Renal artery stenosis-when to screen, what to stent?

Renal artery stensosis (RAS) continues to be a problem for clinicians, with no clear consensus on how to investigate and assess the clinical significance of stenotic lesions and manage the findings. RAS caused by fibromuscular dysplasia is probably commoner than previously appreciated, should be actively looked for in younger hypertensive patients and can be managed successfully with angioplasty. Atheromatous RAS is associated with increased incidence of cardiovascular events and increased cardiovascular mortality, and is likely to be seen with increasing frequency. Evidence from large clinical trials has led clinicians away from recommending interventional revascularisation towards aggressive medical management. There is now interest in looking more closely at patient selection for intervention, with focus on intervening only in patients with the highest-risk presentations such as flash pulmonary oedema, rapidly declining renal function and severe resistant hypertension. The potential benefits in terms of improving hard cardiovascular outcomes may outweigh the risks of intervention in this group, and further research is needed

Re-conceptualising VET: responses to covid-19

The paper addresses the impact of Covid-19 on vocational education and training, seeking to discern the outline of possible directions for its future development within the debates about VET responses to the pandemic. The discussion is set in its socio-economic context, considering debates that engage with the social relations of care and neo-liberalism. The paper analyses discourses that have developed around VET across the world during the pandemic, illustrating both possible continuities and ruptures that may emerge in this field, as the health crisis becomes overshadowed in public policy by the prioritisation of economic recovery and social restoration. The paper concludes that, alongside the possibility of a narrowing of VET to its most prosaic aims and practices, the health crisis could also lead to a re-conceptualisation that develops its radical and emancipatory possibilities in both the global south and north.N/

Optimistic vs. pessimistic endings in climate change appeals

Abstract The use of emotion in climate change appeals is a hotly debated topic. Warning about the perils of imminent mass extinction, climate change communicators are often accused of being unnecessarily ‘doomsday’ in their attempts to foster a sense of urgency and action among the public. Pessimistic messaging, the thinking goes, undermines engagement efforts, straining credulity and fostering a sense of helplessness, rather than concern. Widespread calls for more optimistic climate change messaging punctuate public discourse. This research puts these claims to the test, investigating how affective endings (optimistic vs. pessimistic vs. fatalistic) of climate change appeals impact individual risk perception and outcome efficacy (i.e., the sense that one’s behavior matters). The findings of three online experiments presented in this paper suggest that climate change appeals with pessimistic affective endings increase risk perception (Studies 1 and 2) and outcome efficacy (Study 3), which is the result of heightened emotional arousal (Studies 1–3). Moreover, the results indicate that the mediating effect of emotional arousal is more prevalent among political moderates and conservatives, as well as those who hold either individualistic or hierarchical world views. Given that these audiences generally exhibit lower risk perception and outcome efficacy in relation to climate change, the results suggest that climate change appeals with pessimistic endings could trigger higher engagement with the issue than optimistic endings. These findings are interpreted in light of recent research findings, which suggest that differences in threat-reactivity and emotional arousal may be attributable to brain functions/anatomy mappable to basic motivations for safety and survival. Implications for scholars and practitioners are discussed

Effect of CD40 and sCD40L on renal function and survival in patients with renal artery stenosis

Activation of the CD40 receptor on the proximal tubular epithelium of the kidney results in fibrosis and inflammation in experimental models of kidney injury. Soluble CD40 ligand is released by activated platelets. The role of CD40-soluble CD40 ligand in patients with ischemic renal disease is unknown. Plasma levels of CD40 and soluble CD40 ligand were measured by enzyme linked immunosorbent assay in a single center cohort of 60 patients with renal artery stenosis recruited from Salford Royal Hospital, Manchester, UK. A natural log transformation of CD40 and soluble CD40 ligand was performed to normalize the data. Estimated glomerular filtration rate was used as the primary indicator of renal function. By univariate analysis low baseline levels of circulating CD40 (R(2)=0.06, p<0.05) and baseline creatinine (R(2)=0.08, p=0.022) were associated with loss of kidney function at one-year follow-up, whereas soluble CD40 ligand was not (R(2)=0.02, p=ns). In a multiple linear regression model CD40 (p<0.02) and baseline creatinine (p<0.01) continued to be significantly associated with a decline in renal function (model R(2)=0.17, p<0.005). Baseline CD40 levels were somewhat lower in patients who died during follow-up (survivors, 7.3 ± 0.9 pg/ml, n=48 vs. non-survivors, 6.7 ± 1.0 pg/ml, n=12, p=0.06). The CD40/soluble CD40 ligand signaling cascade may be a novel mechanism contributing to the development and progression of renal injury in patients with atherosclerotic renal artery stenosis

The efficacy of renal angioplasty in patients with renal artery stenosis and flash oedema or congestive heart failure: a systematic review.

Item does not contain fulltextAIMS: Recent randomized controlled trials have reported that angioplasty does not have a beneficial effect compared with pharmacological treatment on blood pressure and renal function in patients with atherosclerotic renal artery stenosis (RAS). We aimed to explore systematically the evidence that angioplasty is effective in subgroups of patients with RAS and either flash pulmonary oedema or congestive heart failure (CHF) and renal insufficiency. METHODS AND RESULTS: We searched online databases (PubMed and ClinicalTrials.gov) and references of included articles. We included 25 articles describing 79 patients with RAS and flash oedema and seven articles describing 94 patients with RAS, CHF, and renal insufficiency. According to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, the quality of the evidence was, at best, low. Seventy-six per cent of patients with flash oedema did not have any recurrence after angioplasty. Recurrence of symptoms was associated with either restenosis of the renal artery or cardiac arrhythmias in all patients. In the patients with CHF and renal insufficiency, the severity of heart failure symptoms, expressed as New York Heart Association (NYHA) functional class, improved after angioplasty in all included articles. CONCLUSION: The evidence included in this systematic review justifies a weak recommendation in favour of angioplasty in patients with atherosclerotic RAS and either flash pulmonary oedema or CHF and renal insufficiency.1 juli 201