THE RISK OF ACUTE KIDNEY INJURY AFTER ELECTIVE VERSUS EMERGENCY CORONARY INTERVENTION.

OBJECTIVE: The aim: A serious and common complication after percutaneous coronary intervention is acute kidney injury, which is associated with an increased risk of renal, cardiovascular and even mortality; therefore, early prognosis and identification of patients at higher risk are essential for early initiation of preventive measures. The aim of this study is to predict and compare the risk for the development of CI-AKI in patient with ACS who undergo emergency PCI or elective (i.e. after medical stabilization) PCI by utilizing the sensitivity of serum NGAL as an early and reliable predictor for CI-AK. PATIENTS AND METHODS: Materials and methods: The study include 37 patients with acute coronary syndrome, baseline serum creatinine, complete blood count and pre and two hours post operative serum neutrophil gelatinase-associated lipocalin were measured and all patients underwent percutaneous coronary intervention according to the standard protocol used in Al Najaf Cardiac Center. RESULTS: Results: This is a Two-Arm study that included a total of 37 patients with acute coronary syndrome aged 38-83 years. Eighteen of them had emergency percutaneous coronary intervention while the remaining 19 had elective percutaneous coronary intervention (after medical stabilization). Elevation of serum neutrophil gelatinase-associated lipocalin level two hours after percutaneous coronary intervention was found to be significantly higher among emergency percutaneous coronary intervention group compared to elective group. CONCLUSION: Conclusions: Acute coronary syndrome patients are undergoing emergency percutaneous coronary intervention are at an increasing risk for the development of contrast induced acute kidney injury than those undergoing elective percutaneous coronary intervention.

The characterisation of dental enamel using transmission Kikuchi diffraction in the scanning electron microscope combined with dynamic template matching.

The remarkable physical properties of dental enamel can be largely attributed to the structure of the hydroxyapatite (HAp) crystallites on the sub-micrometre scale. Characterising the HAp microstructure is challenging, due to the nanoscale of individual crystallites and practical challenges associated with HAp examination using electron microscopy techniques. Conventional methods for enamel characterisation include imaging using transmission electron microscopy (TEM) or specialised beamline techniques, such as polarisation-dependent imaging contrast (PIC). These provide useful information at the necessary spatial resolution but are not able to measure the full crystallographic orientation of the HAp crystallites. Here we demonstrate the effectiveness of enamel analyses using transmission Kikuchi diffraction (TKD) in the scanning electron microscope, coupled with newly-developed pattern matching methods. The pattern matching approach, using dynamic template matching coupled with subsequent orientation refinement, enables robust indexing of even poor-quality TKD patterns, resulting in significantly improved data quality compared to conventional diffraction pattern indexing methods. The potential of this method for the analysis of nanocrystalline enamel structures is demonstrated by the characterisation of a human enamel TEM sample and the subsequent comparison of the results to high resolution TEM imaging. The TKD - pattern matching approach measures the full HAp crystallographic orientation enabling a quantitative measurement of not just the c-axis orientations, but also the extent of any rotation of the crystal lattice about the c-axis, between and within grains. Results presented here show how this additional information highlights potentially significant aspects of the HAp crystallite structure, including intra-crystallite distortion and the presence of multiple high angle boundaries between adjacent crystallites with rotations about the c-axis. These and other observations enable a more rigorous understanding of the relationship between HAp structures and the physical properties of dental enamel.

Energy-dispersive Laue diffraction analysis of the influence of statherin and histatin on the crystallographic texture during human dental enamel demineralization.

Energy-dispersive Laue diffraction (EDLD) is a powerful method to obtain position-resolved texture information in inhomogeneous biological samples without the need for sample rotation. This study employs EDLD texture scanning to investigate the impact of two salivary peptides, statherin (STN) and histatin-1 (HTN) 21 N-terminal peptides (STN21 and HTN21), on the crystallographic structure of dental enamel. These proteins are known to play crucial roles in dental caries progression. Three healthy incisors were randomly assigned to three groups: artificially demineralized, demineralized after HTN21 peptide pre-treatment and demineralized after STN21 peptide pre-treatment. To understand the micro-scale structure of the enamel, each specimen was scanned from the enamel surface to a depth of 250 µm using microbeam EDLD. Via the use of a white beam and a pixelated detector, where each pixel functions as a spectrometer, pole figures were obtained in a single exposure at each measurement point. The results revealed distinct orientations of hydroxyapatite crystallites and notable texture variation in the peptide-treated demineralized samples compared with the demineralized control. Specifically, the peptide-treated demineralized samples exhibited up to three orientation populations, in contrast to the demineralized control which displayed only a single orientation population. The texture index of the demineralized control (2.00 ± 0.21) was found to be lower than that of either the STN21 (2.32 ± 0.20) or the HTN21 (2.90 ± 0.46) treated samples. Hence, texture scanning with EDLD gives new insights into dental enamel crystallite orientation and links the present understanding of enamel demineralization to the underlying crystalline texture. For the first time, the feasibility of EDLD texture measurements for quantitative texture evaluation in demineralized dental enamel samples is demonstrated.

Crystallographic texture and mineral concentration quantification of developing and mature human incisal enamel.

For human dental enamel, what is the precise mineralization progression spatially and the precise timing of mineralization? This is an important question in the fundamental understanding of matrix-mediated biomineralization events, but in particular because we can use our understanding of this natural tissue growth in humans to develop biomimetic approaches to repair and replace lost enamel tissue. It is important to understand human tissues in particular since different species have quite distinct spatial and temporal progression of mineralization. In this study, five human central incisors at different stages of enamel maturation/mineralization were spatially mapped using synchrotron X-ray diffraction and X-ray microtomography techniques. From the earliest developmental stage, two crystallite-orientation populations coexist with angular separations between the crystallite populations of approximately 40° varying as a function of position within the tooth crown. In general, one population had significantly lower texture magnitude and contributed a higher percentage to the overall crystalline structure, compared to the other population which contributed only 20-30% but had significantly higher texture magnitude. This quantitative analysis allows us to understand the complex and co-operative structure-function relationship between two populations of crystallites within human enamel. There was an increase in the mineral concentration from the enamel-dentin junction peripherally and from the incisal tip cervically as a function of maturation time. Quantitative backscattered-electron analyses showed that mineralization of prism cores precedes that of prism boundaries. These results provide new insights into the precise understanding of the natural growth of human enamel.