bluuebunny/crossref_metadata_2025 huggingface dataset:
Endothelium‐dependent vasodilation of the skin microcirculation in heart transplant recipients
Authors: Andreassen Arne K , Gullestad Lars , Holm Torbjørn , Simonsen Svein , Kvernebo Knut
Published: September 2024

Patients with heart failure demonstrate attenuated endothelium‐dependent vasodilation of the peripheral circulation, while this is suggested to be reversed after heart transplantation. However, data from human subjects are limited and conflict with studies on the peripheral vasomotor tone in cyclosporine‐treated animals, suggesting endothelial dysfunction. We recorded forearm skin perfusion responses following graded iontophoresis of 1% acetylcholine (endothelium‐dependent) and 1% sodium nitroprusside (endothelium‐independent) by laser Doppler perfusion measurements in 32 heart transplant recipients and 15 age‐matched controls. In addition, the hyperemic response to 3 min of blood flow occlusion to the forearm was measured on the third finger pulp. With comparable baseline values, the increases in perfusion to the 4 applications of acetylcholine were significantly attenuated in heart transplant recipients compared with controls: 599 vs. 146±32, 24239 vs. 492 ± 77, 480 ± 66 vs. 845 ± 120 and 699 ± 77 vs. 993 ± 139% (mean ± SEM; all p <0.01). Peak hyperemia (134±4 vs. 153 ± 12 arbitrary units (AU); p<0.05)), time for the hyperemic perfusion to return to preocclusive baseline (52.4 vs. 102.9 s; p < 0.01) and hence the area under the perfusion curve (1469±244 vs. 4581±921 AU s; p<0.01) were reduced among heart transplant recipients. The area under the perfusion curve correlated significantly with mean arterial blood pressure (r = ‐0.60; p < 0.01) and with the responses to iontophoresis of acetylcholine (r = 0.41; p<0.01). Two non‐invasive tests of vascular function demonstrate attenuated endothelial‐dependent microvascular responses in heart transplant recipients. The relative impact. of prior congestive heart failure and postoperative factors, such as treatment with cyclosporine, remains to be determined.
Acute renal allograft dysfunction secondary to suprarenal arterial stenosis: a case series and review of the literature
Authors: Mathur Vandana S , Kerlan Robert K , Melzer Juliet , Tomlanovich Stephen J , Amend William
Published: September 2024

Stenosis of vessels proximal to the renal artery is an unusual cause of allograft ischemia. We report four patients who had such ‘suprarenal’ arterial stenoses leading to graft dysfunction that was reversed with revascularization. We additionally review the existing literature on this entity, outline the etiologies of such stenoses, as well as discuss the surgical and non‐surgical therapeutic options in patients with this uncommon cause of allograft dysfunction.
Quality of life after pancreas transplantation: a review
Authors: Gross Cynthia R. , Limwattananon Chulaporn , Matthees Barbara J.
Published: September 2024

For persons with diabetes and end stage renal disease, successful combined or sequential pancreas/kidney transplant is an attractive therapeutic alternative to insulin and dialysis. There is considerable controversy regarding pancreas transplantation (p Tx), however, as some recent reviews have concluded, p Tx results in at most only modest reductions in secondary complications and has increased morbidity and costs compared with kidney transplant alone. While the impact on patients' quality of life (QOL) is a major consideration for p Tx, the literature on this topic has not been carefully considered. The purpose of this review is to evaluate studies of QOL after p Tx and identify well‐validated findings. Comparative cross‐sectional and longitudinal studies have shown that the QOL outcomes of p Tx recipients who achieve insulin‐independence are better than those of candidates or of recipients with pancreas graft loss. More positive health perceptions, improved social interaction and increased vitality/energy are significantly associated with successful p Tx. Researchers have found few areas where the QOL benefits of p Tx significantly exceed or differ from those that occur with kidney transplant alone. A consistent finding across studies is that p Tx improves patient perceptions about diabetes‐specific issues such as satisfaction with diet flexibility and health management, while kidney transplant does not. Future studies should attempt to accrue sufficient sample sizes to permit statistical adjustment for selection biases; follow patients for several years to permit differences in rates of progression of secondary complications to impact QOL; and use current graft loss and morbidity statistics to estimate any added risks of p Tx over kidney‐only transplant. It is still an open question as to whether or not there are sufficient QOL benefits from p Tx long‐term to out‐weigh added risks, and this needs to remain an active area of investigation.
Transplantation in renal amyloidosis1
Authors: Türkmen A , Yildiz A , Erkoç R , Ecder T , Görçin B , Türk S , Aydin AE , Eldegez U , Ark E , Sever
Published: September 2024

In this report, the results of renal transplantation in patients with renal amyloidosis were retrospectively analysed and compared with the control group. Fifteen (3.04%) of the 493 renal transplant recipients whom were followed up in Istanbul School of Medicine transplant outpatient clinic, between 1983 and 1997, were included in the study. The etiology of amyloidosis was familial Mediterranean fever in all patients. The mean follow‐up period was 38.3 ±31.8 (range 7‐65) months. Twelve of the patients were male and 3 female with the mean age 34.13 ±10.87 (range 21‐60) years. Seven patients had living related, 4 living‐unrelated and 4 cadaveric donors. Five patients were lost because of different complications: Three patients died from cardiac amyloidosis all with well functioning grafts, 2, 3 and 36 months after the operation. sepsis and cardiovascular failure was the probable cause of death in 1 patient who also had chronic rejection. Another one patient with chronic rejection died from hepatic failure. acute rejection developed in 2 patients. Renal functions of these patients improved by anti‐rejection therapies. Chronic rejection developed in 3 patients. In the control group, acute rejection and chronic rejection were diagnosed in 5 and 1 patients, retrospectively. While 1 patients returned to hemodialysis in control group, the others are alive with satisfactory graft function. There was no death in control group. The 5‐yr graft and patient survival rates in amyloidosis and the control groups were 75, 77, 95 and 100%, respectively. It was concluded that although transplantation is not a contraindication for the treatment of end stage renal failure in patients with renal amyloidosis, it carries high risk of cardiac complications in the postoperative period. Detailed preoperative cardiovascular evaluations are mandatory in these patients and this intervention should improve the prognosis by excluding the patients who have already been complicated with this problem.
How to convert from traditional cyclosporine to the microemulsion formulation in stable renal transplant patients?
Authors: Gaspari Flavio , Perico Norberto , Pisoni Roberto , Anedda Maria Franca , Signorini Orietta , Caruso Raffaele , Gotti Eliana , Remuzzi Giuseppe
Published: September 2024

How to convert from traditional cyclosporine (CSA) to the microemulsion formulation in stable renal transplant patients is still a matter of debate. The present study was designed to evaluate the effects of changeover from traditional Sandimmune to Neoral formulation at two dose‐ratio conversions on CSA pharmacokinetics, safety and tolerability particularly in terms of renal function. Thirty outpatients regularly followed at our Clinical Research Center were randomized to 1:1 or 1:0.75 dose‐ratio conversion and assigned to the two groups according to a comparable renal function and time post‐transplant. Patients underwent CSA pharmacokinetic evaluation and renal function measurements (GFR and RPF) before, at day 15, and at month 6 after conversion to Neoral formulation. More consistent CSA concentration‐time profiles with Neoral than traditional formulation were obtained at the two time points of evaluation after conversion. At 1:1 dose‐ratio conversion an increased absorption rate, reflected by a shorter time to maximum blood CSA concentration (Tmax), and a greater bioavailability, as shown by an increase in the peak CSA concentration (Cmax) and the 12‐h exposure to drug defined by the area under the time‐concentration curve (AUC0→12h) was found 15 d and 6 months after conversion to Neoral formulation. A similar AUC as compared with traditional Sandimmune was observed in those patients randomized to receive a 25% lower dose of Neoral formulation. All of patients defined as ‘low’ absorbers became ‘high’ absorbers as early as 15 d after conversion to Neoral formulation at 1:1 or 0.75 dose‐ratio regimen. Overall mean GFR was unchanged in both conversion regimens during the 6 months of follow‐up. However, there was a tendency to lower GFR even in some patients randomized to 1:0.75 conversion but mostly in those with 1:1 conversion. A limited sampling strategy utilizing three blood samples (0, 1, 3 h post‐dosing of Neoral formulation) provided an excellent correlation with actual drug exposure (r = 0.977). Enhanced CSA absorption with the microemulsion formulation. results in increased drug exposure that may reduce GFR in some patients who undergo 1:1 dose‐ratio conversion. The Neoral formulation that permits a more effective, consistent, and predicatble absorption of CSA may represent a great advantage in order to prevent acute and possibly chronic rejections. Efforts have to be made to find optimal therapeutic range and dosing schedule for this new formulation, which may be facilitated by using the limited sampling approach to predict AUC after only three‐point sampling.
Isolated iliac artery stenosis as a cause of kidney graft dysfunction post‐transplant
Authors: Humar Abhinav , Grubbs Brian , Zapzalka Dan , Nazarian Wendy , Hunter David , Matas Arthur
Published: September 2024

We report the case of a kidney transplant recipient who, 1 yr post‐transplant, presented with a serum creatinine level elevation secondary to iliac artery stenosis proximal to the graft anastomosis site. Stenosis of the transplant renal artery was initially suspected because of new onset of hypertension in addition to the rising creatinine level. Physical examination, however, revealed a diminished femoral pulse and a significantly lower ankle‐brachial index on the right (versus left) lower extremity; these findings suggested a stenosis of the right iliac artery. Angiography confirmed a short stenotic lesion of the external iliac artery just proximal to the graft anastomosis site. The lesion given its focal nature, its location, and the absence of disease elsewhere in the peripheral vascular system‐was most consistent with a vascular clamp injury. The stenosis was managed by placement of an intravascular stent at the time of angiography. This resulted in normalization. of the vascular examination findings, return to baseline of the serum creatinine level, and resolution of hypertension. This case demonstrates the value of physical examination in diagnosing this uncommon cause of an increased serum creatinine level post‐transplant and the effectiveness of intravascular stents for its management.
Plasmatic amino acids in kidney transplantation in children
Authors: Calvo C , Ruza F , Hernanz A , Madero R , Arroyo I , Delgado MA
Published: September 2024

We studied the evolution of plasma amino acid levels in children with chronic kidney failure after undergoing a renal transplantation. Plasma amino acid profile was studied in 10 children just before surgery, at admission in paediatric intensive care unit and 4, 8, 12, 24, 48 and 72 h after transplantation. Previous to the graft, plasma levels of glutamic acid (p <0.01), hydroxyproline (p <0.01), citrulline (p< 0.01) and arginine (p < 0.05) were significantly increased, whereas plasma levels of serine (p <0.01), glutamine (p <0.03), threonine (p< 0.01), tyrosine (p <0.01), valine (p <0.01), leucine (p <0.01), tryptophan (p<0.01), branched amino acids (BCAA) (p <0.01), aromatic amino acids (AAA) (p <0.01) and essential amino acids (EAA) (p< 0.01) were decreased in relation to control children. The amino acid profile evolution run parallel to the settle down of renal function parameters. Within 72 h after surgery, even before in some cases, all amino acids except tryptophan and arginine reached normal levels.
Outcome of 22 successful pregnancies after liver transplantation
Authors: Wu Anette , Nashan Bjoern , Messner Ute , Schmidt Hartmut H‐J , Guenther Hans‐Heinrich , Niesert Stefan , Pichmayr Rudolf
Published: September 2024

To evaluate course and outcome of pregnancies in liver transplanted patients and to provide a brief summary on the development of these children, 22 pregnancies and 23 children (1 month‐99 months old) of 16 patients who had been liver transplanted at our institution (mean interval from transplantation to pregnancy 43.1 months) were reviewed. Standard immunosuppressive regimen during pregnancy consisted of cyclosporine A (CyA), tacrolimus (FK), azathioprine (Aza) and/or a low‐dose steroid therapy. CyA and FK whole blood trough levels were monitored on a routinely basis to keep therapeutic range (CyA 80‐150 ng/mL; FK 4‐8 ng/mL).

No patient had a graft loss and there were no lethal complications. Beside de novo hypertension (n = 3) and preeclampsia (n = 3) problems during pregnancy included one steroid‐sensitive rejection at 36 wk gestation, one case of tacrolimus toxicity at 24 wk with complete reconstitution, and one case of de novo choledocholithiasis with recurrent cholangitis. Three cases of infections occurred. In total, 23 children, including one set of twins, were born. Terms of gestation (mean = 38.1 wk, ±2.2 SD), deliveries (spontaneous n = 13, cesarean section n = 7, forceps n = 1, vacuum extraction (VE) n = 1) and birth weights (2876 g, ±589.3 SD) were typical. Three pregnancies were preterm, one being a twin pregnancy. Neither congenital malformations nor unusual infections were seen in the children. Postnatal follow‐up revealed appropriate physical growth to date. Psychological development seems to be adequate.

Our data indicate that successful pregnancies after liver transplantation (LTX) under careful management by transplant specialists, obstetricians and perinatalogists have a good outcome. So far, neither prenor postnatal child development appear to be influenced by maternal immunosuppressive therapy during pregnancy.
Hepatic artery pseudoaneurysm with hemobilia following angioplasty after liver transplantation
Authors: Narumi Shunji , Osorio Robert W , Freise Chris E , Stock Peter G , Roberts John P , Ascher Nancy L
Published: September 2024

A 58‐yr‐old female with primary biliary cirrhosis underwent an uncomplicated orthotopic liver transplantation. Elevated liver function tests 2 months post‐transplantation were evaluated with Doppler ultrasound and a hepatic artery stricture was documented. The hepatic artery stenosis was treated with angioplasty. She developed hemobilia 1 d after the procedure, which was confirmed by angiography. Emergent exploratory laparotomy revealed a pseudoaneurysm at the hepatic artery anastomosis. The pseudoaneurysm was resected and the proper hepatic artery of the graft was anastomosed to the splenic artery of the host using preserved homograft. Her post‐operative course was uneventful and liver function tests returned to normal quickly after the surgery. This report will discuss the unusual nature of this complication, and review the problem of hemobilia and pseudoaneurysms in liver transplant recipients.
Trends in organ donation
Authors: Cohen B , McGrath SMC , De Meester J , Vanrenterghem Y , Persijn GG
Published: September 2024

Renal and extrarenal transplant data were collected for seven geographical regions for the period 1989‐1996. In Western Europe and North America the number of kidney donors increased by 926 and 2743, respectively. The total number of transplants also increased in both regions by 3756 and 6936, respectively. Renal transplants accounted for approximately 60% of the total number of transplants and, although the number of renal transplants did not alter in Western Europe, the number rose by 3055 in North America. Outside of these regions the number of extrarenal transplants was 3‐18% of the total. The number of living kidney donors in North America increased each year and was higher than the number recruited in Western Europe (3389 vs 943 in 1996). With the exception of Eastern Europe, where virtually no renal transplants were carried out using organs from living donors, the number of living kidney donors rose in other regions: for example, in Latin America, the proportion of living kidney donors rose from 29% in 1970‐88 to 51% in 1995, and, in Asia, 90% of kidneys were donated by living donors. As the quality of cadaveric donor organs is often sub‐optimal, the use of living donors is likely to increase in both Western Europe and North America, but is unlikely to become the most important source of organs in these regions.
The middle colic vein: an alternative source of portal inflow in orthotopic liver transplantation complicated by portal vein thrombosis
Authors: Rudroff C , Scheele J
Published: September 2024

Background

Portal vein thrombosis (PVT) was previously considered a contraindication to orthotopic liver transplantation (OLT) since adequate portal blood supply is mandatory for graft function and patient survival. Improvements in surgical technique, however, have meant that this problem now can be circumvented in most instances. Nevertheless portal vein thrombosis remains an obstacle in OLT and is associated with increased incidence of primary non‐function and longterm liver failure.

Methods

A 55‐yr‐old patient underwent OLT for secondary biliary cirrhosis associated with hepatitis C infection and complicated by long standing PVT. Involvement of the portal, mesenteric, and splenic veins prevented standard portal venous reconstruction. Portal inflow was accomplished by a side‐to‐end anastomosis between the middle colic vein and the donor portal vein.

Results

Hepatic reperfusion and subsequent liver function were excellent. Portal blood flow, as measured by color‐enhanced Doppler ultrasound, was normal following surgery until discharge. The post‐operative course was complicated by abdominal wound dehiscence and recurrent cytomegalovirus (CMV) infection. The patient was discharged in good clinical condition, with excellent liver function and patent portal vein 89 d after OLT.

Conclusions

The middle colic vein is a novel, not previously described, source of portal venous inflow for OLT complicated by extensive splanchnic venous inflow thrombosis.
Successful pancreas and kidney transplantation: a view of metabolic control
Authors: Balsells M Fernández , Esmatjes E , Ricart MJ , Casamitjana R , Astudillo E , Cruz L Fernández
Published: September 2024

Background

Pancreas and kidney transplantation (PKTx) has become the treatment of choice in uremic patients with insulin‐dependent diabetes mellitus (IDDM). In these patients, the pancreatic graft provides an endogenous source of insulin. However, the determination of its long‐term effect on metabolic control is crucial in order to establish the real efficacy of this treatment in diabetic patients. In this article, we describe the experience of the University of Barcelona in shortand long‐term metabolic control in PKTx recipients. Subjects and methods. We performed seriated determinations of glycosilated hemoglobin (HbA1c) and oral glucose tolerance tests (OGTT) in 55 patients who underwent PKTX at our center from 1983 to 1996 with both grafts functioning for more than 1 yr (mean follow‐up 4.2±2.3 yr). Basal glucose and insulin levels, areas under the curve (AUC) of glycemia and insulinemia after OGTT were analyzed throughout follow‐up, as well as the fasting insulin resistance index (FIRI).

Results

HbA1c levels throughout follow‐up were within the normal range. The OGTT was normal in 80% of the patients 5 yr after transplantation. Hyperinsulinemia was present throughout follow‐up. Over time, no differences were detected in the AUC of glycemia and insulinemia between controls and patients with PKTx. During the evolution, no differences were found in FIRI, in spite of increasing body weight.

Conclusion

When successful, PKTx provides long‐term normalization. of glycemic control, assessed by HbA1c and OGTT, despite the existence of sustained hyperinsulinemia. Our results strongly suggest that PKTX is the most effective treatment for uremic patients with IDDM from a metabolic point of view.
Insulin allergy resolution following pancreas transplantation alone
Authors: Oh Henry K , Provenzano Robert , Hendrix Julie , El‐Nachef MW
Published: September 2024

Clinically significant immunological reactions to exogenous insulin are classified as local or generalized. Most of the insulin allergies are local reactions which usually improve or resolve spontaneously. Generalized allergic reactions to insulin range in severity from simple urticaria to life‐threatening anaphylaxis. Most of the allergic reactions to exogenous insulin are antibody‐mediated reactions to antigens such as zinc, protamine, non‐insulin proteins, and aggregates of insulin molecules as well as animal antigens. Immunologic reactions to endogenous insulin usually result in insulin resistance. Herein, we report a case in which systemic insulin allergy was intractable, thus requiring a pancreas transplantation which is the first of its case according to the International Pancreas Transplant Registry/United Network for Organ Sharing (IPTR/UNOS) Registry.
Thrombotic microangiopathy after liver–small bowel transplant
Authors: Humar Abhinav , Jessurun Jose , Sharp Harvey L , Gruessner Rainer WG
Published: September 2024

We herein report the first case of immunosuppression‐associated thrombotic microangiopathy (TMA) in which an extrarenal graft was primarily affected by the characteristic microvascular lesions. Although TMA is a well‐known complication of cyclosporine (CSA) or tacrolimus therapy in renal and extrarenal (liver, heart, lung) transplant recipients, the kidney (transplanted or native) is typically the site primarily affected. We describe a combined liver‐small bowel transplant recipient who developed tacrolimus‐associated TMA that affected both her transplanted small bowel and her native kidneys. Involvement of the bowel, with evidence of microvascular occlusion on biopsy, led to the development of ischemic mucosal ulcers and eventual bowel perforation. Involvement of the kidney manifested with a doubling of the recipient's baseline serum creatinine level. Significant lowering of the tacrolimus dose resulted in healing of the small bowel ulcers and return to her baseline level of renal function. Therefore, it is important to note that, in transplant recipients, TMA with microvascular occlusion may affect extrarenal sites. In small bowel transplant recipients, the result might be ischemic ulcers in the graft and eventual bowel perforation.
Linking extent of return to fasting state after oral glucose tolerance test to future risk of prediabetes and type 2 diabetes: Insights from the TLGS
Authors: Masrouri Soroush , Tamehri Zadeh Seyed Saeed , Tohidi Maryam , Azizi Fereidoun , Hadaegh Farzad
Published: September 2024

Aims

To assess the risk of difference between 2 h post‐load plasma glucose (2 h‐PG) and fasting plasma glucose (FPG) on incident prediabetes/type 2 diabetes (T2DM) among normoglycemic individuals.

Methods

Among 4,971 individuals aged ≥20 years, the associations of the difference between 2 h‐PG and FPG with outcomes were examined using multivariable‐adjusted Cox regression analysis. Participants were categorized into three groups: a low post‐load group (2 h‐PG ≤ FPG, as the reference group); a high post‐load group (2 h‐PG > FPG and ≥75th percentile of the difference); and a medium post‐load group (2 h‐PG > FPG and <75th percentile of the difference), which was further categorized into three groups by equal ranges.

Results

Over a median of 11.5 years of follow‐up, 2,331 new cases of prediabetes/type 2 diabetes and 360 cases of type 2 diabetes occurred. Greater risks of incident prediabetes/type 2 diabetes in second (9–16 mg/dL) and third (17–24 mg/dL) medium post‐load, as well as high post‐load (≥25 mg/dL) categories, were found, with hazard ratios (95% confidence intervals) of 1.26 (1.11–1.44), 1.32 (1.15–1.51), and 1.69 (1.51–1.90), respectively; the issue was more prominent among women (P for interaction = 0.005). The risk of incident type 2 diabetes was also higher for these categories. After further adjustment for the homeostasis model assessment of insulin resistance, result remained essentially unchanged. Even among individuals with low normal FPG (i.e., <90 mg/dL), ≥9 mg/dL difference between 2 h‐PG and FPG increased the risk of composite prediabetes/ type 2 diabetes.

Conclusions

Greater levels of 2 h‐PG as low as 9 mg/dL than FPG among normoglycemic individuals is a harbinger of prediabetes/type 2 diabetes development.
The Potential of Using Different Legume Species in a Push–Pull Approach to Manage Spodoptera frugiperda in Maize in China
Authors: Bi Sijia , Wang Yinhao , Xu Tingting , Hu Benjin , Wang Zhenying , Jatoi Wajid Ali , Hu Fei , Xu Lina
Published: September 2024

Fall armyworm (FAW), Spodoptera frugiperda (Smith), a notorious pest native to the tropical and subtropical Americas, has recently invaded China, causing substantial damage to crops, particularly maize. The push–pull strategy has been reported to be an effective prevention measure for FAW in Africa, with maize–soybean intercropping significantly reducing FAW infestation. To assess the potential of legume hosts as ‘push’ or ‘pull’ plants to control FAW in maize, we employed life table analysis and indoor cage tests to investigate the offspring performance, feeding and oviposition preference of FAW on five selected legume species, namely mung bean (Vigna radiata L.), soybean (Glycine max L.), kidney bean (Phaseolus vulgaris L.), red bean (Vigna angularis Willd.) and cowpea (Vigna unguiculata L. Walp), with maize (Zea mays L.) as a control. Mung bean and cowpea were subsequently selected as repellent and attractant plant, respectively, to study FAW infestation levels in maize in the field. The results showed that maize was the most suitable host plant for FAW, as indicated by its shortest developmental duration and highest pupal weight. However, among all the tested legume species, cowpea was the best host for FAW, with shorter larval, pre‐adult and adult durations than on the leaves of the other legumes. Moreover, the feeding and oviposition preference tests revealed that FAW had a strong preference for maize and cowpea, but strongly rejected mung bean. Compared with that in the maize monoculture group, the total number of eggs laid in the maize–mung group decreased by 67.25%, whereas that in the maize–cowpea group significantly increased by 2.04‐fold in greenhouse tests. In the randomised block field experiment, the infestation of maize by FAW in the mung bean–cowpea system was significantly lower than that in the maize monoculture or in the system with maize surrounded only by cowpea. This study indicated that mung bean and cowpea are promising candidates as repellent plants (push) and attractant plants (pull), respectively, for intercropping with maize to reduce the damage caused by FAW.
Sleep problems of children with Down syndrome in northern China
Authors: Zhang Y. , Li L. M. , Ding J. N. , Liu Y. , Yuan Y. Q.
Published: September 2024

Background

Limited research has looked at the present‐day sleep problems among Chinese children with Down syndrome (DS). This study aimed to investigate the situation of the sleep problems of school‐aged children with DS in northern China.

Methods

Parents of children with DS were a convenience sample recruited through the special education schools of Shandong Province in China. The Chinese version of the Children's Sleep Habits Questionnaire was applied to assess the sleep problems of children with DS.

Results

Parents of 334 children with DS reported the average sleep duration was 9.7 (9.3–10.2) hours per night, and 62.0% of children with DS were reported sleeping less than 10 h per night. Additionally, the total prevalence rate of sleep problems among children with DS was 69.8%. Sleep‐disordered breathing (59.2%), sleep duration (33.8%) and bedtime resistance (32.0%) were the three most commonly reported sleeping problems. Younger children with DS (age 6–8 years) had severe problems with bedtime resistance, sleep anxiety and parasomnias than older children with DS (age 9–12 years) (all P < 0.05).

Conclusion

Sleep problems are prominent among children with DS in northern China and are worthy of attention. Caregivers and health professionals should raise awareness of sleep problems in this group of children and implement targeted interventions to improve their sleep quality as early as possible.
Association of dynamic hepatic metabolism with clinical outcomes in patients with severe Guillain‐Barré syndrome: A prospective cohort study from multi‐centers in China
Authors: Xie Jiali , Yu Huan , Lv Wenjing , Li Kezheng , Li Hui , Ji Yingxiao , Cai Yunlei , Cheng Yifan , Luo Longfeng , Wu Chunxue , Xu Yiting , Du Lihuai , Chen Yinuo , Pang Chunyang , Deng Binbin
Published: September 2024

Background and Aims

Little is known about the ability of serological biomarkers to monitor clinical outcomes in patients with Guillain‐Barré syndrome (GBS). The objective of this study was to determine the associations of liver function, easily available and convenient biomarkers, with the clinical course and outcome of severe GBS in patients.

Methods

A prospective data collection was conducted in a cohort of 343 GBS patients from multi‐centers between September 2019 and December 2023. Serum samples were obtained at four‐time points for mechanical ventilation (MV) patients and two‐time points for non‐MV patients. The primary endpoint was the need for MV during hospitalization, while secondary outcomes included the ability to walk independently and the mortality at 26‐week follow‐up.

Results

(i) A total of 208 patients were eligible, of whom 50 required MV with a median (interquartile range) ventilation duration of 15 (8–27) days. (ii) Hypohepatia, as evidenced by reduced total protein (OR 0.913 [95% CI 0.862–0.967]) and albumin (0.775 [0.679–0.884]) 1 week after treatment, along with raised liver enzymes (2.732 [1.007–7.413]), was associated with the risk of MV after adjusting for confounders. (iii) After 26‐week follow‐up, patients with hypohepatia were less likely to regain independent walking and exhibited higher mortality in survival analysis (all log‐rank p < .05). (iv) In a cross‐sectional study spanning up to 4 years of follow‐up, patients with prolonged MV (≥15 days) experienced a longer time to regain independent ambulation than those with shorter MV (167 [46–316] vs. 69 [24–106], p = .036). However, no relationships between liver function and prolonged MV were revealed.

Interpretation

Dynamically monitoring hepatic metabolism and promptly adjusting, it can aid the improvement of GBS in patients.
Investigating UK Consumer Perception of Food Sustainability and Consumer Strategies for Improving the Sustainability of Their Most Recent Meal
Authors: Hutchings Scott C. , Chheang Sok L. , Hedderley Duncan I. , Realini Carolina E. , Jaeger Sara R.
Published: September 2024

While numerous studies have examined consumer perceptions of food sustainability, their views on the United Nations defined dimensions (environmental, social, and economic) remain under‐researched. Furthermore, little research has investigated how consumers believe they could improve the sustainability of their food choices from a real‐life meal context. This study had three research objectives: To determine how consumers perceive sustainable and unsustainable foods (RO1), perceive differences among environmentally, socially, and economically sustainable foods (RO2), and perceive how they could improve the sustainability of their most recent meal (RO3). The study was executed using an online survey in the United Kingdom (n = 1522) with open‐ended questions. Results for RO1 showed consumers had a diverse understanding of sustainable/unsustainable foods. For RO2, most consumers had a similar perception of environmentally, socially, and economically sustainable foods. For RO3, many consumers indicated their most recent meal was already sustainable or were uncertain about to how to improve its sustainability.
Transcriptome and Metabolomic Analyses Reveal Tissue‐Specific Glycosylation of Phenylpropanoids and Flavonoids in Toxicodendron vernicifluum
Authors: Zhao Aiguo , He Yuxi , Sun Ruixiang , Xie DongDong , Bai Hangyu , Han Feng , Huang Xiaohua , Wu Haitang , Liu Chaobin
Published: September 2024

Toxicodendron vernicifluum (Stokes) F. A. Barkley is a tree species used primarily for lacquer production. Our study utilized transcriptome and metabolomic analysis to investigate the biosynthesis of phenylpropanoids and flavonoids, specifically the glycosylated forms, in T. vernicifluum roots, stems, and leaves. HPLC‐QTOF‐MS/MS identified 186 compounds, with tissue‐specific distributions revealed by PCA. Flavonoids and phenylpropanoids glycosides were significantly more abundant in leaves compared with roots and stems. Full‐length sequencing uncovered 17,266 transcripts in T. vernicifluum. Gene expression analysis showed higher activity of phenylpropanoid and flavonoid biosynthesis pathways in leaves. Certain genes, such as CYP73A, 4CL, CRR, CYP84A/F5H, and CYP93C, displayed associations with compound content distributions. Root tissue exhibited a higher concentration of isoflavones. Notably, glycosyltransferase expression demonstrated significant correlations with glycosylated compounds' content. Biochemical validation confirmed the involvement of TvPB_c0_g2904, encoding a UDP‐glucosyltransferase, in genistin biosynthesis in T. vernicifluum.
Reinforcement of an endangered goose population: the effect of age and interspecific fostering on survival of released birds
Authors: Liljebäck Niklas , Schekkerman Hans , Månsson Johan , Kowallik Christine , Koffijberg Kees
Published: September 2024

The release of captive‐bred or translocated individuals is a strategy used worldwide to support threatened animal populations. By capture–recapture analysis, we examined the survival of released individuals when reinforcing a critically endangered Lesser White‐fronted Goose population. Our analysis includes data from 646 birds, released 1984–2017, including two different age classes, divided in two distinct periods when different techniques were used. Fledglings were released with foster parents of Barnacle Geese in the first period and by a soft release without support of foster parenting in the second period. Yearlings were released by soft release in both periods. We find that use of foster parents enhances survival rates, but these differences were detectable only in the first year of life. Fledglings supported by foster parents showed significantly higher survival compared to yearlings released by soft release, but this difference was not clear when soft release was applied to both groups. Resighting data suggest that most losses occurred during the acclimation period following the release. Foster parenting may enhance survival rates due to social learning enabling the transfer of crucial behaviors (e.g. feeding, anti‐predator, and migration) to released individuals. However, these conservation benefits need to be balanced against costs and potential inherent risks related to foster parenting, including the imprinting of undesired behaviors in released individuals, such as hybridization. Based on our results, we advise conservationists to carefully consider foster parenting as one method to improve survival probability, especially if capacity to produce individuals to be released is a limiting factor.
Aesthetic peerhood and the significance of aesthetic peer disagreement
Authors: Pharr Quentin , Torregrossa Clotilde
Published: September 2024

Both aestheticians and social epistemologists are concerned with disagreement. However, in large part, their literature has yet to overlap substantially in terms of discussing whether there are viable conceptions of aesthetic peerhood and what the significance of aesthetic peer disagreement might be as a result. This article aims to address this gap. Taking cues from both the aesthetics and social epistemological literature, it develops several conceptions of aesthetic peerhood that are not only constituted by various forms of cognitive peerhood and affective peerhood, but which are also framed by a specific model of ordinary peer disagreement. For each of these conceptions, it suggests what the significance of ordinary aesthetic peer disagreement might be and how future discussions about it might proceed for both aestheticians and social epistemologists alike.
Incomplete filling in the basal region of maize endosperm: timing of development of starch synthesis and cell vitality
Authors: Chen Xian‐Min , Wang Zhi‐Wei , Liang Xiao‐Gui , Li Feng‐Yuan , Li Bin‐Bin , Wu Gong , Yi Fei , Setter Tim L. , Shen Si , Zhou Shun‐Li
Published: September 2024

Starch synthesis in maize endosperm adheres to the basipetal sequence from the apex downwards. However, the mechanism underlying nonuniformity among regions of the endosperm in starch accumulation and its significance is poorly understood. Here, we examined the spatiotemporal transcriptomes and starch accumulation dynamics in apical (AE), middle (ME), and basal (BE) regions of endosperm throughout the filling stage. Results demonstrated that the BE had lower levels of gene transcripts and enzymes facilitating starch synthesis, corresponding to incomplete starch storage at maturity, compared with AE and ME. Contrarily, the BE showed abundant gene expression for genetic processing and slow progress in physiological development (quantified by an index calculated from the expression values of development progress marker genes), revealing a sustained cell vitality of the BE. Further analysis demonstrated a significant parabolic correlation between starch synthesis and physiological development. An in‐depth examination showed that the BE had more active signaling pathways of IAA and ABA than the AE throughout the filling stage, while ethylene showed the opposite pattern. Besides, SNF1‐related protein kinase1 (SnRK1) activity, a regulator for starch synthesis modulated by trehalose‐6‐phosphate (T6P) signaling, was kept at a lower level in the BE than the AE and ME, corresponding to the distinct gene expression in the T6P pathway in starch synthesis regulation. Collectively, the findings support an improved understanding of the timing of starch synthesis and cell vitality in regions of the endosperm during development, and potential regulation from hormone signaling and T6P/SnRK1 signaling.
Evaluation of Coastal Management in the Municipality of Paulista/PE in the Light of the Decalogue
Authors: Lucena de Godoy Maciel Ana Luiza , Paes Barreto Eduardo , Assunção da Silva Carlos Fabricio , Miranda dos Santos Maria Pricila , De Vasconcelos Santos Priscila Fernanda
Published: September 2024

Brazil adopts Integrated Coastal Management as a way of protecting coastal environments through sustainable use and through the National Coastal Management Plan – PNGC structures actions directed at coastal areas, guaranteeing municipalities a prominent position in the integrative process. The structuring of the legal and institutional framework does not remove the picture of degradation borne by coastal cities, which have problems with sanitation, erosion and reduction of biodiversity. The general objective of this article is to analyze the Coastal Management process adopted by the municipality of Paulista, Pernambuco, in order to provide subsidies for institutionalization and sustainable governance. The methodology was structured in two parts. The first part used the Land Use and Land Cover (LULC) dataset available free of charge MapBiomas collection 6. The second part used the methodology proposed by Barragán in the “Decalogue for the Management of Coastal Areas”, where the 10 indicators are analyzed fundamental to evaluate actions related to coastal management. The methodology was adapted to include the mapping of the use and occupation of the municipality's coastal area over a period of 36 (thirty-six) years. The results of the analysis of land use and occupancy indicate a steady growth in anthropized areas from 1986 until the end of the 1990s, stabilizing with few changes. After an increase, there was a new stabilization between 2006 and 2012, followed by a notable growth in 2013–2014 and a subsequent period with less pronounced increments until the year 2021. Regarding the matrix analysis, there is a greater advancement in aspects related to Knowledge and Information, Normative and Competencies, whereas items such as Training and Capacity Building, Resources, and Public Policies require better strategic definitions by the municipality. As for the results of the matrix analysis, they reveal the need for the implementation of impact mitigation measures, the strengthening of oversight and monitoring, the development of strategies for climate change adaptation, the promotion of environmental education, and the fostering of scientific research in coastal areas. Finally, there is a suggestion for the continuous evaluation and correction of actions related to coastal and marine areas of the municipality, as well as the use of scientific evidence in decision-making.
María y el Cauca : un río lleno de vida
Authors:   Pontificia Universidad Javeriana, Jaramillo Villa Úrsula , Torres Carreño Guillermo
Published: September 2024

María y el Cauca, un río lleno de vida cuenta la historia de una niña de siete años que vive cerca a Puerto Valdivia, en el cañón del río Cauca, y cómo toda su cotidianidad (su alimento, su baño, su casa, su transporte) está determinada por la vida presente en el río. A lo largo del relato, la niña va descubriendo cómo ese río está vivo en dimensiones más grandes que las que conoce y cómo ese canal de agua que fluye frente a ella, desde los páramos hasta el mar, conecta personas, animales y ecosistemas. Así, María reconoce que ¡este río está muy vivo! Te invitamos a descubrir todos los secretos de la vida en el río Cauca.
Evaluating Large Language Models for Material Selection
Authors: Grandi Daniele , Jain Yash Patawari , Groom Allin , Cramer Brandon , McComb Christopher
Published: September 2024

Material selection is a crucial step in conceptual design due to its significant impact on the functionality, aesthetics, manufacturability, and sustainability impact of the final product. This study investigates the use of large language models (LLMs) for material selection in the product design process and compares the performance of LLMs against expert choices for various design scenarios. By collecting a dataset of expert material preferences, the study provides a basis for evaluating how well LLMs can align with expert recommendations through prompt engineering and hyperparameter tuning. The divergence between LLM and expert recommendations is measured across different model configurations, prompt strategies, and temperature settings. This approach allows for a detailed analysis of factors influencing the LLMs' effectiveness in recommending materials. The results from this study highlight two failure modes: the low variance of recommendations across different design scenarios and the tendency toward overestimating material appropriateness. Parallel prompting is identified as a useful prompt-engineering method when using LLMs for material selection. The findings further suggest that, while LLMs can provide valuable assistance, their recommendations often vary significantly from those of human experts. This discrepancy underscores the need for further research into how LLMs can be better tailored to replicate expert decision-making in material selection. This work contributes to the growing body of knowledge on how LLMs can be integrated into the design process, offering insights into their current limitations and potential for future improvements.
An Efficient Uncertainty Quantification Method Based on Inter-Blade Decoupling for Compressors
Authors: Fu Yu , Wang Junying , Shi Dalin , Tang Kai , Zhao Jiantong
Published: September 2024

A compressor usually contains multiple blade rows, and its uncertainty dimensionality grows proportionally with the number of blade rows, leading to a rapid increase in required sample size for uncertainty quantification analysis. This paper proposes a new model decomposition method based on inter-blade decoupling, by analyzing uncertainty propagation in compressors. Traditionally, a surrogate model with uncertainty variables of all blade rows as input is directly established and the dimensionality is high. To solve this problem, this study decomposes the compressor domain into subdomains, each containing one blade row. For each subdomain, a submodel introduces aerodynamic uncertainties at the interfaces connecting different subdomains. The dimensionality of a submodel is roughly equal to the uncertainty factors in a single row, significantly reducing the required sample size. The uncertainties in the rotor and stator blade rows of a one-stage compressor are investigated to verify this method. Using principal component analysis and machine learning, the projection amplitudes of the interface aerodynamic flow field onto the principal modes are extracted, and submodels are established. Results show that the original 25-dimensional model can be decoupled into a 13-dimensional submodel for the rotor and a 16-dimensional submodel for the stator, reducing the required sample size from 600 to 90 with similar accuracy. This model decomposition method greatly reduces the cost of predicting compressor performance with uncertainty, laying a foundation for comprehensive analysis and effective control of uncertainty factors in engineering applications.
Conjugate Heat Transfer Validation of an Optimized Film Cooling Configuration for a Turbine Vane Endwall
Authors: Yang Xing , Wu Hang , Feng Zhenping
Published: September 2024

In this study, to improve overall cooling performance for the endwall of a turbine nozzle guide vane that incorporated internal jet impingement and external purge flow and discrete injection cooling, the external film cooling was re-designed based on the knowledge of film coverage patterns from a baseline design, allowing film injection to overcome the crossflow and to cover more areas of the endwall with a given amount of coolant. Experimental conjugate heat transfer validation of the newly designed cooling geometry was conducted in a linear vane cascade by measuring overall cooling effectiveness over the endwall through an infrared (IR) thermography technique and detecting aero-thermal fields at the cascade exit with five-hole and thermocouple probes. For a given total coolant flowrate, the influence of coolant split among different cooling sources was examined. Additionally, parallel computational simulations were undertaken to elaborate the results observed in the experiments by offering in-passage flow physics. Comparisons with the baseline design proved that the newly designed cooling scheme improved the endwall overall cooling performance in terms of both effectiveness levels and coverage. In addition to optimizing the cooling geometry, more efficient usage of the coolant was found to be linked with the proper coolant split, which helped the re-designed cooling geometry to achieve an improvement of cooling effectiveness by approximately 20%. The computational simulations produced satisfactory overall cooling effectiveness, but failed to capture mixing of coolant with mainstream flow. The coolant with mainstream flow interactions visualized by the simulations provided evidence that the coolant jets from the optimized cooling scheme increased mixing flow loss but those from the pressure side suppressed the inherent vortex flow, resulting in no aerodynamic penalty as compared with the baseline cooling design.