bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in Phosphorus Requirement with Increasing Grain Yield for Winter Wheat
Authors: Zhan Ai , Chen Xinping , Li Shiqing , Cui Zhenling
Published: August 2015

Overestimation of the P requirement has been a driving force in the overuse of P fertilization in intensively managed agricultural systems and the resulting extensive environmental pollution. A database comprising 2157 measurements was developed from 2000 to 2013 using 45 on‐farm and station trials to evaluate the relationship between aboveground P uptake and grain yield with different P fertilizer (Pf) treatments and to quantify P requirements per megagram of grain at different grain yield levels. Winter wheat (Triticum aestivum L.) yield ranged from 0.9 to 11.7 Mg ha−1. The P requirement per megagram of grain yield (Preq) increased with Pf supply from 4.1 kg under the treatment without Pf to 4.8 kg under the Pf surplus treatment. These results imply that excessive P application generally does not lead to greater P use efficiency and poses a potential environmental threat. Under the optimal Pf (Pf = Opt) treatment, the average Preq was 4.5 kg, and it declined from 4.7 kg in the yield range of <4.5 Mg ha−1 to 4.2 kg in the yield range of >9 Mg ha−1 due to the increasing harvest index (from 45.7 to 48.2%) and the diluting effect of declining grain P concentrations (from 3.8 to 3.2 g kg−1). The largest variation in shoot biomass and P accumulation under Pf = Opt treatment occurred from the stem elongation to anthesis growth stages, suggesting that, in addition to Pf supply, crop management during the early growth season is also important for achieving higher yields.
Are traditional coping mechanisms effective in managing the risk against extreme events? Evidences from flood-prone region in rural India
Authors: Patnaik Unmesh , Narayanan K.
Published: August 2015

Livelihoods of rural poor in developing countries like India are exposed to risks due to natural disasters like floods. Although these risks are covariate, households are affected in varying degrees due to their location and their relative capacity to cope with them. These in turn are household-specific and are decisive in defining the efficacy of coping mechanisms adopted by households to hedge against the impact of floods. The paper attempts to study the nature of risks faced by households in a major flood-prone region of rural India and examine the effectiveness of coping mechanisms adopted. Findings suggest that (i) floods significantly reduce the consumption of households, (ii) traditional coping mechanisms used to manage the impacts are ineffective in safeguarding the risks to their livelihood and (iii) designing comprehensive coping measures, targeting vulnerable groups and combining informal insurance with safety nets will be useful.
Determinants of farm-level adaptation diversity to cyclone and flood: insights from a farm household-level survey in Eastern India
Authors: Bahinipati Chandra Sekhar
Published: August 2015

A large number of farmers' livelihoods are susceptible to cyclones and floods, and farmers are taking up several adaptation mechanisms. Previous studies, therefore, have examined determinants of various adaptation options and provide policy suggestions to promote a specific one. However, options are undertaken at different points depending on the nature and intensity of extreme events. Hence, it is imperative to identify factors influencing farmers' decisions to adopt an additional option, particularly during ex-ante and ex-post periods. This could assist policy-makers to enhance various farm-level adaptation options. Using survey data from 285 farm households in cyclone- and flood-prone regions in eastern India, this study aims to assess the determinants of adaptation diversity. This study finds that the likelihood of undertaking adaptation diversity is high during the ex-post period, and cyclone-affected farmers are likely to adopt a higher number of adaptation measures. Further, size of household, farming experience, per capita income, agriculture as major source of income and crop loss compensation received are some of the important determinants. These findings emphasize the need for investments in scientific modeling for better prediction of extreme events and suggest restructuring the existing institutions to promote several farm-level adaptation measures.
Is community water management the community’s choice? Implications for water and development policy in Africa
Authors: Hope Rob
Published: August 2015

The global drive for universal drinking water security has faltered in rural Africa. Community management of handpumps, which provide water to over 200 million rural people, is the prevailing but increasingly embattled policy choice. A choice experiment is designed to test alternative maintenance models across competing attributes of maintenance provider, maintenance level, payment mode, and payment level. A sample of 3,540 observations is modeled from 118 handpump users in rural Kenya. Results identify community management of maintenance services as the least preferred option with water user payments contingent on an order of magnitude improvement in handpump repair times. Social choice heterogeneity varies by socio-economic status and water use behaviors indicating uneven adoption profiles within communities compounded by no acceptable payment mode. Policy responses to community choices need to address these institutional challenges through new monitoring platforms and acceptable payment systems.
Newspaper coverage of water issues in China from 1950 to 2000
Authors: Shang Wenxiu , Zheng Hang , Wang Zhongjing , Baimaqvzong  , Wei Yongping
Published: August 2015

Mass media are important sources of information about water issues that significantly influence civil life. This paper presents a content analysis approach to contextualize the water issues reporting of the People's Daily. The intent of our approach is to uncover the reporting pattern of water issues and the relationship between government policies and their news reports. Using the newspaper with the second widest circulation in China, the content analysis approach reveals that the document frequency of water issues had shown a flat trend since the 1970s. Water-related articles were given more significance by providing additional front pages. The results suggest that newspapers have been focusing more on the recreational function and protection of water since the 1980s. The results also show that there was a relative shortage of coverage on certain types of water-related central government documents. Lacking persistence was another feature of policy propaganda. These factors could work against public engagement in water issues and undermine the public's understanding of and confidence in water management measures. We believe these results could help water resource managers to interpret media content of water issues and improve the propaganda of their policies, which would contribute to better administration of water resources.
The natural degradation of benzophenone at low concentration in aquatic environments
Authors: Chen Dao-Yong , Guo Xiao-Feng , Wang Hong , Zhang Hua-Shan
Published: August 2015

The natural degradation caused by sun irradiation and microbes in aquatic environments is of major significance in the elimination process of benzophenone (BP). In this study, the fate of BP in surface water at a low concentration of 10 μg/L was investigated, including both photodegradation and microbial degradation. The result showed that the photodegradation rate of BP was affected by several parameters such as the initial concentration, continuous input, and the presence of the analogue, ions and small molecules. Meanwhile, the rate of microbial degradation of BP was mainly influenced by the kind and amount of microbes in the environmental water.
Influence of dissolved oxygen concentration on the start-up of the anammox-based process: ELAN®
Authors: Morales N. , Val del Río A. , Vázquez-Padín J. R. , Gutiérrez R. , Fernández-González R. , Icaran P. , Rogalla F. , Campos J. L. , Méndez R. , Mosquera-Corral A.
Published: August 2015

The anammox-based process ELAN® was started-up in two different sequencing batch reactor (SBR) pilot plant reactors treating municipal anaerobic digester supernatant. The main difference in the operation of both reactors was the dissolved oxygen (DO) concentration in the bulk liquid. SBR-1 was started at a DO value of 0.4 mg O2/L whereas SBR-2 was started at DO values of 3.0 mg O2/L. Despite both reactors working at a nitrogen removal rate of around 0.6 g N/(L d), in SBR-1, granules represented only a small fraction of the total biomass and reached a diameter of 1.1 mm after 7 months of operation, while in SBR-2 the biomass was mainly composed of granules with an average diameter of 3.2 mm after the same operational period. Oxygen microelectrode profiling revealed that granules from SBR-2 where only fully penetrated by oxygen with DO concentrations of 8 mg O2/L while granules from SBR-1 were already oxygen penetrated at DO concentrations of 1 mg O2/L. In this way granules from SBR-2 performed better due to the thick layer of ammonia oxidizing bacteria, which accounted for up to 20% of all the microbial populations, which protected the anammox bacteria from non-suitable liquid media conditions.
Enhancing nitrogen and phosphorus removal in the BUCT–IFAS process by bypass flow strategy
Authors: Bai Yang , Quan Xie , Zhang Yaobin , Chen Shuo
Published: August 2015

A University of Cape Town process coupled with integrated fixed biofilm and activated sludge system was modified by bypass flow strategy (BUCT–IFAS) to enhance nitrogen and phosphorus removal from the wastewater containing insufficient carbon source. This process was operated under different bypass flow ratios (λ were 0, 0.4, 0.5, 0.6 and 0.7, respectively) to investigate the effect of different operational modes on the nitrogen (N) and phosphorus (P) removal efficiency (λ = 0 was noted as common mode, other λ were noted as bypass flow mode), and optimizing the N and P removal efficiency by altering the λ. Results showed that the best total nitrogen (TN) and total phosphorus (TP) removal performances were achieved at λ of 0.6, the effluent TN and TP averaged 14.0 and 0.4 mg/L meeting discharge standard (TN < 15 mg/L, TP < 0.5 mg/L). Correspondingly, the TN and TP removal efficiencies were 70% and 94%, respectively, which were 24 and 41% higher than those at λ of 0. In addition, the denitrification and anoxic P-uptake rates were increased by 23% and 23%, respectively, compared with those at λ of 0. These results demonstrated that the BUCT–IFAS process was an attractive method for enhancing nitrogen and phosphorus removal from wastewater containing insufficient carbon source.
Enhanced phosphorus removal in the DAF process by flotation scum recycling for advanced treatment of municipal wastewater
Authors: Kwak Dong-Heui , Lee Ki-Cheol
Published: August 2015

To remove phosphorus (P) from municipal wastewater, various types of advanced treatment processes are being actively applied. However, there is commonly a space limit in municipal wastewater treatment plants (MWTPs). For that reason, the dissolved air flotation (DAF), which is well known for small space and flexible application process, is preferred as an additive process to enhance the removal of P. A series of experiments were conducted to investigate the feasibility of flotation scum recycling for effective P removal from a MWTP using a DAF pilot plant over 1 year. The average increases in the removal efficiencies due to flotation scum recycling were 22.6% for total phosphorus (T-P) and 18.3% for PO4-P. A higher removal efficiency of T-P was induced by recycling the flotation scum because a significant amount of Al components remained in the flotation scum. The increase in T-P removal efficiency, due to the recycling of flotation scum, shifted from the boundary of the stoichiometric precipitate to the equilibrium control region. Flotation scum recycling may contribute to improving the quality of treated water and reducing treatment costs by minimizing the coagulant dosage required.
Evaluation of EPS extraction protocols from anaerobic sludge for gel-based proteomic studies
Authors: Zorel J. A. , Aquino S. F. , Sanson A. L. , Castro-Borges W. , Silva S. Q.
Published: August 2015

Despite the importance of anaerobic sludge extracellular polymeric substances (EPSs), their characterization is limited to information regarding their chemical classes and molecular size. This work explores the possibility of using proteomic techniques to study the proteins present in this matrix. Thus, this paper compares eight EPS extraction methods regarding extraction yield, protein/carbohydrate ratio, size distribution profile and suitability to sodium dodecyl sulfate–polyacrylamide gel electrophoresis analyses. Despite the differences found in quantification and size exclusion chromatography assays, the band profile found for all methods was very similar. Considering the band pattern, extraction time and background level, heating method followed by ammonium sulfate precipitation proved to be the most appropriate method for gel-based analyses of anaerobic sludge EPS proteins.
Removal of cadmium(II) ions from aqueous solution using Ni (15 wt.%)-doped α-Fe2O3 nanocrystals: equilibrium, thermodynamic, and kinetic studies
Authors: OuldM'hamed Mohamed , Khezami L. , Alshammari Abdulrahman G. , Ould-Mame S. M. , Ghiloufi I. , Lemine O. M.
Published: August 2015

The present publication investigates the performance of nanocrystalline Ni (15 wt.%)-doped α-Fe2O3 as an effective nanomaterial for the removal of Cd(II) ions from aqueous solutions. The nanocrystalline Ni-doped α-Fe2O3 powders were prepared by mechanical alloying, and characterized by X-ray diffraction and a vibrating sample magnetometer. Batch-mode experiments were realized to determine the adsorption equilibrium, kinetics, and thermodynamic parameters of toxic heavy metal ions by Ni (15 wt.%)-doped α-Fe2O3. The adsorption isotherms data were found to be in good agreement with the Langmuir model. The adsorption capacity of Cd(II) ion reached a maximum value of about 90.91 mg g−1 at 328 K and pH 7. The adsorption process kinetics was found to comply with pseudo-second-order rate law. Thermodynamic parameters related to the adsorption reaction, free energy change, enthalpy change and entropy change, were evaluated. The found values of free energy and enthalpy revealed a spontaneous endothermic adsorption-process. Moreover, the positive entropy suggests an increase of randomness during the process of heavy metal removal at the adsorbent–solution interface.
Effect of organic fouling on micro-pollutant rejection in membrane bioreactor treating municipal solid waste landfill leachate
Authors: Sanguanpak Samunya , Chiemchaisri Chart , Chiemchaisri Wilai , Yamamoto Kazuo
Published: August 2015

Effect of membrane fouling on the removal of micro-pollutants from municipal solid waste landfill leachate, i.e. 4-methyl-2,6-di-tert-butylphenol (BHT), bisphenol A (BPA), and bis(2-ethylhexyl)phthalate (DEHP), in membrane bioreactor (MBR) was investigated. Modifications of membrane surface properties were analyzed to determine their relationship with their removals. Membrane fouling was simulated with foulants of different particle sizes on cellulose acetate (CA) microfiltration membrane to investigate the effect of foulant characteristics on BHT, BPA, and DEHP retention in the filtration experiment. The rejection efficiencies of the organic micro-pollutants in the MBR were 82–97% by fouled membrane, and 70–90% by cleaned membrane. The fouled membrane provided higher rejection of micro-pollutants from about 5% for BPA and BHT to 19% for DEHP. These improvements were due to the modification of membrane surface characteristics in terms of surface morphology, and contact angle after membrane fouling. The degree of rejection was found to be dependent upon the characteristics of foulant deposited on CA membrane surface. Increasing foulant particle size and its density shifted the mechanism of micro-pollutant rejection from membrane pore narrowing to pore blocking and cake formation while increasing pollutant adsorption capacity onto the foulant layer.
Cultivation of rice for animal feed with circulated irrigation of treated municipal wastewater for enhanced nitrogen removal: comparison of cultivation systems feeding irrigation water upward and downward
Authors: Muramatsu A. , Ito H. , Sasaki A. , Kajihara A. , Watanabe T.
Published: August 2015

To achieve enhanced nitrogen removal, we modified a cultivation system with circulated irrigation of treated municipal wastewater by using rice for animal feed instead of human consumption. The performance of this modified system was evaluated through a bench-scale experiment by comparing the direction of circulated irrigation (i.e. passing through paddy soil upward and downward). The modified system achieved more than three times higher nitrogen removal (3.2 g) than the system in which rice for human consumption was cultivated. The removal efficiency was higher than 99.5%, regardless of the direction of circulated irrigation. Nitrogen in the treated municipal wastewater was adsorbed by the rice plant in this cultivation system as effectively as chemical fertilizer used in normal paddy fields. Circulated irrigation increased the nitrogen released to the atmosphere, probably due to enhanced denitrification. Neither the circulation of irrigation water nor its direction affected the growth of the rice plant and the yield and quality of harvested rice. The yield of rice harvested in this system did not reach the target value in normal paddy fields. To increase this yield, a larger amount of treated wastewater should be applied to the system, considering the significant amount of nitrogen released to the atmosphere.
Effective carbon and nutrient treatment solutions for mixed domestic-industrial wastewater in India
Authors: Saha S. , Badhe N. , Seuntjens D. , Vlaeminck S. E. , Biswas R. , Nandy T.
Published: August 2015

The present study evaluates effectiveness of up-flow anaerobic sludge blanket (UASB) reactor followed by two post-anaerobic treatment options, namely free-surface, up-flow constructed wetland (FUP-CW) and oxygen-limited anaerobic nitrification/denitrification (OLAND) processes in treating sewage from the peri-urban areas in India receiving illegal industrial infiltrations. The UASB studies yielded robust results towards fluctuating strength of sewage and consistently removed 87–98% chemical oxygen demand (COD) at a hydraulic retention time of 1.5–2 d. The FUP-CW removed 68.5 ± 13% COD, 68 ± 3% NH4+-N, 38 ± 5% PO43−-P, 97.6 ± 5% suspended particles and 97 ± 13% fecal coliforms. Nutrient removal was found to be limiting in FUP-CW, especially in winter. Nitrogen removal in the OLAND process were 100 times higher than the FUP-CW process. Results show that UASB followed by FUP-CW can be an excellent, decentralized sewage treatment option, except during winter when nutrient removal is limited in FUP-CW. Hence, the study proposes bio-augmentation of FUP-CW with OLAND biomass for overall improvement in the performance of UASB followed by FUP-CW process.
Rheological behaviors of anaerobic granular sludge in a spiral symmetry stream anaerobic bioreactor
Authors: Chen Xiaoguang , Dai Ruobin , Xiang Xinyi , Ma Chengyu , Li Gang , Hu Tao , Xu Zhengqi , Abdelgadir Awad
Published: August 2015

The rheological behaviors of the anaerobic granular sludge (AGS) in a spiral symmetry stream anaerobic bioreactor (SSSAB) were investigated. Shear-thinning behavior, thixotropic behavior, concentration–viscosity behavior and temperature–viscosity behavior were evaluated based on the constitutive equation of the AGS. The results indicated that the Herschel–Bulkley model was able to adequately describe the constitutive relation of AGS in the SSSAB. The AGS also showed shear-thinning behavior as well as thixotropic behavior. The critical shear rate and network strength of the AGS were 61.8 s−1 and 497.0 W m−3, respectively. The relationship between the apparent viscosity and the sludge concentration was illustrated and explained by the Woodcock formula. The relationship between apparent viscosity of the AGS and temperature could be modeled using the Arrhenius equation. The AGS was significantly thermo-sensitive and its mean energy of activation was 14.640 kJ mol−1. Notably, it was necessary to consider such behaviors in the hydrodynamic modeling of SSSAB in which shear condition, sludge concentration and temperature were in non-uniform distribution.
Micellar-enhanced ultrafiltration for the solubilization of various phenolic compounds with different surfactants
Authors: Huang Jin-Hui , Zhao Yong , Zeng Guang-Ming , Peng Lei , Li Xue , Liu Liu-Xia , Li Fei , Shi Li-Xiu , Yuan Fang
Published: August 2015

Micellar-enhanced ultrafiltration (MEUF) was applied to the separation of phenolic compounds p-nitrophenol (PNP), p-chlorophenol (PCP), p-cresol (PC) and phenol (P) from effluents using a hydrophilic polyethersulfone ultrafiltration membrane. Cationic cetylpyridinium chloride (CPC), nonionic TX-100 and anionic sodium dodecyl benzene sulfonate (SDBS) were chosen as the surfactants. Several important parameters, i.e. the separation efficiency, the distribution coefficient of phenolic compounds and the removal ratio of surfactants, were investigated. It was shown that the separation efficiency and the distribution coefficient of phenolic compounds ascended with the increasing surfactant concentration and could be arranged as the following order: PNP > PCP > PC > P. Moreover, in the case of phenolic compound separation, CPC achieved the highest treatment efficiency, and the separation efficiency of SDBS was a little lower than that of TX-100. The removal ratios of the same surfactant when treating different phenolic effluents were nearly similar. However, when treating the same phenolic compound, the sequence of the surfactant rejection was in the following order: TX-100 > CPC > SDBS. These results indicate that CPC has a distinct superiority in the treatment of phenolic effluents via the MEUF process, and PNP easily solubilizes in the surface of the micelles.
Are there precursor lesions for ovarian cancer: A review
Authors: Cvetkovic Dusica , Williams Stephen
Published: August 2015

Precancer is a very early noninvasive lesion that has genetic abnormalities,
loss of cellular control functions, some phenotypic characteristics of
invasive cancer, and predicts a significant likelihood of developing invasive
cancer. Currently, there is no consensus on the existence of ovarian cancer
precursor lesions, though many dysplasias in the ovary have been found to
date. Our inability to detect precancer in the ovary has hampered early
detection efforts. After review of current literature, inclusion cysts, deep
surface invaginations and papillomatosis, commonly referred to as ?putative
ovarian precancer lesions? appear to correlate with known genetic alterations
found in the advanced disease in predisposed cohorts. Although we suggest
that screening for these lesions would underestimate the ovarian cancer risk
in general population, data on chemoprevention studies offers new hope for
combating this deadly disease.
Mitotic index in evaluation of tumour proliferative activity
Authors: Mitrovic Dragan , Govedarovic Vitomir , Markovic-Lipkovski Jasmina
Published: August 2015

Tumour mitotic index represents a number of dividing cells per 100 tumour
cells. It is the oldest and most frequently used parameter of cell
proliferation kinetics in tumours, which is, in addition to numerous
immunohistochemical and other markers, still routinely practised as a golden
standard. Determination is dependent on urgent tissue fixation, fixative
type, manner and procedure of staining, thickness of tissue sections,
statistical expression of mitotic count, tissue and microscopic field
sampling as well as a counting protocol. When the identical counting
techniques are applied, determination of tumour mitotic index becomes an
essentially reproductive method. Proposal for routine usage is to express the
number of mitotic figures in standard vision area of 2 mm2. Proceeding from
minimal variability of mitotic time duration, there were showed a few
original formulas which connect mitotic index, acquired by stereological
methodology, with differential equation of tumour growth function. In this
mathematical way, it is possible to connect structure of the tumour with
tumour growth kinetics parameters, for example with potential doubling time.
This approach provides growth kinetic examination of once occurring measured
human solid tumours, according to their morphology. Tumour mitotic index has
been actually applied in classification, biological behaviour prediction,
grading, prognosis, evaluation of relapse potential, malignant transformation
and metastasis, treatment decision and therapy effect follow-up. In some
malignant tumours, such as breast carcinoma, it is an independent prognostic
factor.
The biomechanics of dental implants and dentures
Authors: Stamenkovic Dragoslav
Published: August 2015

INTRODUCTION. Osseointegrated implants are actually replacements for natural
teeth, and, like natural teeth, they are exposed to various forces. Rejection
and bad osseointegration of implants rarely occur today because oral implants
are made from biocompatible materials. Most complications are a consequence
of badly planned implant loading. OBJECTIVE. The aim of this work was the
optimization of the process of planning and inserting oral implants and
dentures based on the analysis of the biomechanical problems in implantology.
METHOD. In order to determine the influence of the number of cantilevered
superstructures, the number of implants and implant microdesign on tensions
within the implant and in the peri-implant tissue, a calculation of tensions
and deformations was made in a virtual model (control model) using the finite
elements analysis. The obtained values served as reference values in the
analysis of the results from three experimental models. RESULTS. In the
control model, as well as in the experimental models, the first implant bears
the heaviest load with dominant contraction tensions, the second one carries
significantly weaker straining tensions, the third one carries weak
contraction tensions and the fourth one the weakest straining tensions. The
values of tensions and deformations have the same sign (-/+), but the
absolute values depend on the number of cantilevered superstructures, implant
microdesign and the number of inserted implants. CONCLUSION. Knowing the
biomechanics of oral implants and the dentures on them allows for proper
indication, a good choice of implants and good superstructure design. The
prevention measures for bone resorption caused by biomechanical factors are:
insertion of symmetrical screw implants and root-shaped cylindrical implants
as long and as wide as possible, insertion of implants with the total
supporting area expanded, choosing materials that are rigid enough, the right
direction of implants, narrowing of the denture occlusal surfaces and
location of the contact point at the centre.
Anaesthesiological approach to the patient in early stage of trauma disease
Authors: Vucovic Dragan
Published: August 2015

INTRODUCTION. The paper presents 20-year long experience gained in work with
traumatized patients at the Emergency Centre in Belgrade. The paper is
primarily related to analysis of the so-called secondary approach to the
patient in the Resuscitation Unit of the Emergency Centre Admission
Department. Secondary approach is carried out in resuscitation room, and
implies the restoration of patient?s vital parameters to physiological frame,
observation of the patient and application of diagnostic procedures, set up
of definitive agenda of treatment and preparation of the patient for surgery.
OBJECTIVE. The objective of our study was to define doctrinal postulations in
reanimation of traumatized patients considering the specifics of our region.
METHOD. Statistical analysis of the patients was based on a one-year period
(2006) and the obtained results were compared with the large 10-year mega
American study (Scanel Waxman, Steven Baker). RESULTS. The comparison
evidenced certain specificities characteristic for our settings. Trauma
related death is the leading cause of mortality in population up to 30 years
of age in our milieu. According to our statistics, injuries caused by traffic
traumatism were most prevalent. Injuries caused by fire-arms were the second,
and stabs were in the third place. Resuscitation measures were carried out
according to strictly defined agenda based on 20-year experience, in relation
to the extent of injuries, jeopardy of vital functions of the injured body
and in the line with the definite plan of further treatment of the patient.
CONCLUSION. All traumatized patients were hypovolemic, most of them were
haemodynamically unstable, consciousness disorders of different degrees were
present and in all of the patients morbidity was increased due to trauma.
Resolution of each of the above disorders during early admission to hospital
is frequently vital for the patient.
Renal tumours of childhood: The last 100 years and where to from here
Authors: Vujanic Gordan
Published: August 2015

Renal tumours of childhood represent a fascinating group of tumours in which
very significant discoveries have been made in the last 100 years, leading to
better understanding of these not only tumours but also tumour in general. By
studying a large series of renal tumours of childhood collected through
international multicentre trials, their clinico-pathological features have
been better recognised resulting in more appropriate treatment and better
prognosis, numerous new tumour entities have been identified, and thank to
new molecular biology studies and techniques, many tumour genes and genetic
abnormalities which are important in tumorigenesis have been found. The most
common renal tumour of childhood is Wilms? tumour, which is now regarded as
the most treatable tumour in children with overall survival of 90%. New
multicentre trials are focused on reduction of treatment in order to avoid
longterm sequalae of treatment, but without jeopardising these excellent
survival results. Histopathological studies are searching for subtypes of
Wilms? tumour, which could be treated with milder therapy, and in a recently
launched trial patients will be stratified in different treatment groups on
the basis of molecular features of their tumours. Molecular biology studies
have helped us recognising that some renal tumours are identical to tumours
of other sites (such as cellular mesoblastic nephroma and infantile
fibrosarcoma of soft tissue, renal and extra-renal rhabdoid tumour), as well
as that some tumours of other sites may also occur in the kidney (primitive
neuroectodermal tumour, desmoplastic small round cell tumour, synovial
sarcoma). Finally, some new, kidney-specific entities have been recognised
too (metanephric stromal tumour, metanephric adenofibroma, anaplastic sarcoma
of the kidney). It is very likely that new advances in molecular biology will
result in identification of features, which are going to be even more
important in predicting tumour behaviour, response to treatment and
prognosis.
The use of recombinant activated factor VII in traumatic intracranial haemorrhage
Authors: Novak Vesna , Mitov Ljiljana , Rancic Zoran , Petrovic Budimir , Novak Martin
Published: August 2015

INTRODUCTION. A group of patients with craniocerebral injuries received
recombinant activated factor VII (rFVIIa ) in order to reduce or stop further
bleeding in brain tissue. OBJECTIVE. Fundamental objective was to show that
the use of rFVIIa can stop intracerebral bleeding and that operative
treatment of such patients can be avoided. METHODS. rFVIIa was applied in the
group of patients who sustained traumatic brain injuries. The control group
was formed retrospectively out of patients with the same pathology previously
treated at this clinic throughout 2003 and 2004. It is important to mention
that in all patients rFVIIa was applied within first four hours after injury.
Coagulation status and GCS were monitored in all patients. RESULTS. The
treated patients had different mechanism of injury and pathological substrate
of brain tissue. Results were compared with the group of patients who had
similar pathological substrate and GCS on admission but did not receive
rFVIIa. There were no complications or lethal outcomes recorded in the group
of the treated patients. CONCLUSION. Cessation of intracerebral bleeding
after timely use of rFVIIa enabled the use of only pharmacological treatment
and avoiding operative treatment in some patients. Results were encouraging.
Our experince with the use of recombinant activated factor VII in postpartum haemorrhage
Authors: Ilic-Mostic Tatjana , Sparic Radmila , Argirovic Rajka , Ljubic Aleksandar , Bozanovic Tatjana , Arsenijevic Ljubica , Tomanovic-Kokovic Jelena , Stefanovic Aleksandar
Published: August 2015

INTRODUCTION. Massive obstetric bleeding is the most common cause of maternal
mortality and morbidity. The first step in treatment of these patients is
establishing the adequate circulatory volume. The primary goal of therapy is
to identify and remove the cause of bleeding, with appropriate symptomatic
and substitution therapy. Human recombinant activated factor VII (rFVIIa) is
officially registered for the treatment of patients suffering from
haemophilia with inhibitors. Its use has also proved successful in other
congenital and acquired coagulopathies and in patients with acute
non-haemophilic bleeding. A special significance is given to the application
of rFVIIa in cases of obstetric haemorrhage, in order to avoid postpartum
hysterectomy and occurrence of complications of haemorrhagic shock in
obstetrics. OBJECTIVE. The aim of this study is to show our experience and
results of the use of rFVIIa in the treatment of patients with massive
postpartum bleeding. METHOD. The retrospective study encompassed six patients
with primary postpartum haemorrhage treated with rFVIIa at our institution in
the period from 2005 to 2007. RESULTS. The treated patients were divided into
two groups. In the first group, there were three patients who underwent
hysterectomy and who received rFVIIa over 24 hours after delivery. The second
group consisted of three patients who received rFVIIa in the first 24 hours
after delivery, before we decided to perform hysterectomy. The application of
rFVIIa led to successful cessation of bleeding in all patients. Relevant side
effects were not registered. CONCLUSION. The administration of rFVIIa in
obstetrics should be considered for each patient before decision to apply
hysterectomy, and it should certainly be applied in patients who want to
preserve the uterus and fertile capability. According to our experience, in
cases of postpartum hemorrhagia rFVIIa is to be administered in intravenous
bolus doses of at least 90 mcg/kg, at least 6 hours after the onset of
bleeding. rFVIIa is not an alternative to adequate surgical haemostasis;
therefore, it needs to be administered after its detailed revision.
Treatment of psoas haematoma in a patient with haemophilia and inhibitors
Authors: Janic Dragana , Dokmanovic Lidija , Krstovski Nada , Rodic Predrag , Lazic Jelena , Smoljanic Zeljko
Published: August 2015

INTRODUCTION. Particular problem in treating haemophiliacs with serious
muscle bleeding such as iliopsoas haematoma, are patients with inhibitor.
CASE OUTLINE. Our study describes three episodes of psoas haematoma in a
patient with haemophilia and inhibitor successfully treated with recombinant
activated factor VII (rFVIIa). CONCLUSION. Based on our experience,
initiating therapy within two hours in our patient, contributed to successful
treatment, although small cumulative doses of rFVIIa were used. Therefore,
introducing home treatment along with adequate patient and family education
similar to developed countries becomes imperative in our environment, not
only for providing better quality of life, but also from pharamacoeconomic
point of view.
The use of recombinant activated factor VII to control haemorrhage following exentheresis and massive transfusion in coagulopathic patients
Authors: Vucelic Dragica , Kecmanovic Dragutin , Pavlov Maja , Rankovic Vitomir , Masirevic Vesna , Djukic Alma , Palibrk Ivan , Tomasevic Ljubica , Velickovic Jelena , Milovanovic Aleksandra , Pesko Predrag
Published: August 2015

INTRODUCTION. Exentheresis pelvis totalis due to locally advanced pelvic
malignancies is an extensive surgical procedure. The operation is commonly
associated with anticipated perioperative haemorrhage requiring a large
volume of haemoproducts. Sometimes, the intervention can result in unexpected
massive and uncontrolled haemorrhage that is frequently a combination of
surgical and coagulopathic bleeding. Attempts to arrest massive bleeding by
conventional means may fail. CASES OUTLINE. We describe our experience in the
use of recombinant activated factor VII (rFVIIa) in three previously
hemostatically competent patients who underwent exentheresis in order to
control massive bleeding resulting from dilution coagulopathy in the
operating theatre, as well as in the treatment of postoperative bleeding
associated with consumptive coagulopathy. Of these, two massively transfused
patients developed dilution coagulopathy in the operative theatre, which was
poorly responsive to conventional management. In both cases, a single dose of
rFVIIa (70 ?g/kg and 60 ?g/kg respectively) was given. Prompt clinical
response was achieved and operations were successfully finished. In the third
case, the patient developed consumptive coagulopathy on the first day after
surgical procedure that was treated with conventional therapy. On the second
postoperative day the patient became anuric and experienced severe
intraabdominal bleeding. The bleeding was successfully controlled with rFVIIa
in a single dose of 70 ?g/kg. CONLUSION. RFVIIa can be a treatment option in
patients suffering from intractable coagulopathic bleeding when standard
therapy has failed.
The use of recombinant activated factor VII in a patient with uncontrolled bleeding from the gastrointestinal tract
Authors: Vitkovic Radomir , Petrovic Ivan
Published: August 2015

NTRODUCTION. Massive intestinal bleeding is a life threatening clinical
condition that requires prompt reaction. Recombinant activated factor VII
(rFVIIa) is a novel and promising therapeutic approach. The administration of
rFVIIa usually represents the last therapy resort, when all other
alternatives are exhausted. CASE OUTLINE. We present a 55-year old female
patient admitted to our hospital due to intestinal bleeding of unknown
origin, with anamnestic and heteroanamnestic data, clinical condition that
was the consequence of massive bleeding, diagnostic and therapeutic
procedures. After diagnostic procedures, the conventional medicamentous
therapy was commenced. On the 6th day of therapy, surgery was performed with
the aim to identify the source of bleeding. After the confirmation that the
bleeding was not due to surgical reasons, we administrated rFVIIa in a bolus
dose of 90 mcg/kg, which resulted in the prompt arrest of bleeding. Side
effects of the drug were not registered. CONCLUSION. In our patient, the
administration of rFVIIa resulted in a prompt and efficient haemostasis,
which was not followed by the recurrence of bleeding. Preconditions necessary
for rFVIIa administration are the adequate substitution of blood products,
exclusion of surgical cause of bleeding, as well as the levels of fibrinogen,
platelets and pH equal or above recommended.
Recombinant activated factor VII in haemostasis after radical nephrectomy
Authors: Jovanovic Petar , Ivanovic Dragan , Timotijevic Sladjan , Trpkovic Sladjana , Bojovic Predrag , Dobricanin Vladimir , Cvetkovic Milena
Published: August 2015

INTRODUCTION. The paper presents important facts in the application of
recombinant human factor VIIa (rFVIIa) and in the treatment of renal cell
carcer. CASE REPORT. A 69-year old male with infiltrative renal cell carcer
underwent radical nephrectomy using Hasagawa`s approach. The extirpated tumor
was 35 cm in diameter. During surgery, the patient suffered cardiac arrest
with 3500 ml blood loss. Twenty-four hours after operation, he lost
additional 2100 ml of blood. Despite adequate blood substitution with
intensive surgical attempts to treat haemostasis, bleeding did not stop until
the application of rFVIIa (300 IU). The patient survived and fully recovered.
CONCLUSION. To control massive non-surgical bleeding additionally complicated
by paraneoplastic syndrome, extensive surgical intervention, haemodilution
and massive blood substitution, the application of rFVIIa has proved to be
most successful.
Alport’s syndrome and benign familial haematuria: Light and electron microscopic studies of the kidney
Authors: Dimitrijevic Jovan , Todorovic Vera , Aleksic Anastasija , Jovanovic Dijana , Pilcevic Dijana , Vignjevic Sanja , Micic Sava , Jovanovic Dragan , Pilcevic Dejan , Kovacevic Zoran , Hrvacevic Rajko , Maksic Djoko , Brajuskovic Goran , Savic Vojin , Bogdanovic Radovan
Published: August 2015

INTRODUCTION. Hereditary nephropathy is clinically characterized by the
familial occurrence in successive generations of progressive haematuric
nephritis and neural hearing loss. Hereditary nephropathy of Alport?s
syndrome (AS) and benign familial (recurrent) haematuria (BFH) are
morphologically characterized by specific and diagnostically important
thickening and splitting of lamina densa of the glomerular basement
membranes. Those lesions can be recognized only by electron microscopy.
Hereditary nephritis is usually present clinically with haematuria, and new
mutations without a family history of haematuria. It is therefore important
to differentiate hereditary nephritis from BFH and no familial haematuria.
Thus, electron microscopy is essential in diagnosis of haematuria. OBJECTIVE.
The aim of this study was to describe, by light microscopy, constellation of
renal alterations by which hereditary nephropathy can be recognized with high
probability as well as to compare the diagnostic validity of the findings
observed by light and electron microscopy in AS and BFH. METHOD. We examined
48 renal biopsies of the patients with hereditary nephoropathies by light and
electron microscopy. Tissue samples were fixed in buffered paraformaldehyde
and embedded in paraffin for long-term preservation. For the electron
microscopy analysis, the following fixation in 4% glutaraldehyde tissue was
postfixed in 1% osmium tetroxide. Thereafter, the following dehydration
procedure tissue slices were embedded in epon. RESULTS. Our results
demonstrated that the interstitial foam cells, foetal-like glomeruli, minimal
glomerular abnormalities with stain less intense in basement membranes, mild
irregular mesangial widening, focal thickening of Bowman?s capsule, foci of
dilatation tubules, tubular ectasia and atrophy, erythrocyte tubules casts
were present in hereditary nephritis. Additionally, light microscopic biopsy
findings in patients with BFH were either normal or revealed minor changes
(e.g. increased mesangial matrix). All biopsies were reevaluated by electron
microscopy and ultrastructural findings confirmed the diagnosis of hereditary
nephropathies. CONCLUSION. The findings observed by light microscopy
represent an important step that leads to a definitive diagnosis of AS and
BFH. The definitive diagnosis, however, depends on electron microscopy.
The significance of Goodpasture antigen in hereditary nephritis
Authors: Basta-Jovanovic Gordana , Radojevic-Skodric Sanja , Jovanovic Milena , Bogdanovic Ljiljana , Bogdanovic Radovan , Lezaic Visnja , Nesic Vidosava , Dikman Steven
Published: August 2015

INTRODUCTION. Two types of hereditary nephritis, nonprogressive and
progressive, clinically present as asymptomatic haematuria, sometimes
combined with proteinuria. At the onset, in both types, light microscopic
changes are minimal, immunofluorescence findings are negative, and diagnosis
can be made only upon electron microscopic findings that are considered to be
specific. OBJECTIVE. The aim of this study was to determine the significance
of Goodpasture antigen detection in diagnosis of progressive and
nonprogressive hereditary nephritis in its early phase. METHOD. Analysis of
renal biopsy specimens was done in patients with hereditary nephritis that
were followed from 1990 to 2005. Progression of renal disease was examined in
14 patients with Alport?s syndrome, 10 patients with thin basement membrane
disease, and 6 patients with unclassified hereditary nephritis diagnosed. For
all these cases, indirect immunofluorescence study with serum from a patient
with high titer of Goodpasture autoantibodies that recognize the antigenic
determinants in human glomerular and tubular basement membrane was performed.
RESULTS. In 11 out of 14 cases diagnosed as Alport?s syndrome, there was
negative staining with Goodpasture serum, and in 3 additional cases with
Alport?s syndrome, expression of Goodpasture antigen in glomerular basement
membrane and thin basement membrane was highly reduced. In all 10 patients
with thin basement membrane disease, immunofluorescence showed intensive,
bright linear staining with Goodpasture serum along glomerular and tubular
basement membrane. In 2 out of 6 patients with unclassified hereditary
nephritis, Goodpasture antigen expression was very strong, in one patient it
was very reduced, and in 3 patients it was negative. CONCLUSION. The results
of our study show that Goodpasture antigen detection plays a very important
role in differential diagnosis of progressive and nonpregressive hereditary
nephritis, particularly in early phases of the disease.
Autosomal dominant polycystic kidney disease
Authors: Pljesa Steva
Published: August 2015

Autosomal dominant polycystic kiney disease is a hereditary systemic
disorder, characterized by the developement of cysts, mainly in the kidney
and liver, also with gastrointestinal and cardiovascular abnormalities. It
affects 4 to 6 million people wordwide and accounts for end-stage renal
disease in 7-10% of dialysis patients. The genetic penetrance is 100%, all
affected individuals develop renal cysts until 70 years of age, and because
of a great renal function reserve only about 50% of patients develop some
degree of renal failure until the age of 60. Autosomal dominant polycystic
kiney disease is a heterogeneous disorder, from a clinical as well as from a
genetic point of view. There are at least three genes responsible for the
disease: PKD-1 gene localized on chromosome 16p in the 16p13.3 segment which
encodes Polycystin 1 protein similar to membrane receptor, PKD-2 gene
localized on chromosome 4q in 4q13-23 segment which encodes Polycystin 2
protein wery similar to voltage L type Ca++ channel as well as Na+ channel
and PKD-3 gene of unknown localization. Specific proteins participate in
regulation od cell proliferation, apoptosis, secretion, polarity, cell-matrix
interactions as cell-cell interactions and lead to the developement of cystic
kidney disease. Renal manifestations of disease include structural (cyst
development), functional (concentration alility falls), endocrine (renin
erythropoietin) abnormalities and extra- renal manifestations. A routine
diagnostic methods are good case-history about cystic kidney disease in
family, ultrasonographic examination of kidneys and computerized tomography.
In therapy of autosomal dominant polycystic kiney disease, low protein diets
may help, treatment of arterial hypertension with ACE inhibitors and
angiotensin II receptor blockers, the vasopressin V2 antagonists (VSR),
rapamycin and long-acting somatostatin analogue may have some benefit.