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Acute kidney injury (AKI) remains a challenge in terms of diagnosis and classification, its morbidity and mortality remaining high in the face of improving clinical protocols. Current clinical criteria use serum creatinine (sCr) and urine output to classify patients. Ongoing research has identified novel biomarkers that may improve the speed and accuracy of patient evaluation and prognostication, yet the route from basic science to clinical practice remains poorly paved. International evidence supporting the use of plasma neutrophil gelatinase-associated lipocalin (NGAL) as a valuable biomarker of AKI and chronic kidney disease (CKD) for a number of clinical scenarios was presented at the 31st International Vicenza Course on Critical Care Nephrology, and these data are detailed in this review. NGAL was shown to be highly useful alongside sCr, urinary output, and other biomarkers in assessing kidney injury; in patient stratification and continuous renal replacement therapy (CRRT) selection in paediatric AKI; in assessing kidney injury in conjunction with sCr in sepsis; in guiding resuscitation protocols in conjunction with brain natriuretic peptide in burn patients; as an early biomarker of delayed graft function and calcineurin inhibitor nephrotoxicity in kidney transplantation from extended criteria donors; as a biomarker of cardiovascular disease and heart failure, and in guiding CRRT selection in the intensive care unit and emergency department. While some applications require further clarification by way of larger randomised controlled trials, NGAL nevertheless demonstrates promise as an independent biological marker with the potential to improve earlier diagnosis and better assessment of risk groups in AKI and CKD. This is a critical element in formulating quick and accurate decisions for individual patients, both in acute scenarios and in long-term care, in order to improve patient prognostics and outcomes.

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Numerical MHD simulations are used to gain insight into how sawteeth are affected by three-dimensional shaping from the Compact Toroidal Hybrid (CTH) stellarator field. CTH is a small stellarator-tokamak hybrid and sawteeth are sometimes seen on soft x-ray signals when operating with tokamak like profiles. We use NIMROD to compute numerical solutions having repeated sawtooth relaxations for a sequence of configurations with increasing helical stellarator field strength. The experimentally observed trend of the sawtooth period decreasing as the helical field strength is increased is recovered in the simulations. Careful attention to numerical convergence was required to obtain the results, and these considerations may be relevant to simulations of other phenomena in devices with non-axisymmetric plasmas such as perturbed tokamaks, RFPs, and stellarators.

New studies identify the critical parameters and physics governing disruptive neoclassical tearing mode (NTM) onset. An m/n = 2/1 mode in DIII-D that begins to grow robustly after a seeding event (edge localized mode ELM or sawtooth precursor and crash) causes the mode rotation to drop close to the plasma’s E r = 0 rest frame; this condition opens the stabilizing ion-polarization current ‘gate’ and destabilizes an otherwise marginally stable NTM. Our new experimental and theoretical insights and novel toroidal theory-based modeling are benchmarked and scalable to ITER and other future experiments. The nominal ITER rotation at q = 2 is found to be stabilizing (‘gate closed’) except for MHD-induced transients that could ‘open the gate’. Extrapolating from the DIII-D ITER baseline scenario (IBS) discharges, MHD transients are much more likely to destabilize problematic robustly growing 2/1 NTMs in ITER; this makes predictions of seeding and control of both ELMs and sawteeth imperative for more than just minimizing divertor pulsed-heat loading.