Steroid-resistant idiopathic nephrotic syndrome in children: long-term follow-up and risk factors for end-stage renal disease

INTRODUTION: Steroid resistant idiopathic nephrotic syndrome (SRINS) in children is one of the leading causes of progression to chronic kidney disease stage V (CKD V)/end stage renal disease (ESRD). OBJECTIVE: The aim of this retrospective study is to evaluate the efficacy of immunosuppressive drugs (IS) and to identify risk factors for progression to ESRD in this population. METHODS: Clinical and biochemical variables at presentation, early or late steroid resistance, histological pattern and response to cyclosporine A (CsA) and cyclophosfamide (CP) were reviewed in 136 children with SRINS. The analyzed outcome was the progression to ESRD. Univariate as well as multivariate Cox-regression analysis were performed. RESULTS: Median age at onset was 5.54 years (0.67-17.22) and median follow up time was 6.1 years (0.25-30.83). Early steroid-resistance was observed in 114 patients and late resistance in 22. Resistance to CP and CsA was 62.9% and 35% respectively. At last follow-up 57 patients reached ESRD. The renal survival rate was 71.5%, 58.4%, 55.3%, 35.6% and 28.5% at 5, 10, 15, 20 and 25 years respectively. Univariate analysis demonstrated that older age at onset, early steroid-resistance, hematuria, hypertension, focal segmental glomerulosclerosis (FSGS), and resistance to IS were risk factors for ESRD. The Cox proportional-hazards regression identified CsAresistance and FSGS as the only predictors for ESRD. CONCLUSION: Our findings showed that CsA-resistance and FSGS were risk factors for ESRD.

Purple urine bag syndrome in end-stage chronic kidney disease

Introduction: When faced with violet, purple or purplish-blue urine, clinicians should consider urinary tract infection in their differential diagnosis. Case report: A 60-year-old woman with end-stage kidney disease and non-adherence to renal replacement therapy was admitted to our hospital for placement of hemodialysis catheter. During her hospitalization she had purple urine, and purple urine bag syndrome (PUBS) was diagnosed. She was effectively treated with antibiotics and her urine returned to a dark yellow color. Discussion: Although this condition is often easily treated, diagnosing PUBS in chronic renal patients probably means an increased serum concentration of indoxyl sulfate, metabolite that is involved in the progression of both CKD and cardiovascular disease. Conclusion: Hence, in the context of our renal patients, perhaps PUBS is not as benign as supposed.

Erythropoietin resistance in end-stage renal disease patient with gastric antral vascular ectasia

AbstractWe observed a case of recombinant human erythropoietin resistance caused by Gastric Antral Vascular Ectasia in a 40-year-old female with ESRD on hemodialysis. Some associated factors such as autoimmune disease, hemolysis, heart and liver disease were discarded on physical examination and complementary tests. The diagnosis is based on the clinical history and endoscopic appearance of watermelon stomach. The histologic findings are fibromuscular proliferation and capillary ectasia with microvascular thrombosis of the lamina propria. However, these histologic findings are not necessary to confirm the diagnosis. Gastric Antral Vascular Ectasia is a serious condition and should be considered in ESRD patients on hemodialysis with anemia and resistance to recombinant human erythropoietin because GAVE is potentially curable with specific endoscopic treatment method or through surgical procedure.

Erythropoietin resistance in end-stage renal disease patient with gastric antral vascular ectasia

AbstractWe observed a case of recombinant human erythropoietin resistance caused by Gastric Antral Vascular Ectasia in a 40-year-old female with ESRD on hemodialysis. Some associated factors such as autoimmune disease, hemolysis, heart and liver disease were discarded on physical examination and complementary tests. The diagnosis is based on the clinical history and endoscopic appearance of watermelon stomach. The histologic findings are fibromuscular proliferation and capillary ectasia with microvascular thrombosis of the lamina propria. However, these histologic findings are not necessary to confirm the diagnosis. Gastric Antral Vascular Ectasia is a serious condition and should be considered in ESRD patients on hemodialysis with anemia and resistance to recombinant human erythropoietin because GAVE is potentially curable with specific endoscopic treatment method or through surgical procedure.

Seed moisture range in a soybean plant

It is common to see in any soybean plant that seeds reach maturity at different times. Thus the objective of the present study was to determine the magnitude of the seed moisture range at different stages of maturation in a soybean plant. The field study was conducted in a tropical region in the state of Mato Grosso - Brazil, established with foundation seeds of the MTBR-45 cultivar, and at flowering, 100 plants were marked at the same maturity stage. Harvesting began when seeds still were at high moisture content (MC). At each of eight harvesting times, during 16 days, all pods from two plants were harvested and the seeds from each pod were hand threshed individually and determined the moisture content . The results revealed that there is a great distribution of seed MC in a soybean plant, where at physiological maturity, the magnitude can reach more than 30 percentage points. Also, even with an average MC below 12%, there were more than 20 % of the seeds with MC above 13% and some seeds at this point had been waiting to be harvested for more than a week. The following conclusions and/or recommendations can be taken: 1- The great seed MC range in a soybean seed lot harvested at field maturity leads to the presence of seeds susceptible to mechanical damage and with MC unsafe for adequate storage; 2 - It is recommended that harvesting be accomplished when the seeds are in the 15-18% MC range, in order to minimize field deterioration and the percentage of seeds with high MC; 3- Drying is recommended, even when soybean seeds are in their average MC safe for storage.

Modulaarisen sylinterin kokoonpanon automatisointi

Yrityksen harkitessa tuotteidensa kokoonpanon automatisoinnin implementointia, tulee automatisoitavan tuotteen kokoonpanon soveltuvuutta automaattiseen kokoonpanoon tutkia yksityiskohtaisesti. Tällöin mahdollisten investointien päätöksenteon tueksi suoritetaan usein automatisoinnin toteutettavuustutkimus. Tutkimuksen tavoitteena on arvioida tutkittavan tuotteen soveltuvuutta uuteen prosessiin, sekä arvioida ehdotetun järjestelmän suorituskykyä ja kannattavuutta. Ideaali tilanteessa yritys aloittaa tuotteen automatisoinnin toteutettavuustutkimuksen jo tuotteen tuotesuunnitteluvaiheessa, jolloin suuri osa tuotteet automatisointiin liittyvistä ongelmista voidaan havaita ja eliminoida mahdollisimman aikaisessa vaiheessa. Työn tavoitteena oli tutkia Abloy Oy:n uuden avainpesätuotteen lukkosylinterin kokoonpanon automatisoinnin toteutettavuutta ja kannattavuutta. Työ toteutettiin tuotteen tuotesuunnittelunprosessin loppuvaiheessa, jolloin tuotteen kokoonpanon automatisointia vaikeuttaviin ominaisuuksiin voitiin vielä puuttua. Tutkimus perustui tuotteen soveltuvuuden tutkimisen osalta pääosin Geoffrey Boothroydin DFA -metodin periaatteisiin. Automaattisen kokoonpanon kannattavuutta tutkittiin yhteistyössä eurooppalaisten automaatiovalmistajien kanssa. Tutkimuksen avulla tuotteen kokoonpantavuutta pystyttiin parantamaan. Koonpantavuutta parannettiin yhdistämällä osa pienistä osista yhdeksi isommaksi kokonaisuudeksi. Lisäksi tuotteen kokoonpantavuutta edistettiin suunnittelemalla kokoonpanojigi kokoonpanon helpottamiseksi. Tuotteen automaattiselle kokoonpanolle löydettiin kaksi potentiaalista konseptia joiden pohjalta projektia aiotaan jatkaa tuotteen kokoonpanon automatisoimiseksi.

Droplet Deposition in the Last Stage of Steam Turbine

During the expansion of steam in turbine, the steam crosses the saturation line and hence subsequent turbine stages run under wet condition. The stages under wet condition run with low efficiency as compared to stages running with supersaturated steam and the life of the last stage cascade is reduced due to erosion. After the steam crosses the saturation line it does not condense immediately but instead it becomes supersaturated which is a meta-stable state and reversion of equilibrium results in the formation of large number of small droplets in the range of 0.05 - 1 μm. Although these droplets are small enough to follow the stream lines of vapor however some of the fog droplets are deposited on the blade surface. After deposition they coagulate into films and rivulets which are then drawn towards the trailing edge of the blade due to viscous drag of the steam. These large droplets in the range of radius 100 μm are accelerated by steam until they impact on the next blade row causing erosion. The two phenomenon responsible for deposition are inertial impaction and turbulent-diffusion. This work shall discuss the deposition mechanism in steam turbine in detail and numerically model and validate with practical data.

Crowdfunding as a new funding alternative for early stage start-ups

Attracting outside capital is a common problem for start-up companies. Capital markets define the funding options for companies and firms which suffer the most from these capital market imperfections are small start-up companies. Therefore it is important to study any new funding model which can offer a new solution to this inefficiency of capital markets. This study explains the traditional funding models for start-ups such as founders, friends & family, banks, business angels and venture capitalist. After giving background to traditional start-up funding this study delves into crowfunding (CF) and introduces it as a new funding method. The objective of the thesis is to answer one broad research question: Why and how should start-up companies use CF as an alternative funding method? To properly delve into this, this question has the following sub-questions: What kind of funding alternatives do start-up companies have? What are the pros and cons of CF compared to other funding options? How can start-ups benefit from CF? This study gives background on the rise of CF and the reasons why this new model is needed. Author will explain the different components of CF such as platforms, crowdfunders and projects. Also benefits and challenges of the crowdfunding model are investigated. As a new funding model CF has had to clear out many obstacles from its way. These are, for example, legal and regulatory issues as well education of crowd investors to understand this new investment option. . Start-up entrepreneurs can gain valuable insight from this study. The author has attempted to form best practices and guidelines of how to operate in the CF environment. This study was conducted by performing expert interviews, collecting data from previous studies and performing a content analysis of successful crowdfunding cases. Main findings from the study were that CF has huge potential in funding entrepreneurial projects. It is still a niche way for funding but growing rapidly. CF is earning its place among traditional funding options and has potential to fund projects which otherwise would struggle to find funding. With CF entrepreneur can tap into geographically diverse audience. It is a powerful validation tool for products and ideas and has the power to bring democratic elements to entrepreneurial funding.

1970 Convocation Stage

View of the Convocation Stage during the May 26, 1970 ceremonies.

Foundation

View of the construction of the foundations in November 1971.

Pool Foundation

Exposed escarpment rock during the construction of the pool.

Foundation Work

Work on the foundation for the Aquatic Centre around 1980.

Aquatic Centre Foundation

The steel, rock, and conrete foundation of the Aquatic Centre.