discussed. [Copyright &y& Elsevier]

Exercise-induced hemoconcentration is a useful mechanism, particularly in heart failure, because it increases oxygen content of blood, perfusing the working muscles; in 50 normal subjects and 50 patients with congestive heart failure, hemoglobin at peak exercise increased by 7 +/- 3% and 5 +/- 3%, respectively. Hemoconcentration was due to fluid flux out of the vascular bed, likely through oncotic forces related to intracellular lactate accumulation and not to red blood cell recruitment from other organs (spleen), because hemoglobin increase, as a percentage, was similar to plasma protein increase. [ABSTRACT FROM AUTHOR]

An abstract of the article "Platelet-Associated Tissue Factor: Still an Ongoing controversy," by M. Camera, M. Brambilla, G. Colombo, G. Arenzi, P. Canzano, E. Titloni and E. Tremoli is presented.