Prospective Randomized Trial of Na/K Citrate for the Prevention of Contrast-Induced Nephropathy in High-risk Patients.

Background: Contrast-induced nephropathy (CIN) or contrast-induced acute kidney injury (CI-AKI) refers to an acute kidney injury (AKI) occurring after exposure to contrast media, commonly used in diagnostic procedures or therapeutic angiographic interventions. Recently, Na/K citrate, used for urine alkalinization, has been assessed for preventing CIN. This experiment evaluated Na/K citrate's efficacy in preventing CIN in high-risk patients undergoing cardiac catheterization. Methods: A prospective randomized clinical trial involved 400 patients with moderate- to high-risk factors for CIN undergoing elective percutaneous coronary intervention (PCI). They were randomly assigned to either the control or Na/K citrate groups. The Na/K citrate group (n = 200) received a 5 g Na/K citrate solution diluted in 200 mL water 2 hours before and 4 hours after the first administration, along with intravenous hydration for 2 hours before and 6 hours after the procedure. In contrast, the control group (n = 200) received only intravenous hydration. Serum creatinine (SCr) levels were measured before contrast exposure and 48 hours afterward. CIN was defined as a 25% increase in serum creatinine (SCr) or > 0.5 mg/dL 48 hours after contrast administration. The significance level was set at P ˂ 0.05. Results: CIN was observed in 33 patients (16.5%) in the control group and 6 patients (3%) in the Na/K citrate group. The incidence of CIN was found to have a significant difference between the 2 groups 48 hours after receiving the radiocontrast agent (P < 0.001). Conclusion: Our results show that Na/K citrate is helpful and substantially reduces the incidence of CIN.

Recent advances on high-efficiency of microRNAs in different types of lung cancer: a comprehensive review.

Carcinoma of the lung is among the most common types of cancer globally. Concerning its histology, it is categorized as a non-small cell carcinoma (NSCLC) and a small cell cancer (SCLC) subtype. MicroRNAs (miRNAs) are a member of non-coding RNA whose nucleotides range from 19 to 25. They are known to be critical regulators of cancer via epigenetic control of oncogenes expression and by regulating tumor suppressor genes. miRNAs have an essential function in a tumorous microenvironment via modulating cancer cell growth, metastasis, angiogenesis, metabolism, and apoptosis. Moreover, a wide range of information produced via several investigations indicates their tumor-suppressing, oncogenic, diagnostic assessment, and predictive marker functions in different types of lung malignancy. miRNA mimics or anti-miRNAs can be transferred into a lung cancer cell, with possible curative implications. As a result, miRNAs hold promise as targets for lung cancer treatment and detection. In this study, we investigate the different functions of various miRNAs in different types of lung malignancy, which have been achieved in recent years that show the lung cancer-associated regulation of miRNAs expression, concerning their function in lung cancer beginning, development, and resistance to chemotherapy, also the probability to utilize miRNAs as predictive biomarkers for therapy reaction.

Graphene oxide nanoarchitectures in cancer therapy: Drug and gene delivery, phototherapy, immunotherapy, and vaccine development.

The latest advancements in oncology involves the creation of multifunctional nanostructures. The integration of nanoparticles into the realm of cancer therapy has brought about a transformative shift, revolutionizing the approach to addressing existing challenges and limitations in tumor elimination. This is particularly crucial in combating the emergence of resistance, which has significantly undermined the effectiveness of treatments like chemotherapy and radiotherapy. GO stands as a carbon-derived nanoparticle that is increasingly finding utility across diverse domains, notably in the realm of biomedicine. The utilization of GO nanostructures holds promise in the arena of oncology, enabling precise transportation of drugs and genetic material to targeted sites. GO nanomaterials offer the opportunity to enhance the pharmacokinetic behavior and bioavailability of drugs, with documented instances of these nanocarriers elevating drug accumulation at the tumor location. The GO nanostructures encapsulate genes, shielding them from degradation and facilitating their uptake within cancer cells, thereby promoting efficient gene silencing. The capability of GO to facilitate phototherapy has led to notable advancements in reducing tumor progression. By PDT and PTT combination, GO nanomaterials hold the capacity to diminish tumorigenesis. GO nanomaterials have the potential to trigger both cellular and innate immunity, making them promising contenders for vaccine development. Additionally, types of GO nanoparticles that respond to specific stimuli have been applied in cancer eradication, as well as for the purpose of cancer detection and biomarker diagnosis. Endocytosis serves as the mechanism through which GO nanomaterials are internalized. Given these advantages, the utilization of GO nanomaterials for tumor elimination comes highly recommended.

A rare case of spontaneous and simultaneous multivessel coronary artery spasm leading to multisite myocardial infarction and ventricular fibrillation.

BACKGROUND: Coronary artery spasm (CAS) can result in life-threatening arrhythmia and sudden cardiac death. Although this disorder has been known for a long time, little is known about it, and its mechanisms have been not identified yet. CASE REPORT: We describe a 52-year-old woman with no significant cardiovascular risk factors who experienced several episodes of spontaneous and coincident multivessel coronary artery spasm, which led to myocardial infarction as well as malignant arrhythmias. Coronary angiography revealed severe migratory narrowing in the left anterior descending artery and right coronary artery. CONCLUSION: Simultaneous multivessel coronary artery spasm develop multisite myocardial infarction (MI), and malignant arrhythmias could occur even in the absence of significant stenosis and triggering factors, which would lead to an increased risk of life-threatening cardiac events.

Efficacy of nicorandil treatment for prevention of contrast-induced nephropathy in high-risk patients undergoing cardiac catheterization: A prospective randomized controlled trial.

BACKGROUND: Contrast-induced nephropathy (CIN) remains to be a potentially serious complication of radiographic procedures and is the third leading cause of the acute kidney injury (AKI) among hospitalized patients. This clinical trial was performed to assess the preventive effect of oral nicorandil on CIN in high-risk patients undergoing cardiac catheterization. METHODS: In this prospective, randomized, controlled trial, 128 patients with at least two risk factors for CIN undergoing elective percutaneous coronary intervention (PCI) were randomly assigned to either the nicorandil group or the control group. Patients in the nicorandil group (n = 64) received 10 mg nicorandil, daily from 30 min before and up to 3 days after procedure and intravenous hydration for 2 h before and 6 h after the procedure, whereas patients in the control group (n = 64) just received intravenous hydration. Serum creatinine (SCr) was measured before contrast exposure and at 72 h. CIN was defined as an increase of 25% in SCr or > 0.5 mg/dL 72 h after contrast administration. RESULTS: Contrast-induced nephropathy occurred in 14 out of 64 (21.9%) patients in the control group and in 3 out of 64 (4.7%) patients in the nicorandil group. There was a significant difference in the incidence of CIN between the two groups at 72 h after administering the radiocontrast agent (p = 0.008). Moreover, there were significant differences between the two groups in SCr and estimated glomerular filtration rate 72 h after radiocontrast administration (p < 0.05). CONCLUSIONS: The findings revealed that oral nicorandil had substantial efficacy over hydration protocol for the development of CIN in high-risk patients undergoing cardiac catheterization.

Allopurinol prophylactic therapy and the prevention of contrast-induced nephropathy in high-risk patients undergoing coronary angiography: A prospective randomized controlled trial.

BACKGROUND: Contrast-induced nephropathy (CIN) is considered to be a possibly severe complication of radiography and thus, remains to be the main cause of acute kidney injury (AKI) for inpatients. A clinical trial was executed to measure the preventive effect of allopurinol against CIN in high-risk patients undertaking coronary angiography. METHODS: Through randomized controlled trial, 140 patients with at minimum two risk factors of CIN, undertaking coronary angiography, were randomly allocated to the allopurinol (n = 70) or control group (n = 70). Those in the allopurinol group received allopurinol (300 mg) a day before their coronary angiography and intravenous hydration for 12 hours before and after their procedure, while members of the control group only received intravenous hydration. Serum creatinine (SCr), blood urea nitrogen (BUN) and uric acid were measured before and 48 hours after the procedure. CIN was defined by a 25% increase in SCr or the concentration of > 0.5 mg/dl, 48 hours after coronary angiography. RESULTS: CIN was observed in 8 (11.4%) patients in the allopurinol group and 11 (15.7%) patients in the control group. There was no significant difference in the incidence of CIN between the two groups at 48 hours after coronary angiography (P = 0.459). In the allopurinol group, the median SCr concentration decreased non-significantly from 1.16 mg/dl to 1.13 mg/dl, 48 hours after coronary angiography (P = 0.189). In the control group, the median SCr concentration increased significantly from 1.11 mg/dl to 1.2 mg/dl, 48 hours after coronary angiography (P < 0.001). CONCLUSION: Allopurinol presents no considerable effectiveness over the hydration protocol for development of CIN in high-risk patients.

Bone Marrow Edema Syndrome in the Foot and Ankle.

Bone marrow edema syndrome (BMES) is an uncommon and self-limited syndrome characterized by extremity pain of unknown etiology. Symptoms may include sudden or gradual onset of swelling and pain at rest or during activity, usually at night. This syndrome mostly affects middle-aged men and younger women who have pain in the lower extremities. The most common sites involved with BMES, in decreasing order of frequency, are the bones about the hip, knee, ankle, and foot. The diagnosis of BMES is confirmed with magnetic resonance imaging to exclude other causes of bone marrow edema. The correct diagnosis in the foot and ankle often is delayed because of the low prevalence and nonspecific signs. This delay may intensify bone pain and impair patient function and quality of life. The goal of BMES treatment is to relieve pain and shorten disease duration. Treatment options are limited and may include symptomatic treatment, pharmacologic treatment, and surgery. LEVEL OF EVIDENCE: Level V, expert opinion.