Opening an onconephrology clinic: Recommendations and basic requirements

Onconephrology is a rapidly evolving subspeciality that covers all areas of renal involvement in cancer patients. The complexity of the field may benefit from well-defined multidisciplinary management administered by a dedicated team. Since there is an increasing need to address the needs of this population in dedicated outpatient clinics, it is critical to highlight basic characteristics and to suggest areas of development. In this brief perspective article, we analyse the requirements of an onconephrology clinic in terms of logistics, critical mass of patients and building a multidisciplinary team. We will further discuss which patients to refer and which conditions to treat. The last part of the article is dedicated to education and performance indicators and to analysis of the potential advantages of applying the hub-and-spoke model to this field. The ultimate aim of this experience-based article is to initiate debate about what an onconephrology outpatient clinic might look like in order to ensure the highest quality of care for this growing population of patients

Opening an onconephrology clinic: recommendations and basic requirements

Onconephrology is a rapidly evolving subspeciality that covers all areas of renal involvement in cancer patients. The complexity of the field may benefit from well-defined multidisciplinary management administered by a dedicated team. Since there is an increasing need to address the needs of this population in dedicated outpatient clinics, it is critical to highlight basic characteristics and to suggest areas of development. In this brief perspective article, we analyse the requirements of an onconephrology clinic in terms of logistics, critical mass of patients and building a multidisciplinary team. We will further discuss which patients to refer and which conditions to treat. The last part of the article is dedicated to education and performance indicators and to analysis of the potential advantages of applying the hub-and-spoke model to this field. The ultimate aim of this experience-based article is to initiate debate about what an onconephrology outpatient clinic might look like in order to ensure the highest quality of care for this growing population of patients

Modélisation de l'entretien du paysage par des herbivores en moyenne montagne : une approche multi-agents

L'abandon de l'utilisation des ressources herbagères par l'activité pastorale entraîne un appauvrissement de la diversité écologique et spécifique. A terme, cette évolution se traduit par le déplacement des activités humaines hors de ces zones et à un déséquilibre au niveau du territoire national. Un programme de recherche pluridisciplinaire, dans le cadre d'un Groupement d'intérêt Scientifique, a été mis en place dès 1994 pour élaborer de nouveaux modes de gestion qui concilient production agricole et entretien de l'espace en condition de sous chargement (peu d'animaux par unité de surface). Cet article s'inscrit dans une démarche d'acquisition de méthodes afin d'expérimenter des techniques de gestion de pâturage mixte bovins et chevaux selon une hypothèse de complémentarité entre ces deux espèces. La partie informatique présentée vise à simuler les dynamiques animales, végétales et paysagères futures et, à terme, proposer des protocoles de gestion aptes à répondre à ces nouvelles demandes. L'objectif de la modélisation que nous présentons est de simuler le fonctionnement de l'estive, afin de comprendre l'interaction entre l'évolution de la végétation, les déplacements et les actions des animaux en pâture. Un des modes de simulation utilise un système multi-agents. Le modèle conceptuel de la simulation est en cours de validation, il a été formalisé avec la notation graphique du langage de modélisation unifié (UML) et la version actuelle du logiciel est implémentée avec le langage de programmation Java. Pour suivre et enregistrer les localisations des animaux sur le terrain, ceux-ci sont équipés d'un récepteur satellite GPS (Global Positioning System). L'activité de pâturage des animaux est enregistrée par des colliers Ethosys. / The surrender of herbaceous resources by the grazing activity results in an impoverishment of both ecological and specific diversity. On the long term, this trend imposes the localization of human activities far from these zones and a national imbalance. A multidisciplinary research program was set up in 1994 with the aim of elaborating new ways of management, which would contribute to maintain both the productivity and the opened landscapes within the condition of low grazing pressure. This paper exposes the methods we elaborated in order to test several management techniques of grasslands by mean of cattle and horses within the hypothesis of complementarity between these two species. The computer science part of this paper presents the results of simulations of future dynamic behaviors of the animals, vegetation and landscape, in order to propound some management protocols. The simulator is based on a multi-agent system. The conceptual model, formalized with Unified Modeling Language graphical notation is actually in validation phase and the implementation of the software was done in the Java programming language. The following of the animals in the field was done by means of GPS equipments and the animal activity was recorded by Ethosys equipments

Hydrogenation processes at the surface of ruthenium nanoparticles: A NMR study

1022-5528The reactivity of ruthenium nanoparticles stabilized by 4-(3-phenylpropyl)pyridine in hydrogen transfer and hydrogenation processes was monitored by NMR spectroscopy. Unsaturated substrates such as styrene, 4-vinylpyridine and 4-phenyl-but-3-en-2-one were used as model molecules to investigate the surface properties of nanoparticles by a combination of NMR studies. Interestingly, the hydrides present at the metallic surface after nanoparticles synthesis are selectively transferred to vinylic groups without reducing the aromatic rings, under dihydrogen-free atmosphere. DOSY and NOE NMR experiments permitted to propose a way of interaction of the organic compounds at the metallic surface. In particular, the coordination of the substrate could be evidenced for 4-vinylpyridine and 4-ethylpyridine but not for styrene derivatives. Curved double arrows represent magnetization exchanges. Straight arrows represent adsorption/desorption phenomena

Membranous glomerulonephritis as a novel paraneoplastic syndrome in a young man with chronic myeloid leukemia

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Renal adverse effects of immune checkpoints inhibitors in clinical practice: ImmuNoTox study

International audienceBackground/objectives: Acute Kidney Injury (AKI), induced by Checkpoint Inhibitors therapies (CPI-induced AKI), is an uncommon but severe Immune-Related Adverse Event (IRAE). The aim was to describe the epidemiology, risks factors, clinical, and laboratory characteristics of these renal adverse events (AEs) in a real-life cohort treatment.Design/participants: Consecutive patients undergoing a checkpoint inhibitor (CPI) therapy at the Hopital Lyon Sud from January 2015 to July 2017 were included. A systematic retrospective analysis of medical files was performed, monthly serum creatinine levels, associated treatments, and occurrence of other IRAEs data were collected. AKI episodes explained by classic AKI aetiologies (prerenal, obstructive, septic) were excluded from the analysis.Results: CPI-induced AKI incidence was 3.7% (13/ 352) and appeared to be time- dependent (7.7% (11/143) for patients with >3 months of CPI exposure), ranging from 1 to 16 months. All cases with available histology were acute tubulointerstitial nephritis (ATIN), with poor urinary sediment. The severity of AKI was mild (stage 1 in 50% of cases), with no need for renal-replacement therapy. Although CPI-induced AKI patients had more frequently other IRAEs (77% versus 39%), this was not associated with a greater risk of AKI. Pre-existing chronic kidney disease (defined as an estimated glomerular filtration rate (eGFR) <60 ml/ min) was not associated with a greater risk of CPI-induced AKI. Treatments of CPIinduced AKI were heterogeneous, with discontinuation of CPIs, and inconstant systemic corticosteroid therapy.Conclusion: The monitoring of renal function and early identification of AKI during CPIs treatment is essential. The optimal management of CPI-induced AKI remains unclear and requires a close collaboration between the oncology and nephrology departments

In Hemodialysis Patients, Intradialytic Resistance Exercise Improves Osteoblast Function: A Pilot Study

International audienceOBJECTIVE: Abnormalities in mineral and bone metabolism are frequent in chronic kidney disease patients. Physical exercise can improve many indicators of physical functioning, and recent studies showed beneficial effects on bone mineral density in the general population. The aim of this study was to evaluate the effects of resistance exercise training on bone markers and body composition in hemodialysis (HD) patients. DESIGN: This was a randomized controlled trial. SUBJECTS: The study included 13 HD patients (46.2% men). INTERVENTION: Patients were divided into a control group and an exercise group, which performed 8 weeks of intradialytic resistance exercise. Serum sclerostin, bone alkaline phosphatase (BAP), insulin, leptin, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and body composition were measured before and after the exercise period. RESULTS: In the exercise group, BAP levels increased from 11.4 +/- 6.5 to 14.6 +/- 6.4 U/L (P \textless .05) and serum 1,25-dihydroxyvitamin D levels from 46.0 +/- 23.5 to 87.2 +/- 31.8 ng/mL (P \textless .05). After exercise, serum BAP levels were inversely correlated with serum sclerostin (r = -0.96, P \textless .05). There was no change in body composition in either group. CONCLUSION: Resistance exercise training appears to be an interesting approach for stimulating BAP production in HD patients and may prevent bone loss and stimulate bone formation