Urinary tract infections in children and the risk of ESRF.

Paediatric guidance on diagnosis and treatment of urinary tract infections (UTIs) has in the past largely focused on identifying children with vesicoureteral reflux, thought to be at greatest risk of renal scarring. This practice has been questioned, specifically the accepted association between UTI and end-stage renal failure (ESRF) through renal scarring. The aim of this article is to ascertain whether we can predict with confidence the true level of risk that a child with a first-time UTI will subsequently develop ESRF attributable to UTI

Cyclophosphamide and rituximab in frequently relapsing/steroid-dependent nephrotic syndrome

BACKGROUND: Steroid-sensitive nephrotic syndrome is the most common form of nephrotic syndrome in childhood, defined by the response to treatment with glucocorticoids with consequent remission. While most children eventually experience spontaneous resolution of the disease, some have a difficult course with frequent relapses or steroid dependence nephrotic syndrome (FRSDNS). The consequent steroid toxicity often prompts administration of other immunosuppressive drugs, traditionally cyclophosphamide. Recently, rituximab has been reported as effective in this disorder, but long-term experience is lacking. METHODS: Retrospective note review of all children with FRSDNS treated with a first course of cyclophosphamide and/or rituximab in our center between December 2006 and April 2015. We reviewed time to first relapse after treatment, co-medications, and side effects. RESULTS: A total of 102 children were treated with cyclophosphamide (79) and/or rituximab (42). Of these, 34 received cyclophosphamide prior to rituximab. Median time to first relapse was 7 months after cyclophosphamide and 14 months after rituximab. Documented side effects of cyclophosphamide included neutropenia, hair loss, and hemorrhagic cystitis (1). Rituximab was associated with an allergic reaction at infusion in two patients. CONCLUSIONS: Rituximab was used in children with the most difficult to treat FRSDNS, yet was associated with longer remission time and less side effects than cyclophosphamide. A randomized controlled trial is needed to directly compare these drugs

Imaging in the evaluation of renovascular disease

Renovascular disease (RVD) is an important cause of hypertension in children, as it often is amenable to potentially curative treatment. Imaging aimed at finding RVD therefore needs to have high sensitivity so as not to miss important findings. Digital subtraction angiography is the gold standard investigation. Doppler ultrasonography, computed tomography (CT) angiography and magnetic resonance (MR) angiography can all be helpful, but none has, at present, high enough sensitivity to rule out RVD in a child with a suggestion of that diagnosis

Alustaimestik ja seda mõjutavad tegurid endistel põllumajandusmaadel kasvavates noortes lehtpuuistandikes

The establishment of forest plantations (including short-rotation forest plantations) is seen as one way to reemploy abandoned agricultural sites. The main goal of commercial forest plantations is the production of timber and woody biomass, however, the implications for biodiversity (including floristic diversity) can not be neglected. Due to the agricultural legacy the understorey of forests established on former agricultural land differs from the understorey of forests that were never cleared and these differences may persist for long periods. Since 1999 more than 700 ha of plantations with semi-exotic hybrid aspen (Populus × wettsteinii Hämet-Ahti) have been established on former agricultural land in Estonia that can be managed with 20- to 30-year rotations. Experience from other countries has indicated that environmental problems may occur in the plantations of exotic tree species. Among the native deciduous tree species silver birch (Betula pendula Roth) is considered to be a suitable tree species for the establishment of plantations in Estonia. However, abandoned agricultural sites become afforested also in the process of secondary succession with Betula spp among first arrivers. Studies conducted in former mining areas that have compared unassisted natural succession and the establishment of plantations have pointed out that naturally regenerated stands may support higher understorey species richness and diversity than plantations. Given the above mentioned, the following aims were set to the thesis: 1) to determine which site- and stand-related factors have affected understorey vegetation characteristics in young commercial forest plantations on abandoned agricultural land; 2) to study if plantations of semi-exotic hybrid aspen offer similar habitat for the understorey as plantations of native tree species silver birch; 3) to characterize the formation of the bryophyte layer; 4) to characterize the formation of forest understorey; 5) to compare understorey vegetation characteristics between naturally regenerated birch stands and silver birch plantations. Data on understorey, overstorey and site factors were collected from 73 experimental plots established in 24 hybrid aspen and 11 silver birch plantations and in 11 naturally regenerated birch stands. Two monitorings were carried out in plantations: the first monitoring in 7 to 9-year-old plantations and the second monitoring in 13 to 14-year-old plantations. Based on the results of the thesis, the observable trends in the understorey vegetation of young plantations were mostly driven by the former agricultural land use, site preparation method, and soil properties. With increasing stand age the influence of pre-establishment disturbances becomes less pronounced and the impact of overstorey-related factors increases. The majority of the vascular plant and bryophyte understorey vegetation characteristics were similar in young hybrid aspen and silver birch plantations and it may be concluded that semi-exotic hybrid aspen provides similar habitat for understorey as native silver birch. The proportion of forest species was low in the vascular plant understorey of plantations at the time of both monitorings. Although the number and cover of forest species slowly increased between the two monitorings, clear domininance of grassland species continued. The cover of the bryophyte layer was low in young plantations. Typical bryophytes were light-demanding perennials. The silvicultural management of plantations in the future should include measures that provide habitats for epixylic and epiphytic bryophyte species. The comparison of naturally regenerated stands and plantations showed that the species richness and diversity of bryophytes were higher in naturally regenerated birch stands, but the species richness and diversity of vascular plants did not differ between the two stand types. However, significantly higher numbers of forest species (both vascular plant and bryophyte) indicated that the formation of forest understorey had progressed further in naturally regenerated stands. This can be explained by the longer undisturbed succession and colonization period of naturally regenerated stands. Both natural and artificial regeneration can be recommended as possible alternatives for the establishment of new forests on former agricultural land.Intensiivmeetodil, sh lühikese raieringiga majandatavate puuistandike rajamine on alternatiivseks kasutusvõimaluseks endistele põllumajandusmaadele. Tootmisele suunatud istandikes ehk puupõldudel ei ole peamiseks eesmärgiks metsökosüsteemi kujundamine, vaid soovitakse saavutada maksimaalne puidu või mõne teise puudega seotud toorme produktsioon. Puupõldude pindala pidev kasv maailmas tõstatab aga küsimuse, milline on nende mõju looduslikule, sh floristilisele mitmekesisusele. Kirjanduse andmetel võib endistele põllumajandusmaadele rajatud metsade, sh istandike alustaimestik jääda pikaks ajaks erinevaks põliste metsade alustaimestikust, mis seostub põllumajandusliku maakasutuse mõjudega. Alates 1999. aastast on Eestis endistele põllumajandusmaadele rajatud u 700 ha puuistandikke poolvõõrliigi hübriidhaavaga (Populus × wettsteinii Hämet-Ahti), mida plaanitakse majandada lühikese 20–30-aastase raieringiga. Mujal maailmas on võõrpuuliikidega rajatud istandikes täheldatud mõnikord keskkonnakaitselisi probleeme. Kohalikest lehtpuudest soovitatakse Eestis endiste põllumajandusmaade metsastamiseks eelkõige arukaske (Betula pendula Roth), ent kaasikud võivad endistele põllumajanduskõlvikutele tekkida ka looduslikult. Endiste karjäärialade metsastamisel on istandike ja looduslikult tekkinud puistute võrdlusel täheldatud, et looduslikult tekkinud puistute alustaimestik võib olla liigirikkam ja mitmekesisem kui istandikes. Lähtuvalt eespool toodust seati doktoritööle järgnevad eesmärgid: 1) analüüsida, millised kasvukoha ja puistu tunnused mõjutavad alustaimestiku karakteristikuid endistel põllumajandusmaadel kasvavates noortes istandikes; 2) hinnata, kas poolvõõrliigi hübriidhaava istandikud pakuvad alustaimestiku liikidele sarnaseid kasvutingimusi kodumaise puuliigi arukase istandikega; 3) iseloomustada samblarinde kujunemist ja sammalde liigilist koosseisu; 4) iseloomustada metsa alustaimestiku kujunemist; 5) võrrelda alustaimestiku karakteristikuid arukaseistandikes ja looduslikult tekkinud kaasikutes. Alustaimestikku, puurinnet ja kasvukohta iseloomustav andmestik koguti seitsmekümne kolmelt püsiproovitükilt, mis paiknesid 11 arukase- ja 24 hübriidhaavaistandikus ning 11 looduslikult tekkinud kaasikus. Istandike kohta on doktoritöös esitatud alustaimestiku esimese kirjelduse (vanuses 7 kuni 9 aastat) ja korduskirjelduse (vanuses 13 kuni 14 aastat) andmed. Doktoritöös leiti, et noore istandiku alustaimestiku karakteristikuid mõjutasid esialgu eelnev põllumajanduslik maakasutus, istandiku rajamisel rakendatud maapinna ettevalmistusviis ja mullastiku tingimused. Istandike vanuse kasvades muutub istandiku rajamisele eelnenud häiringute mõjust olulisemaks puurindega seotud tegurite mõju rohu- ja samblarindele. Hübriidhaava- ja arukaseistandike alustaimestiku (soontaimede ja sammalde) karakteristikud olid suures osas sarnased, mis lubab väita, et hübriidhaavikute rajamisega Eestis ei kaasne alustaimestikus ebasobivaid arenguid, nt võõrliikide levikut. Metsaliikide osakaal istandike alustaimestikus oli väike nii esimese kirjelduse kui ka korduskirjelduse ajal. Hoolimata sellest, et metsaliikide arv ja katvus kasvasid vähehaaval, domineerisid ka 13–14-aastaste istandike alustaimestikus jätkuvalt rohumaaliigid. Ka samblarinde katvus noortes istandikes oli väike. Tüüpilised noortes istandikes kasvavad liigid olid valgusnõudlikud mitmeaastased samblad. Istandike edasisel majandamisel oleks soovitatav rakendada abinõusid, mis pakuvad lisakasvukohti epiksüülsetele ja epifüütsetele samblaliikidele. Hüpotees, et endistele põllumajandusmaadele looduslikult tekkinud puistud toetavad suuremat alustaimestiku liigirikkust, leidis kinnitust üksnes maapinnal kasvanud sammalde arvu ja mitmekesisusindeksi osas. Lisaks kasvas looduslike kaasikute alustaimestikus rohkem metsaliike (nii soon- kui sammaltaimi), mida võib seletada pikema rahuliku suktsessiooni ja kolonisatsiooni ajaga.Publication of this dissertation is supported by the Estonian University of Life Sciences and by the Doctoral School of Earth Sciences and Ecology created under the auspices of European Social Fund

International validation of a urinary biomarker panel for identification of active lupus nephritis in children.

Conventional markers of juvenile-onset systemic lupus erythematosus (JSLE) disease activity fail to adequately identify lupus nephritis (LN). While individual novel urine biomarkers are good at detecting LN flares, biomarker panels may improve diagnostic accuracy. The aim of this study was to assess the performance of a biomarker panel to identify active LN in two international JSLE cohorts.Novel urinary biomarkers, namely vascular cell adhesion molecule-1 (VCAM-1), monocyte chemoattractant protein 1 (MCP-1), lipocalin-like prostaglandin D synthase (LPGDS), transferrin (TF), ceruloplasmin, alpha-1-acid glycoprotein (AGP) and neutrophil gelatinase-associated lipocalin (NGAL), were quantified in a cross-sectional study that included participants of the UK JSLE Cohort Study (Cohort 1) and validated within the Einstein Lupus Cohort (Cohort 2). Binary logistic regression modelling and receiver operating characteristic curve analysis [area under the curve (AUC)] were used to identify and assess combinations of biomarkers for diagnostic accuracy.A total of 91 JSLE patients were recruited across both cohorts, of whom 31 (34 %) had active LN and 60 (66 %) had no LN. Urinary AGP, ceruloplasmin, VCAM-1, MCP-1 and LPGDS levels were significantly higher in those patients with active LN than in non-LN patients [all corrected p values (p c) < 0.05] across both cohorts. Urinary TF also differed between patient groups in Cohort 2 (p c = 0.001). Within Cohort 1, the optimal biomarker panel included AGP, ceruloplasmin, LPGDS and TF (AUC 0.920 for active LN identification). These results were validated in Cohort 2, with the same markers resulting in the optimal urine biomarker panel (AUC 0.991).In two international JSLE cohorts, urinary AGP, ceruloplasmin, LPGDS and TF demonstrate an 'excellent' ability for accurately identifying active LN in children

Elevated atmospheric CO2 and humidity delay leaf fall in Betula pendula, but not in Alnus glutinosa or Populus tremula × tremuloides

Context: Anthropogenic activity has increased the level of atmospheric CO2, which is driving an increase of global temperatures and associated changes in precipitation patterns. At Northern latitudes, one of the likely consequences of global warming is increased precipitation and air humidity. Aims: In this work, the effects of both elevated atmospheric CO2 and increased air humidity on trees commonly growing in northern European forests were assessed. Methods: The work was carried out under field conditions by using Free Air Carbon dioxide Enrichment (FACE) and Free Air Humidity Manipulation (FAHM) systems. Leaf litter fall was measured over 4 years (FACE) or 5 years (FAHM) to determine the effects of FACE and FAHM on leaf phenology. Results: Increasing air humidity delayed leaf litter fall in Betula pendula, but not in Populus tremula × tremuloides. Similarly, under elevated atmospheric CO2, leaf litter fall was delayed in Betula pendula, but not in Alnus glutinosa. Increased CO2 appeared to interact with periods of low precipitation in summer and high ozone levels during these periods to effect leaf fall. Conclusions: This work shows that increased CO2 and humidity delay leaf fall, but this effect is species specific

Effect of environmental factors on the composition of terrestrial bryophyte and lichen species in Scots pine forests on fixed sand dunes

Aim of the study: To investigate terrestrial bryophyte and lichen species richness and environmental factors affecting the composition of species.Area of the study: Four Boreal zone fixed dunes were selected in the coastal area of the Baltic Sea in southwest Estonia.Material and methods: Non-metric multidimensional scaling was performed to analyse distribution patterns and environmental factors like canopy cover, photosynthetically active radiation, soil organic horizon thickness and decomposition rates, soil volumetric water content, soil pH and electrical conductivity and soil nutrients correlated with bryophyte and lichen species composition.Main results: Thirty bryophytes and 22 lichens were found on 232 sample plots, the most frequent species were Pleurozium schreberi (Willd. ex Brid.) Mitt., Hylocomium splendens (Hedw.) Schimp., Dicranum polysetum Sw. ex anon., Cladonia arbuscula (Wallr.) Flot. and Cladonia furcata (Huds.) Schrad. The lichen species richness was highest on the slopes of the dunes and decreased towards the bottoms and tops; bryophyte species richness was higher on the bottoms and decreased towards the tops of the dunes.Research highlights: The composition of bryophytes and lichens is significantly influenced by the aspect and the location on the dune, light conditions, soil pH, soil salinity (measured as electrical conductivity) and volumetric water content, thickness of moderately decomposed organic horizon and vascular plant species cover.KeywordsInland dunes; terrestrial bryophyte and lichen communities; environmental factors; topography