EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Inventaire biologique de la forêt de Tsinjoarivo, Ambatolampy

International audienc

Extinction Risks and the Conservation of Madagascar's Reptiles

<div><p>Background</p><p>An understanding of the conservation status of Madagascar's endemic reptile species is needed to underpin conservation planning and priority setting in this global biodiversity hotspot, and to complement existing information on the island's mammals, birds and amphibians. We report here on the first systematic assessment of the extinction risk of endemic and native non-marine Malagasy snakes, lizards, turtles and tortoises.</p><p>Methodology/Principal Findings</p><p>Species range maps from The IUCN Red List of Threatened Species were analysed to determine patterns in the distribution of threatened reptile species. These data, in addition to information on threats, were used to identify priority areas and actions for conservation. Thirty-nine percent of the data-sufficient Malagasy reptiles in our analyses are threatened with extinction. Areas in the north, west and south-east were identified as having more threatened species than expected and are therefore conservation priorities. Habitat degradation caused by wood harvesting and non-timber crops was the most pervasive threat. The direct removal of reptiles for international trade and human consumption threatened relatively few species, but were the primary threats for tortoises. Nine threatened reptile species are endemic to recently created protected areas.</p><p>Conclusions/Significance</p><p>With a few alarming exceptions, the threatened endemic reptiles of Madagascar occur within the national network of protected areas, including some taxa that are only found in new protected areas. Threats to these species, however, operate inside and outside protected area boundaries. This analysis has identified priority sites for reptile conservation and completes the conservation assessment of terrestrial vertebrates in Madagascar which will facilitate conservation planning, monitoring and wise-decision making. In sharp contrast with the amphibians, there is significant reptile diversity and regional endemism in the southern and western regions of Madagascar and this study highlights the importance of these arid regions to conserving the island's biodiversity.</p></div

The 22 Critically Endangered species of Malagasy reptiles.

<p>The 22 Critically Endangered species of Malagasy reptiles.</p

Percentage of reptile species' range represented in all Madagascar Protected Areas by IUCN Red List Category.

<p>Dotted line indicates grand mean and black short lines indicate mean percentage of range protected in each IUCN Red List Category.</p

The number of Malagasy reptile species in each family assigned to the IUCN Red List categories.

<p>The number of Malagasy reptile species in each family assigned to the IUCN Red List categories.</p

Species richness, species richness of threatened species, and range-size rarity calculated separately for five major Madagascan reptile groups.

<p>See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0100173#s2" target="_blank">Materials and Methods</a> for an explanation of the metrics used.</p

Major ongoing threats currently affecting Madagascar's reptiles.

<p>Major ongoing threats currently affecting Madagascar's reptiles.</p

Spatial patterns for all reptile species included in this assessment.

<p>A) species richness; B) richness of threatened species; C) residuals of the relationship between threatened species and total number of species (positive values were mapped in red, indicating cells that have more threatened species than expected for their richness alone, and equal or negative values in gray, indicating cells that have the same or fewer threatened species as/than expected for richness alone); D) richness of range-size rarity.</p