bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic factors and early resumption of cyclosporin A in renal allograft recipients with thrombotic microangiopathy and hemolytic uremic syndrome
Authors: Wiener Yaron , Nakhleh Raouf E. , Lee Min W. , Escobar Francisco S. , Venkat K. K. , Kupin Warren L. , Mozes Martin F.
Published: September 2024

Biopsy‐proven thrombotic microangiopathy (TMA) was found in 22 of 436 (5%) renal transplant recipients, with similar incidence in recipients of cadaver or living related allografts. All patients with TMA presented different degrees of severity of the hemolytic uremic syndrome (HUS). Prognosis was poor when HUS occurred shortly after transplant in recipients of cadaveric kidneys (55% graft loss). It was more favorable when HUS occurred later in the post‐transplant course or in recipients with allografts from living related donors, irrespective of time of occurrence. Other factors such as extent of TMA, degree of thrombocytopenia, hemolysis or renal dysfunction were not predictive of graft loss. Cyclosporine was resumed in 14 of 16 recipients shortly after clinical recovery without recurrence of HUS. In conclusion, HUS carries poor prognosis when occurring shortly after transplant in cadaver kidney recipients. Once the graft function. improves, cyclosporine can be safely resumed.
Clostridial infection of a liver transplant treated with retransplantation
Authors: Knechtle Stuart J. , Babalola John A. , D'Alessandro Anthony M. , Pirsch John D. , Kalayoglu Munci
Published: September 2024

Clostridial infection of a liver transplant is reported and was treated successfully with immediate retransplantation and antibiotics. This strategy may salvage patients who otherwise have a fulminant course and certain death. This case supports the general principle that infection localized to the liver can be successfully treated with retransplantation when appropriate.
Three‐dimensional helical computed tomographic cholangiography: application to living related hepatic transplantation
Authors: Cheng Yu Fan , Lee Tze Yu , Chen Chao Long , Huang Tung Liang , Chen Yaw Sen , Lui Chun Chung
Published: September 2024

Variations in the anatomy of intrahepatic bile ducts complicate operations in living related hepatic transplantation (LRHT). Preoperative delineation of the biliary system is important to achieve successful results. The purpose of this study was to assess the utility and accuracy of three‐dimensional helical computed tomographic cholangiography (3DHCTC) as a replacement for endoscopic retrograde cholangiography (ERC) in evaluating the anatomy of the intersegmental biliary connection of the potential donors in LRHT. Helical CT was performed in 16 potential donors after a slow infusion of 100 cm3 meglumine iodipamide. By using the maximum intensity projection and shaded surface displaced image reconstruction technique, three‐dimensional images of the bile ducts were isolated from the surrounding hepatic parenchyma. Among the 16 potential donors, 3 cases underwent an ERC study and another 7 cases donated liver graft during LRHT. In all 16 cases the anatomy of the bilateral essential intrahepatic ducts was well displayed with and without the liver parenchyma background in an axial and three‐dimensional fashion which had good correlation with images from ERC and intra‐operative cholangiography. Two variants were found, including drainage of the right posterior intrahepatic duct into the left hepatic duct and direct drainage of the segment II bile duct into the common hepatic duct, respectively. It is concluded that unusual routes of intrahepatic ducts may necessitate a change in the cutting plane during graft retrieval and patterns of ductoenteral anastomosis to avoid potential complications to both donors and recipients. With the advantages of non‐invasiveness and comparable accuracy in demonstrating biliary anatomy, 3DHCTC may replace the traditional ERC in the pre‐transplant survey of potential donors for LRHT.
Regional vs. national renal sharing organizations: pros and cons
Authors: Bertoni Elisabetta , Carmellini Mario , Bandini Sandro , Tosi Pierluigi , Zanazzi Maria , Rosati Alberto , Pradella Fabio , Fossombroni Vittorio , Rindi Paolo , Rizzo Gaetano , Mattiuz Pierluigi , Mosca Franco , Salvadori Maurizio
Published: September 2024

Delayed graft function, defined as the need of dialysis in the first week after transplantation, neither due to immunological nor technical causes, determines a poor outcome of renal grafts. Delayed graft function is related to the cold ischemia time, which is shorter in local allocation programs. These, however, do not assure an optimal HLA‐A,B,DR matching that can be provided by national allocation organizations.

We reviewed 160 cadaveric kidney grafts performed in our local transplant network. Owing to the long waiting list caused by organ shortage, we were able to ensure both a high‐grade histocompatibility and short cold ischemia times. The mean HLA‐B,DR mismatch was 1.17. Cold ischemia time was < 24 h in 85% of cases. The incidence of DGF was 23.1%. In our experience a regional sharing program in the case of organ shortage provides good graft outcome (86.9% graft survival at 1 yr) with low incidence of delayed graft function.
Bloodstream infections in liver transplant recipients receiving tacrolimus
Authors: Singh Nina , Gayowski Timothy , Wagener Marilyn M. , Marino Ignazio R.
Published: September 2024

The microbial origin, timing, risk factors, and outcome of bloodstream infections (bacteremia and fungemia) were prospectively analyzed in 130 consecutive liver transplant recipients receiving tacrolimus‐based immunosuppression; median followup was 3 yr. 22% (29/130) of the patients developed 36 episodes of bloodstream infections (0.28 episodes/patient). Bloodstream infections accounted for 36% (36/100) of all major infections. 81% (29/36) of bloodstream infections were due to bacteremia and 19% (7/36) due to fungemia (candidemia 14% and cryptococcemia 5%). Intravascular catheters were the most frequent source and methicillin‐resistantStaphylococcus aureuswas the most frequent pathogen causing bloodstream infections. 70% of the catheter related and all bacteremias due to intra‐abdominal infections occurred ≤ 90 d, whereas 75% of the bacteremias due to biliary source occurred > 90 d after transplantation. Length of initial post‐transplant intensive care unit stay (p = 0.014) and readmission to the intensive care unit (p = 0.003) were independently significant predictors of bloodstream infections. 40% of the candidemias occurred within 30 d of transplantation and were of unknown portal, whereas the portal in all candidemias occurring > 30 d post‐transplant was known (catheter, hepatic abscess, urinary tract). Mortality in patients with bloodstream infections was 52% (15/29) vs. 9% (9/101) in patients without bloodstream infections (p = 0.0001). In conclusion, intravascular catheters (and not intra‐abdominal infections) have emerged as the most common source of bloodstream infections, and gram‐positive cocci (S. aureus) as the predominant pathogens in bloodstream infections after liver transplantation.
Quality of life of hepatitis B and C patients after liver transplantation
Authors: Dickson Rolland C. , Wright Rollin M. , Bacchetta Matthew D. , Bodily Samuel E. , Caldwell Stephen H. , Driscoll Carolyn J. , Pruett Timothy L. , Ishitani Michael B.
Published: September 2024

Liver transplantation is an accepted treatment for end‐stage liver disease due to hepatitis C (HCV), but remains controversial for patients with hepatitis B (HBV). Recently, the use of aggressive hepatitis B immunoglobulin (HBIg) to maintain hepatitis B surface antibody (anti‐HBs) titers greater than 500 IU/L has been reported to improve outcome of transplantation for hepatitis B. The aim of this study was to compare the quality of life of patients transplanted for HBV using this regimen of HBIg immunoprophylaxis (group 1) to patients transplanted for HCV (group 2). The State‐Trait Anxiety Inventory (STAI), Sickness Impact Profile (SIP), and a work survey were administered to two groups of patients. The STAI measured anxiety while the SIP evaluated physical and psychosocial function. Lower scores indicated less anxiety and dysfunction. Questions regarding hours worked prior to illness and hours worked after transplantation were administered to both groups. Group 1 included a majority of patients who were hepatitis B e antigen (HBeAg) positive prior to transplantation. Survey response was 13: 16 (81%) for group 1; and 17: 24 (72%) for group 2. Group 1 revealed significantly lower scores than group 2 on the STAI and the overall SIP score. Group 1 reported working similar hours after transplantation as prior to illness while group 2 did not. Thus, patients transplanted for HBV and treated with aggressive HBIg immunoprophylaxis attained a higher quality of life than patients transplanted for HCV.
Predictors of progression of diabetic nephropathy: implication for timing of kidney transplantation
Authors: Cheng Stephen S. , Wilson David M. , Munn Stephen R.
Published: September 2024

Multiple risk factors are important predictors in the development of diabetic nephropathy (DN). Once DN has developed, it progresses steadily to renal failure. To determine the rate of renal function decline and the parameters that influence the rate of decline, we retrospectively reviewed the charts of patients with DN who had undergone dialysis or kidney transplantation at the Mayo Clinic from 1983 to 1993. Forty patients were found to have two or more iothalamate clearance (IothmCl) measurements where a slope of renal function decline over time, expressed as mL/ min/month/1.73 m2, can be calculated. The parameters examined included age of onset and duration of diabetes (DM), age at initial presentation, insulin dosage, glycosylated hemoglobin level, proteinuria, blood pressure (BP), number of antihypertensive medications (HTM), use of ACE inhibitors, creatinine, and initial IothmCl. The mean overall decline of clearance was 1.36±1.1 mL/min/month, corrected. Univariate regression analysis showed that only systolic and mean BP (p<0.05), use of HTM (p=0.02), and the number of HTM used (p=0.0001) correlated with the rate of clearance decline. No other parameter was significant. The decline of IothmCl was 0.72±0.41, 1.20±0.9, and 2.34±1.38 mL/min/month, for patients taking no HTM, <3 HTM, and ≥ 3HTM, respectively. Of the eight patients on HTM who presented with initial IothmCl of <30 mL/min/1.73 m2, seven (88%) had clearance of <10 mL/min/1.73 m2 within 1 yr. We conclude that hypertension is an important marker of DN progression, and that the more HTM required for control of BP, the faster the decline of renal function. We recommend that a suitable transplant candidate with DN who presents with hypertension requiring HTM and a clearance of <30 mL/min should be placed on the transplant waiting list.
Renal outcomes in pediatric liver transplantation
Authors: Bartosh Sharon M. , Alonso Estella M. , Whitington Peter F.
Published: September 2024

The outcomes of 294 orthotopic liver transplants performed in 221 children at The University of Chicago Children's Hospital between October 1984 and October 1992 have been retrospectively reviewed. Medical information for 281 transplants in 210 children was sufficient for inclusion in this analysis. The mean age at transplant was 4.1± 5.0 yr. Forty‐four percent of the children were male, and 16% of the transplants were living‐related. Four children received combined liver‐kidney transplants. Seventysix percent of the children are currently alive. The incidence of acute renal failure occuring following transplantation and requiring dialysis was 6.2% with a mortality rate of 85%. Early postoperative hypertension was seen in 65% of the children and persistent hypertension of greater than 12 months duration was seen in 28%. Sixteen percent of children developed metabolic acidosis requiring sustained sodium bicarbonate supplementation. Aggregate and longitudinal analysis of serial calculated glomerular filtration rates revealed abnormal renal function in approximately one third of children at any given time period following transplantation. The renal dysfunction was unrelated to age at transplant, type of transplant, gender, previous transplants, rejection episodes, courses of nephrotoxic drugs, presence of hypertension, or cyclosporin dose. This review supports prior studies which document abnormal renal function following orthotopic liver transplantation in a significant proportion of children.
Assessment of long‐term risks for living related kidney donors by 24‐h blood pressure monitoring and testing for microalbuminuria
Authors: Eberhard O. K. , Kliem V. , Offner G. , Oldhafer K. , Fangmann J. , Pichlmay R. , Koch K. M. , Brunkhorst R.
Published: September 2024

Our aim was to assess the long‐term risks for kidney donors of developing arterial hypertension and hypertension‐associated diseases or hyperfiltration injury of the remaining solitary kidney. We conducted a cross‐sectional study in which 29 donors who were nephrectomized at our center between October 1973 and March 1990 were enrolled. At the time of evaluation median age was 54 (37–70) yr. Since kidney donation an average time interval of 11.1±3.8 yr had elapsed. Body weight, casual blood pressure, S‐ creatinine and proteinuria were recorded. In 28/29 donors 24‐h blood pressure monitoring was performed; all 29 were tested for microalbuminuria (MAU). The patient history was checked for treatment with antihypertensives, coronary heart disease and diabetes mellitus. From all 29 kidney donors surveyed up to 19.8 yr none developed marked renal insufficiency: median S‐creatinine was 1.0 mg/dl (range 0.7‐1.6), only 3 donors had a S‐ creatinine >1.3 mg/dl. Glomerular filtration rate (GFR) decreased in an age‐dependent manner. While all donors had been normotensive without an antihypertensive treatment at time of nephrectomy, actually 29% proved to be hypertensive with average values >130/80 mmHg in the 24‐h assessment. 5/29 donors received antihypertensives, 3 of whom nevertheless were hypertensive. Day‐night profile was lost in 2 patients. After donation one patient developed coronary heart disease. 7/29 donors (24%) displayed positive testing for MAU, furthermore one had proteinuria (approx. 300 mg/l). MAU was associated in one case with slightly elevated S‐creatinine (1.3 mg/dl) and in 3 cases with arterial hypertension. In the long‐term course living related kidney donors do not seem to be at risk for developing hypertensive disorders more often than the general population. The prevalence of MAU in the 29 cases studied was higher than so far described for healthy subjects. This may reflect subclinical hyperfiltration damage of the glomerulus. Progressive renal insufficiency with clinical relevant function loss of the remaining solitary organ, however, was not observed up to 19.8 yr after kidney donation.
Cytomegalovirus immune globulin (CMVIG) prophylaxis is associated with increased survival after orthotopic liver transplantation
Authors: Falagas Matthew E. , Snydman David R. , Ruthazer Robin , Griffith John , Werner Barbara G. , Freeman Richard , Rohrer Richard ,   Boston Center for Liver Transplantation CMVIG Study Group
Published: September 2024

Cytomegalovirus (CMV) causes considerable morbidity and mortality in orthotopic liver transplant (OLT) recipients. Several prophylactic strategies against CMV have been studied in solid organ transplant recipients, including cytomegalovirus immune globulin (CMVIG). We examined the effect of CMVIG prophylaxis on first‐year and long‐term survival after liver transplantation. Data were analysed for 162 OLT recipients from four transplant centers in Boston who participated in two CMVIG prophylaxis trials. Ninety patients received CMVIG (median follow‐up 5.6 yr), and 72 patients received placebo (median follow‐up 5.4 yr). CMVIG prophylaxis was shown to be associated with increased first‐year (86% vs. 72%, p=0.029) and long‐term (68% vs. 54%, p=0.055) survival. The distribution of baseline characteristics including donor and recipient demographics, donor CMV serostatus, United Network for Organ Sharing (UNOS) status, pre‐transplant renal and liver function tests, transplantation surgical time, number of units of blood products administered during transplantation, primary immunosuppressive regimen, use of solumedrol or antilymphocyte therapy for induction of immunosuppression or treatment of rejection, and surgical complications was similar for CMVIG and placebo recipients. CMVIG recipients were more likely to have primary biliary cirrhosis than placebo recipients (21% vs. 8%, p=0.025). Using a Cox proportional hazards multivariate model to control for pre‐transplant liver disease, CMVIG was shown to be independently associated with increased first‐year survival (p=0.042); a trend toward association with increased long‐term survival (p=0.098) was also shown. These data support that CMVIG prophylaxis, beyond its proven efficacy in decreasing the incidence of severe CMV‐associated disease, is associated with increased survival when used prophylactically in OLT recipients.
Thrombocytopenia in an established solitary pancreas graft recipient
Authors: Benedetti Enrico , Kirby John P. , Asolati Massimo , Mihalov Michael L. , Ghosh Luna , Pollak Raymond
Published: September 2024

Isolated, life‐threatening thrombocytopenia from a previously well tolerated pancreas allograft has not been reported in the literature. Herein we report such a case where a 31‐year‐old, Caucasian, Type I diabetic male developed severe thrombocytopenia 6 months following isolated pancreas transplantation and 2 wk after enteric conversion of the graft. Despite extensive diagnostic work‐up, the cause remained unclear and his thrombocytopenia did not remit with standard treatment, but did resolve upon explantation. Pathologic examination of the pancreatic graft showed evidence of chronic rejection along with CMV pancreatitis. We conclude that unremitting isolated thrombocytopenia in solitary pancreas grafts may reflect a localized DIC phenomenon that requires graft explantation.
Equivalence of cyclosporine blood level assays in patients receiving cyclosporine microemulsion or cyclosporine
Authors: Pescovitz Mark D. , Wong Robert L. , Choc M. Gerry , Chang Cheng Tao ,   Sandoz Neoral Study Group N103
Published: September 2024

The more rapid absorption of the cyclosporin A (CyA) microemulsion formulation (Neoral, NEO) compared to Sandimmune (SIM) might bypass intestinal metabolism resulting in differing amounts of CyA metabolites in blood as compared to SIM. If true, then CyA levels obtained with a CyA monoclonal antibody assay (TDx) that has metabolite cross‐reactivity might differ depending on the CyA formulation received by the patient, thereby affecting safety and efficacy. Fifty‐one NEO vs. 50 SIM treated de novo renal transplant recipients from a multicenter double‐blind randomized trial had morning, whole‐blood, trough‐samples obtained at the ends of weeks 1, 4, 8, and 12 post‐transplant assayed for CyA by HPLC and TDx. The slopes (ratio of TDx value to HPLC value) for the regression. lines between TDx and HPLC levels as a function of time post‐transplant and CyA formulation were determined using a general linear model. For NEO, the slopes at each week (1.21‐1.41 × HPLC) did not differ significantly (p=0.82). For SIM, the week 1 slope (1.2) was significantly (p=0.006) less than the other weeks (1.4‐1.44). The slopes (NEO vs. SIM) were not different at either week 1 (1.21 vs. 1.22, p=0.82) or at pooled weeks 4, 8, and 12 (1.33 vs. 1.4, p= 0.1). These results indicate that despite the improved absorption, TDx values obtained on NEO are qualitatively similar to those obtained on SIM.
Molecular Genetics in Haemophilia A
Authors: Oldenburg Johannes , Brackmann Hans‐Hermann , Hanfland Peter , Schwaaba Rainer
Published: September 2024

Efficient mutation screening methods have greatly facilitated the analysis of the factor VIII gene. The fast growing number of identified mutations has led to an increasing understanding of the genetics in haemophilia A. In combination with the recently generated molecular models of the factor VIII protein systematic studies of structural‐functional relationships of the factor VIII protein have started. The knowledge of the causative gene defect has also become an important instrument in haemophilia care with respect to prediction of the patients' clinical course and safe genetic counselling of relatives.
DNA Vaccines
Authors: Reimann Jörg , Schirmbeck Reinhold
Published: September 2024

Background and Objectives:

Humoral and cellular immune responses to protein antigens can be efficiently primed by nucleic acid or DNA vaccination. In DNA‐based vaccination, immunogenic proteins are expressed with correct posttranslational modification, conformation or oligomerization; this ensures the integrity of epitopes that stimulate neutralizing antibody (B cell) responses. DNA (or RNA) immunization is exceptionally potent in stimulating T cell responses because antigenic peptides are efficiently generated in (endogenous or exogenous) processing pathways (without interference by viral proteins) from intracellular or extracellular protein antigens expressed after transient in vivo transfection. Both features are difficult to achieve with recombinant subunit vaccines produced in eukaryotic or prokaryotic expression systems. The current state of vector designs, strategies for delivery of DNA vaccines, priming humoral and cellular immune responses by DNA vaccines, experimental strategies facilitated by DNA vaccines, unique advantages of DNA vaccination, experience of DNA vaccination in preclincal animal models and clinical trials, and potential risks of DNA vaccination are discussed. Excellent reviews on DNA‐based vaccination have been published recently [1‐3].
Red Cell Transfusion Strategies in the ICU
Authors: Hébert Paul C. ,   Transfusion Requirements in Critical Care Investigators and the Canadian Critical Care Trials Group
Published: September 2024

Transfusion of red blood cells continues to be an important therapy for treatment of anemia in intensive care settings. The critically ill are a population predisposed to the adverse outcomes of anemia and, as such, the risks imposed on them by transfusion therapy is one of great interest. Over the past decade there has been a shift in transfusion practice with guidelines being developed that promote more conservative and safer use of blood. The Transfusion Requirements in Critical Care (TRICC) trial clearly established the safety of a restrictive transfusion strategy, suggesting that physicians could easily minimize exposure to allogeneic RBCs by lowering their transfusion threshold. Further research will add to the generalizability of this study as well as explore the possible mechanism to explain why red cell transfusions did not improve outcomes in the critically ill.
Trigger for Platelet Transfusion
Authors: Rebulla Paolo
Published: September 2024

Background and Objectives:

The terms ‘platelet transfusion trigger’ are used in the scientific literature to indicate a value of the platelet count above which prophylactic platelet transfusion is usually not indicated. Most clinicians share the currently prevalent consensus published in several guidelines that a platelet transfusion trigger of 10,000 platelets per microliter is safe in stable oncohematology recipients carefully monitored at both the clinical and laboratory levels. whereas higher values may be necessary in patients with high fever, infection, splenomegaly, rapid platelet count decrease, on drugs able to affect platelet function and survival, in cases undergoing invasive maneuvers and in some pediatric patients such as premature newborns. The safety of this policy is supported by the results obtained in several randomized clinical trials and prolonged observational studies. Lowering the platelet transfusion trigger from the traditional value set at 20,000 platelets per microliter to the currently recommended value of 10,000 per microliter further stresses the importance of high‐quality, sufficient and prompt platelet availability and close cooperation between clinicians and blood transfusion specialists. Furthermore, it requires a clear understanding of the discriminatory power of current automated hematology counters at very low platelet counts. In the surgical setting. where randomized clinical trials on the most appropriate platelet transfusion trigger are largely missing, current guidelines propose to maintain higher platelet count values (50.000‐100,000 per microliter) during surgery and in the carly postoperative period.
Inactivation of Viruses, Bacteria, Protozoa and Leukocytes in Platelet and Red Cell Concentrates
Authors: Corash Laurence
Published: September 2024

Substantial increments in the safety of blood transfusion have been achieved through continued improvements in donor testing, yet residual concern about the safety of blood components persists. To further reduce the risk of transfusion‐associated infection, additional measures, such as nucleic acid testing for selcted pathogens, are being introduced. Transfusion of cellular components has been implicated in transmission of viral, bacterial, and protozoan discases [1]. While it is commonly recognized that hepatitis B virus (HBV), hepatitis C virus (HCV), cytomegalovirus (CMV), and the retroviruses, such as human immunodeficiency virus (HIV) and the human lymphotrophic viruses (HTLV) can be transmitted through cellular components, other pathogens are emerging as potentially significant transfusion‐associated infectious agents. For example, transmission of protozoan infections due to trypanosomes [2‐4] and babesia have been reported [5]. In addition to viral and protozoal infectious agents, bacterial contamination of platelet and red cell concentrates continues to be reported [6, 7]; and may be an under reported transfusion complication [8]. More importantly, new infectious agents may periodically enter the donor population before they can be definitively identified and tested for to maintain consistent safety of the blood supply. The paradigm for this possibility is the HIV pandemic, which erupted in 1979. During the past decade a number of methods to inactivate infectious pathogens have been developed and have entered the advanced clinical trial phase.
Research on Training in Marriage and Family Therapy: Status, Issues, and Directions
Authors: Kniskern David P. , Gurman Alan S.
Published: September 2024

Research investigating training in family therapy is scant. This paper describes existing models of training in marriage and family therapy, major issues pertinent to the evaluation of the effectiveness of such training, and suggests a methodology for such evaluation.
The Influence of Patient–Provider Communication on Self‐Management Among Patients With Chronic Illness: A Systematic Mixed Studies Review
Authors: Iroegbu Christin , Tuot Delphine S. , Lewis Lisa , Matura Lea Ann
Published: September 2024

Aim

To explore the influence of patient–provider communication on patient self‐management of chronic illness.

Design

Systematic Mixed Studies Review.

Data Sources

CINAHL, Google Scholar, EMBASE and PubMed were searched until March 2024.

Methods

Employed a result‐based convergent design and the Mixed Method Appraisal Tool to evaluate studies. Narrative analysis, quantitative studies and thematic analysis for qualitative studies and overall results.

Results

Thirteen articles published between 2003 and 2023 were included. Chronic illnesses studied: diabetes, heart failure, hypertension, chronic obstructive pulmonary disease and asthma. Data synthesis yielded the overarching theme: adaptive interpersonal communication. An approach that adapts communication content to each patient's unique needs, employs verbal and nonverbal communication, builds a connection and establishes patient rapport.

Conclusion

Available evidence suggests that patient–provider communication influences chronic illness self‐management. A provider's ability to adjust and tailor their communication style is an important factor in helping patients to achieve optimal self‐management. Future research should explore this phenomenon in other common chronic illnesses not included in this review. Additionally, research on the patient's role in this process could help improve patient–provider communication.

Implications for the Profession and/or Patient Care

Findings from this review have significant implications for shared and participatory decision making, where patients and providers collaborate to develop plans of care for patients to achieve optimal self‐management. Additionally, this review can contribute to the development of educational content and communication strategies for nurses and all healthcare professionals caring for patients with chronic illnesses.

Impact

This is the first mixed studies systematic review to describe the influence patient–provider communication on patient self‐management of chronic illness. These findings consolidate existing evidence, providing a pathway for practical application to clinical practice and the potential to significantly impact the delivery of patient‐centred care and healthcare quality.

Patient or Public Contribution

No patient or public contribution.
Optimal blood pressure control with fewer antihypertensive medications: Achieved mostly in low‐risk hypertensive patients
Authors: Zhou Zhanyang , Miao Huanhuan , Yang Shijie , Yin Zheng , Chen Yingjun , Zhang Yuqing
Published: September 2024

Recent studies indicate that intensive blood pressure (BP) targets can be reached with less than two medications. This cross‐sectional study, involving 4991 individuals from the Majiapu community, assessed the correlation between BP control and the burden of antihypertensive drugs. Participants on medication were categorized into controlled (BP < 140/90 mm Hg) and uncontrolled (BP ≥ 140/90 mm Hg) groups, with the former further divided into optimal (BP < 130/80 mm Hg) and good control (BP < 140/90 but >130/80 mm Hg) subgroups. Multivariate logistic regression analyzed factors affecting hypertension control across these BP categories. The study found that, 54% of participants had hypertension. Of those treated (62.5%), 55.7% achieved BP control, including 23.15% maintaining BP below 130/80 mm Hg. The average number of antihypertensive medications was 1.61 for the controlled group (with an average BP of 126.6/76 mm Hg) and 1.75 for the uncontrolled group (with an average BP of 150.6/84.0 mm Hg). Additionally, the average number of antihypertensive medications was 1.66 in the good control group and 1.55 in the optimal control group. The uncontrolled group had a higher mean systematic coronary risk estimation (SCORE) of 5.59, against 3.97 and 2.5 in the good and optimal control groups, respectively. Key factors linked to poor BP control included age over 65, male sex, obesity, and former smoking, whereas lipid‐lowering medication use was associated with better control. In conclusions, patients needing fewer antihypertensive drugs to achieve stricter targets may have a lower risk profile. Notably, only a small proportion of treated patients are low‐risk individuals who can easily achieve BP levels below 130/80 mm Hg.
Super‐resolved highly multiplexed immunofluorescence imaging for precise protein localization and podocyte ultrastructure
Authors: Siegerist Florian , Kitzel Svenja , Telli Nihal , Dikou Juan Saydou , Drenić Vedran , Chadjichristos Christos E. , Chatziantoniou Christos , Endlich Nicole
Published: September 2024

Deep insights into the complex cellular and molecular changes occurring during (patho‐)physiological conditions are essential for understanding the interactions and regulation of proteins. This understanding is crucial for research and diagnostics. However, the effectiveness of conventional immunofluorescence and light microscope, tools for visualizing the spatial distribution of cells or proteins, are limited both in resolution and multiplexity in complex tissues. This is mainly due to challenges such as the spectral overlap of fluorophore wavelengths, a limited range of antibody types, the inherent variability of samples and the optical resolution limit. The herein demonstrated combination of multiplex immunofluorescence imaging and super resolution microscopy offers a solution to these limitations by enabling the identification of different cell types and precise subcellular localization of proteins in tissue sections. In this study, we demonstrate the cyclic staining and de‐staining of paraffin kidney sections, making it suitable for routine use and compatible with super‐resolution microscopy for podocyte ultrastructural studies. We have further developed a computerized workflow for data processing which is accessible through available reagents and open‐access code. As a proof of principle, we identified CDH2 as a marker for cellular lesions of sclerotic glomeruli in the nephrotoxic serum nephritis mouse model and cross‐validated this finding with a human Nephroseq dataset indicating its translatability. In summary, our work represents an advance in multiplex imaging, which is crucial for understanding the localization of numerous proteins in a single FFPE kidney section and the compatibility with super‐resolution microscopy to study ultrastructural changes of podocytes.
Melatonin regulates mitochondrial dynamics and mitophagy: Cardiovascular protection
Authors: Rahmani Sohrab , Roohbakhsh Ali , Pourbarkhordar Vahid , Hayes A. Wallace , Karimi Gholamreza
Published: September 2024

Despite extensive progress in the knowledge and understanding of cardiovascular diseases and significant advances in pharmacological treatments and procedural interventions, cardiovascular diseases (CVD) remain the leading cause of death globally. Mitochondrial dynamics refers to the repetitive cycle of fission and fusion of the mitochondrial network. Fission and fusion balance regulate mitochondrial shape and influence physiology, quality and homeostasis. Mitophagy is a process that eliminates aberrant mitochondria. Melatonin (Mel) is a pineal‐synthesized hormone with a range of pharmacological properties. Numerous nonclinical trials have demonstrated that Mel provides cardioprotection against ischemia/reperfusion, cardiomyopathies, atherosclerosis and cardiotoxicity. Recently, interest has grown in how mitochondrial dynamics contribute to melatonin cardioprotective effects. This review assesses the literature on the protective effects of Mel against CVD via the regulation of mitochondrial dynamics and mitophagy in both in‐vivo and in‐vitro studies. The signalling pathways underlying its cardioprotective effects were reviewed. Mel modulated mitochondrial dynamics and mitophagy proteins by upregulation of mitofusin, inhibition of DRP1 and regulation of mitophagy‐related proteins. The evidence supports a significant role of Mel in mitochondrial dynamics and mitophagy quality control in CVD.
LncRNA ALMS1‐IT1 modulates ferroptosis and immune evasion in colorectal cancer through activating STAT3
Authors: Wu Zhaoying , Zou Junwei , Xie Hao , Wang Jie , Huang Yong , Liu Fei , Xing Chungen
Published: September 2024

Colorectal cancer (CRC) represents a significant malignancy within the digestive system, characterized by high incidence and mortality rates. In recent years, molecular targeted therapy has been introduced as a supplementary strategy in CRC management, complementing traditional modalities such as surgery, radiation and chemotherapy. The identification of novel therapeutic targets for CRC remains critically important. Ferroptosis, a unique form of programmed cell death distinct from apoptosis and necrosis, is characterized by cellular damage resulting from iron‐induced lipid peroxidation, leading to cell death. This study utilizes a combination of bioinformatics analysis and clinical specimen validation to demonstrate that the long non‐coding RNA (lncRNA) ALMS1‐IT1 is significantly upregulated in CRC tissues and strongly associated with ferroptosis. Through a series of experimental investigations, we have determined that ALMS1‐IT1 negatively regulates ferroptosis in CRC cells, thereby promoting cancer growth and metastasis, acting as an oncogenic factor. Furthermore, we explored the molecular interactions of ALMS1‐IT1, revealing its role in activating STAT3 protein phosphorylation. This activation enhances the immune evasion capabilities of CRC cells. Rescue experiments indicated that STAT3 activation is essential for ALMS1‐IT1's suppression of ferroptosis, immune evasion and oncogenic behaviour in CRC. Our findings underscore the critical biological role of ALMS1‐IT1 in the progression of CRC and suggest its potential as a target for drug development.
Modified oxymatrine as novel therapeutic inhibitors against Monkeypox and Marburg virus through computational drug design approaches
Authors: Islam Md. Rezaul , Biswas Suvro , Amena Ummy , Rahman Miadur , Islam Shirmin , Islam Md. Ariful , Saleh Md. Abu , Hassan Hesham M. , Al‐Emam Ahmed , Zaki Magdi E. A.
Published: September 2024

Global impact of viral diseases specially Monkeypox (mpox) and Marburg virus, emphasizing the urgent need for effective drug interventions. Oxymatrine is an alkaloid which has been selected and modified using various functional groups to enhance its efficacy. The modifications were evaluated using various computatioanal analysis such as pass prediction, molecular docking, ADMET, and molecular dynamic simulation. Mpox and Marburg virus were chosen as target diseases based on their maximum pass prediction spectrum against viral disease. After that, molecular docking, dynamic simulation, DFT, calculation and ADMET prediction were determined. The main objective of this study was to enhance the efficacy of oxymatrine derivatives through functional group modifications and computational analyses to develop effective drug candidates against mpox and Marburg viruses. The calculated binding affinities indicated strong interactions against both mpox virus and Marburg virus. After that, the molecular dynamic simulation was conducted at 100 ns, which confirmed the stability of the binding interactions between the modified oxymatrine derivatives and target proteins. Then, the modified oxymatrine derivatives conducted theoretical ADMET profiling, which demonstrated their potential for effective drug development. Moreover, HOMO‐LUMO calculation was performed to understand the chemical reactivity and physicochemical properties of compounds. This computational analysis indicated that modified oxymatrine derivatives for the treatment of mpox and Marburg virus suggested effective drug candidates based on their binding affinity, drug‐like properties, stability and chemical reactivity. However, further experimental validation is necessary to confirm their clinical value and efficacy as therapeutic candidates.
Women's Experiences of Intimate and Sexual Relationships During Menopause: A Qualitative Synthesis
Authors: Bulut Hatice , Hinchliff Sharron , Ali Parveen , Piercy Hilary
Published: September 2024

Aim

The aim of this literature review was to explore women's experiences of their intimate and sexual relationships during menopause.

Background

Evidence shows that the menopause transition can be a difficult time for women due to symptoms of menopause. There is little research evidence about how menopause‐related symptoms impact women's intimate and sexual relationships.

Method

A qualitative synthesis was carried out on research published between May 2005 and July 2023 using five electronic databases: ASSIA, CINAHL, PubMed, PsycINFO and Web of Science. We also searched Google Scholar and used backward and forward chaining methods to identify results not listed in the databases and ensure that no relevant literature was omitted.

Results

Eighteen qualitative studies were included in this review. Six main themes were identified: the meaning of menopause to women in different cultures; factors affecting women's sexual lives; changes in sexual desire and orgasm; talking about sexual issues; women's attempts to overcome the impact of ageing and menopause on their sexual lives; and concerns about partner sexual satisfaction during the menopause.

Conclusion

During the menopause transition, women can experience sexual difficulties that have an impact on their lives and intimate relationships. Qualitative studies showed that sexual changes associated with menopause can be difficult to manage and must be viewed in the social and cultural contexts of the women's lives.

Relevance to Clinical Practice

The results of this review will be of interest to nurses to assess patient needs while offering health services to women in menopause. In addition, the results can be used to inform education and support programmes for women.

Reporting Method

We have adhered to relevant EQUATOR guidelines and used the PRISMA‐ScR reporting method. No patient or public contribution was required for this study.
Reliability of the Assessment of Tooth Wear Severity on Dental Hard Tissues and Dental Restorations, Using the TWES 2.0, by Nonexperts
Authors: Roehl Jakob C. , Katzer Lukasz , Jakstat Holger A. , Wetselaar Peter , Ahlers M. Oliver
Published: September 2024

Background

Tooth wear is a multifactorial process resulting in the loss of dental hard tissues. For its assessment, the tooth wear evaluation system (TWES) 2.0 has been published. Previous studies on the TWES involved well‐trained practitioners, rather than nonexperts.

Objective

The first aim of this study was to investigate the reliability of the assessment of tooth wear severity on dental hard tissues, using the TWES 2.0, by nonexperts. The second aim was to investigate the reliability of assessment of wear severity on dental restorations, using a third scale.

Methods

Forty‐seven dental students evaluated at least 9 of 14 possible patient cases on dental casts and intraoral photographs. Cohen's kappa (agreement with sample solution) and Fleiss' kappa (Inter‐rater reliability) were calculated.

Results

The agreements of the operators' ratings compared to the sample‐solution resulted in Cohen's kappa between 0.02 and 0.9. The agreements were 0.34 for occlusal; 0.43 for vestibular; 0.57 for oral surfaces.

Inter‐rater reliability (Fleiss' kappa) was 0.35 for occlusal, 0.17 for vestibular and 0.24 for oral assessment. The inter‐rater reliability of the ratings on tooth surfaces with restorations was lower with 0.21 (occlusal), 0.14 (vestibular) and 0.39 (oral). The agreement on different restorations differed tremendously.

Conclusions

The ability to correctly assess the cases varied considerably between individual examiners. Within the limits of this study, assessment of restorations was slightly more challenging compared to natural teeth, particularly in occlusal regions or when the restorative material is gold. Subsequent studies should address whether enhanced training and improved definition of tooth wear grades result in higher reliability scores.
Impact of Global Major Reservoirs and Lakes on Plastic Dynamics Using a Process‐Based Eco‐Hydrology Model
Authors: Nakayama Tadanobu
Published: September 2024

Environmental contamination by plastics has been receiving considerable attention from scientists, policymakers and the public. In this study, the process‐based model NICE‐BGC was extended to couple with LAKE2K in a stratified water quality model to evaluate the global plastic dynamics in both lotic and lentic waters. The new model could simulate riverine plastic transport in inland waters with and without the presence of global major reservoirs and lakes. The result showed the simulated plastic transport with the presence of reservoirs becomes slightly smaller than that without the presence of reservoirs. In particular, the plastic burial simulated by the model became different with and without the lake model when the density of plastic was higher than that of water. This result showed there are limits to the application of the same partial differential equations as in inorganic carbon for the derivatives either with or without the reservoirs as assumed in a previous study by this author, especially when the plastic density is higher than that of water. The model also simulated plastic sedimentation in the global lakes and reservoirs together, and showed that more plastic deposits in the reservoirs than in the lakes with the exception of the Caspian Sea and most of lentic waters are found to deposit more microplastics than macroplastics as pointed out in a previous study. Finally, the weighted average of plastic budget in the global major rivers with the effect of anthropogenic factors such as construction of artificial dams and global lakes in lentic water was quantified. The simulated result also showed that incorporation of the lake model in NICE‐BGC led to improved estimates of plastic dynamics in inland waters, and may aid the development of solutions and measures to reduce plastic input to the ocean.
Cerebral Microcirculation: Progress and Outlook of Laser Doppler Flowmetry in Neurosurgery and Neurointensive Care
Authors: Wårdell Karin , Richter Johan , Zsigmond Peter
Published: September 2024

Laser Doppler flowmetry (LDF) is a well‐established technique for the investigation of tissue microcirculation. Compared to skin, the use in the human brain is sparse. The measurement of cerebral microcirculation in neurointensive care and during neurosurgery is challenging and requires adaptation to the respective clinical setting. The aim of the review is to present state of the art and progress in neurosurgery and neurointensive care where LDF has proven useful and can find clinical importance in the investigation of cerebral microcirculation. The literature in the field is summarized and recent technical improvements regarding LDF systems and fiber optical probe designs for neurosurgical and neurocritical care described. By combining two signals from the LDF unit, the measurement of the microcirculation (Perfusion) and gray whiteness (TLI) of the brain tissue, the full potential of the device is achieved. For example, a forward‐looking LDF‐probe detects high‐risk hemorrhage areas and gray‐white matter boundaries along intraoperative trajectories during stereotactic neurosurgery. Proof of principles are given for LDF as a guidance tool in deep brain stimulation implantation, brain tumor needle biopsies, and as long‐term monitoring device in neurocritical care. With well‐designed fiber optical probes, surgical fixation, and signal processing for movement reduction, LDF monitoring of the cerebral microcirculation is successful up to 10 days. The use of LDF can be combined with other physiological measurement techniques, for example, fluorescence spectroscopy for identification of glioblastoma during tumor surgery. Fiber optics can also be used during magnetic resonance imaging (MRI). Despite the many advantages, fiber optical LDF has not yet reached its full potential in clinical neuro‐applications. Multicenter studies are required to further evaluate LDF in neurosurgery and neurointensive care. In conclusion, the present status of LDF in neurosurgery and neurointensive care has been reviewed. By combining Perfusion and TLI with tailored probe designs the full potential of LDF can be achived in measuring cerebral microcirculation. This includes guidance during DBS implantation and needle biopsies, and long‐term monitoring in neurocritical care.