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Background: Preliminary evidence suggests a nephroprotective effect of urinary alkalinization in patients at risk of acute kidney injury. In this study, we tested whether prophylactic bicarbonate-based infusion reduces the incidence of acute kidney injury and tubular damage in patients undergoing open heart surgery. Methods and Findings: In a multicenter, double-blinded (patients, clinical and research personnel), randomized controlled trial we enrolled 350 adult patients undergoing open heart surgery with the use of cardiopulmonary bypass. At induction of anesthesia, patients received either 24 hours of intravenous infusion of sodium bicarbonate (5.1 mmol/kg) or sodium chloride (5.1 mmol/kg). The primary endpoint was the proportion of patients developing acute kidney injury. Secondary endpoints included the magnitude of acute tubular damage as measured by urinary neutrophil gelatinase-associated lipocalin (NGAL), initiation of acute renal replacement therapy, and mortality. The study was stopped early under recommendation of the Data Safety and Monitoring Committee because interim analysis suggested likely lack of efficacy and possible harm. Groups were non-significantly different at baseline except that a greater proportion of patients in the sodium bicarbonate group (66/174 [38%]) presented with preoperative chronic kidney disease compared to control (44/176 [25%]; p = 0.009). Sodium bicarbonate increased urinary pH (from 6.0 to 7.5, p Conclusions: Urinary alkalinization using sodium bicarbonate infusion was not found to reduce the incidence ofacute kidney injury or attenuate tubular damage following open heart surgery; however, it was associated with a possible increase in mortality. On the basis of these findings we do not recommend the prophylactic use of sodium bicarbonate infusion to reduce the risk of acute kidney injury. Discontinuation of growing implementation of this therapy in this setting seems to be justified. Trial registration: ClinicalTrials.gov NCT00672334, Introduction Acute kidney injury is a global health problem with more than 10 million people affected annually [1]. It is independently related to long-term morbidity [2] and an estimated 4 [...]

Information sharing systems such as iCloud, Dropbox, Facebook, and Twitter are ubiquitous today, but all of them depend on massive server infrastructure and always-on Internet connectivity. We have designed and implemented a sharing system that does not require infrastructure yet supports robust, distributed, secure sharing by opportunistically using any and all connectivity, local or global, permanent or transient, to communicate. One key element of this system is a new information routing model that so far has proven to be as scalable and efficient as the best of the current Internet routing protocols, while operating in an environment more complex and dynamic than they can tolerate. The new routing model is made possible by new affordances offered by information-centric networking, in particular, the open source CCN [1] release. This article describes the new system and its routing model, and provides some performance measurements. [ABSTRACT FROM PUBLISHER]