bluuebunny/crossref_metadata_2025 huggingface dataset:
The relationship between metabolic syndrome and asthma in the elderly
Authors: Park Sangshin , Choi Nam-Kyong , Kim Seungsoo , Lee Chang-Hoon
Published: June 2018

The burden of asthma in the elderly is increasing, but the etiology of asthma in the elderly is not clearly understood. Recent studies have reported the epidemiological link between metabolic syndrome (MS) and asthma, but it has rarely been studied in the elderly. This study investigated the association between MS and asthma and the contribution of insulin resistance (IR) and systemic inflammation to this MS-asthma association in the elderly. Our study analyzed 4,060 elderly participants (≥65 years old) from a cross-sectional survey, the Korean National Health and Nutritional Examination Survey 2007–2012. Mediation analyses were performed to examine whether IR and systemic inflammation mediates the MS-asthma association. Participants with MS had significantly higher prevalence of asthma (adjusted odds ratio = 1.34; 95% confidence interval = 1.09–1.64), and those who had greater waist circumference and lower HDL-C were especially likely to have asthma. Participants with IR and systemic inflammation were associated with higher prevalence of asthma. Prevalence of IR and systemic inflammation were higher in participants with MS or with each MS component. The MS-asthma association was substantially mediated by IR and systemic inflammation. Our study showed a significant association between MS and asthma in the elderly. MS might affect asthma through both IR and systemic inflammation.
Targeting the association between telomere length and immuno-cellular bioenergetics in female patients with Major Depressive Disorder
Authors: Boeck Christina , Salinas-Manrique Juan , Calzia Enrico , Radermacher Peter , von Arnim Christine A. F. , Dietrich Detlef E. , Kolassa Iris-Tatjana , Karabatsiakis Alexander
Published: June 2018

Major Depressive Disorder (MDD) has been associated with telomere dysfunction and alterations in mitochondrial activity, which seem to be co-regulated in human cells. To investigate this co-regulation in MDD, we assessed telomere length (TL) in peripheral blood mononuclear cells (PBMC) and selected immune cell subsets by quantitative fluorescence in situ hybridization and mitochondrial respiratory activity in PBMC by high-resolution respirometry in a study cohort of 18 MDD patients and 21 non-depressed controls. We provide initial evidence for a differential vulnerability to telomere attrition in selected adaptive immune cell populations. Here we found the highest difference in TL between depressed and control subjects for memory cytotoxic T cells. Depression was associated with reduced mitochondrial activity (mitochondrial bioenergetics), but increased mitochondrial density (mitochondrial biogenesis) in PBMC. Exploratory post-hoc analyses indicated that the changes in TL and immune cell bioenergetics were most pronounced in MDD patients who reported experiences of childhood sexual abuse. Among MDD patients, PBMC TL was as a trend positively associated with mitochondrial density and negatively associated with mitochondrial leak respiration, but not with mitochondrial activity related to biological energy production. These initial findings support the hypothesis of a co-regulation between telomeres and mitochondrial biogenesis but not mitochondrial bioenergetics among MDD patients.
A novel vibration-induced exercise paradigm improves fitness and lipid metabolism of Caenorhabditis elegans
Authors: Teo Emelyne , Batchu Krishna Chaithanya , Barardo Diogo , Xiao Linfan , Cazenave-Gassiot Amaury , Tolwinski Nicholas , Wenk Markus , Halliwell Barry , Gruber Jan
Published: June 2018

Exercise has been known to reduce the risk of obesity and metabolic syndrome, but the mechanisms underlying many exercise benefits remain unclear. This is, in part, due to a lack of exercise paradigms in invertebrate model organisms that would allow rapid mechanistic studies to be conducted. Here we report a novel exercise paradigm in Caenorhabditis elegans (C. elegans) that can be implemented under standard laboratory conditions. Mechanical stimulus in the form of vibration was transduced to C. elegans grown on solid agar media using an acoustic actuator. One day post-exercise, the exercised animals showed greater physical fitness compared to the un-exercised controls. Despite having higher mitochondrial reactive oxygen species levels, no mitohormetic adaptations and lifespan extension were observed in the exercised animals. Nonetheless, exercised animals showed lower triacylglycerides (TAG) accumulation than the controls. Among the individual TAG species, the most significant changes were found in mono- and polyunsaturated fatty acid residues. Such alteration resulted in an overall lower double bond index and peroxidation index which measure susceptibility towards lipid peroxidation. These observations are consistent with findings from mammalian exercise literature, suggesting that exercise benefits are largely conserved across different animal models.
Avian influenza surveillance in domestic waterfowl and environment of live bird markets in Bangladesh, 2007–2012
Authors: Khan Salah Uddin , Gurley Emily S. , Gerloff Nancy , Rahman Md Z. , Simpson Natosha , Rahman Mustafizur , Haider Najmul , Chowdhury Sukanta , Balish Amanda , Zaman Rashid Uz , Nasreen Sharifa , Chandra Das Bidhan , Azziz-Baumgartner Eduardo , Sturm-Ramirez Katharine , Davis C. Todd , Donis Ruben O. , Luby Stephen P.
Published: June 2018

Avian influenza viruses, including highly pathogenic strains, pose severe economic, animal and public health concerns. We implemented live bird market surveillance in Bangladesh to identify the subtypes of avian influenza A viruses in domestic waterfowl and market environments. We collected waterfowl samples monthly from 4 rural sites from 2007 to 2012 and environmental samples from 4 rural and 16 urban sites from 2009 to 2012. Samples were tested through real-time RT-PCR, virus culture, and sequencing to detect and characterize avian influenza A viruses. Among 4,308 waterfowl tested, 191 (4.4%) were positive for avian influenza A virus, including 74 (1.9%) avian influenza A/H5 subtype. The majority (99%, n = 73) of the influenza A/H5-positive samples were from healthy appearing waterfowl. Multiple subtypes, including H1N1, H1N3, H3N2, H3N6, H3N8, H4N1, H4N2, H4N6, H5N1 (clades 2.2.2, 2.3.2.1a, 2.3.4.2), H5N2, H6N1, H7N9, H9N2, H11N2 and H11N3, H11N6 were detected in waterfowl and environmental samples. Environmental samples tested positive for influenza A viruses throughout the year. Avian influenza viruses, including H5N1 and H9N2 subtypes were also identified in backyard and small-scale raised poultry. Live bird markets could be high-risk sites for harboring the viruses and have the potential to infect naive birds and humans exposed to them.
Further dissection of QTLs for salt-induced stroke and identification of candidate genes in the stroke-prone spontaneously hypertensive rat
Authors: Niiya Kaoru , Ohara Hiroki , Isono Masato , Sheikh Abdullah Md. , Matsuo Hiroyuki , Fujikawa Koichi , Isomura Minoru , Kato Norihiro , Nabika Toru
Published: June 2018

We previously revealed that two major quantitative trait loci (QTLs) for stroke latency of the stroke-prone spontaneously hypertensive rat (SHRSP) under salt-loading were located on chromosome (Chr) 1 and 18. Here, we attempted further dissection of the stroke-QTLs using multiple congenic strains between SHRSP and a stroke-resistant hypertensive rat (SHR). Cox hazard model among subcongenic strains harboring a chromosomal fragment of Chr-1 QTL region showed that the most promising region was a 2.1 Mbp fragment between D1Rat177 and D1Rat97. The QTL region on Chr 18 could not be narrowed down by the analysis, which may be due to multiple QTLs in this region. Nonsynonymous sequence variations were found in four genes (Cblc, Cxcl17, Cic, and Ceacam 19) on the 2.1 Mbp fragment of Chr-1 QTL by whole-genome sequence analysis of SHRSP/Izm and SHR/Izm. Significant changes in protein structure were predicted in CBL-C and CXCL17 using I-TASSER. Comprehensive gene expression analysis in the kidney with a cDNA microarray identified three candidate genes (LOC102548695 (Zinc finger protein 45-like, Zfp45L), Ethe1, and Cxcl17). In conclusion, we successfully narrowed down the QTL region on Chr 1, and identified six candidate genes in this region.
Consequences of in utero exposure to Zika virus in offspring of AG129 mice
Authors: Julander Justin G. , Siddharthan Venkatraman , Park Albert H. , Preston Elizabeth , Mathur Pranav , Bertolio Michael , Wang Hong , Zukor Katherine , Van Wettere Arnaud J. , Sinex Donal G. , Morrey John D.
Published: June 2018

Zika virus (ZIKV) can cause various diseases in offspring after congenital infection. The purpose of this study was to identify disease phenotypes in pups exposed to ZIKV in utero. Female interferon-α/β, -γ receptor knockout mice (AG129) were infected intraperitoneally with ZIKV 7.5 days’ post coitus (dpc). Viral RNA, antigen and infectious virus were detected in some, but not all, maternal and fetal tissues at various times during gestation. Fetuses of infected dams had significant intrauterine growth restriction (IUGR), which was more pronounced as females neared parturition. Pups born to infected dams were significantly smaller and had significantly shortened skull lengths, as determined by measurement with a caliper and by micro-CT analysis, as compared with age-matched controls. Growth rates of exposed pups after birth, however, was similar to sham-exposed offspring. Viral RNA was detected in pups of infected dams after birth. A lower survival rate was observed in neonates exposed to ZIKV in utero. A mortality rate of over 50%, attributed to consequences of ZIKV infection, occurred after birth in pups born to infected dams. A transient hearing loss was observed in some animals exposed to virus in utero. No motor deficits or cognitive deficits were detected using running wheel or viral paresis scoring assays. Abnormalities in offspring included smaller size, shorter skull length and increased neonatal mortality, while the only functional deficit we could detect was a low incidence of transient hearing loss.
Ion energy spectra directly measured in the interaction volume of intense laser pulses with clustered plasma
Authors: Bochkarev S. G. , Faenov A. , Pikuz T. , Brantov A. V. , Kovalev V. F. , Skobelev I. , Pikuz S. , Kodama R. , Popov K. I. , Bychenkov V. Yu.
Published: June 2018

The use of gas cluster media as a target for an intense femtosecond laser pulses is considered to be uniquely convenient approach for the development of a compact versatile pulsed source of ionizing radiation. Also, one may consider cluster media as a nanolab to investigate fundamental issues of intense optical fields interaction with sub-wavelength scale structures. However, conventional diagnostic methods fail to register highly charged ion states from a cluster plasma because of strong recombination in the ambient gas. In the paper we introduce high-resolution X-ray spectroscopy method allowing to study energy spectra of highly charged ions created in the area of most intense laser radiation. The emission of CO2 clusters were analyzed in experiments with 60 fs 780 nm laser pulses of 1018 W/cm2 intensity. Theory and according X-ray spectra modeling allows to reveal the energy spectra and yield of highly charged oxygen ions. It was found that while the laser of fundamental frequency creates commonly expected monotonic ion energy spectrum, frequency doubled laser radiation initiates energy spectra featuring of distinctive quasi-monoenergetic peaks. The later would provide definite advantage in further development of laser-plasma based compact ion accelerators.
Effect of calcium electroporation on tumour vasculature
Authors: Staresinic Barbara , Jesenko Tanja , Kamensek Urska , Krog Frandsen Stine , Sersa Gregor , Gehl Julie , Cemazar Maja
Published: June 2018

Calcium electroporation (CaEP) is a novel anti-tumour treatment that induces cell death by internalization of large quantities of calcium. The anti-tumour effectiveness of CaEP has been demonstrated in vitro, in vivo, and in preliminary clinical trials; however, its effects on the vasculature have not been previously investigated. Using a dorsal window chamber tumour model, we observed that CaEP affected to the same degree normal and tumour blood vessels in vivo, as it disrupted the vessels and caused tumour eradication by necrosis. In all cases, the effect was more pronounced in small vessels, similar to electrochemotherapy (ECT) with bleomycin. In vitro studies in four different cell lines (the B16F1 melanoma, HUVEC endothelial, FADU squamous cell carcinoma, and CHO cell lines) confirmed that CaEP causes necrosis associated with acute and severe ATP depletion, a picture different from bleomycin with electroporation. Furthermore, CaEP considerably inhibited cell migratory capabilities of endothelial cells and their potential to form capillary-like structures. The finding that CaEP has anti-vascular effects and inhibits cell migration capabilities may contribute to the explanation of the high efficacy observed in preclinical and clinical studies.
Raman Spectroscopy detects changes in Bone Mineral Quality and Collagen Cross-linkage in Staphylococcus Infected Human Bone
Authors: Khalid Mohamed , Bora Tanujjal , Ghaithi Ahmed Al , Thukral Sharanjit , Dutta Joydeep
Published: June 2018

Diagnosis of osteomyelitis presents a formidable challenge. Lack of pathognomonic clinical sign(s) and diagnostic tests that can diagnose osteomyelitis at an early stage contribute to this difficulty. If the diagnosis is not made early, the disease becomes very difficult to eradicate and can lead to limb threatening and potentially life-threatening complications. Staphylococcus aureus is the most common organism causing osteomyelitis. Raman Spectroscopy provides information about molecular vibration that could potentially be harnessed as a spectral signature for cellular changes in specific pathologic conditions. In this study we describe a technique using Raman spectroscopy that could potentially be used to diagnose staphylococcal osteomyelitis. Human bone samples were co-cultured with Staphylococcus aureus (S. aureus) and the effects of bacterial growth on bone quality were then monitored using Raman spectroscopy. A major drop in the bone mineral quality and crystallinity was observed in the infected bones compared to the controls. S. aureus infection was also found to alter the collagen cross-linking. Our study shows that specific spectral signatures are present for the cause as well as the effect of staphylococcal osteomyelitis, opening the possibility of developing a useful diagnostic modality for early and rapid diagnosis of this condition.
Occurrence and source analysis of selected antidepressants and their metabolites in municipal wastewater and receiving surface water
Authors: Ma Luo-dan , Li Jian , Li Jia-jun , Liu Min , Yan Dong-zhi , Shi Wen-yan , Xu Gang
Published: June 2018

Seven commonly utilized antidepressants (amitriptyline, fluoxetine, sertraline, citalopram, paroxetine, venlafaxine, and bupropion) and three of their metabolites were detected in four wastewater treatment plants (WWTPs) and corresponding receiving waters including the mainstream and three of the tributaries of Huangpu River, Shanghai.
Nanodispersions of beta-carotene: effects on antioxidant enzymes and cytotoxic properties
Authors: Rocha Felipe , Yumi Sugahara Letícia , Leimann Fernanda Vitória , de Oliveira Sara Marchesan , da Silva Brum Evelyne , Calhelha Ricardo Costa , Barreiro Maria Filomena , Ferreira Isabel C. F. R. , Porto Ineu Rafael , Gonçalves Odinei Hess
Published: June 2018

Beta-carotene is a carotenoid precursor of vitamin A, known for its biological activities.
High-performance p-type inorganic–organic hybrid thermoelectric thin films
Authors: Zheng Zhuang-hao , Fan Ping , Luo Jing-ting , Liang Guang-xing , Ma Hong-li , Zhang Xiang-hua , Yang Chang , Fu Yong Qing
Published: June 2018

The performance of organic–inorganic hybrid thermoelectric thin films can be dramatically enhanced by optimizing energy filtering and carrier transport states at the organic–inorganic interfaces.
Raw walnut shell modified by non-thermal plasma in ultrafine water mist for adsorptive removal of Cu(ii) from aqueous solution
Authors: Wu Long , Shang Zhongsheng , Chen Shixian , Tu Jiayong , Kobayashi Noriyuki , Li Zhanyong
Published: June 2018

The adsorption capacity of Cu(ii) by the UWM-plasma modified walnut shell is 8 times of raw walnut shell.
Ion transport mechanisms in bipolar membranes for (photo)electrochemical water splitting
Authors: Vermaas David A. , Wiegman Sandra , Nagaki Tetsuro , Smith Wilson A.
Published: June 2018

Electrolysis with a bipolar membrane induced pH gradient: the conditions for high energy efficiency (low membrane voltage) are explored.
Fully integrated electrochromic-OLED devices for highly transparent smart glasses
Authors: Cossari Pierluigi , Pugliese Marco , Gambino Salvatore , Cannavale Alessandro , Maiorano Vincenzo , Gigli Giuseppe , Mazzeo Marco
Published: June 2018

Fully integrated electrochromic organic light emitting diode devices for building integration and smart lighting.
In Vivo Use of 1D and 2D 1H NMR to Examine the Glycosylation of Scopoletin in Duboisia myoporoides Cell Suspensions
Authors: Fliniaux Ophélie , Roscher Albrecht , Cailleu Dominique , Mesnard François
Published: June 2018

Cell suspensions initiated from Duboisia myoporoides–a shrub belonging to the Solanaceae family and being a rich source of tropane alkaloids–previously showed their ability to glycosylate scopoletin into scopolin, which represent coumarins showing health benefits. To investigate the time course of this glycosylation reaction, an in vivo NMR approach was developed using a perfusion system in an 8-mm NMR tube and 1H NMR with 1D and 2D (TOCSY and NOESY) experiments. The time course of metabolic changes could therefore be followed without any labeling.
Skin Development in H. huso Larvae
Authors: Fazel Shooraki H. , Saadatfar Z. , Shahsavani D.
Published: June 2018

Introduction Fish skin is important for life and protection mechanisms. Sturgeon skin also has an economical potential for its leather.

Materials and Methods This article is a light microscopy study for knowledge the development of epidermis and dermis in one species of sturgeon (Huso. huso). The fishes from different days of week-1 to week-6 were caught from Shahid Marjani propagation center and were processed.

Results From 1(dph) the epidermis as two layers and dermis as a very thin collagen layer had formed. Sensory buds in epidermis and chromatophore cells in dermis of head and also arranged the dermal endothelial cells were features of 3 (dph). At 10 (dph) there was an increase in epidermal cell line, existence the circular cells as club cells in epidermis and increase in dermal thickness observed. From the character of 20 (dph) was organized epidermis to three layers and collagen fibrils as parallel to body. From 25- 40 (dph) an increase in cell lines of epidermis up to 10 rows in some areas was observed.

Conclusion The most important changes were the events occurred in dermis. The self-organized collagen fibrils to several lamellae, invading the fibroblasts to derm and forms of stratum campactum and stratum spongiosum.
Osteoporosis: Current Concepts
Authors: Akkawi Ibrahim , Zmerly Hassan
Published: June 2018

Osteoporosis is a worldwide disease characterized by reduction of bone mass and alteration of bone architecture resulting in increased bone fragility and increased fracture risk. Causes of osteoporosis include increasing age, female sex, postmenopausal status, hypogonadism or premature ovarian failure, low body mass index, ethnic background, rheumatoid arthritis, low bone mineral density (BMD), vitamin D deficiency, low calcium intake, hyperkyphosis, current smoking, alcohol abuse, immobilization, and long-term use of certain medications. The diagnosis of osteoporosis is established by measurement of BMD of the hip and spine using dual energy X-ray absorptiometry. According to the World Health Organization criteria, osteoporosis is defined as a BMD that lies 2.5 standard deviation or more below the average value for young healthy women. Bone turnover biomarker detection may be useful in monitoring osteoporosis treatment and assessing fracture risk but not for diagnosis of osteoporosis. Management of osteoporosis consists of nonpharmacological interventions, which are recommended for all subjects, and pharmacological therapy in all postmenopausal women who have had an osteoporotic fracture or have BMD values consistent with osteoporosis.
„Frei von“ – tatsächlich frei von Allergenen und Gluten?
Authors: Ebock Anett
Published: June 2018

Die „Frei-von“-Welle hat neben den glutenfreien Lebensmitteln auch die Allergene mit erfasst. Allergiker fühlen sich von solchen Produkten besonders
angesprochen, jedoch können selbst minimale Spurenverunreinigungen bei Allergikern Symptome auslösen. Daher müssen die Hersteller sicherstellen, dass derart
beworbene Produkte nicht mit den ausgelobten Allergenen verunreinigt sind.
10.23 Product Class 23: Pyrido[X,Y-b]indoles (Carbolines)
Authors: Joule J. A.
Published: June 2018

Methods for the synthesis of the four isomeric carboline (pyrido[X,Y-b]indole) ring systems are discussed. Reports from 1919, when the word “carboline” was first coined, up to 2015 are covered, with some references from early 2016 also included.
Chip-scale high Q-factor glassblown microspherical shells for magnetic sensing
Authors: Freeman Eugene , Wang Cheng-Yu , Sumaria Vedant , Schiff Steven J. , Liu Zhiwen , Tadigadapa Srinivas
Published: June 2018

A whispering gallery mode resonator based magnetometer using chip-scale glass microspherical shells is described. A neodynium micro-magnet is elastically coupled and integrated on top of the microspherical shell structure that enables transduction of the magnetic force experienced by the magnet in external magnetic fields into an optical resonance frequency shift. High quality factor optical microspherical shell resonators with ultra-smooth surfaces have been successfully fabricated and integrated with magnets to achieve Q-factors of greater than 1.1 × 107 and have shown a resonance shift of 1.43 GHz/mT (or 4.0 pm/mT) at 760 nm wavelength. The main mode of action is mechanical deformation of the microbubble with a minor contribution from the photoelastic effect. An experimental limit of detection of 60 nT Hz−1/2 at 100 Hz is demonstrated. A theoretical thermorefractive limited detection limit of 52 pT Hz−1/2 at 100 Hz is calculated from the experimentally derived sensitivity. The paper describes the mode of action, sensitivity and limit of detection is evaluated for the chip-scale whispering gallery mode magnetometer.
Grimon: graphical interface to visualize multi-omics networks
Authors: Kanai Masahiro , Maeda Yuichi , Okada Yukinori
Published: June 2018

Rapid advances in high-throughput sequencing technologies have enabled more efficient acquisition of massive amount of multi-omics data. However, interpretation of the underlying relationships across multi-omics networks has not been fully succeeded, partly due to the lack of effective methods in visualization. To aid interpretation of the results from such multi-omics data, we here present Grimon (Graphical interface to visualize multi-omics networks), an R package that visualizes high-dimensional multi-layered data sets in three-dimensional parallel coordinates. Grimon enables users to intuitively and interactively explore their analyzed data, helping their understanding of multiple inter-layer connections embedded in high-dimensional complex data.

Availability and implementation

Grimon is freely available at https://github.com/mkanai/grimon as an R package with example omics data sets.

Supplementary information

Supplementary data are available at bioinformatics online.
Ionizing radiation and radiation protection
Authors: Kraft Jeannette Kathrin , Howells Peter
Published: June 2018

Ionizing radiation continues to revolutionize the diagnostic process in medicine. However, it comes with risks to patients and staff. The amount of radiation patients receive is rising, mainly due to the use of high-dose examinations such as computed tomography and image-guided interventional procedures. In some countries, the amount of radiation a population receives from medical use is already larger than that from natural background radiation. A basic knowledge of radiation effects on the human body and radiation protection principles enables clinicians to assess potential risks associated with ionizing radiation and guides the choice of investigation.
Approach to the patient with hypo-/hyperkalaemia
Authors: Wingo Charles S. , Weiner I. David
Published: June 2018

The differential diagnosis and approach to patients with high or low serum potassium are described. Patients with either abnormality have an increased mortality in large population-based studies. Most have significant renal, cardiovascular, endocrine, liver, or gastrointestinal disease. They are frequently taking prescription or other drugs and the evaluation of their electrolyte disorder should not be conducted in isolation, but within the context of their disease or diseases.
The presence of isolated hypokalaemia or hyperkalaemia in the absence of these other diseases or any apparent drug administration should prompt the clinician to re-consider the clinical history and the reported laboratory values.
Approach to the patient with hypercalcaemia
Authors: Joseph Dennis , Guise Theresa A.
Published: June 2018

While mild hypercalcaemia is asymptomatic, moderate to severe hypercalcaemia can cause wide-ranging symptoms in multiple organ systems. Calcium homeostasis is tightly controlled by the hormones parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D. Hypercalcaemia occurs when the entry of calcium into plasma (from bone or gut) exceeds its removal through bone deposition and renal excretion.
The most common causes of hypercalcaemia are primary hyperparathyroidism and hypercalcaemia of malignancy. Hence, the initial step in the diagnostic approach to hypercalcaemia is measurement of PTH levels to differentiate PTH-mediated and non-PTH-mediated conditions. Identification of the underlying pathophysiology responsible for hypercalcaemia is key to selecting the appropriate therapeutic approach.
Membranous glomerulonephritis
Authors: Cattran Daniel C. , Reich Heather N.
Published: June 2018

Membranous glomerulonephritis (MGN) usually presents as nephrotic syndrome, which may be severe. It is primarily a disease of adults, men more than women, with a peak incidence in the fourth and fifth decades. It is hoped that proven tests for the characteristic anti-PLA2R antibodies of primary MGN may become established, but the diagnosis currently rests on renal biopsy showing characteristic subepithelial granular immune deposits. These usually contain immunoglobulin G4 and complement. Other patterns may suggest secondary causes of MGN.
Secondary membranous nephropathy occurs in lupus and some other immune or autoimmune disorders, in hepatitis B infection, after exposure to some drugs or toxins, and in some cancers. Secondary causes are more common at extremes of age, and are often made obvious by the history or clinical picture. How hard to look for malignancy is controversial, but malignancy is much more likely in patients over 60 years, and may be apparent at presentation.
Immunoglobulin A nephropathy
Authors: Lai Kar Neng , Tang Sydney C. W.
Published: June 2018

Immunoglobulin A (IgA) nephropathy characteristically causes haematuria and may present as a nephritic illness in older children and young adults. However, it may occur at any age and is commonly asymptomatic, associated first with haematuria alone, later progressing in some patients to hypertension, proteinuria, and progressive loss of glomerular filtration. While this evolution is characteristically slow, over decades, in some it is rapid, leading to early end-stage renal failure.
It is common for the disease to present late, as advanced renal disease, or malignant hypertension. It may present with acute kidney injury caused by crescentic disease, but acute kidney injury caused by haematuria may be confused clinically with the same.
Henoch–Schönlein purpura is a type of small vessel vasculitis that is most commonly seen in children, but which occurs at all ages, that is associated with IgA deposition. In older children and most adults it merges closely into IgA nephropathy after the acute event. Outcomes in adults are less good.
IgA nephropathy is the most common type of glomerulonephritis in most developed countries. The disease is more common in men, and appears to be much less common in black people. The detected incidence is strongly influenced by biopsy policies; the lower your threshold to biopsy patients with haematuria, the more of this condition you discover. There are clear genetic tendencies but the strongest risk seems to come from genes in the human leucocyte antigen complex.
Chronic kidney disease in developing countries
Authors: Zhang Luxia , Wang Haiyan
Published: June 2018

The spread of non-communicable diseases (NCDs) is a barrier to the development of goals including reduction of poverty, health equity, economic stability, and human security. NCDs accounted for 61% of the estimated 58 million deaths and 46% of the global burden of diseases worldwide in 2005. Among NCDs, chronic kidney disease (CKD) is of particular significance. It is recognized that the burden of CKD is not only limited to its impact on demands for renal replacement therapy but has equally major impacts on the health of the overall population. For example, it is now well established that among the general population as well as in the diabetic or hypertensive population, the prognosis, especially the mortality and acceleration of cardiovascular events, depends on kidney involvement. Also, CKD is associated with other major serious consequences including increased risk of acute kidney injury, increased risk of mineral and bone disease, adverse metabolic and nutritional consequences, infections, and reduced cognitive function. As a consequence of these amplifying effects, the financial expenditure and medical resources consumed for the management of CKD patients is much higher than expected. The burden of CKD is likely to have profound socioeconomic and public health consequences in developing countries.
Leishmaniasis and trypanosomiasis
Authors: Sakhuja Vinay , Kohli Harbir Singh
Published: June 2018

Visceral leishmaniasis, also known as kala-azar, has an insidious onset with constitutional features. Subsequently the intense parasitism of the reticuloendothelial system causes hepatosplenomegaly, anaemia, leucopenia, and thrombocytopaenia as well as hypergammaglobulinaemia. Kidney involvement manifests with proteinuria up to 1 g/24 hours, micro/macrohaematuria, and leucocyturia. Kidney involvement is generally mild and reversible with the treatment of infection. Biopsy appearances of diffuse proliferative glomerulonephritis, mesangial proliferation, and occasionally focal necrotizing glomerulonephritis with crescents have been described. Defects of urinary concentration and acidification have also been observed. Acute kidney injury (AKI) may be seen in one-third of patients and is associated with increased mortality.

Trypanosomiasis has two forms. It causes sleeping sickness in Africa (T. brucei, transmitted by tsetse flies) or Chagas disease in South America (T. cruzei, transmitted by reduvid bugs). There is no direct association of these conditions with nephropathy, although there is in experimental models. AKI may occur, typically as a manifestation of multi-organ failure in African trypanosomiasis. APOL1 genotypes that confer susceptibility to FSGS are protective against T. brucei infection.
Schistosomiasis
Authors: Barsoum Rashad S.
Published: June 2018

The urinary system is the primary target of Schistosoma haematobium infection, which leads to granuloma formation in the lower urinary tract that heals with fibrosis and calcification. While the early lesions may be associated with distressing acute or subacute symptoms, it is the late lesions that constitute the main clinical impact of schistosomiasis. The latter include chronic cystitis, ureteric fibrosis, ureterovesical obstruction or reflux which may lead to chronic pyelonephritis. Secondary bacterial infection and bladder cancer are the main secondary sequelae of urinary schistosomiasis.

The kidneys are also a secondary target of S. mansoni infection, attributed to the systemic immune response to the parasite. Specific immune complexes are responsible for early, often asymptomatic, possibly reversible, mesangioproliferative lesions which are categorized as ‘class I’. Subsequent classes (II–VI) display different histopathology, more serious clinical disease, and confounding pathogenic factors. Class II lesions are encountered in patients with concomitant salmonellosis; they are typically exudative and associated with acute-onset nephrotic syndrome. Classes III (mesangiocapillary glomerulonephritis) and IV (focal segmental sclerosis) are progressive forms of glomerular disease associated with significant hepatic pathology. They are usually associated with immunoglobulin A deposits which seem to have a significant pathogenic role. Class V (amyloidosis) occurs with long-standing active infection with either S. haematobium or S. mansoni. Class VI is seen in patients with concomitant HCV infection, where the pathology is a mix of schistosomal and cryoglobulinaemic lesions, as well as amyloidosis which seems to be accelerated by the confounded pathogenesis.

Early schistosomal lesions, particularly those of the lower urinary tract, respond to antiparasitic treatment. Late urological lesions may need surgery or endoscopic interventions. As a rule, glomerular lesions do not respond to treatment with the exception of class II where dual antiparasitic and antibiotic therapy is usually curative. Patients with end-stage kidney disease may constitute specific, yet not insurmountable technical and logistic problems in dialysis or transplantation. Recurrence after transplantation is rare.
Definitions, classification, epidemiology, and risk factors of acute kidney injury
Authors: Hoste Eric A. J. , Kellum John A. , Lameire Norbert
Published: June 2018

The lack of a precise biochemical definition of acute kidney injury (AKI) resulted in at least 35 definitions in the medical literature, which gave rise to a wide variation in reported incidence and clinical significance of AKI, impeded a meaningful comparison of studies.

The first part of this chapter describes and discusses different definitions and classification systems of AKI. Patient outcome and the need for renal replacement therapy are directly related to the severity of AKI, an observation that supports the use of a categorical staging system rather than a simple binary descriptor. The severity of AKI is commonly characterized using the relative changes in serum creatinine and urine output. Recently introduced staging systems including the RIFLE classification and the Acute Kidney Injury Network (AKIN) use these relatively simple and readily available parameters allowing the assignment of individual patients to different AKI stages. More recently, a Kidney Disease: Improving Global Outcomes (KDIGO) workgroup developed a consensus-based AKI staging system drawing elements of both RIFLE and AKIN. The potential pitfalls and limitations of the proposed definitions and classifications are briefly described.

The second part of the chapter describes the epidemiology of AKI in different clinical settings; the intensive care unit (ICU), the hospitalized population, and the community. The different spectrum of AKI in the emerging countries is discussed and the most important causes and aetiologies of the major clinical types of AKI, prerenal, renal, and post-renal are summarized in table form. Finally the patient survival and renal functional outcome of AKI are briefly discussed
The role of novel biomarkers in acute kidney injury
Authors: Lameire Norbert
Published: June 2018

Although there is a growing literature on the performance of various biomarkers in clinical studies, there is limited information on how these biomarkers would be utilized by clinicians to manage patients with acute kidney injury (AKI). The majority of investigations have focused on the ability of biomarkers to detect early either incipient or established AKI. Other studies have prospectively explored their prognostic performance in predicting either need for renal replacement therapy or intensive care unit (ICU) or hospital mortality or duration of either ICU or hospital stay. A few studies have also investigated their potential in the differential diagnosis between ‘transient AKI’, ‘prerenal AKI’, and established intrinsic AKI, mostly acute tubular necrosis.
Acute kidney injury in the elderly
Authors: Cruz Dinna N. , Clementi Anna , Rosner Mitchell H.
Published: June 2018

Acute kidney injury (AKI) is largely a disease of the elderly patient. As described in this chapter, age-related changes in the kidney as well as the accumulated co-morbid conditions and polypharmacy associated with ageing greatly increase the susceptibility to the development of AKI. The aetiologies of AKI in the elderly patient represent the same spectrum of prerenal, intrarenal, and postrenal causes as in other age categories. However, elderly patients tend to have a higher relative risk for developing AKI due to volume depletion and urinary tract obstruction. Diagnosis of AKI can be confounded by the use of serum creatinine which has limitations in the diagnosis of AKI.

Poorer short- and long-term outcomes may influence decision-making on the provision of aggressive care such as offering renal replacement therapy. These complex decisions require a careful analysis of potential outcomes as well as coordinated discussions with family members to ensure that the most thoughtful and rational treatments are offered.
Immunosuppression
Authors: Kuypers Dirk R. J. , Naesens Maarten
Published: June 2018

Combination immunosuppressive therapy produces excellent short-term results after kidney transplantation. Long-term graft survival has improved, but less dramatically. Death with a functioning graft remains the primary cause of graft loss.
Dosing of current immunosuppressive therapy balances between careful clinical interpretation of time-driven immunological risk assessments and drug-related toxicity on the one hand, and the use of simple surrogate drug exposure indicators like blood/plasma concentrations on the other.
The combined use of calcineurin-inhibitors (CNIs) with mycophenolic acids and corticosteroids has been fine-tuned over the last decade, based on empirically derived observations as well as on the results of large multicentre randomized clinical studies. Corticosteroid withdrawal and avoidance are feasible, at least in patients with a low immunological risk, but CNI-free protocols have had few long-term successes. Some minimization strategies have increased risk of developing acute rejection or (donor-specific) anti-HLA antibodies, with deleterious effects on the graft.
Mammalian target of rapamycin inhibitors (mTORi) have shown limited benefit in early CNI replacement regimens and their long-term use as primary drug is hampered by intolerance. In the setting of particular malignant disease occurring after transplantation, such as squamous cell carcinoma of the skin and Kaposi’s sarcoma, mTORi seem promising.
Induction agents (anti-interleukin 2 receptor monoclonal antibodies, antithymocyte globulins) effectively diminish the risk of early immunological graft loss in recipients with moderate to high immunological risk but at the price of more infectious or malignant complications.
While personalized transplantation medicine is only in its early stages of development, attempts are made to quantitatively measure the clinical degree of immunosuppression, to tailor immunosuppressive therapy more specifically to the patient’s individual profile, and to monitor graft status by use of invasive (e.g. surveillance renal biopsies) and non-invasive biomarkers. These scientific endeavours are a necessity to further optimize the current immunosuppressive therapy which will remain for some time to come.
Autosomal dominant polycystic kidney disease management
Authors: Hwang Young-Hwan , Pei York
Published: June 2018

Management of patients with autosomal dominant polycystic kidney disease (ADPKD) currently comprises non-specific measures including promotion of healthy lifestyle, optimization of blood pressure control, and modification of cardiovascular risk factors. A high water intake of 3–4 L per day in patients with glomerular filtration rate greater than 30 mL/min/1.73 m2 may decrease the risk of kidney stones, but its potential benefit in reducing renal cyst growth is presently unproven. Maintenance of a target blood pressure of 130/80 mmHg is recommended by expert clinical guidelines though this is unlikely to slow cyst growth. It is unclear whether pharmacological blockade of the renin–angiotensin axis confers an extrarenal protective effect. Recognition of the variable clinical presentations of cyst infection, cyst haemorrhage, or nephrolithiasis is important for early diagnosis and optimal management of these complications. Most patients with ADPKD do well on dialysis and after transplantation. Nephrectomy may be needed to make space for a donor kidney, or if kidney size or infection is an issue after end-stage renal failure is reached. Recent advances in ADPKD have led to the identification of multiple potential therapeutic targets with more than 10 clinical trials completed or currently in progress. Given the promising results of the TEMPO trial, tolvaptan may well be the first disease-modifying drug to be approved for clinical use. Several other classes of drugs (e.g. somatostatin analogues, triptolide, metformin, and glucosylceramide synthase inhibitors) with good long-term safety profiles are promising candidates which may be repurposed for this disease. In the future, identifying patients with different risks of renal disease progression by their genotype and/or kidney volume will likely assume an important role for the clinical management of ADPKD.
Autosomal dominant tubule-interstitial kidney disease, including medullary cystic disease
Authors: Sayer John A.
Published: June 2018

The term medullary cystic kidney disease (MCKD) describes a group of autosomal dominantly inherited renal disorders. The term MCKD is used interchangeably with other terms, most commonly autosomal dominant interstitial kidney disease, and now may be distinguished using a molecular genetic diagnosis into at least three types. These include MCKD type 1, MCKD type 2 (also known now as uromodulin-associated kidney disease), and REN-associated kidney disease. Each of these types have phenotypic overlap but with a few distinguishing features. MCKD typically leads to end-stage renal failure between 30 and 70 years of age. Extrarenal features may include gout and childhood anaemia.
Oral-facial-digital type 1 syndrome
Authors: Franco Brunella
Published: June 2018

This chapter discusses oral-facial-digital type 1 syndrome (OFD1), which represents a rare syndromic form of inherited renal cystic disease associated with dysfunction of primary cilia. The disease is transmitted as an X-linked dominant male lethal trait. Embryonic lethality in affected hemizygous males is usually reported in the first and second trimesters of pregnancy. The clinical spectrum for this disease includes malformation of the face, oral cavity, and digits with a high degree of phenotypic variability, even within the same family, possibly due to X-inactivation. Renal cystic disease is present in over 65% of adult cases and is usually observed in the second and third decades of life.
The impact and incidence of altered body image in patients with head and neck tumors: a systematic review
Authors: Manier Karra K , Rowe Lindsay S , Welsh Judith , Armstrong Terri S
Published: June 2018

Body image dissatisfaction is a common issue among patients with cancer and is associated with difficulty coping, anxiety, and depression. Patients with tumors involving the head and neck are at increased risk of body image dissatisfaction due to the visible disfigurement that can occur from their illness and its treatment. Patients with primary central nervous system (CNS) malignancies often face similar tumor-related and treatment-related effects, yet there is limited research conducted in this population. Our aim was to perform a systematic review of the literature on body image in patients with tumors of the head and neck, and identify factors associated with body image alterations during treatment, with the intention of applying these approaches to those with CNS disease. A systematic search of PubMed and EMBASE was performed using predefined criteria. Nine studies met the inclusion criteria and were selected for review. The literature collected showed a relationship between body image and age, depressive symptoms, and tumor grade or stage. In addition, body image disturbance had an impact on patients’ daily functioning and psychosocial indices including anxiety, coping, and body reintegration. Evaluation of the impact of body image alterations in patients with CNS tumors is needed to direct clinical care, explore research opportunities, and improve patient quality of life.
A web-based dietary intervention in early pregnancy and neonatal outcomes: a randomized controlled trial
Authors: Kennedy R A K , Reynolds C M E , Cawley S , O’Malley E , McCartney D M , Turner M J
Published: June 2018

Background

Maternal nutrition is a determinant of pregnancy outcomes. Few studies have evaluated the potential of online nutrition resources to modify behaviour. This randomized controlled trial aimed to determine whether access to a customized evidence-based nutrition website in pregnancy improved neonatal outcomes.

Methods

Women <18 weeks gestation were recruited at their convenience. The control group received standard care. In addition to standard care, the intervention group received access to an evidence-based nutrition website, customized to the preferences of pregnant women.

Results

Of the 250 women, there were no differences in characteristics between the two groups. Of the women, 91.0% reported they make a conscious effort currently to eat a healthy diet. However, only 19.6% met dietary requirements for calcium, 13.2% for iron, 2.7% for folate and 2.3% for iodine. The most popular website section was pregnancy nutrition advice but engagement was not sustained. Access to the website was not associated with any improvement in clinical outcomes (P > 0.05).

Conclusions

We found that provision of a customized website providing nutrition information, did not improve neonatal outcomes. Future studies should explore whether redesign with website interactivity or embedding information on popular digital platforms sustains women’s engagement and modifies dietary behaviour.
Primary Extracranial Meningioma of the Lacrimal Sac Fossa
Authors: Radke Phillip M. , Herreid Peter A. , Sires Bryan S.
Published: June 2018

Primary extracranial meningioma is a rare tumor, unlike its common intracranial counterpart. Infrequently found in the head and neck region, it can cause local or neurologic symptoms depending on its location and interaction with cranial nerves. While uncommon, it is an important diagnosis to have on the differential of periorbital lesions as surgical removal and prognosis are generally good. The authors present the first report of a patient with primary extracranial meningioma originating in the lacrimal sac fossa.