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Amelia Focaccio - One of the best experts on this subject based on the ideXlab platform.
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renal insufficiency following contrast media administration trial iii Urine Flow Rate guided versus left ventricular end diastolic pressure guided hydration in high risk patients for contrast induced acute kidney injury rationale and design
Catheterization and Cardiovascular Interventions, 2020Co-Authors: Carlo Briguori, Carmen Damore, Francesca De Micco, Nicola Signore, Giovanni Esposito, Giovanni Napolitano, Amelia FocaccioAbstract:BACKGROUND: Urine Flow Rate (UFR)-guided and left-ventricular end-diastolic pressure (LVEDP)-guided hydration regimens have been proposed to prevent contrast-induced acute kidney injury (CIAKI). The REnal Insufficiency Following Contrast MEDIA Administration triaL III (REMEDIAL III) is a randomized, multicenter, investigator-sponsored trial aiming to compare these two hydration stRategies. METHODS: Patients at high risk for CIAKI (that is, those with estimated glomerular filtration Rate ≤ 45 mL/min/1.73 m2 and/or with Mehran's score ≥11 and/or Gurm's score >7) will be enrolled. Patients will be randomly assigned to (a) LVEDP-guided hydration with normal saline (LVEDP-guided group) and (b) UFR-guided hydration carried out by the RenalGuard system (RenalGuard group). Seven-hundred patients (350 in each arm) will be enrolled. In the LVEDP-guided group the fluid infusion Rate will be adjusted according to the LVEDP as follows: 5 mL kg-1 hr-1 for LVEDP ≤12 mmHg, 3 mL kg-1 hr-1 for LVEDP 13-18 mmHg, and 1.5 mL kg-1 hr-1 for LVEDP >18 mmHg. In the RenalGuard group hydration with normal saline plus low-dose of furosemide is controlled by the RenalGuard system, in order to reach and maintain a high (>300 mL/hr) UFR. In all cases, iobitridol (a low-osmolar, nonionic contrast agent) will be administered. RESULTS: The primary endpoint is the composite of CIAKI (i.e., serum creatinine increase ≥25% and/or ≥0.5 mg/dL from the baseline to 48 hr after contrast media exposure) and/or acute pulmonary edema. CONCLUSION: The REMEDIAL III will test the hypothesis that the UFR-guided hydration is superior to the LVEDP-guided hydration to prevent the composite of CIAKI and/or acute pulmonary edema.
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Renal insufficiency following contrast media administration trial III: Urine Flow Rate‐guided versus left‐ventricular end‐diastolic pressure‐guided hydration in high‐risk patients for contrast‐induced acute kidney injury. Rationale and design
Catheterization and Cardiovascular Interventions, 2019Co-Authors: Carlo Briguori, Francesca De Micco, Nicola Signore, Giovanni Esposito, Giovanni Napolitano, Carmen D'amore, Amelia FocaccioAbstract:BACKGROUND: Urine Flow Rate (UFR)-guided and left-ventricular end-diastolic pressure (LVEDP)-guided hydration regimens have been proposed to prevent contrast-induced acute kidney injury (CIAKI). The REnal Insufficiency Following Contrast MEDIA Administration triaL III (REMEDIAL III) is a randomized, multicenter, investigator-sponsored trial aiming to compare these two hydration stRategies. METHODS: Patients at high risk for CIAKI (that is, those with estimated glomerular filtration Rate ≤ 45 mL/min/1.73 m2 and/or with Mehran's score ≥11 and/or Gurm's score >7) will be enrolled. Patients will be randomly assigned to (a) LVEDP-guided hydration with normal saline (LVEDP-guided group) and (b) UFR-guided hydration carried out by the RenalGuard system (RenalGuard group). Seven-hundred patients (350 in each arm) will be enrolled. In the LVEDP-guided group the fluid infusion Rate will be adjusted according to the LVEDP as follows: 5 mL kg-1 hr-1 for LVEDP ≤12 mmHg, 3 mL kg-1 hr-1 for LVEDP 13-18 mmHg, and 1.5 mL kg-1 hr-1 for LVEDP >18 mmHg. In the RenalGuard group hydration with normal saline plus low-dose of furosemide is controlled by the RenalGuard system, in order to reach and maintain a high (>300 mL/hr) UFR. In all cases, iobitridol (a low-osmolar, nonionic contrast agent) will be administered. RESULTS: The primary endpoint is the composite of CIAKI (i.e., serum creatinine increase ≥25% and/or ≥0.5 mg/dL from the baseline to 48 hr after contrast media exposure) and/or acute pulmonary edema. CONCLUSION: The REMEDIAL III will test the hypothesis that the UFR-guided hydration is superior to the LVEDP-guided hydration to prevent the composite of CIAKI and/or acute pulmonary edema.
Mitchell L Halperin - One of the best experts on this subject based on the ideXlab platform.
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minimum Urine Flow Rate during water deprivation importance of the permeability of urea in the inner medulla
Kidney International, 1998Co-Authors: M Gowrishankar, Ilan Lenga, Richard Y Cheung, Surinder Cheemadhadli, Mitchell L HalperinAbstract:Minimum Urine Flow Rate during water deprivation: Importance of the permeability of urea in the inner medulla. We evaluated whether altering the Rate of excretion of sodium (Na) and chloride (Cl) when antidiuretic hormone (ADH) acts would cause urea to behave as an ‘effective' or ‘ineffective' urinary solute. Urine composition was compared to that in the excised papillary tip in rats treated with DDAVP while on a normal or a low electrolyte diet; half the rats were given a urea load. Studies were also carried out in humans who were water restricted for 12 to 16 hours and given DDAVP. One group had a high Rate of NaCl excretion induced by a thiazide diuretic, while the other group consumed a low salt diet to decrease the Rate of excretion of electrolytes. Urea (3 mmol/kg) was ingested after the control Urine samples were collected. On the high salt protocols, the Urine Flow Rate was directly proportional to the Rate of excretion of electrolytes (‘non-urea' osmoles) and there was no change in the ‘non-urea' osmolality despite large changes in Na and Cl excretion Rates. After urea was administered, there was no change in Urine Flow Rate, ‘non-urea' osmolality, or ‘non-urea' osmole excretion Rate, whereas the urinary urea concentration, Urine osmolality and the Rate of excretion of urea were higher. The papilla of the salt-loaded rats had a similar urea concentration to that in the Urine. In contrast, in the low electrolyte excretion protocols, the sum of the concentrations of ‘non-urea' osmoles in the Urine was much lower than that in the excised papilla, and the converse applied to urea. Similar changes were observed in the composition of the Urine in human subjects with high and low Rates of excretion of electrolytes. We conclude that urea appears to be an ‘ineffective' Urine osmole when there is a high Rate of salt excretion, whereas urea is an ‘effective' osmole when there is a low Rate of excretion of electrolytes.
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minimum Urine Flow Rate during water deprivation importance of the nonurea versus total osmolality in the inner medulla
Journal of The American Society of Nephrology, 1997Co-Authors: Steven Demetri Soroka, Surinder Cheemadhadli, Sirithon Chayaraks, Jeffrey Myers, Stanley I Rubin, H Sonnenberg, Mitchell L HalperinAbstract:Antidiuretic hormone leads to an increase in the permeability for water and urea in the inner medullary collecting duct. Hence, urea may not be an "effective" osmole in the inner medulla during maximal renal water conservation. Accordingly, the purpose of this study was to evaluate whether differences in the Rate of urea excretion would influence maximum renal water conservation in humans. In water-deprived rats, the concentration of urea and total osmolality were somewhat higher in the Urine exiting the inner medullary collecting duct than in interstitial fluid obtained from the entire papillary tip. Nevertheless, the "nonurea" (total osmolality minus urea in millimolar terms) osmolality was virtually identical in both locations. Chronically fasted human subjects that were water-deprived for 16 h had a lower Rate of urea excretion (71 +/- 7 versus 225 +/- 14 mumol/min) and a somewhat lower Urine osmolality (745 +/- 53 versus 918 +/- 20 mosmol/kg H2O). Nevertheless, they had identical Urine Flow Rates (0.5 +/- 0.01 and 0.5 +/- 0.02 ml/min, respectively), and their nonurea osmolality also was similar (587 +/- 25 and 475 +/- 14 mosmol/kg H2O, respectively) to the water-deprived normal subjects. The composition of their Urine differed in that the principal nonurea osmoles became NH4+ and beta-hydroxybutyRate rather than Na and C1. During water deprivation in normal subjects, the ingestion of urea caused a twofold rise in Urine Flow Rate, a fall in the nonurea osmolality, and a rise in the Rate of excretion of nonurea osmoles. The nonurea osmolality of the Urine, and presumably the medullary interstitial fluid as well, was inversely related to the urea excretion Rate. In chronic fasting, the nature, but not the quantity, of nonurea osmoles changed. The similar minimum Urine volume was predictable from an analysis based on nonurea osmole considerations.
Mokhtar Nibouche - One of the best experts on this subject based on the ideXlab platform.
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Urine Flow Rate curve shapes and their descriptors
Neurourology and Urodynamics, 2018Co-Authors: Rui Li, Mokhtar Nibouche, Andrew GammieAbstract:© 2018 Wiley Periodicals, Inc. Aims: To review the descriptors and definitions of Urine Flow Rate curve shape with a view to promoting greater clarity and to propose standard terms. Methods: A search was made in the PubMed and ICS standardization documents on Urine Flow Rate curve shape. Results: The Flow shape descriptors and their definitions are summarized and presented. “Normal” was widely used for describing a bell-shaped Flow curve, and “plateau” was mostly used where the ICS describe “constrictive” Flow shape. The use of shape descriptors “fluctuating,” “compressive,” “tower-shaped,” and “intermittent” varied in the literature. Conclusion: This survey provides an overview of Flow shape descriptors and their definitions. We suggest it is clearer to use only descriptors that describe shape alone, that is, normal, fluctuating, intermittent, and plateau, with comments on symmetry and Q max .
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Urine Flow Rate shape template and intermittent Flow in males
Neurourology and Urodynamics, 2018Co-Authors: Rui Li, Andrew Gammie, Mokhtar NiboucheAbstract:UroFlowmetry serves as a preliminary urodynamic test for physicians to indicate the possible cause of lower urinary tract symptoms. Alongside the most researched parameter maximum Flow Rate (Qmax), the shape of Urine Flow Rate curve is also reported to associate with one or more voiding abnormalities [1]. Therefore, this novel study aims at by mathematically generating free-Flow shape template in specified diagnostic groups, bladder outlet obstruction (BOO) and detrusor underactivity (DU), to assess its possibility for non-invasive diagnostic use.
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mathematical analysis of the male Urine Flow Rate curve for differentiating between du and boo
2018Co-Authors: Rui Li, Andrew Gammie, Mokhtar NiboucheAbstract:Mathematical analysis of the male Urine Flow Rate curve for non-invasive differentiating between DU and BOO
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A new procedure for analysis and modelling of male Urine Flow Rate
2015 34th Chinese Control Conference (CCC), 2015Co-Authors: Rui Li, Mokhtar Nibouche, Andrew Gammie, Zhu Quanmin, Janice KielyAbstract:In the first stage studies, this paper proposes a new piecewise linear discrete time dynamic model for describing global Urine Flow Rate profiles against time sequence. The establishment of model has been guided by physician meaningful principles and measured data. To obtain the model parameters from measured data sequence, a number of existing approaches have been tailored/integRated including least squares algorithm for model time constant and gain estimation, Butterworth filter with specified cut off frequencies, for reducing noise effect induced by abdominal and bladder squeezing, then to facilitate counting the number of peaks. A few of real case studies are selected to demonstRate the effectiveness and efficiency of the proposed procedure.
Andrew Gammie - One of the best experts on this subject based on the ideXlab platform.
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Urine Flow Rate curve shapes and their descriptors
Neurourology and Urodynamics, 2018Co-Authors: Rui Li, Mokhtar Nibouche, Andrew GammieAbstract:© 2018 Wiley Periodicals, Inc. Aims: To review the descriptors and definitions of Urine Flow Rate curve shape with a view to promoting greater clarity and to propose standard terms. Methods: A search was made in the PubMed and ICS standardization documents on Urine Flow Rate curve shape. Results: The Flow shape descriptors and their definitions are summarized and presented. “Normal” was widely used for describing a bell-shaped Flow curve, and “plateau” was mostly used where the ICS describe “constrictive” Flow shape. The use of shape descriptors “fluctuating,” “compressive,” “tower-shaped,” and “intermittent” varied in the literature. Conclusion: This survey provides an overview of Flow shape descriptors and their definitions. We suggest it is clearer to use only descriptors that describe shape alone, that is, normal, fluctuating, intermittent, and plateau, with comments on symmetry and Q max .
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Urine Flow Rate shape template and intermittent Flow in males
Neurourology and Urodynamics, 2018Co-Authors: Rui Li, Andrew Gammie, Mokhtar NiboucheAbstract:UroFlowmetry serves as a preliminary urodynamic test for physicians to indicate the possible cause of lower urinary tract symptoms. Alongside the most researched parameter maximum Flow Rate (Qmax), the shape of Urine Flow Rate curve is also reported to associate with one or more voiding abnormalities [1]. Therefore, this novel study aims at by mathematically generating free-Flow shape template in specified diagnostic groups, bladder outlet obstruction (BOO) and detrusor underactivity (DU), to assess its possibility for non-invasive diagnostic use.
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mathematical analysis of the male Urine Flow Rate curve for differentiating between du and boo
2018Co-Authors: Rui Li, Andrew Gammie, Mokhtar NiboucheAbstract:Mathematical analysis of the male Urine Flow Rate curve for non-invasive differentiating between DU and BOO
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A new procedure for analysis and modelling of male Urine Flow Rate
2015 34th Chinese Control Conference (CCC), 2015Co-Authors: Rui Li, Mokhtar Nibouche, Andrew Gammie, Zhu Quanmin, Janice KielyAbstract:In the first stage studies, this paper proposes a new piecewise linear discrete time dynamic model for describing global Urine Flow Rate profiles against time sequence. The establishment of model has been guided by physician meaningful principles and measured data. To obtain the model parameters from measured data sequence, a number of existing approaches have been tailored/integRated including least squares algorithm for model time constant and gain estimation, Butterworth filter with specified cut off frequencies, for reducing noise effect induced by abdominal and bladder squeezing, then to facilitate counting the number of peaks. A few of real case studies are selected to demonstRate the effectiveness and efficiency of the proposed procedure.
Rui Li - One of the best experts on this subject based on the ideXlab platform.
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mathematical modelling and analysis on male Urine Flow Rate
2019Co-Authors: Rui LiAbstract:Troublesome voiding lower urinary tract symptoms (LUTS) are a common problem in men, particularly with ageing. Management of voiding LUTS can be guided by accuRate determination of underlying mechanisms, distinguishing men with voiding symptoms caused by outlet obstruction from those with reduced bladder contractility. The aim of this dissertation is by analysing measured data to establish proper characteristic vector and model sets to provide quantitative interpretation of the male Urine Flow Rate (UFR) in order to assist medical diagnosis and prediction non-invasively. The methods we propose have not been described before, so this work is clearly novel. This study initially demonstRates a critical review of Urine Flow shape and current non-invasive urodynamic methods on diagnosing Bladder outlet obstruction (BOO) and Detrusor underactivity (DU), along with diagnosing accuracy and limitations of each method. Furthermore, a urodynamic model using first order discrete transfer function has been designed initially to lay down a fundamental assessment of whole Urine Flow shape. However, in follow up research this model shows limited diagnosing power for differentiation. To view the possible frequency difference between two groups, a simple Butterworth filter with two different cut-off values is designed and adapted to sepaRate the frequency components caused by abdominal straining and detrusor contraction. Continuously to quantify the difference of frequency range in BOO and DU Flow curve, an elliptic filter has been developed and adapted for UFR curve and fast Fourier transform is employed to derive median power frequency. Additionally, the diagnosing utility of Flow template is assessed and mathematical criteria of intermittent shape is proposed.
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Urine Flow Rate curve shapes and their descriptors
Neurourology and Urodynamics, 2018Co-Authors: Rui Li, Mokhtar Nibouche, Andrew GammieAbstract:© 2018 Wiley Periodicals, Inc. Aims: To review the descriptors and definitions of Urine Flow Rate curve shape with a view to promoting greater clarity and to propose standard terms. Methods: A search was made in the PubMed and ICS standardization documents on Urine Flow Rate curve shape. Results: The Flow shape descriptors and their definitions are summarized and presented. “Normal” was widely used for describing a bell-shaped Flow curve, and “plateau” was mostly used where the ICS describe “constrictive” Flow shape. The use of shape descriptors “fluctuating,” “compressive,” “tower-shaped,” and “intermittent” varied in the literature. Conclusion: This survey provides an overview of Flow shape descriptors and their definitions. We suggest it is clearer to use only descriptors that describe shape alone, that is, normal, fluctuating, intermittent, and plateau, with comments on symmetry and Q max .
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Urine Flow Rate shape template and intermittent Flow in males
Neurourology and Urodynamics, 2018Co-Authors: Rui Li, Andrew Gammie, Mokhtar NiboucheAbstract:UroFlowmetry serves as a preliminary urodynamic test for physicians to indicate the possible cause of lower urinary tract symptoms. Alongside the most researched parameter maximum Flow Rate (Qmax), the shape of Urine Flow Rate curve is also reported to associate with one or more voiding abnormalities [1]. Therefore, this novel study aims at by mathematically generating free-Flow shape template in specified diagnostic groups, bladder outlet obstruction (BOO) and detrusor underactivity (DU), to assess its possibility for non-invasive diagnostic use.
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mathematical analysis of the male Urine Flow Rate curve for differentiating between du and boo
2018Co-Authors: Rui Li, Andrew Gammie, Mokhtar NiboucheAbstract:Mathematical analysis of the male Urine Flow Rate curve for non-invasive differentiating between DU and BOO
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A new procedure for analysis and modelling of male Urine Flow Rate
2015 34th Chinese Control Conference (CCC), 2015Co-Authors: Rui Li, Mokhtar Nibouche, Andrew Gammie, Zhu Quanmin, Janice KielyAbstract:In the first stage studies, this paper proposes a new piecewise linear discrete time dynamic model for describing global Urine Flow Rate profiles against time sequence. The establishment of model has been guided by physician meaningful principles and measured data. To obtain the model parameters from measured data sequence, a number of existing approaches have been tailored/integRated including least squares algorithm for model time constant and gain estimation, Butterworth filter with specified cut off frequencies, for reducing noise effect induced by abdominal and bladder squeezing, then to facilitate counting the number of peaks. A few of real case studies are selected to demonstRate the effectiveness and efficiency of the proposed procedure.
