Diffusion tensor imaging of the human kidney: Does image registration permit scanning without respiratory triggering?

PURPOSE To investigate if image registration of diffusion tensor imaging (DTI) allows omitting respiratory triggering for both transplanted and native kidneys MATERIALS AND METHODS: Nine kidney transplant recipients and eight healthy volunteers underwent renal DTI on a 3T scanner with and without respiratory triggering. DTI images were registered using a multimodal nonrigid registration algorithm. Apparent diffusion coefficient (ADC), the contribution of perfusion (FP ), and the fractional anisotropy (FA) were determined. Relative root mean square errors (RMSE) of the fitting and the standard deviations of the derived parameters within the regions of interest (SDROI ) were evaluated as quality criteria. RESULTS Registration significantly reduced RMSE in all DTI-derived parameters of triggered and nontriggered measurements in cortex and medulla of both transplanted and native kidneys (P < 0.05 for all). In addition, SDROI values were lower with registration for all 16 parameters in transplanted kidneys (14 of 16 SDROI values were significantly reduced, P < 0.04) and for 15 of 16 parameters in native kidneys (9 of 16 SDROI values were significantly reduced, P < 0.05). Comparing triggered versus nontriggered DTI in transplanted kidneys revealed no significant difference for RMSE (P > 0.14) and for SDROI (P > 0.13) of all parameters. In contrast, in native kidneys relative RMSE from triggered scans were significantly lower than those from nontriggered scans (P < 0.02), while SDROI was slightly higher in triggered compared to nontriggered measurements in 15 out of 16 comparisons (significantly for two, P < 0.05). CONCLUSION Registration improves the quality of DTI in native and transplanted kidneys. Diffusion parameters in renal allografts can be measured without respiratory triggering. In native kidneys, respiratory triggering appears advantageous. J. Magn. Reson. Imaging 2016.

MINERALOCORTICOID REGULATION OF ION CONDUCTIVE PATHWAYS OF THE CORTICAL COLLECTING DUCT

Mineralocorticoids (DOCA) are known to increase Na('+) absorption and K('+) secretion in the rabbit cortical collecting duct (CCD). However, the mechanism of regulation of the apical and basolateral cell membranes and tight junction ion conductive pathways (G('a), G('b), and G('tj), respectively) by mineralocorticoids are only partially understood. Using electrophysiological techniques and microelectrodes it was demonstrated that the apical cell membrane contained a dominant Ba('2+) sensitive K('+) conductive pathway, G(,K)('a), and an amiloride sensitive Na('+) conductive pathway, G(,Na)('a). The basolateral membrane contained a dominant Cl('-) conductive pathway, G(,Cl)('b), and a significant Ba('2+) sensitive K('+) conductive pathway, G(,K)('b). Upon elevating the mineralocorticoid levels of rabbits with intact adrenal glands it was found that V('te) was significantly increased after 1 day with a further increase after 13-16 days. These results indicated both primary and secondary effects of mineralocorticoid elevation. After 1 day of DOCA treatment, G(,Na)('a), I(,Na)('a) and I(,K)('a) increased by more than 2-fold and were maintained at high levels after 13-16 days of DOCA treatment. Secondary (chronic) effects of mineralocorticoids were evident after 4 days or more of DOCA treatment. These included a significant increase in G(,K)('a) from 4.0 to 10.2 mS.cm('-2) and a hyperpolarization of V('b) by -20 mV after 4 days of treatment. After 13-16 days of DOCA treatment V('b) remained hyperpolarized at -98.1 mV and G('tj) decreased from 5.6 to 4.2 mS.cm('-2). The hyperpolarization of V('b) was due to an increase in electrogenic Na('+) pump activity as the pump current, I(,act)('b), increased significantly from 35.7 to 195.2 (mu)A.cm('-2). Whereas net passive K('+) current across the basolateral membrane, I(,K)('b), was near zero in the control group of animals, i.e., K('+) near equilibrium, I(,K)('b) was approximately -40 (mu)A.cm('-2) in chronic DOCA treated animals. These results demonstrate that the initial effect of mineralocorticoid elevation is to increase G(,Na)('a). The ensuing depolarization of the apical membrane increases the driving force for K('+) exit into the lumen. Between 1 and 4 days of elevation, G(,K)('a) more than doubles in magnitude and at the same time the electrogenic activity of the Na('+) pump increases. This results in a hyperpolarization of V('b) which increases the driving force for K('+) uptake from the bath to the cell through a basolateral membrane conductive pathway. After 13-16 days G('tj) decreases thereby serving to maintain high electrochemical gradients across the epithelium. Therefore, the long term effects of mineralocorticoid elevation on the CCD appear to be adaptive mechanisms that serve to maintain high levels of K('+) secretion and Na('+) absorption. ^

A case-control study of medication-associated acute kidney injuries in hospitalized pediatric patients

Acute kidney Injury (AKI) in hospitalized pediatric patients can be a significant event that can result in increased patient morbidity and mortality. The incidence of medication associated AKI is increasing in the pediatric population. Currently, there are no data to quantify the risks of developing AKI for various potentially nephrotoxic medications. The primary objective of this study was to determine the odds of nephrotoxic medication exposure in hospitalized pediatric patients with AKI as defined by the pediatric modified pRIFLE criteria. A retrospective case-control study was performed with patients that developed AKI, as defined by the pediatric pRIFLE criteria, as cases, and patients without AKI as controls that were matched by age category, gender, and disease state. Patients between 1 day and 18 years of age, admitted to a non-intensive care unit at Texas Children's Hospital for at least 3 days, and had at least 2 serum creatinine values drawn were included. Patient data was analyzed with Student's t test, Mann-Whitney U test, Chi square analysis, ANOVA, and conditional logistic regression. ^ Out of 1,660 patients identified for inclusion, 561 (33.8%) patients had AKI, and 357 cases were matched with 357 controls to become pairs. Of the cases, 441 were category 'R', 117 category 'I', 3 patients were category 'F', and no patient died. Cases with AKI were significantly younger than controls (p < 0.05). Significantly longer hospital length of stays, increased hospital costs, and exposure to more nephrotoxic medications for a longer period of time were characteristics of patients with AKI compared to patient without AKI. Patients with AKI had greater odds of exposure to one or more nephrotoxic medication than patients without AKI (OR 1.3, 95% CI 1.1–1.4, p < 0.05). Percent changes in estimated creatinine clearance (eCCl) from baseline were greatest with increased number of nephrotoxic medication exposures. ^ Exposure to potentially nephrotoxic medications may place pediatric patients at greater risk of acute kidney injury. Multiple nephrotoxic medication exposure may confer a greater risk of development of acute kidney injury, and result in increased hospital costs and patient morbidity. Due to the high percentage of patients that were exposed to potentially nephrotoxic medications, monitoring and medication selection strategies may need to be altered to prevent or minimize risk.^

Effects of overweight and obesity on economic outcomes among U.S. adults with kidney disease

Background. Kidney disease is a growing public health phenomenon in the U.S. and in the world. Downstream interventions, dialysis and renal transplants covered by Medicare's renal disease entitlement policy in those who are 65 years and over have been expensive treatments that have been not foolproof. The shortage of kidney donors in the U.S. has grown in the last two decades. Therefore study of upstream events in kidney disease development and progression is justified to prevent the rising prevalence of kidney disease. Previous studies have documented the biological route by which obesity can progress and accelerate kidney disease, but health services literature on quantifying the effects of overweight and obesity on economic outcomes in the context of renal disease were lacking. Objectives . The specific aims of this study were (1) to determine the likelihood of overweight and obesity in renal disease and in three specific adult renal disease sub-populations, hypertensive, diabetic and both hypertensive and diabetic (2) to determine the incremental health service use and spending in overweight and obese renal disease populations and (3) to determine who financed the cost of healthcare for renal disease in overweight and obese adult populations less than 65 years of age. Methods. This study was a retrospective cross-sectional study of renal disease cases pooled for years 2002 to 2009 from the Medical Expenditure Panel Survey. The likelihood of overweight and obesity was estimated using chi-square test. Negative binomial regression and generalized gamma model with log link were used to estimate healthcare utilization and healthcare expenditures for six health event categories. Payments by self/family, public and private insurance were described for overweight and obese kidney disease sub-populations. Results. The likelihood of overweight and obesity was 0.29 and 0.46 among renal disease and obesity was common in hypertensive and diabetic renal disease population. Among obese renal disease population, negative binomial regression estimates of healthcare utilization per person per year as compared to normal weight renal disease persons were significant for office-based provider visits and agency home health visits respectively (p=0.001; p=0.005). Among overweight kidney disease population health service use was significant for inpatient hospital discharges (p=0.027). Over years 2002 to 2009, overweight and obese renal disease sub-populations had 53% and 63% higher inpatient facility and doctor expenditures as compared to normal weight renal disease population and these result were statistically significant (p=0.007; p=0.026). Overweigh renal disease population had significant total expenses per person per year for office-based and outpatient associated care. Overweight and obese renal disease persons paid less from out-of-pocket overall compared to normal weight renal disease population. Medicare and Medicaid had the highest mean annual payments for obese renal disease persons, while mean annual payments per year were highest for private insurance among normal weight renal disease population. Conclusion. Overweight and obesity were common in those with acute and chronic kidney disease and resulted in higher healthcare spending and increased utilization of office-based providers, hospital inpatient department and agency home healthcare. Healthcare for overweight and obese renal disease persons younger than 65 years of age was financed more by private and public insurance and less by out of pocket payments. With the increasing epidemic of obesity in the U.S. and the aging of the baby boomer population, the findings of the present study have implications for public health and for greater dissemination of healthcare resources to prevent, manage and delay the onset of overweight and obesity that can progress and accelerate the course of the kidney disease.^

(Table 1) Retinol (vitamin A) and alpha-tocopherol (vitamin E) concentration in polar bear (Ursus maritimus) kidney

Vitamins A and E content of inner organs, among these the kidneys, are increasingly being used as an indicator of adverse effects caused to the organism by e.g. environmental contaminants. In general, only a renal sub sample is used for analyses, and it is thus essential to know which part of the organ to sample in order to get a representative value for this important biomarker. The aim here was to assess the distribution of vitamins A (retinol) and E (alpha-tocopherol) within the polar bear multireniculate kidney (i.e. polar vs. medial position) and also within the cortex vs. medulla of each separate renculi. The results showed no significant difference between the medial and polar renculi with regards to either retinol (p = 0.44) or alpha-tocopherol (p = 0.75). There were, however, significant differences between cortex and medulla for both vitamins (retinol, p = 0.0003; alpha-tocopherol, p<0.0001). The kidney cortex contained higher values of both vitamins than the medulla; on average 29% more retinol and 57% more alpha-tocopherol. Mean concentrations in the medulla was 2.7 mg/kg for retinol and 116 mg/kg for alpha-tocopherol, and in the cortex 3.5 mg/kg for retinol and 182 mg/kg for alpha-tocopherol. These results clearly indicate that one should take precautions when analyzing retinol and alpha-tocopherol in polar bear kidneys. Prior to analysis, the renculi should be separated into medulla and cortex. The results indicated no significant differences between renculi from different parts of the kidney.

A location model proposal for collecting used portable batteries in Spain

The main objective of this paper is to propose a model for helping logistics managers to choose the appropriate location points in order to situate the collection points for used portable batteries. The proposed model has two parts: a static part and a dynamic part. We can conclude that this model helps managers in the decision of locating/modifying collection points in two ways: to add new collection points to a reverse logistics network that needs more points or to delete collection points from a network that has more points than those recommended.

Diagnostics of classical and dusty plasmas w ith collecting and emissive langmuir probes = Diagnosis de plasmas clásicos y granulares mediante sondas colectoras y emisoras de Langmuir

Las sondas eléctricas se emplean habitualmente en la diagnosis de plasmas. La presente tesis aborda la operación de las sondas colectoras y emisoras de Langmuir en plasmas fríos de baja densidad. El estudio se ha centrado en la determinación del potencial de plasma, Vsp, mediante el potencial flotante de una sonda emisora. Esta técnica consiste en la medida del potencial de la sonda correspondiente a la condición de corriente neta igual a cero, el cual se denomina potencial flotante, VF. Este potencial se desplaza hacia el potencial del plasma según aumenta la emisión termoiónica de la sonda, hasta que se satura cerca de Vsp. Los experimentos llevados a cabo en la pluma de plasma de un motor iónico y en un plasma de descarga de glow muestran que la corriente de electrones termoiónicos es mayor que la corriente de electrones recogidos para una sonda polarizada por debajo del potencial del plasma, resultado inconsistente con la teoría tradicionalmente aceptada. Para investigar estos resultados se ha introducido el parámetro R, definido como el cociente entre la corriente de electrones emitidos y recogidos por la sonda. Este parámetro, que está relacionado con la diferencia de potencial VF - Vsp, también es útil para la descripción de los modos de operación de la sonda emisora (débil, fuerte y más allá del fuerte). Los resultados experimentales evidencian que, al contrario de lo que indica la teoría, R es mayor que la unidad. Esta discrepancia se puede solucionar introduciendo una población efectiva de electrones. Con dicha población, el nuevo modelo para la corriente total de la sonda reproduce los datos experimentales. El origen de este grupo electrónico es todavía una cuestión abierta, pero podría estar originada por una nueva estructura de potencial cerca de la sonda cuando ésta trabaja en el régimen de emisión fuerte. Para explicar dicha estructura de potencial, se propone un modelo unidimensional compuesto por un mínimo de potencial cerca de la superficie de la sonda. El análisis numérico indica que este pozo de potencial aparece para muy altas temperaturas de la sonda, reduciendo la cantidad de electrones emitidos que alcanzan el plasma y evitando así cualquier posible perturbación de éste. Los aspectos experimentales involucrados en el método del potencial flotante también se han estudiado, incluyendo cuestiones como las diferentes técnicas de obtención del VF, el cociente señal-ruido, el acoplamiento de la señal de los equipos utilizados para la obtención de las curvas I-V o la evidencia experimental de los diferentes modos de operación de la sonda. Estas evidencias empíricas se encuentran en todos los aspectos de operación de la sonda: la recolección de electrones, el potencial flotante, la precisión en las curvas I-V y la emisión electrónica. Ésta última también se estudia en la tesis, debido a que un fenómeno de super emisión tiene lugar en el régimen de emisión fuerte. En este modo de operación, las medidas experimentales indican que las corrientes termoiónicas de electrones son mayores que aquéllas predichas por la ecuación de Richardson-Dushman clásica. Por último, la diagnosis de plasmas usando sondas eléctrica bajo presencia de granos de polvo (plasmas granulares) en plasmas fríos de baja densidad también se ha estudiado, mediante la aplicación numérica de la técnica del potencial flotante de la sonda emisora en un plasma no convencional. Los resultados apuntan a que el potencial flotante de una sonda emisora se vería afectado por altas densidades de polvo o grandes partículas. ABSTRACT Electric probes are widely employed for plasma diagnostics. This dissertation concerns the operation of collecting and emissive Langmuir probes in low density cold plasmas. The study is focused on the determination of the plasma potential, Vsp, by means of the floating potential of emissive probes. This technique consists of the measurement of the probe potential, corresponding to the zero net probe current, which is the so-called floating potential, VF . This potential displaces towards the plasma potential as the thermionic electron emission increases, until it saturates near Vsp. Experiments carried out in the plasma plume of an ion thruster and in a glow discharge plasma show the thermionic electron current of the emissive Langmuir probe is higher than the collected electron current, for a probe with a bias potential below Vsp, which is inconsistent with the traditional accepted theory. To investigate these results, a parameter R is introduced as the ratio between the emitted and the collected electron current. This parameter, which is related to the difference VF - Vsp, is also useful for the description of the operation modes of the emissive Langmuir probe (weak, strong and beyond strong). The experimental results give an inconsistency of R > 1, which is solved by a modification of the theory for emissive probes, with the introduction of an effective electron population. With this new electron group, the new model for the total probe current agrees with the experimental data. The origin of this electron group remains an open question, but it might be originated by a new potential structure near the emissive probe when it operates in the strong emission regime. A simple one-dimension model composed by a minimum of potential near the probe surface is discussed for strongly emitting emissive probes. The results indicate that this complex potential structure appears for very high probe temperatures and the potential well might reduce the emitted electrons population reaching the plasma bulk. The experimental issues involved in the floating potential method are also studied, as the different obtaining techniques of VF, the signal-to-noise ratio, the signal coupling of the I-V curve measurement system or the experimental evidence of the probe operation modes. These empirical proofs concern all the probe operation aspects: the electron collection, the floating potential, the I-V curve accuracy as well as the electron emission. This last issue is also investigated in this dissertation, because a super emission takes place in the strong emission regime. In this operation mode, the experimental results indicate that the thermionic electron currents might be higher than those predicted by the classical Richardson-Dushman equation. Finally, plasma diagnosis using electric probes in the presence of dust grains (dusty plasmas) in low density cold plasmas is also addressed. The application of the floating potential technique of the emissive probe in a non-conventional complex plasma is numerically investigated, whose results point out the floating potential of the emissive probe might be shifted for high dust density or large dust particles.