Demographic Scenarios for the EU: Migration, population and education

Over the recent decades, the EU has been shaped by population growth, but now its population is ageing. Together with North America and East Asia, the EU is moving towards longer-living, lower-fertility, and higher-educated societies. Facing this new demographic frontier naturally prompts the questions: Who will live and work in Europe in the coming decades? How many, and with what skills? To answer these, this report examines the key factors that will shape European demographics over the coming decades. By examining not only the role of migration, fertility and mortality, but also education levels and labour force participation rates, a more comprehensive view of possible futures can be outlined than the conventional demographic projections allow for. The first five sections of this report focus on demographic challenges inside the EU, such as population ageing, a shrinking labour force, more non-working people being dependent on working people, and showing the impact of high levels of emigration in some EU Member States. With these challenges in mind and with a view towards 2060, the report builds scenarios to understand the long-term effects of changes in key trends, and whether undesirable consequences can be limited or counteracted. As the EU and its demographics do not exist in isolation, the following sections explore the relevant trends for world demographics and for migration flows

Role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: a position statement on behalf of the Heart Failure Association (HFA), the European Association of Cardiovascular Imaging (EACVI) and the Cardio‐Oncology Council of the European Society of Cardiology (ESC)

Cardiovascular (CV) imaging is an important tool in baseline risk assessment and detection of CV disease in oncology patients receiving cardiotoxic cancer therapies. This position statement examines the role of echocardiography, cardiac magnetic resonance, nuclear cardiac imaging and computed tomography in the management of cancer patients. The Imaging and Cardio‐Oncology Study Groups of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) in collaboration with the European Association of Cardiovascular Imaging (EACVI) and the Cardio‐Oncology Council of the ESC have evaluated the current evidence for the value of modern CV imaging in the cardio‐oncology field. The most relevant echocardiographic parameters, including global longitudinal strain and three‐dimensional ejection fraction, are proposed. The protocol for baseline pre‐treatment evaluation and specific surveillance algorithms or pathways for anthracycline chemotherapy, HER2‐targeted therapies such as trastuzumab, vascular endothelial growth factor tyrosine kinase inhibitors, BCr‐Abl tyrosine kinase inhibitors, proteasome inhibitors and immune checkpoint inhibitors are presented. The indications for CV imaging after completion of oncology treatment are considered. The typical consequences of radiation therapy and the possibility of their identification in the long term are also summarized. Special populations are discussed including female survivors planning pregnancy, patients with carcinoid disease, patients with cardiac tumours and patients with right heart failure. Future directions and ongoing CV imaging research in cardio‐oncology are discussed

Prognostic and Diagnostic Value of Endocan in Kidney Diseases

Endocan, previously called endothelial cell-specific molecule-1, is a soluble proteoglycan that is predominantly expressed in vascular endothelial cells of the lungs and kidneys. It is upregulated by proinflammatory cytokines and plays a critical role in inflammatory, proliferative, and neovascularization processes. The utility of endocan as a biomarker in a wide spectrum of diseases is being increasingly acknowledged. In this review, we summarize the current evidence concerning the role of endocan in kidney diseases, with emphasis on its prognostic and diagnostic value. It seems that the determination of plasma endocan levels may provide useful prognostic information in many types of renal failure such as chronic kidney disease, IgA nephropathy, and diabetic nephropathy. Endocan could additionally improve the early diagnostic evaluation of acute kidney disease, chronic renal allograft injury, and acute rejection after kidney transplantation, thus contributing to endothelial cell injury monitoring in a timely manner. © 2022 Elisabeth Samouilidou et al

Alkaline diet and long term preservation of renal function in stage 5 CKD

Kidneys produce bicarbonate ions that neutralize acids in the blood. Patients suffering from Chronic Kidney Disease (CKD) often present metabolic acidosis, as the kidney can no longer neutralize the acid load. Alkaline diet based on fruits, vegetables and mostly plant protein may have a positive effect on long-term preservation of the renal function in patients with stage 4-5 CKD while maintaining the nutritional status.</p

Does the extracorporeal circulation worsen anemia in hemodialysis patients? Investigation with advanced microscopes of red blood cells drawn at the beginning and end of dialysis

Dimosthenis Stamopoulos,1 Nerantzoula Bakirtzi,2,3 Efthymios Manios,1 Eirini Grapsa41Institute of Advanced Materials, Physicochemical Processes, Nanotechnology and Microsystems, National Center for Scientific Research &#39;Demokritos,&#39; Athens, Greece; 2Department of Nephrology, Hospital &#39;G. Gennimatas,&#39; Athens, Greece; 3Renal Unit, Hospital &#39;Alexandra,&#39; Athens, Greece; 4Renal Unit, Hospital &#39;Aretaieion,&#39; Athens, GreeceBackground: In hemodialysis (HD) patients, anemia relates to three main factors: insufficient production of erythropoietin; impaired management of iron; and decreased lifespan of red blood cells (RBCs). The third factor can relate to structural deterioration of RBCs due to extrinsic (extracorporeal circuit; biochemical activation and/or mechanical stress during dialysis) and intrinsic (uremic milieu; biochemical interference of the RBC membrane constituents with toxins) mechanisms. Herein, we evaluate information accessed with advanced imaging techniques at the cellular level.Methods: Atomic force and scanning electron microscopes were employed to survey intact RBCs (iRBCs) of seven HD patients in comparison to seven healthy donors. The extrinsic factor was investigated by contrasting pre- and post-HD samples. The intrinsic environment was investigated by comparing the microscopy data with the clinical ones.Results: The iRBC membranes of the enrolled HD patients were overpopulated with orifice-like (high incidence; typical size within 100&ndash;1,000 nm) and crevice-like (low incidence; typical size within 500&ndash;4,000 nm) defects that exhibited a statistically significant (P < 0.05) relative increase (+55% and +350%, respectively) in respect to healthy donors. The relative variation of the orifice and crevice indices (mean population of orifices and crevices per top membrane surface) between pre- and post-HD was not statistically significant (&minus;3.3% and +4.5%, respectively). The orifice index correlates with the concentrations of urea, calcium, and phosphorus, but not, however, with that of creatinine.Conclusion: Extracorporeal circulation is not detrimental to the structural integrity of RBC membranes. Uremic milieu is a candidate cause of RBC membrane deterioration, which possibly worsens anemia.Keywords: hemodialysis, anemia, red blood cells, atomic force microscopy, scanning electron microscop

A holistic approach to factors affecting depression in haemodialysis patients

Depression in dialysis populations is affected by co-morbid diseases, such as cardiovascular disease, diabetes, and immune dysfunction, and it also includes high suicide risk and frequent hospitalizations. Depressive disorders have a close association with malnutrition and chronic inflammation, as well as with cognitive impairment. Impaired cognitive function may be manifested as low adherence to dialysis treatment, leading to malnutrition. Additionally, chronic pain and low quality of sleep lead to high rates of depressive symptoms in haemodialysis patients, while an untreated depression can cause sleep disturbances and increased mortality risk. Depression can also lead to sexual dysfunction and non-adherence, while unemployment can cause depressive disorders, due to patients’ feelings of being a financial burden on their family. The present review provides a holistic approach to the factors affecting depression in haemodialysis, offering significant knowledge to renal professionals. © 2018, Springer Science+Business Media B.V., part of Springer Nature