Data from the ERA-EDTA Registry were examined for trends in excess mortality in European adults on kidney replacement therapy

The objective of this study was to investigate whether the improvement in survival seen in patients on kidney replacement therapy reflects the enhanced survival of the general population. Patient and general population statistics were obtained from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry and the World Health Organization databases, respectively. Relative survival models were composed to examine trends over time in all-cause and cause-specific excess mortality, stratified by age and modality of kidney replacement therapy, and adjusted for sex, primary kidney disease and country. In total, 280,075 adult patients started kidney replacement therapy between 2002 and 2015. The excess mortality risk in these patients decreased by 16% per five years (relative excess mortality risk (RER) 0.84; 95% confidence interval 0.83-0.84). This reflected a 14% risk reduction in dialysis patients (RER 0.86; 0.85-0.86), and a 16% increase in kidney transplant recipients (RER 1.16; 1.07-1.26). Patients on dialysis showed a decrease in excess mortality risk of 28% per five years for atheromatous cardiovascular disease as the cause of death (RER 0.72; 0.70-0.74), 10% for non-atheromatous cardiovascular disease (RER 0.90; 0.88-0.92) and 10% for infections (RER 0.90; 0.87-0.92). Kidney transplant recipients showed stable excess mortality risks for most causes of death, although it did worsen in some subgroups. Thus, the increase in survival in patients on kidney replacement therapy is not only due to enhanced survival in the general population, but also due to improved survival in the patient population, primarily in dialysis patients.Peer reviewe

Dynamic replication strategies in data grid systems: A survey

In data grid systems, data replication aims to increase availability, fault tolerance, load balancing and scalability while reducing bandwidth consumption, and job execution time. Several classification schemes for data replication were proposed in the literature, (i) static vs. dynamic, (ii) centralized vs. decentralized, (iii) push vs. pull, and (iv) objective function based. Dynamic data replication is a form of data replication that is performed with respect to the changing conditions of the grid environment. In this paper, we present a survey of recent dynamic data replication strategies. We study and classify these strategies by taking the target data grid architecture as the sole classifier. We discuss the key points of the studied strategies and provide feature comparison of them according to important metrics. Furthermore, the impact of data grid architecture on dynamic replication performance is investigated in a simulation study. Finally, some important issues and open research problems in the area are pointed out

Dynamic replication strategies in data grid systems: a survey

In data grid systems, data replication aims to increase availability, fault tolerance, load balancing and scalability while reducing bandwidth consumption, and job execution time. Several classification schemes for data replication were proposed in the literature, (i) static vs. dynamic, (ii) centralized vs. decentralized, (iii) push vs. pull, and (iv) objective function based. Dynamic data replication is a form of data replication that is performed with respect to the changing conditions of the grid environment. In this paper, we present a survey of recent dynamic data replication strategies. We study and classify these strategies by taking the target data grid architecture as the sole classifier. We discuss the key points of the studied strategies and provide feature comparison of them according to important metrics. Furthermore, the impact of data grid architecture on dynamic replication performance is investigated in a simulation study. Finally, some important issues and open research problems in the area are pointed out. © 2015, Springer Science+Business Media New York

Radiologic-pathologic correlation in liver angiomyolipoma in a 68-year-old woman

International audienc

Laparoscopic Habib™ 4X: a bipolar radiofrequency device for bloodless laparoscopic liver resection

Background. In recent years the progress of laparoscopic procedures and the development of new and dedicated technologies have made laproscopic hepatic surgery feasible and safe. In spite of this laparoscopic liver resection remains a surgical procedure of great challenge because of the risk of massive bleeding during liver transection and the complicated biliary and vascular anatomy in the liver. A new laparoscopic device is reported here to assist liver resection laparoscopically. Methods. The laparoscopic Habib™ 4X is a bipolar radiofrequency device consisting of a 2x2 array of needles arranged in a rectangle. It is introduced perpendicularly into the liver, along the intended transection line. It produces coagulative necrosis of the liver parenchyma sealing biliary radicals and blood vessels and enables bloodless transection of the liver parenchyma. Results. Twenty-four Laparoscopic liver resections were performed with LH4X out of a total of 28 attempted resections over 12 months. Pringle manoeuvre was not used in any of the patients. None of the patients required intraoperative transfusion of red cells or blood products. Conclusion. Laparoscopic liver resection can be safely performed with laparoscopic Habib™ 4X with a significantly low risk of intraoperative bleeding or postoperative complications