bluuebunny/crossref_metadata_2025 huggingface dataset:
Intervention
Authors: Kennish Steven
Published: June 2018

Imaging technology allows complex yet minimally invasive diagnostic and therapeutic interventions in the genitourinary tract. It provides precise targeting for tissue biopsy to allow accurate diagnosis. Percutaneous nephrolithotomy is invaluable in the treatment of complex stone disease and percutaneous nephrostomy insertion preserves normal renal tissue in the patient with malignant or benign urinary tract obstruction. (Percutaneous nephrolithotomy and percutaneous nephrostomy are very different.) Antegrade ureteric procedures allow strictures, stones, and tumours to be dealt with, often with much greater ease than the retrograde approach. Collections and leaks can be drained and urine can be diverted to facilitate healing. Minimally invasive endovascular techniques can arrest iatrogenic or trauma-related haemorrhage from the renal tract. Although interventional radiological procedures are generally safe, they do come with risks of specific complications that the nephrologist needs to be aware of. Nephrologists need to be familiar with interventional uroradiological techniques to allow appropriate counseling and care of patients who require these procedures.
Membranous glomerulonephritis
Authors: Cattran Daniel C. , Reich Heather N.
Published: June 2018

Membranous glomerulonephritis (MGN) is the most common cause of adult-onset nephrotic syndrome, and a common glomerular cause of end-stage renal failure. It is caused by antibodies to podocyte surface molecules, usually autoantibodies. In most patients with primary membranous nephropathy the target is the phospholipase A2 receptor. It is hoped that robust assays for this antibody will help to guide therapy but it has not been possible to test this adequately yet.
Primary MGN accounts for about 70% of cases with regional variations. MGN is more common in men than women (approximately 2:1) and its peak incidence is in middle adult life.
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.
Antiglomerular basement membrane disease
Authors: Cui Zhao , Turner Neil , Zhao Ming-hui
Published: June 2018

Antiglomerular basement membrane (anti-GBM) disease may present as rapidly progressive glomerulonephritis alone, or in the presence of a secondary pulmonary insult (e.g. smoking or other toxicity, or infection) in combination with lung haemorrhage. Rarely it presents as lung disease alone (with haematuria) or as subacute glomerulonephritis.
The major differential diagnoses are small vessel vasculitis, which is a more common cause of pulmonary haemorrhage with rapidly progressive glomerulonephritis, and causes of simultaneous pulmonary and renal failure. For most of these, the lung lesion is not pulmonary haemorrhage.
The diagnosis often most quickly, most sensitively, specifically and usefully made by renal biopsy, but immunoassays showing a high titre of anti-GBM antibodies in the setting of severe renal disease are also useful. Borderline and even normal anti-GBM titres are not so specific or reliable in some forms of the disease though.
Epidemiology of calcium, phosphate, and parathyroid hormone disturbances in chronic kidney disease
Authors: Biggar Patrick , Rothe Hansjörg , Ketteler Markus
Published: June 2018

Chronic kidney disease-mineral and bone disorders (CKD-MBD), calcium, phosphate, and parathyroid hormone are biomarkers of mortality and cardiovascular risk. Hyperphosphataemia is a prominent and pathophysiologically most plausible risk indicator. Calcium balance and load appear to be more important than serum concentrations. Parathyroid hormone is a less reliable marker with a relatively wide range extending above that applicable for a normal population especially when used as a singular laboratory parameter without additional assessment of bone metabolism, for example, bone-specific alkaline phosphatase and bone biopsy. There is not a single prospective controlled hard-outcome study that provides us with unequivocal evidence that such an isolated laboratory parameter-based treatment approach will lead to significant clinical improvements. As CKD-MBD is complex, clinical decisions would be made easier by informative prospective trials.
Gastroenterology and renal medicine
Authors: Goel Rishi M. , Patel Kamal V. , Wong Terry
Published: June 2018

Gastrointestinal (GI) symptoms are a major feature of very low glomerular filtration rate and may be the presenting feature in some patients presenting late with renal failure. GI haemorrhage is increased in frequency inpatient with renal failure, even more so in those given therapeutic anticoagulation. There are some differences in likely causes. Oral bowel cleansing preparations that contain phosphate are dangerous in patients with CKD as they may cause phosphate crystallization in the kidneys: the resulting AKI may have limited reversibility. Patients with end stage renal disease have an increased incidence of bowel and other malignancies, best studied after transplantation. Those on peritoneal dialysis present particular issues for colonoscopy.
Preparation for renal replacement therapy
Authors: Wong Muh Geot , Cooper Bruce A. , Pollock Carol A.
Published: June 2018

Although the primary aim of management in chronic kidney disease (CKD) is to prevent progression to stage 5 CKD, for many patients renal replacement therapy (RRT) is inevitable. Planning for the initiation of dialysis is aimed at ensuring that it takes place in a supported environment in which adverse events will be minimized, that the modality chosen is appropriate for the individual circumstances, and the patient has full knowledge of what RRT entails. Beginning dialysis inevitably involves medical, psychological, family, and social issues, and preparation for RRT is optimally managed by a team with appropriate expertise in these areas. Multidisciplinary education programmes that inform patients and their families about their disease and the treatment options are likely to result in patients starting dialysis in a planned and elective manner.
Patient selection when resources are limited
Authors: Thomas Bernadette A. , Blagg Christopher R.
Published: June 2018

More than 50 years ago, outpatient care for patients with end-stage renal disease (ESRD) became possible through the invention of the Scribner shunt. Since that time, renal replacement therapy (RRT) has expanded to include haemodialysis, peritoneal dialysis, and renal transplantation. There has been tremendous global growth in the number of patients with access to RRT for ESRD, but many societies face difficult triage decisions for these costly modalities similar to those faced by the pioneers of outpatient dialysis in the early 1960s. Developed and developing societies will face the complex challenges of addressing the costly needs of an ESRD population that is projected to rise rapidly secondary to population ageing, as well as the increased burden of chronic diseases such as diabetes mellitus and hypertension.
The history of outpatient RRT is outlined and trends in RRT growth throughout the world noted. The ethical considerations with which both developed and developing societies will have to contend to address the growing global burden of ESRD are discussed.
The patient with diabetes mellitus
Authors: Gnudi Luigi , Gentile Giorgio , Ruggenenti Piero
Published: June 2018

About one third of patients with type 1 diabetes develop diabetic nephropathy long-term (usually not before at least 10 years of diabetes), though this proportion is falling as standards of care have risen. Nephropathy is strongly associated with other microvascular complications of diabetes, so that some degree of retinopathy is to be expected, and evidence of neuropathy is common. Patients with type 2 diabetes are equally susceptible, but this is an older group in which vascular disease and other pathologies are also more likely. The rise in type 2 diabetes accounts for diabetes being the most common recorded cause of end stage renal disease (ESRD) in the developed world.

Diabetic nephropathy is characterized by a progression through hyperfiltration, microalbuminuria, hypertension, overt proteinuria, nephrotic syndrome, loss of GFR, to ESRD. Risk factors for developing it include genetic factors (though no major single gene effects have been identified), and quality of glycaemic control.

The risk of progression can at early stages be reduced by improved glycaemic control, and control of hypertension also slows progression. However angiotensin converting enzyme inhibitors or receptor blockers (ACEi, ARB) are the standard of care for patients with microalbuminuria or overt proteinuria, as they have been shown to reduce the risk of renal endpoints. Combination therapy with both ACEi and ARB together has been associated with a high risk of AKI, hyperkalaemia and other adverse effects so is not generally recommended. Other promising agents in combination are under investigation but none adequately proven at this stage.

Patients who reach ESRD have reduced survival on all modalities compared to age-matched patients with other diagnoses. Best rehabilitation and survival for those who are suitable is through renal transplantation, though combined pancreas-renal transplantation may offer still better outcomes for selected patients.
The patient with myeloma
Authors: Kastritis Efstathios , Dimopoulos Meletios A.
Published: June 2018

Renal impairment is a common feature of multiple myeloma and often the presenting symptom of a patient with symptomatic myeloma. ‘Myeloma kidney’ results from the excess of immunoglobulin light chains which form aggregates and casts that result in tubular obstruction; however, light chains may cause renal damage with a variety of mechanisms, which often may coexist in the same patient. The presence of significant renal dysfunction in a patient with myeloma is associated with a risk for significant complications, including early death. Myeloma kidney is usually associated with high tumour burden and high rates of paraprotein production.

Patients with renal impairment should be managed immediately with appropriate antimyeloma therapy and supported vigorously. New drugs such as bortezomib are probably the most effective therapies for patients with renal dysfunction and may improve renal function in a significant proportion of patients with myeloma-related renal impairment, especially with dexamethasone at high doses. Other drugs such as thalidomide or lenalidomide may also be helpful in certain patients. Direct removal of the toxic free light chains may improve outcomes in some patients, but randomized studies are still ongoing. The role of plasmapheresis has not been established.

Autologous stem cell transplantation, with appropriate dose adjustments for high-dose melphalan should be offered in eligible patients, even those on dialysis, although this procedure may be associated with a higher risk of toxicity in patients with more severe renal dysfunction. Renal transplantation may be an option for selected patients who have responded well to therapy.
The patient with vasculitis
Authors: Salama Alan D.
Published: June 2018

Primary systemic vasculitis frequently leads to renal involvement and is responsible for significant numbers of patients progressing to end-stage renal disease. Frequently this is due to small vessel vasculitis, in association with antineutrophil cytoplasm antibody, which requires prompt recognition and timely therapeutic intervention to optimize renal and patient outcomes. Other organ systems are often affected. Relapses occur in about 50%.

Less commonly medium or larger vessel vasculitis may involve the kidneys and through ischaemia lead to impaired renal function and renovascular hypertension, as in Takayasu’s or Kawasaki disease, and polyarteritis nodosa (PAN).
The patient with hepatorenal syndrome
Authors: Cárdenas Andrés , Ginès Pere
Published: June 2018

Hepatorenal syndrome (HRS) is a dreaded and common complication of patients with end-stage liver disease. The syndrome is characterized by functional renal failure due to renal vasoconstriction in the absence of underlying kidney pathology. The pathogenesis of HRS is the result of an extreme underfilling of the arterial circulation secondary to an arterial vasodilation located in the splanchnic circulation. This phenomenon triggers a compensatory response with activation of vasoconstrictor systems leading to intense renal vasoconstriction.

Besides HRS, there are several other causes of renal failure in patients with cirrhosis including those secondary to bacterial infections, hypovolaemia, nephrotoxicity, and intrinsic renal disease. Thus, the diagnosis of HRS is based on established diagnostic criteria aimed at excluding non-functional causes of renal failure.

The prognosis of patients with HRS is poor, especially in those who have a rapidly progressive course. Liver transplantation is the best option in suitable candidates, but it is not always applicable due to the short survival expectancy of listed candidates.

Pharmacological therapies based on the use of vasoconstrictor drugs to reverse splanchnic vasodilation are the standard first line of therapy. The vasopressin analogue terlipressin is the best proven. Transjugular intrahepatic portosystemic shunts may be helpful in limited circumstances. Prevention of HRS can be attained with the use of albumin infusion in patients with spontaneous bacterial peritonitis, with norfloxacin in patients very advanced liver disease and with N-acetylcysteine in those with severe acute alcoholic hepatitis.
Infection of the lower urinary tract
Authors: Ali Ased , Pickard Rob
Published: June 2018

Lower urinary tract infection is common, distressing, and when recurrent can have a significant impact on quality of life. The normally sterile urinary tract is the site of an ongoing but complex interplay between an evolving pathogen and a highly developed host immune defence system. The development of an active infection generally requires either greater virulence in the pathogen or deficient host immune defence. Nonetheless, even where infection has occurred, the interplay between pathogen and host continues, influencing the extent and level of invasion as well as the duration of infection and extent of tissue damage caused.

Asymptomatic bacteriuria is discussed, with implications for treatment (usually not). The risk factors, diagnosis and management of simple cystitis are discussed, with a discussion of approaches to managing recurrent infections. Urethritis requires consideration of sexually transmitted infections and co-infections. Prostatitis requires more prolonged antibiotic treatment.
Uric acid stones
Authors: Daudon Michel , Jungers Paul
Published: June 2018

Uric acid (UA) stones are typically red-orange and often appear as sand/ gravel though they may be large. They are totally radiolucent. They account for about 10% of all kidney stones in most countries, and up to 20% in some populations. It is twice as frequent in males, prevalence increases with age, and it is two to three times higher in patients with type 2 diabetes or with features of the metabolic syndrome. Factors that induce the formation of UA stones are a low urine volume, hyperuricosuria, and, more importantly, a permanently low urine pH (< 5). Indeed, below its pKa of 5.35 at 37°C, UA is in non-dissociated form, whose solubility is at best 100 mg/L, whereas urinary UA excretion normally exceeds 600 mg/day and may exceed 1g/day.

Because UA solubility increases up to approximately 500 mg/L at urine pH > 6, urine alkalinization, with a target pH of 6.5–7, is the cornerstone of medical treatment. This most often allows dissolution of existing stones and prevention of recurrent stone formation so that urological intervention is infrequently needed. The preferred agent for alkalinization is potassium citrate (30–60 mEq/day in divided doses), because potassium urate is twice more soluble than sodium urate. However, in patients with poor gastric tolerance to potassium citrate or contraindication to potassium supplements, sodium bicarbonate is an acceptable alternative. Limitation of animal proteins, purine-rich foods (including beer), alcoholic drinks and acidified beverages (sodas) are useful measures, together with large fluid intake (> 2–2.5 L/day). Allopurinol may be indicated in cases of symptomatic hyperuricaemia. Regular observance of alkalinisation, with periodic controls of urine pH by the patient, is needed to prevent the rapid formation of UA stones. Patients affected by UANL, especially if overweight, should be evaluated for type 2 diabetes or glucose intolerance and managed accordingly.
Cystine stones
Authors: Daudon Michel , Jungers Paul
Published: June 2018

Cystinuria, an autosomal recessive disease (estimated at 1:7000 births worldwide), results from the defective reabsorption of cystine and dibasic amino acids (also ornithine, arginine, lysine, COAL) by epithelial cells of renal proximal tubules, leading to an abnormally high urinary excretion of these amino acids. Due to the poor solubility of cystine at the usual urine pH, formation of cystine crystals and stones ensues. Incidence of homozygotes is estimated at 1 in 7000 births worldwide, but is lower in European countries and much higher in populations with frequent consanguinity. Cystine stones represent 1–2% of all stones in adults and 5–8% in paediatric patients, with an equal distribution between males and females.

Cystinuria is caused by inactivating mutations in the gene SLC3A1 or SLC7A9, both encoding proteins contributing to the function of the heterodimeric transport system of cystine.

Cystine nephrolithiasis may present in infants, most frequently in adolescents or young adults, sometimes later. Cystine calculi are weakly radio-opaque. Stone analysis using infrared spectroscopy (or X-ray diffraction) allows immediate and accurate diagnosis. Urinary amino acid chromatography quantifies urinary cystine excretion, needed to define the therapeutic strategy.

Urological treatment of cystine stones currently uses extracorporeal stone wave lithotripsy or flexible ureterorenoscopy with Holmium laser, that is, minimally invasive techniques. However, as cystine stones are highly recurrent, preventive therapy is essential.

Medical treatment combines reduced methionine and sodium intake, to lower cystine excretion; hyperdiuresis (> 3 L/day) to reduce cystine concentration; and active alkalinization preferably using potassium citrate (40–80 mEq/day) to increase cystine solubility by rising urine pH up to 7.5–8. If these measures are insufficient to prevent recurrent stone formation, a thiol derivative (D-penicillamine or tiopronin), which converts cystine into a more soluble disulphide, should be added. Close monitoring and adherence of the patient to the therapeutic programme are needed to ensure life-long compliance, the key for successful prevention in the long term.
Prevention of acute kidney injury
Authors: Lameire Norbert
Published: June 2018

The prevention of acute kidney injury (AKI) should start with an assessment of the risk to develop AKI, by identification of co-morbidities, use of potentially nephrotoxic medications, and early recognition of acute reversible risk factors associated with AKI. This chapter discusses first the most relevant general risk factors for AKI and describes the recent introduction of several surveillance systems. In addition, some specific risk factors play a role in the pathogenesis of post-cardiac surgery AKI. Finally risks associated with commonly used drugs such as non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins, and warfarin are considered.
Acute kidney injury in pregnancy
Authors: Dragun Duska , Hegner Björn
Published: June 2018

Any kind of acute renal deterioration that occurs in young women may, besides typical pregnancy-related disorders, account for pregnancy-related acute kidney injury (PR-AKI). Incidence of PR-AKI is continuously decreasing, yet still represents a significant cause of fetomaternal morbidity and mortality. Hyperemesis gravidarum causing volume depletion and septic shock with renal cortical necrosis upon septic abortion are major causes of PR-AKI during early pregnancy. Pre-eclampsia and bleeding complications associated with placental abruption or other causes of obstetric haemorrhage are responsible for the majority of cases during late pregnancy (after week 35) and puerperium. Haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura disorders are less common than pre-eclampsia, yet represent a diagnostic and therapeutic challenge due to similar features to severe pre-eclampsia cases.
Immediate post-transplant care and surgical complications
Authors: Knight Simon R. , Ploeg Rutger J.
Published: June 2018

Care of the post-transplant kidney patient is complex and requires multidisciplinary team working. Careful attention is paid to haemodynamics, fluid balance, microbiology, drug prescription, and patient instruction. Delays in, or reduction of, graft function should be investigated and treated immediately to ensure long-term graft survival. Because complications do occur, they must be recognized early and dealt with promptly. The nature of the transplant operation and the need for immunosuppression mean that the complications differ from those of ordinary general surgical patients, and so require specialist medical, microbiological, or radiological input with a narrower time window for correction. This chapter covers the immediate postoperative care of the renal transplant recipient both as an inpatient and the early period as an outpatient, highlighting the potential complications and their management.
Contraception in patients with kidney disease
Authors: Wiles Kate , Nelson-Piercy Catherine
Published: June 2018

Three per cent of women of childbearing age have chronic kidney disease, and although end-stage renal failure impacts on fertility, conception and high-risk pregnancy do occur. Following renal transplantation, the patient should understand the potential impact of a pregnancy on transplant function and vice versa. Surveys show that a large proportion of pregnancies in female renal patients are unplanned. The effectiveness of a particular contraceptive method is dependent upon acceptability to the patient and compliance. Contraceptive decision-making needs to balance acceptability and safety with the risk of an unplanned pregnancy. Oestrogen-containing contraceptive methods are considered unacceptable for many renal patients because of their association with increased blood pressure and thrombotic and vascular events. Progesterone-only methods have an advantageous safety profile. The progesterone-only pill (desogestrel preparations), intrauterine system (Mirena®), and implant (Nexplanon®) are safe and effective in women with CKD. Concerns regarding the intrauterine system (Mirena®) in women taking immunosuppression are unfounded and observational evidence does not demonstrate an increased risk of infection. Sterilization is effective and should be considered to be irreversible. The effectiveness of barrier methods is reduced when ‘typical use’ is compared to ‘perfect use’. Unplanned pregnancy rates are high with fertility awareness methods and reliance on lactational amenorrhoea is not advocated.

Interactions between drugs which are commonly prescribed in the renal population and different contraceptive methods are outlined in this chapter.
Pregnancy after renal transplantation
Authors: Bramham Kate , Nelson-Piercy Catherine
Published: June 2018

There is now experience of many thousands of pregnancies over more than 50 years of renal transplantation. Most such patients have some degree of hypertension and chronic kidney disease, and as expected their rates of complications are substantially higher than those of age-matched controls. However, rates of successful pregnancy are now high and pregnancy is no longer an unusual event in transplanted patients. As for other patients with chronic kidney disease, additional risks depend on pre-pregnancy glomerular filtration rate, proteinuria, and hypertension. Fertility returns rapidly after transplantation but delay of at least a year is usually recommended to be sure of stable graft function and drug dosage. Early discussion of these issues with women of childbearing age is essential as drug regimens may need to be altered to agents of known safety, and to stress the importance of planning the pregnancy. The combination of tacrolimus and azathioprine with or without low-dose prednisolone is probably the most common, but in many centres agents such as mycophenolate mofetil, which is teratogenic, are commonly used. Blood pressure should be well controlled as outside pregnancy but some drugs are contraindicated and others are best avoided.
Cystinosis
Authors: Levtchenko Elena N. , Janssen Mirian C.
Published: June 2018

Cystinosis is a rare autosomal recessive disease caused by mutations in the lysosomal cystine transporter cystinosin encoded by the CTNS gene (17p.13.2). Cystinosis is characterized by lysosomal cystine accumulation throughout the body with renal Fanconi syndrome being the most common presenting symptom of a multisystem disorder. It must be distinguished from cystinuria in which formation of cystine stones is the core problem. When left untreated, kidney dysfunction gradually progresses towards end-stage renal failure during the first 10 years of life. The advent of renal replacement therapy allowed cystinosis patients to survive into adulthood, but revealed numerous extrarenal manifestations of the disease, affecting eyes, endocrine organs, gastrointestinal tract, muscles, and central and peripheral nervous systems. The disease mechanism of cystinosis is not fully understood. The administration of the cystine-depleting agent cysteamine slows down renal and extrarenal organ damage, pointing to the pivotal role of cystine accumulation in the disease pathogenesis. Treatment with cysteamine should be initiated as early as possible and continued lifelong, and also after kidney transplantation for protecting extrarenal organs. Cysteamine eye drops are an indispensable part of the treatment of corneal cystine accumulation. Life expectancy of cystinosis patients has substantially improved and is now above 50 years.
Chronic Interstitial Nephritis in Agricultural Communities
Authors: Jayasumana Channa , Orantes Carlos , De Broe Marc E.
Published: June 2018

Chronic Interstitial Nephritis in Agricultural Communities (CINAC) has been increasingly recognized since the early 1990s. It has been called epidemic chronic kidney disease unknown cause (CKDu) in Sri Lanka, and meso-American nephropathy in Central America.
CINAC occurs regionally in the Tropics, predominantly in rural/agricultural zones. It is increasingly recognized, but also believed to be increasing in incidence. Men are affected up to three times more often than women. Its incidence increases with age, and a number of other epidemiological factors impact on it. In some areas, such as the North Central Province of Sri Lanka and regions of Central America, it drives extreme rates of CKD and end-stage renal failure.
Clinically, it has the non-specific characteristics of other slowly-evolving chronic interstitial nephritis (Chapter 86). Perhaps distinctive is an inconsistent history of episodes of dysuria, sometimes loin pain, in earlier disease.
Its aetiology remains unsolved. Maps of incidence commonly show a mosaic pattern, suggesting that exposure to local factors are implicated. It has been associated with working outdoors in high temperatures, but this seems inadequate as the sole explanation. Exposure to nephrotoxins, natural or possibly as agrochemicals, seems likely.
Predictors of Recurrence, Progression, and Retreatment in Basilar Tip Aneurysms: A Location-Controlled Analysis
Authors: Abecassis Isaac Josh , Sen Rajeev D , Barber Jason , Shetty Rakshith , Kelly Cory M , Ghodke Basavaraj V , Hallam Danial K , Levitt Michael R , Kim Louis J , Sekhar Laligam N
Published: June 2018

BACKGROUND

Endovascular treatment of intracranial aneurysms is associated with higher rates of recurrence and retreatment, though contemporary rates and risk factors for basilar tip aneurysms (BTAs) are less well-described.

OBJECTIVE

To characterize progression, retreatement, and retreated progression of BTAs treated with microsurgical or endovascular interventions.

METHODS

We retrospectively reviewed records for 141 consecutive BTA patients. We included 158 anterior communicating artery (ACoA) and 118 middle cerebral artery (MCA) aneurysms as controls. Univariate and multivariate analyses were used to calculate rates of progression (recurrence of previously obliterated aneurysms and progression of known residual aneurysm dome or neck), retreatment, and retreated progression. Kaplan–Meier analysis was used to characterize 24-mo event rates for primary outcome prediction.

RESULTS

Of 141 BTA patients, 62.4% were ruptured and 37.6% were unruptured. Average radiographical follow-up was 33 mo. Among ruptured aneurysms treated with clipping, there were 2 rehemorrhages due to recurrence (6.1%), and none in any other cohorts. Overall rates of progression (28.9%), retreatment (28.9%), and retreated progression (24.7%) were not significantly different between surgical and endovascular subgroups, though ruptured aneurysms had higher event rates. Multivariate modeling confirmed rupture status (P = .003, hazard ratio = 0.14) and aneurysm dome width (P = .005, hazard ratio = 1.23) as independent predictors of progression requiring retreatment. In a separate multivariate analysis with ACoA and MCA aneurysms, basilar tip location was an independent predictor of progression, retreatment, and retreated progression.

CONCLUSION

BTAs have higher rates of progression and retreated progression than other aneurysm locations, independent of treatment modality. Rupture status and dome width are risk factors for progression requiring retreatment.
OBSERVATION OF VITREOUS FEATURES USING ENHANCED VITREOUS IMAGING OPTICAL COHERENCE TOMOGRAPHY IN HIGHLY MYOPIC RETINOSCHISIS
Authors: Song Minlu , Shen Mengxi , Zhou Yanping , Zheng Kairong , Zhai Yuanqi , Xiao Meichun , Wang Xiaohan , Wang Fenghua , Sun Xiaodong
Published: June 2018

Purpose:

To observe features of the posterior vitreous and vitreoretinal interface in highly myopic eyes with retinoschisis using enhanced vitreous imaging optical coherence tomography.

Methods:

Comprehensive ophthalmologic examination and enhanced vitreous imaging optical coherence tomography were performed in 77 eyes of 63 patients with highly myopic retinoschisis. Two different modes of spectral domain optical coherence tomography were employed to estimate retinoschisis and the posterior vitreous features in optical coherence tomography images, respectively. The types and distribution of vitreoretinal interface abnormalities were also analyzed.

Results:

Complete posterior vitreous detachment (PVD) was identified in 55 eyes (71.4%) with a Weiss ring. Residual cortex was found in 39 eyes (70.9%) with complete PVD. Vitreoretinal interface changes, including vitreoretinal adhesion and epiretinal membrane (ERM), most frequently appeared in the macular area (47.3%), followed by the inferior arched vessels region (34.5%). In partial PVD eyes, vitreoretinal traction, vitreoretinal adhesion, and epiretinal membrane tended to be observed in the inferior and superior arched vessels regions (54.5 and 40.9%, respectively). Among all types of vitreoretinal interface abnormalities, epiretinal membrane comprised the largest proportion (46.8%) despite the status of PVD. The presence of inner layers of retinoschisis connoted a relatively high possibility of vitreoretinal interface abnormalities occurring.

Conclusion:

Enhanced vitreous imaging optical coherence tomography reveals a high prevalence of vitreoretinal interface abnormalities in highly myopic eyes with retinoschisis. Vitreous cortex tends to remain on the macular area in eyes with complete PVD. Our findings may lead to better guidance for the surgical treatment of highly myopic retinoschisis.
Are college students told by health care providers about their risk factors for developing diabetes?
Authors: Saylor Jennifer L. , Calamaro Christina J. , Hardie Thomas , Ness Michelle , Selekman Janice
Published: June 2018

Background and Purpose:

Communication about risk factors for diabetes between nurse practitioners and college students may not be occurring as the prevalence of Type 2 diabetes increases. The purpose of this secondary analysis was to evaluate if college students are being told of their risk for diabetes based on known risk factors of weight, sleep, and depressive symptoms.

Methods:

Descriptive, cross-sectional study was completed using National Health and Nutrition Examination Survey 2011–2012. Using listwise deletion for all variables in the analyses, the sample (N = 313) included college participants aged 18–25 years. Logistic regression model found that body mass index (BMI), sleep quantity, and gender were significant predictors of not being told one was at risk for diabetes. In those with a BMI >25 kg/m2 (n = 159), only 22% were told about their risk for diabetes by a health care provider.

Conclusions:

Nurse practitioners may not be recognizing the factors that affect on the development of prediabetes in college-age students or not providing guidance for measures to prevent the morbidity related to diabetes.

Implications for Practice:

Nurse practitioners are in a prime position to identify individuals with overweight/obesity, poor sleep, and depressive symptoms and recommend lifestyle changes to prevent the onset of disease.
Birth attendance in rural Bangladesh: practices and correlates
Authors: Korim Fozlul
Published: June 2018

Introduction

The maternal mortality ratio (MMR) and neonatal mortality rate (NMR) are higher in the rural regions of Bangladesh compared to the urban areas or the national average. These two rates could be reduced by increasing use of skilled birth attendance in rural regions of this country. Although the majority of Bangladeshi population lives in rural areas, there has been a little investigation of the practices and determinants of delivery attendance in this region of Bangladesh. This study investigated the practices and determinants of attendance during child-births in rural Bangladesh.

Methods

Data were collected by the 2014 Bangladesh Demographic and Health Survey (BDHS 2014). After reporting the distribution of deliveries by types of attendance and distribution of selected factors, logistic regression was applied to calculate the crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs), and p-values.

Results

More than half of the deliveries (53.1%) were conducted by traditional attendants; community skilled attendants were present in only a small number of deliveries. The following factors were positively associated with deliveries by skilled attendants: 25-34 years age group of women (adjusted odds ratio (AOR): 1.4; 95% CI: 1.1-1.8), a higher education level of women (AOR: 2.9; 95% CI: 1.7-4.9), or their husbands (AOR: 2.4; 95% CI: 1.6-3.7), receiving antenatal care (AOR: 2.1; 95% CI: 1.6-2.7), and higher wealth quintiles (AOR of the richest wealth quintile vs the poorest: 3.5; 95% CI: 2.3-5.3). On the other hand, women having a higher parity (i.e., number of pregnancy, ≥2) led to a lower likelihood of delivery by skilled birth attendants. The proportion of deliveries attended by skilled attendants was significantly lower in the other six divisions compared to Khulna.

Conclusions

Socioeconomic factors should be considered to design future interventions to increase the proportion of deliveries attended by skilled delivery attendants. Awareness programs are required in rural areas to highlight the importance of skilled attendants. Further re-evaluation of the community skilled birth attendants program is required.
Knowledge and attitudes of Ebola among the general public of Trinidad and Tobago during the 2014-15 West Africa outbreak
Authors: Pooransingh S , Mohammed S , Melville K , Mohammed C , Mohammed M , Mohammed R , Mootoo W , Morris M , Motilal D , Bhagwandeen B , Dialsingh I
Published: June 2018

Objective

Health system resilience and resilience of a country include the capacity of health personnel, institutions, and populations to prepare for and effectively respond to crises. This study investigates the knowledge and attitudes of the public concerning Ebola Virus Disease in Trinidad and Tobago.

Design and Methods

A cross sectional study whereby respondents (n = 920) were sampled from public places. Data were collected via interviewer administered questionnaires. Data were analysed using SPSS version 23.

Results

The response rate was 67.6 % (622/920). The main age category of responders was the 20 to 30 year age category (40.5%); responders were mostly female (58.0 %). Regarding knowledge, there were significant differences among occupational categories (F = 2.811, df1 = 6, df2 = 571, p-value = 0.011). Tukey’s HSD post hoc test revealed that the mean knowledge scores for professional and sales occupations differed significantly (p-value = 0.003). There was a significant association between being afraid to go for treatment and age (p-value = 0.001). Significant associations were also found between occupational grouping and education attainment with opinion about the preparedness of private medical facilities, likelihood to shun family members with Ebola, being afraid to go for treatment and preference for traditional medicine (p-value <0.05).

Conclusion

This study highlights opportunities for community engagement to enhance health system resilience during outbreaks which would maximise national and global health security.
An implementation framework of value management in the Nigerian construction industry
Authors: Tanko Bruno Lot , Abdullah Fadhlin , Mohamad Ramly Zuhaili , Enegbuma Wallace Imoudu
Published: June 2018

Purpose

The purpose of this paper is to develop a framework for value management (VM) implementation by establishing the effect of critical success factors on current construction practices. This will aid stakeholders to improve productivity of construction practices in the Nigerian construction industry. The study established the requirements that ought to be satisfied for VM to successfully enhance productivity of construction activities.

Design/methodology/approach

Data collection was based on self-administered questionnaires from 344 registered construction professionals in Nigeria. The Statistical Package for Social Sciences version 25 and structural equation modelling were used to analyse the data for both descriptive and inferential analyses. Kaiser-Meyer-Olkin measure of sampling adequacy revealed that the internal consistency of the developed research instrument was appropriate, while the confirmatory factor analysis indicated satisfactory goodness-of-fit indices among acknowledged determinants of the structural model.

Findings

A framework that established the requirements for the successful implementation of VM construction practices in the Nigerian construction industry.

Originality/value

A structural model validated the requirements of applying VM on current construction practices. The established requirements (environment, people, government and information/methodology) can be used by decision makers and stakeholders to improve productivity of the current construction practices in the Nigerian construction environment. A framework was developed and validated by construction experts to confirm its suitability, usefulness and acceptance.
On approach to model stabilization of anomalous distribution of concentration of radiation defects in a multilayer structure
Authors: Pankratov Evgeny L.
Published: June 2018

Purpose

The purpose of this paper is to introduce a model of redistribution of point radiation defects, interaction between themselves and redistribution of their simplest complexes in a multilayer structure. The model gives a possibility to qualitatively describe nonmonotonicity of distributions of concentrations of radiation defects on interfaces between layers of the structure, which recently was found experimentally. To take into account the nonmonotonicity, the authors complement the model for the analysis of distribution of concentration of radiation defects, which were recently used in the literature. To analyze the model, the authors used an approach of solution of boundary problems, which could be used without crosslinking of solutions on interfaces between layers of the considered multilayer structures.

Design/methodology/approach

The authors introduce a model of redistribution of point radiation defects, interaction between themselves and redistribution of their simplest complexes in a multilayer structure. The model gives a possibility to qualitatively describe nonmonotonicity of distributions of concentrations of radiation defects on interfaces between layers of the structure, which recently was found experimentally. To take into account the nonmonotonicity, the authors complement the model for analysis of distribution of concentration of radiation defects, which were recently used in the literature. To analyze the model, the authors used an approach of solution of boundary problems, which could be used without crosslinking of solutions on interfaces between layers of the considered multilayer structures.

Findings

The authors obtain better agreement of obtain results in comparison with recently obtained results in the literature.

Originality/value

The results are original.
Using revegetation to suppress invasive plants in grasslands and forests
Authors: Schuster Michael J. , Wragg Peter D. , Reich Peter B.
Published: June 2018

Following the removal of invasive plant species, most land managers rely on natural succession to re‐establish native plant communities. However, insufficient native propagule pressure combined with legacy effects of invasive plant species means that passive approaches to restoration are often inadequate to establish native communities and prevent reinvasion.

In this paper, we review literature evaluating the ability of active revegetation to suppress re‐establishment of invaders in grasslands and woodlands.

We find that existing literature consistently demonstrates reduced performance of invasive plant species in revegetated grasslands, but that the magnitude of impact on invasive plants is highly variable. In contrast, the efficacy of revegetation in woodlands has rarely been reported, but the small number of such studies are consistent with results from grasslands.

Synthesis and applications. Our review highlights the mechanisms that lead to revegetation suppressing invasive plants in grasslands and identifies knowledge gaps associated with revegetation using woody species or targeting woody invaders. We recommend concerted efforts be made to evaluate the viability of woody plant revegetation and the efficacy of revegetation in woodlands. Furthermore, we suggest that land managers may need to embrace novel species assemblages in order to prevent reinvasion.
Do N‐fixing legumes promote neighbouring diversity in the tropics?
Authors: Xu Han , Detto Matteo , Li Yanpeng , Li Yide , He Fangliang , Fang Suqin
Published: June 2018

1. Although nitrogen‐fixing plants play a crucial role in maintaining high ecosystem productivity, their effects on forest diversity are greatly debated. Legumes can reduce local diversity because of the fertilization effect; however, they can also facilitate species coexistence through complementary resource utilization.

2. In natural forests, nitrogen requirements and biological nitrogen fixation (BNF) vary widely among legumes. We used leaf nitrogen isotopic composition to differentiate the level of BNF activity among seven legumes across a steep gradient of soil available nitrogen within a 60‐ha stem‐mapping plot in a montane tropical rainforest in Hainan Island, China, and we evaluated their spatial distribution and neighbourhood diversity.

3. Results show that the levels of BNF activity are tightly correlated with legume association to available soil nitrogen, where legumes associated with nitrogen‐rich habitats exhibit surprisingly greater BNF activity and a more diverse neighbourhood.

4. Synthesis. These findings indicate that legumes satisfy their nitrogen‐demanding metabolism through a synergy of habitat preference and BNF activity. High BNF activity drives local diversity by promoting complementary resource utilization rather than intensifying above‐ground competition. This may be achieved by improving litter quality and stimulating mycorrhizal and microbial diversity. The abundance of nitrogen fixers in nitrogen‐rich habitats also explains how legumes contribute to maintaining high levels of soil nitrogen in tropical forests.
Housing prices and population dynamics in urban China
Authors: Ding Yi
Published: June 2018

In this study, a dynamic stochastic general equilibrium (DSGE) model is used to investigate the influence of population on housing price dynamics in urban China. The contribution of population growth to the housing price trend and the contribution of population shocks to housing price fluctuations are quantitatively measured. The empirical results indicate that the ongoing policy to control the population size in large cities in China can decrease the growth rate of housing prices by 0.49% every year, which accounts for 1/10 of the total housing price trend. Furthermore, this policy cannot stabilize housing prices because population shocks have negligible effects on the housing price cycle. Housing technology shocks and housing preference shocks are responsible for most of the housing price fluctuations.
State‐Led Financial Regulation and Representations of Spatial Fixity: The Example of the Spanish Real Estate Sector
Authors: Yrigoy Ismael
Published: June 2018

This article offers a bottom‐up contribution to the fixity–motion literature. It aims to unravel the apparent contradiction of real estate spatial fixity in Spain, which is portrayed both as a barrier to accumulation and as a unique source of investment by different capitalist actors. Empirically, it describes the shifts in real estate ownership and changes in profit‐making strategies that have taken place across the real estate sector during the crisis years, and the role of the state in these shifts. The article asserts that the idea of spatial fixity representing a spatial barrier for accumulation does not necessarily apply in the Spanish case. It further claims that the tensions in capital circulation through real estate are not only to be found in the action of time, but in different state strategies pursued by various actors. The opposing representations of fixity are the result of state regulation of interest rates, taxation and risk weighting. The state also increasingly promotes land rents as a source of liquidity creation.