Hemodialysis vascular access options in pediatrics: considerations for patients and practitioners

Recent data indicate that the incidence of end-stage renal disease (ESRD) in pediatric patients (age 0–19 years) has increased over the past two decades. Similarly, the prevalence of ESRD has increased threefold over the same period. Hemodialysis (HD) continues to be the most frequently utilized modality for renal replacement therapy in incident pediatric ESRD patients. The number of children on HD exceeded the sum total of those on peritoneal dialysis and those undergoing pre-emptive renal transplantation. Choosing the best vascular access option for pediatric HD patients remains challenging. Despite a national initiative for fistula first in the adult hemodialysis population, the pediatric nephrology community in the United States of America utilizes central venous catheters as the primary dialysis access for most patients. Vascular access management requires proper advance planning to assure that the best permanent access is placed, seamless communication involving a multidisciplinary team of nephrologists, nurses, surgeons, and interventional radiologists, and ongoing monitoring to ensure a long life of use. It is imperative that practitioners have a long-term vision to decrease morbidity in this unique patient population. This article reviews the various types of pediatric vascular accesses used worldwide and the benefits and disadvantages of these various forms of access

Enzymatic oligomerization and polymerization of arylamines: state of the art and perspectives

The literature concerning the oxidative oligomerization and polymerization of various arylamines, e.g., aniline, substituted anilines, aminonaphthalene and its derivatives, catalyzed by oxidoreductases, such as laccases and peroxidases, in aqueous, organic, and mixed aqueous organic monophasic or biphasic media, is reviewed. An overview of template-free as well as template-assisted enzymatic syntheses of oligomers and polymers of arylamines is given. Special attention is paid to mechanistic aspects of these biocatalytic processes. Because of the nontoxicity of oxidoreductases and their high catalytic efficiency, as well as high selectivity of enzymatic oligomerizations/polymerizations under mild conditions-using mainly water as a solvent and often resulting in minimal byproduct formation-enzymatic oligomerizations and polymerizations of arylamines are environmentally friendly and significantly contribute to a "green'' chemistry of conducting and redox-active oligomers and polymers. Current and potential future applications of enzymatic polymerization processes and enzymatically synthesized oligo/polyarylamines are discussed

Tips and tricks in creation of forearm arteriovenous fistulae.

Forearm arteriovenous fistula (AVF) is a direct anastomosis between the radial artery and the cephalic vein or the ulnar artery and the basilic vein, which are small-caliber vessels. The surgical technique must be precise to avoid postoperative stenosis of the anastomosis which may result in early thrombosis or nonmaturation. In our experience, microsurgery and preventive hemostasis are two major contributions to creation of forearm AVF. Using these techniques, construction of a radial-cephalic fistula was possible in 78\% of children in our hospital, with 60\% secondary patency rates at 4 years. In a personal unpublished series, 69\% of the first arteriovenous angioaccess of adult patients were forearm fistulae, with 63\% and 91\% primary and secondary 1-year patency rates, respectively. Finally, 68\% primary patency and 96\% secondary patency rates at 1 year were reported by Pirozzi et al. in adults with an internal diameter of <1.6 mm in the radial artery

L'emploi dans la production de légumes de serre en France et aux Pays-Bas : un marché du travail des disponibilités

Economie agricole et agro-alimentaireA également fait l'objet d'une communication à l'Ecole chercheurs de l'INRA/ESR : Economie des institutions, les 14-18/09/1992 à SoustonsNational audienceSynthèse des résultats d'une enquête effectuée en France et aux Pays-Bas sur les problèmes de travail dans la production de légumes de serre. Il caractérise le marché du travail dans ce secteur, c'est-à-dire le mode de gestion collectif de la force de travail, en étudie les formes en crise pour conclure à l'existence de mécanismes fondamentalement différents de ceux du marché du travail professionnel. Il rebondit cependant, à travers l'analyse des formes mutantes observées aux Pays-Bas, pour s'interroger finalement sur l'existence de passerelles entre les deux modèles. Une partie de description empirique et une autre plus théorique, se proposent d'apporter, sur la base des résultats obtenus dans un secteur de production particulier, une contribution et une vision un peu différente sur des aspects de marché du travail