The two approaches most commonly applied to characterizing the chemical form and 'reactivity' of metals in the soil solid phase are sequential extraction procedures (SEPs) and isotopic dilution (ID). The development and limitations of both approaches are described and their application to contaminated soils discussed. It may be argued that ID offers a better means of discriminating between 'reactive' and 'inert' forms of metal. However, the literature on SEPs is considerably larger, providing greater scope for comparative analysis of new data. Although ID methods are subject to operational constraints, the procedural dependency of SEPs is probably much greater. Thus greater effort has been expended to standardize and verify methodologies for SEPs. However, despite achieving a level of 'political ratification' at the procedural level, the use of SEPs within risk assessments for planning or development purposes is currently almost absent. The future for ID methods in this context may lie in site-specific risk assessments that include improved methods for the prediction of metal solubility and bioavailability.
Short rotation coppice (SRC) such as Salix spp. can be grown as an energy crop and offers some potential for economic and practical phytoextraction of marginally contaminated arable soil. This study tested various soil amendments intended to increase soil metal availability to Salix, investigated the distribution of metal between different tree fractions and assessed the viability of phytoextraction using SRC on arable soils. Several Salix genotypes were grown in field trials over 4 years. Cd and Zn concentrations were generally ranked in the order leaves > bark > wood. Metal concentrations in wood increased towards the top of the willow stems, whereas concentrations in leaves showed the opposite trend. None of the amendments significantly increased uptake of Zn by willow. However, in response to a range of soil HCl treatments, mean Cd concentrations in stems and leaves were 112% and 130% of control values. Data from the current experiment, and previous studies, were combined to develop a predictive model of Cd and Zn stem uptake by Salix. The minimum biological concentration factor (BCF) required to achieve a prescribed soil metal target was also calculated based on typical proportions of bioavailable Cd in sludgeamended soils for a 25-year Salix rotation. The best Salix genotypes investigated achieved less than 20% of the uptake rate required to remove one third of the soil Cd content (equivalent to the average isotopically exchangeable Cd fraction in soils at the study site).
ObjectiveRituximab is an effective treatment for children with steroid dependent or frequently relapsing nephrotic syndrome. The optimum dosing schedule for rituximab has not been established. We hypothesized that a single low dose of 375 mg/m2 would have comparable outcomes to higher doses in reducing the frequency of relapse and time to B cell reconstitution.MethodsWe conducted a multicenter retrospective observational cohort study of children with steroid-sensitive frequently relapsing nephrotic syndrome. Data were extracted from clinical records including the dates of diagnosis, treatment, relapses, the use of concomitant immunosuppression, and lymphocyte subset profiling. Patients treated earlier received variable doses of rituximab, although typically two doses of 750 mg/m2. Later, patients received the current regimen of a single dose of 375 mg/m2. The primary outcome was an absence of clinically confirmed relapse 12 months following rituximab administration. Secondary outcomes were median time to relapse, probability of being relapse-free at 6 and 24 months and time to reconstitution of CD19+ B cells.ResultsSixty patients received 143 courses of rituximab. Seven different dosing regimen strategies were used, ranging between 375 and 750 mg/m2 per dose, with administration of 1–4 doses. There was no significant difference in event-free survival at 12 months between dosing strategies. The median time to reconstitution of B cells was not significantly different between groups.ConclusionsUse of a single low-dose regimen of rituximab in the management of frequently relapsing nephrotic syndrome does not affect the probability of relapse at 12 months or time to B cell reconstitution compared to a conventional higher dose.Electronic supplementary materialThe online version of this article (10.1007/s00467-018-4172-3) contains supplementary material, which is available to authorized users.
Background: Vesico-ureteral reflux (VUR) is considered to be a risk factor for recurrent febrile urinary tract infections and impaired renal transplant survival.
Methods: An online survey supported by the European Society for PaediatricNephrology was designed to evaluate current management strategies of VUR in native and transplanted kidneys of recipients aged <18 years.Results: Seventy-three pediatric transplant centers from 32 countries contributed to the survey. All centers performed urological evaluation prior to pediatric kidney transplantation (KTx) with subsequent interdisciplinary discussion. Screening for VUR in native kidneys (30% in all, 70% in selected patients) led to surgical intervention in 78% (11% in all, 89% in selected patients) with a decided preference of endoscopic intervention over ureterocystoneostomy. Following KTx, continuous antibiotic prophylaxis was applied in 65% of the patients and screening for allograft VUR performed in 93% of selected patients. The main management strategies of symptomatic allograft VUR were continuous antibiotic prophylaxis (83%) and surgical treatment (74%) (endoscopic intervention 55%, redo ureterocystoneostomy 26%).Conclusions: This survey demonstrates the high variability in the management of VUR in pediatric KTx recipients, points to knowledge gaps, and might serve as a starting point for improving the care for patients with VUR in native and transplanted kidneys.
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