Identifying cisplatin-induced kidney damage in paediatric oncology patients.

Cisplatin is one chemotherapeutic agent used to treat childhood cancer in numerous treatment protocols, including as a single agent. It is likely to remain in clinical use over the long term. However, cisplatin-related toxicities, including neurotoxicity and nephrotoxicity, are common, affecting treatment, day-to-day life and survival of such children. With one in 700 young adults having survived childhood cancer, patients who have completed chemotherapy that includes cisplatin can experience long-term morbidity due to treatment-related adverse reactions. A better understanding of these toxicities is essential to facilitate prevention, surveillance and management. This review article discusses the effect of cisplatin-induced nephrotoxicity (Cis-N) in children and considers the underlying mechanisms. We focus on clinical features and identification of Cis-N (e.g. investigations and biomarkers) and the importance of magnesium homeostasis and supplementation.

Coarse particulate organic matter dynamics in ephemeral tributaries of a Central Appalachian stream network.

Headwater ephemeral tributaries are interfaces between uplands and downstream waters. Terrestrial coarse particulate organic matter (CPOM) is important in fueling aquatic ecosystems; however, the extent to which ephemeral tributaries are functionally connected to downstream waters through fluvial transport of CPOM has been little studied. Hydrology and deposition of leaf and wood, and surrogate transport (Ginkgo biloba leaves and wood dowels) were measured over month-long intervals through the winter and spring seasons (6 months) in 10 ephemeral tributaries (1.3-5.4 ha) in eastern Kentucky. Leaf deposition and surrogate transport varied over time, reflecting the seasonality of litterfall and runoff. Leaf deposition was higher in December than February and May but did not differ from January, March, and April. Mean percent of surrogate leaf transport from the ephemeral tributaries was highest in April (3.6% per day) and lowest in February (2.5%) and May (2%). Wood deposition and transport had similar patterns. No CPOM measures were related to flow frequency. Ephemeral tributaries were estimated to annually contribute 110.6 kg AFDM·km-1·yr-1 of leaves to the downstream mainstem. Ephemeral tributaries are functionally connected to downstream waters through CPOM storage and subsequent release that is timed when CPOM is often limited in downstream waters.

Febrile neutropenia in children treated for malignancy.

Febrile neutropenia (FN) in children treated for malignancy is a common and direct sequela of chemotherapy. Episodes of FN can be life-threatening, and demand prompt recognition, assessment and treatment with broad spectrum antibiotics. While in the majority of episodes no causal infection is identified, 10-20% are secondary to a bloodstream infection (BSI). A reduction in episodes of BSI could be achieved through robust infection prevention strategies, such as CVL care bundles. Alongside good antimicrobial stewardship, these strategies could reduce the risk of emergent, multi-drug resistant (MDR) infections. Emerging bacterial pathogens in BSI include Viridans Group Streptococci (VGS) and Enterobacteriaceae such as Klebsiella spp. which are known for their ability to carry MDR genes. There is also increased recognition of the role of invasive fungal infection (IFI) in FN, in particular with Aspergillus spp. Novel diagnostics, including multiplex blood and respiratory polymerase chain reaction assays can identify infections early in FN, facilitating targeted therapy, and reducing unnecessary antimicrobial exposure. Given appropriate, and sensitive rapid diagnostics, potential also exists to safely inform the risk assessment of patients with FN, identifying those at low risk of complication, who could be treated in the out-patient setting. Several clinical decision rules (CDR) have now been developed and validated in defined populations, for the risk assessment of children being treated for cancer. Future research is needed to develop a universal CDR to improve the management of children with FN.