Surgical Management of Autosomal Dominant Polycystic Kidney Disease: Principles and Current Practice.

Autosomal dominant polycystic kidney disease is the third most common cause of renal failure with no definitive treatment available that can directly target the development and growth of the cysts. Endeavours are being made to retard the growth of the cysts and preservation of renal function through medical treatment. However, 50% of the autosomal dominant polycystic kidney disease-affected persons develop complications and end-stage renal disease by the age of fifty-five and need surgical intervention for the management of complications, creation of dialysis access and renal transplantation. This review highlights the principles and current practice pertinent to the surgical management of autosomal dominant polycystic kidney disease. Keywords: polycystic kidney disease; nephrectomy; transplantation.

Brain Death and Organ Donation.

N/A.

Changes in Blood Pressure and Arterial Hemodynamics following Living Kidney Donation.

BACKGROUND AND OBJECTIVES: The Effect of a Reduction in GFR after Nephrectomy on Arterial Stiffness and Central Hemodynamics (EARNEST) study was a multicenter, prospective, controlled study designed to investigate the associations of an isolated reduction in kidney function on BP and arterial hemodynamics. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Prospective living kidney donors and healthy controls who fulfilled criteria for donation were recruited from centers with expertise in vascular research. Participants underwent office and ambulatory BP measurement, assessment of arterial stiffness, and biochemical tests at baseline and 12 months. RESULTS: A total of 469 participants were recruited, and 306 (168 donors and 138 controls) were followed up at 12 months. In the donor group, mean eGFR was 27 ml/min per 1.73 m2 lower than baseline at 12 months. Compared with baseline, at 12 months the mean within-group difference in ambulatory day systolic BP in donors was 0.1 mm Hg (95% confidence interval, -1.7 to 1.9) and 0.6 mm Hg (95% confidence interval, -0.7 to 2.0) in controls. The between-group difference was -0.5 mm Hg (95% confidence interval, -2.8 to 1.7; P=0.62). The mean within-group difference in pulse wave velocity in donors was 0.3 m/s (95% confidence interval, 0.1 to 0.4) and 0.2 m/s (95% confidence interval, -0.0 to 0.4) in controls. The between-group difference was 0.1 m/s (95% confidence interval, -0.2 to 0.3; P=0.49). CONCLUSIONS: Changes in ambulatory peripheral BP and pulse wave velocity in kidney donors at 12 months after nephrectomy were small and not different from controls. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: NCT01769924 (https://clinicaltrials.gov/ct2/show/NCT01769924).

The Declaration of Helsinki on Medical Research involving Human Subjects: A Review of Seventh Revision.

The pinnacle of success achieved by the medical science and the benefits accrued to the patients have become possible through the medical research where human participants in the research are exposed to hazards inherent to the experiments. To protect the human subjects and to maintain high ethical standards, the World Medical Association has adopted "The Declaration of Helsinki" in 1964. After two years of consultation with the experts throughout the world, the seventh revision of the Declaration was adopted on 19th October 2013 in Brazil. The aim of this article is to review the seventh revision of the Declaration of Helsinki in relation to medical research involving human subjects and highlight the amendments made in the latest revision which are relevant to clinical research in human subjects. The latest revision has made four substantial changes on the existing Declaration, whch include dealing with the compensation of the trial-related injuries, approval of use of placebos in the clinical trials, protection of vulnerable groups and the post-trial provisions. The implications of these amendments in the clinical research are highlighted. Keywords: Consent; Declaration of Helsinki; ethics; experimental medicine; research; seventh revision.

Flood hazard mapping and assessment in data-scarce Nyaungdon area, Myanmar.

Torrential and long-lasting rainfall often causes long-duration floods in flat and lowland areas in data-scarce Nyaungdon Area of Myanmar, imposing large threats to local people and their livelihoods. As historical hydrological observations and surveys on the impact of floods are very limited, flood hazard assessment and mapping are still lacked in this region, making it hard to design and implement effective flood protection measures. This study mainly focuses on evaluating the predicative capability of a 2D coupled hydrology-inundation model, namely the Rainfall-Runoff-Inundation (RRI) model, using ground observations and satellite remote sensing, and applying the RRI model to produce a flood hazard map for hazard assessment in Nyaungdon Area. Topography, land cover, and precipitation are used to drive the RRI model to simulate the spatial extent of flooding. Satellite images from Moderate Resolution Imaging Spectroradiometer (MODIS) and the Phased Array type L-band Synthetic Aperture Radar-2 onboard Advanced Land Observing Satellite-2 (ALOS-2 ALOS-2/PALSAR-2) are used to validate the modeled potential inundation areas. Model validation through comparisons with the streamflow observations and satellite inundation images shows that the RRI model can realistically capture the flow processes (R2 ≥ 0.87; NSE ≥ 0.60) and associated inundated areas (success index ≥ 0.66) of the historical extreme events. The resultant flood hazard map clearly highlights the areas with high levels of risks and provides a valuable tool for the design and implementation of future flood control and mitigation measures.

Impact Factor of Medical Journals.

Impact factor, which is a measure of the frequency of citation of articles published in a journal over a specified time, measures the rank or importance of a journal.  There is a trend towards publication of high quality research in journals with high impact factor. This paper has outlined the importance, method of calculation, clinical implications, pitfalls and financial issues related to the impact factor of medical journals.

Open mesh versus suture repair of umbilical hernia: Meta-analysis of randomized controlled trials.

BACKGROUND: The optimal methodology of surgical treatment of umbilical hernia in adults remains controversial. Previously published randomized controlled trials (RCTs) and cohort studies have demonstrated advantage for open mesh over suture repair. Two published meta-analyses, including RCTs and retrospective cohort studies, have compared the outcomes of open mesh versus suture repair of umbilical hernia in adult, which were flawed since they included both elective and emergency repairs of umbilical hernias. The aim of this meta-analysis is to include RCTs to examine whether open mesh repair of umbilical hernia produces a better outcome than suture repair in adult patients. METHODS: A literature search using Medline, Embase and Cochrane Database was performed, and meta-analysis was performed using RevMan 5.3.5 software. Outcomes evaluated incidence of hernia recurrence, wound infection, haematoma, seroma and patient death. RESULTS: Of the 620 records identified, 4 RCTs, including 620 patients, were included in the meta-analysis. In the RCTS, when open mesh repair was compared with suture repair, open mesh repair was associated with significantly low incidence of recurrence (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.10-0.48; P = 0.0001). The incidence of wound infection (OR 0.89, 95% CI 0.35-2.31; P = 0.82), haematoma (OR 0.83, 95% CI 0.28-2.41; P = 0.73), and seroma (OR 2.01, 95% CI 0.82-4.91; P = 0.13), were similar between the two groups. CONCLUSIONS: Open mesh repair was associated with significant reduction in the recurrence rate in comparison to suture repair of umbilical hernia.