bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in mammary infection status in dairy cows during the dry period using dry cow therapy approaches on three farms
Authors: Nagahata Hajime , Komori Nodoka , Fukutome Mayu , Sugiura Tomochika , Hisaeda Keiichi , Gondaira Satoshi , Higuchi Hidetoshi , Ando Tatsuya , Nakada Ken
Published: October 2024

This case study evaluated the mammary infection status of dairy cows during the dry periods and explored the associated problems in their quarters with dry cow therapy (DCT). This study assessed intramammary infections, antibiotic efficacy, and antimicrobial resistance of pathogens in 464‐quarter milk samples from 59 dairy cows during the dry periods after applying blanket DCT, non‐DCT, and selective DCT approaches on three farms. The recovery rates of intramammary infections were 95% (19/20 quarters) with blanket DCT on farm A, 70% (14/20) with non‐DCT on farm B, and 19% (4/21) with selective DCT on farm C. Analysis of mammary infections in cows with DCT revealed that mammary infections were controlled by blanket DCT, well controlled by non‐DCT, and substantial problems remained in selective DCT. Lower intramammary infection prevalence in the quarters at postpartum appeared to be associated with higher recovery of mammary infections, fewer new infections, and lower uncured mammary infections within the herds. Antibacterial resistance in 14 coagulase‐negative staphylococci isolated to six antimicrobial drugs was suggested to be linked to antibiotic use on the farm. Follow‐up studies on the quarter‐based infection status with DCT will assist in improving mastitis control in cows during the dry period.
Posterior pituitary tumors and other rare entities involving the pituitary gland
Authors: Roncaroli Federico , Giannini Caterina
Published: October 2024

Non‐neuroendocrine tumors account for around 10% of all primary neoplasms of the sella. If meningiomas, craniopharyngiomas, and germ cell tumors are excluded, the remaining lesions include a broad spectrum of uncommon, benign, and aggressive, often diagnostically challenging lesions. This review aims to summarize the essential clinicopathological features of tumors of the posterior pituitary gland, infundibulum spectrum expressing thyroid transcription factor 1, and primary sellar atypical rhabdoid teratoid tumor, and provide the criteria for their diagnosis and management.
Make new friends, leave my friends: A dialogical investigation into transition experiences and agency in children from UK Armed Forces families
Authors: Lee Claire
Published: October 2024

This article provides new perspectives on the transitions of children from military families. It examines the experiences and agency of a group of UK primary‐school Service children who were undergoing far‐reaching transitions while participating in an arts‐based research project. Transitions are conceived here not as events, such as school moves, but as processes of changing, the dialogical interplay between ever‐changing socio‐cultural and physical environments and the psychological work individuals undertake in response to change. This reconceptualisation of transitions shifts attention away from children's resilience, or lack thereof, and towards unique, nuanced understandings of their subjective experiences and priorities. Presenting multimodal pieces created by three children as they explored the question, ‘What's it like to be a Service child in this school?’, I describe their diverse and agentic responses to their changing circumstances, as they sought to mitigate anticipated and past losses and perceived disadvantage and to use their transitions as positive opportunities for self‐development. Although punctuated by observable moments of change, this transition work happened over an indefinite timescale, highlighting a need for long‐term support informed by understandings of children's agency and priorities. Such support and insight may be achieved through developing spaces for multimodal dialogue with Service children.
Fully digital versus conventional workflow: Are removable complete overdentures equally good? A randomized crossover trial
Authors: Van de Winkel Thomas , Delfos Frans , van der Heijden Olleke , Bronkhorst Ewald , Verhamme Luc , Meijer Gert
Published: October 2024

Introduction

Implant‐supported removable complete overdentures (IODs) are a common treatment in case of edentulism and malfunctioning of the conventional denture. Manufacturing IODs in a conventional way (C‐IODs) is time‐consuming, but in a digital workflow, this can be done in three sessions. Digitally produced IODs (3D‐IODs) are also more advantageous than C‐IODs because lost or broken 3D‐IODs can be swiftly reproduced as the digital design is always available.

Purpose

To prove in a non‐inferiority study, with a margin of 0.3 point per Oral Health Impact Profile‐20 (OHIP‐20) question, that IODs made according to a fully digital workflow (3D‐IODs), function as good as C‐IODs with respect to patient‐reported outcome measures (PROMs).

Materials and Methods

This randomized crossover study included 36 fully edentulous patients who showed extreme resorption of the maxillary alveolar process, making denture retention difficult. After a maxillary bone augmentation and the installation of 4–6 implants, each patient wore both types of IOD for 1 year each, with the order reversed in two subsets of patients. The 3D‐IODs and C‐IODs were fabricated in advance for both jaws (at least two mandibular implants were already present).

The OHIP‐20 survey was performed at baseline, after 1 year (before the IOD switch), and after 2 years to determine patient satisfaction scores using a visual analog scale (VAS). The general health status was assessed using the Short Form (SF‐36) questionnaire.

Results

Regarding the PROMs, patients preferred the 3D‐IOD: the improvement on the overall OHIP scale (0–4), expressed as a mean, was 0.26 points greater than for the C‐IOD (p < 0.001). This applied also to the VAS scale (1–100) with an increase of 7.37 points (p < 0.001). Regarding the SF‐36 scale, only for the item “emotional well‐being,” the 3D‐IOD scored significantly better (p = 0.033).

Conclusion

Compared with conventionally fabricated C‐IODs, fully digitally produced 3D‐IODs resulted in significantly higher OHIP‐20 and satisfaction scores.
The CO‐OP Approach: A transdiagnostic perspective
Authors: Madieu Emmanuel , Cantin Noémi
Published: October 2024

This commentary is on the original article by Kangarani‐Farahani et al. on pages 216–222 of this issue.
Effectiveness of the MyDiaMate application in reducing diabetes distress in adults with type 1 diabetes: Study protocol of the multi‐national, randomised‐controlled MyREMEDY trial
Authors: Mohr Theresa C. , de Wit Maartje , Embaye Jiska , Ehrmann Dominic , Hermanns Norbert , Lehmann Gina , Anarte Ortiz María Teresa , Torreblanca Murillo Laura , Winkley Kirsty , Famiglietti Alexandra , Pouwer Frans , Snoek Frank J.
Published: October 2024

Aims

Diabetes distress is common among people with type 1 diabetes (T1D), negatively affecting quality of life, self management, and diabetes outcomes. E‐health‐based interventions could be an effective and low‐cost way to improve the psychological care for people with T1D experiencing diabetes distress. The MyREMEDY study aims to test the effectiveness of the online unguided self‐help intervention MyDiaMate in decreasing diabetes distress in adults with T1D. MyDiaMate is based on Cognitive Behavioural Therapy and consists of eight modules, each focusing on a different aspect of living with T1D that is often experienced as burdensome (e.g. hypoglycaemia, fatigue).

Methods

The effectiveness of MyDiaMate will be tested through a randomised‐controlled trial across four European countries (the Netherlands, Germany, Spain and the United Kingdom). Six hundred and sixty adults (N = 165 per country) with T1D will be recruited and randomised with a balance of 2:1 into the intervention and care as usual groups. Intervention group members receive access to MyDiaMate for 6 months, care as usual group members receive access after 3 months for 3 months. Participants fill in questionnaires at 0 (baseline), 3 (effectiveness) and 6 months (follow‐up). Primary outcome is diabetes distress at 3 months. Secondary outcomes are emotional well‐being, psychological self‐efficacy in relation to diabetes, social engagement, fatigue, and glycaemic outcomes. Moreover, logdata of MyDiaMate use is passively collected. Linear mixed model analyses will be used to test the effectiveness of MyDiaMate along with identifying which user subgroup benefits most from MyDiaMate use.

Trial Registration

Clinicaltrials.gov NCT06308549.
Partial chemogenetic inhibition of the locus coeruleus due to heterogeneous transduction of noradrenergic neurons preserved auditory salience processing in wild‐type rats
Authors: Kabanova Anna , Yang Mingyu , Logothetis Nikos K. , Eschenko Oxana
Published: October 2024

The acoustic startle reflex (ASR) and prepulse inhibition of the ASR (PPI) assess the efficiency of salience processing, a fundamental brain function that is impaired in many psychiatric conditions. Both ASR and PPI depend on noradrenergic transmission, yet the modulatory role of the locus coeruleus (LC) remains controversial. Clonidine (0.05 mg/kg, i.p.), an alpha2‐adrenoreceptor agonist, strongly reduced the ASR amplitude. In contrast, chemogenetic LC inhibition only mildly suppressed the ASR and did affect the PPI in virus‐transduced rats. The canine adenovirus type 2 (CAV2)–based vector carrying a gene cassette for the expression of inhibitory receptors (hM4Di) and noradrenergic cell–specific promoter (PRSx8) had high cell‐type specificity (94.4 ± 3.1%) but resulted in heterogeneous virus transduction of DbH‐positive LC neurons (range: 9.2–94.4%). Clozapine‐N‐oxide (CNO; 1 mg/kg, i.p.), a hM4Di actuator, caused the firing cessation of hM4Di‐expressing LC neurons, yet complete inhibition of the entire population of LC neurons was not achieved. Case‐based immunohistochemistry revealed that virus injections distal (> 150 μm) to the LC core resulted in partial LC transduction, while proximal (< 50 μm) injections caused neuronal loss due to virus neurotoxicity. Neither the ASR nor PPI differed between the intact and virus‐transduced rats. Our results suggest that a residual activity of virus‐non‐transduced LC neurons might have been sufficient for mediating an unaltered ASR and PPI. Our study highlights the importance of a case‐based assessment of the virus efficiency, specificity, and neurotoxicity for targeted cell populations and of considering these factors when interpreting behavioral effects in experiments employing chemogenetic modulation.
Examining the Psychometric Impact of Targeted and Random Double‐Scoring in Mixed‐Format Assessments
Authors: Xu Yangmeng , Wind Stefanie A.
Published: October 2024

Double‐scoring constructed‐response items is a common but costly practice in mixed‐format assessments. This study explored the impacts of Targeted Double‐Scoring (TDS) and random double‐scoring procedures on the quality of psychometric outcomes, including student achievement estimates, person fit, and student classifications under various conditions that reflect operational performance assessments. Using a simulation study, our results suggest no notable advantages for TDS over the random double‐scoring approach across various psychometric outcomes, regardless of conditions related to student misfit, rater misfit, and rater severity. This study holds significant implications for mixed‐format assessments, offering insights into a comprehensive evaluation of double‐scoring methods. We recommend that researchers consider these findings when considering among double‐scoring procedures.
Increasing access to justice for families through preventive legal advocacy
Authors: Finck Kara R.
Published: October 2024

What is the role of preventive legal advocacy in promoting justice for families and redefining child welfare to focus on family and community‐based systems which prioritize community‐based support and to forego government oversight, regulation and punishment? Given the timeline for systemic reforms and the necessity of providing access to justice for families presently struggling to protect their family autonomy, preventive legal advocacy is a critical piece of reform efforts and scholarly attention. This article advocates for the expansion of existing preventive legal advocacy models and legislation codifying early access to counsel with the goal of disrupting the traditional pathways into the child welfare and family regulation system, enforcing the rights of parents and children to their family autonomy and meaningfully supporting families to thrive.
DASC‐21 score and risk of rehospitalization and all‐cause mortality after discharge in older patients with heart failure
Authors: Shimizu Ruri , Ishikawa Joji , Jyubishi Chihiro , Toba Ayumi , Futami Shutaro , Morozumi Ai , Saito Yoshihiro , Komatsu Shunsuke , Fujimoto Hajime , Ishiyama Taizo , Usui Shinichi , Tuboko Yusuke , Awata Shuichi , Akishita Masahiro , Harada Kazumasa
Published: October 2024

Aim

The impact of cognitive dysfunction‐associated activities of daily living (ADL) on mortality and rehospitalization for heart failure has not yet been evaluated.

Methods

We retrospectively evaluated DASC‐21, the incidence of all‐cause mortality, and rehospitalization for heart failure after discharge in 329 older patients with heart failure.

Results

The mean age was 85.1 ± 7.4 years (62.6% women). There were 110 cases of death from any cause (33.4%) during 25.5 ± 16.1 months of follow‐up and 166 cases of rehospitalization from heart failure (50.5%) during 16.1 ± 15.2 months of follow‐up. The DASC‐21 score was not significantly associated with an increased risk of all‐cause mortality or rehospitalization. For each item of the DASC‐21 questionnaire, defective route‐finding (item 6) (HR = 2.631, P = 0.003), common sense and capacity for judgement (item 9) (HR = 1.717, P = 0.040), instrumental ADL (IADL) for shopping (item 10) (HR = 1.771, P = 0.020), and IADL for meal preparation (item 14) (HR = 1.790, P = 0.019) were significantly associated with an increased risk of all‐cause mortality. Disabilities in route finding (HR = 2.257, P = 0.005), IADL for shopping (HR = 1.632, P = 0.016), and IADL for transportation (HR = 1.537, P = 0.033) were significant risk factors for rehospitalization due to heart failure. Even in the multivariate‐adjusted model, disability in defective route‐finding was significantly associated with an increased risk of all‐cause mortality (hazard ratio [HR] = 2.148, 95% confidence interval [CI] 1.090–4.236; P = 0.027) and of rehospitalization for heart failure (HR = 2.138, 95% CI 1.153–3.963, P = 0.016).

Conclusions

In older patients hospitalized for heart failure, route disability was associated with all‐cause mortality and rehospitalization for heart failure after discharge. Geriatr Gerontol Int 2024; 24: 1130–1136.
Uncertainties of Temporary Protection: Forcibly Displaced People From Ukraine and Bosnia and Herzegovina
Authors: Krilić Sanja Cukut , Zavratnik Simona
Published: October 2024

The experiences of displaced persons, currently particularly from Ukraine, are reflected in the concept of temporary protection as an immediate response to mass displacement. This article proposes a consideration of temporary protection from the perspective of ‘openness’, ‘in‐betweenness’ and the various forms of insecurities in people's lives in new societies and on their journeys. Refugees are connected in multi‐layered networks along their routes; forced migration goes in all directions; therefore, fluidity, situational dependency and macro factors determine its dynamics. The empirical data on Ukrainian refugees in Slovenia and the consideration of the situation of Bosnian refugees in the period of the Yugoslav wars show a complex interplay of structural and individual factors that determine the position of temporarily protected persons in larger transnational networks. The article also reflects on the relational question of international protection from the perspective of ‘deservedness’ and hierarchies among different migrant groups.
A step forward to gender equality: Breaking the political glass ceiling at local level
Authors: Ribeiro Bruna Filipa Gonçalves , Rodrigues Miguel Ângelo , Tejedo‐Romero Francisca
Published: October 2024

Gender quota policies have the ability to alleviate the scarcity of women in politics. However, opponents of quotas argue that such policies may constitute, in the long term, a “glass ceiling.” In Portugal, although there is still a long way to go in terms of gender equality, some municipalities have been successful in electing many women. Therefore, the aim of this article is to investigate, through the lenses of historical institutionalism and contagion theory, the factors that help women break out of the glass ceiling trap at local level. The study is based on a dataset from the last local elections and uses a panel data regression to calculate the probabilities of electing more women to municipal councils. The results underline that left‐wing parties that have adopted voluntary quotas, municipal experience with women mayors, and competitive environments increase the likelihood of electing more women. Gender equality.
WHAT IS HISTORY IN A SETTLER COLONIAL SOCIETY? MAPPING THE LIMITS AND POSSIBILITIES OF ETHICAL HISTORIOGRAPHY USING AN AUSTRALIAN CASE STUDY
Authors: CLARK ANNA
Published: October 2024

In recent decades, the role of the history discipline as part of the architecture of colonization has become more visible and better understood. Such acknowledgement reflects foundational shifts in historical practice and theory prompted by transdisciplinary and transnational scholarship in fields such as postcolonial and settler‐colonial studies, First Nations knowledges, and historical perspectives and practices contextualized by transatlantic slavery. Their intervention in turn prompted a vital question: How do we map settler‐colonial historiography if the discipline has been complicit in the settler‐colonial project? Using Australian historiography as a case study, this article explores how History has been part of the architecture of colonization, policing whose stories can be told and by whom. Drawing on the work of Indigenous history‐makers and knowledge‐holders, it also points to ways that researchers might reach outside the traditional scope of historiography to map and contemplate the range of history‐making that comprises history in the settler colony.
Petrological and Geochemical Constraints on the Pelitic Hornfels of the Champaner Group, Western India: Implications for Its Origin and Evolution
Authors: Gorania Parita K. , Akolkar Gayatri N. , Joshi Aditya U. , Limaye Manoj A. , Singh Mahendra K.
Published: October 2024

The granitic intrusions emplaced into a terrane causes several textural, chemical and compositional changes in the host rock by wall‐rock alteration and forms contact metamorphic rocks that is, hornfels. The low‐grade metasedimentary rocks of the Champaner Group exposed as horse‐shoe‐shaped map pattern have envisaged several pulses of granitic intrusion with granitoid ages ranging from 2.5 to 0.95–0.93 Ga enclosing its most peripheries. However, it has been observed that the contact metamorphic signatures are most prominent on the eastern periphery of Champaner fading away towards the west slicing up the Champaner Group into outer, middle, and inner zone rocks. The present work is focused on the detailed study of inner zone pelitic hornfels by providing new constraints on field characteristics, reaction textures, mineral chemical compositional analyses, geochemical signatures, and P–T conditions. Three distinguished varieties of pelitic hornfels that is, biotite hornfels, andalusite‐cordierite hornfels, and andalusite‐sillimanite hornfels with increasing proximity to granitic intrusion respectively were identified. Based on the mesoscopic features, textural and phase relations, and mineral compositions, biotite, andalusite, cordierite, and sillimanite isograds were demarcated. The development of distinct mineral assemblages in different pelitic hornfels is correlated to the varying Al2O3, FeO, and MgO content in the bulk rock composition of the rocks and the geometry of the intruding felsic pluton (Godhra granite) beneath the Champaner supracrustals. The geochemical constraints suggest K‐rich clay dominant shale protolith of post archean age comparable to Post‐Archean Australian Shales (PAAS) deposited in an active continental margin tectonic setting. The increase in temperature gradient rather than pressure induced by 0.95–0.93 Ga “Godhra granitic” intrusion is considered to be a significant factor controlling the development of the observed progressive mineral assemblages. The P–T conditions constrained through P–T pseudosections built in a KFMASHTi model system suggest LP/HT metamorphism with P–T range from 200 to 350 MPa and 530°C–600°C respectively.
Effect of heat‐treatment on the microstructure and room‐temperature mechanical properties of alumina–silica fiber
Authors: Chen Mo , Yang Xiang , Qing‐zhuang Han , Zhi‐hang Peng , Jin Wen , Ping Liu
Published: October 2024

Effect of heat‐treatment (900°C∼1600°C) on the microstructure and mechanical properties of alumina–silica fiber was well investigated. The results indicated that the recommended temperature threshold for the use of the alumina–silica fiber was not more than 1100°C to maintain its mechanical integrity. Above this temperature, the elastic modulus of the fibers increased, and the tensile strength significantly decreased, mainly because of the transformation of the structure from γ‐Al2O3 and amorphous SiO2 to mullite. The tensile strength of the fiber was 0.87 GPa at 1200°C. Compared to the as‐received fibers, the strength retention was only 63.50%. Moreover, as revealed by Weibull statistical analysis, the formation of more defects due to mullite phase transformation resulted in higher dispersion of the fiber tensile strength. However, at this temperature, the Young's modulus of the fiber increased from the initial value 146.24 ± 5.19 GPa to 183.06 ± 5.83 GPa. Finally, the rate of mullite reaction was seen to be strongly temperature dependent. The higher the heat‐treated temperature, the shorter the time required for γ‐Al2O3 and amorphous SiO2 to completely transform into mullite grains.
Thermal shock stability and corrosion resistance to LiNixCoyMn1−x–yO2 of mullite–cordierite‐CA6 saggar materials
Authors: Cao Duoke , Li Shujing , Li Yuanbing , Tan Junfeng , Wei Changdong
Published: October 2024

Mullite–cordierite saggar materials commonly used in the industry are easily corroded by LiNixCoyMn1−x–yO2 (LNCM) materials during the synthesis of Li‐ion batteries. To extend their service life, the influence of varying the proportion of calcium hexaluminate (CA6) ranging from 0 to 12 wt% on the sintering behavior of the mullite–cordierite system was investigated. These samples were then tested to evaluate their physical characteristics, resistance to corrosion by LNCM materials, and thermal shock stability. The experimental results show that the open‐pore structure formed by the interstacking grains of CA6 effectively impedes further penetration of the corrosion phase. Moreover, the addition of CA6 resulted in the in situ formation of anorthite within the material, enhancing its sintering and bonding properties and significantly improving the material's corrosion resistance. Consequently, incorporating CA6 effectively enhances the saggar's thermal shock stability and corrosion resistance.
Effects of modifying hinotori™ surgical robot system on perioperative outcome of robot‐assisted radical prostatectomy
Authors: Teishima Jun , Wakita Naoto , Bando Yukari , Okamura Yasuyoshi , Suzuki Kotaro , Hara Takuto , Terakawa Tomoaki , Chiba Koji , Matsushita Kei , Nakano Yuzo , Kitatsuji Hiroaki , Miyake Hideaki
Published: October 2024

Objectives

One of the main advantages of the hinotori™ surgical robot system (HSRS) is that it can be easily adjusted. This study aimed to clarify the effects of modifying the HSRS on the perioperative outcomes of robotic‐assisted radical prostatectomy (RARP).

Methods

Overall, 158 cases of RARP using the HSRS were classified into three groups based on the modification to the system: group A (no modification, 70 cases), group B (addition of the ability to switch between two types of scopes and to adjust the arm base tilt back and forth, left and right, 42 cases), and group C (reduction of arm floating sensation, mitigation of emergency stop during arm collision, and addition of clutch function via hand switch in addition to foot pedal, 46 cases). The perioperative outcomes of each group were compared.

Results

The median of operation time, cockpit time, and cockpit time excluding the time required for lymph node dissection of group C were 223, 146, and 135 min, respectively, where are significantly shorter than those of group A (308, 228, and 208 min, p < 0.0001, respectively) and group B (319, 241, and 214 min, p < 0.0001, respectively). There was no significant difference in the rate of positive margin rates and the pad‐free rate before the first follow‐up visit among these three groups. The complication rates in groups A, B, and C were 11.4%, 9.4%, and 8.4% (Clavien‐Dindo grades I–II), and 4.3%, 2.4%, and 0% (grade III), respectively.

Conclusions

The modifications to the HSRS have enabled smoother surgical procedures for RARP.
Hepatitis antigenemia and survival after renal transplantation
Authors: Pfaff William W. , Blanton John W.
Published: October 2024

Some transplant programs regard hepatitis B antigenemia (HBsAg+) as a contraindication to renal transplantation. We studied the records of 13,287 renal transplant recipients, 781 (5.88%) who were positive for HBsAg, the remainder negative (HBsAg‐). Patient survival for HBsAg‐recipients is 91.8% at 1 year, 80.6% at 5 years, and 65.8% at 10 years. Patient survival for HBsAg+ recipients was 88.8% at 1 year, 77.6% at 5 years, and 61.6% at 10 years. The difference in patient survival was 3‐4%, and graft survival was nearly constant at 3%. The statistical significance for patient survival was p = 0.02 by the log‐rank test and p = 0.007 by the Wilcoxon test. There is far more statistical power (p = 0.0001) in other risk factors such as transplant number, recipient race, recipient age, and diabetes. Currently available diagnostic studies may allow better risk stratification of HBsAg+ candidates. We believe that hepatitis antigenemia without added and related risk factors has only a mild effect on graft and patient outcome.
The impact of pre‐transplant obesity on renal transplant outcomes
Authors: Drafts H. H. , Anjum M. R. , Wynn J. J. , Mulloy L. L. , Bowley J. N. , Humphries A. L.
Published: October 2024

The impact of obesity on graft survival after renal transplantation continues to be controversial. We have reviewed our experiences with living donor and cadaver transplantation in the current decade, focusing specifically on the impact of obesity on transplant outcome. Preoperative body mass index (BMI, kg/m2) was calculated for all adult renal transplant recipients between January 1990 and December 1995 and was used to classify patients as non‐obese, moderately obese or morbidly obese. The effect of the degree of obesity on early and late outcomes after renal transplantation was examined. Three hundred and thirty‐three recipients had pre‐transplant BMI < 30 (normal or mild obesity), 68 BMI 30‐40 (moderate obesity), and 7 BMI over 40 (morbid obesity). There was no correlation between obesity and other demographic factors. Wound infections and delayed graft function occurred more commonly in moderately and morbidly obese than in other cadaver donor recipients. Obese patients gained more weight after surgery and were given lower doses per kilogram of cyclosporine. There was, however, no significant correlation between obesity and graft survival for either cadaver or living donor transplants. Although obese patients have an increased risk of delayed graft function with cadaver donor transplantation, obesity has no discernible impact on either immunologic or overall graft survival with cadaver or living donor transplantation. The impact of moderate obesity on transplant outcome is modest and should not prevent these patients from receiving a transplant.
Steroid withdrawal in kidney transplant recipients: is it a safe option?
Authors: Sanfey H. , Haussman G. , Isaacs I. , Ishitani M. , Lobo P. , McCullough C. , Pruett T.
Published: October 2024

The long‐term side effects of lifelong steroid immunosuppression are well documented, therefore, steroid withdrawal (SW) if safe would clearly be of benefit. From 1987‐1996, 470 kidney transplants were performed at our institution. During this time period, steroid withdrawal was offered to a select group of patients (n=43) who were at least 1 year post transplant (27.6±12.0 months, 15‐64 months), had stable graft function and had experienced only mild episodes of rejection in the postoperative period. Informed consent was obtained from all participants. Twenty‐five patients were male and 18 were female. The mean age at time of transplantation was 42.4±14.1 years (17‐65 years). There were 28 cadaveric renal transplants (CRT), 10 living related kidney transplants (LRT) and 5 simultaneous kidney‐pancreas transplants (SPK). Maintenance immunosuppression in all patients consisted of CSA 3‐5 mg/kg, and AZA 1‐2 mg/kg. Twenty‐nine patients (67%) have remained off steroids with good renal function for 13‐ 59 months (38.3±11.0). Steroids were restarted in 14/43 (32%) patients 1‐ 36 months post SW (13.3±11.0 months). Eight of these 14 patients had a rise in creatinine and biopsy proven rejection, 5 of whom responded to reinstitution of steroid immunosuppression, and have stable renal function (CR=2.0±0.4) 41‐53 months (45+4.0 months) post SW. Three (7%) patients lost their allograft. One was a SPK recipient who retained good pancreatic function and subsequently received a successful 2nd kidney transplant. The other 2 patients died awaiting retransplantation. Steroids were recommenced in 6/14 patients who did not develop rejection for inability to tolerate CSA/AZA (2), anxiety (2) or recurrent disease (2). In the majority of our patients, (93%) SW did not result in immunologic graft loss. A graft loss of 7% (3) is not significantly different from the expected graft loss in a kidney transplant recipient population over a time period of 9 years. Therefore, we feel that with careful monitoring steroid withdrawal can be safely accomplished in select patients.
Current issues in living donor nephrectomy
Authors: Jones Kenneth W. , Peters Thomas G. , Charlton Ronald K. , Lenz Barbara J. , Walker George W. , Repper Suzanne , Crews Martha Jo , Antonucci Laurel E. , Peters Elizabeth J.
Published: October 2024

Of 96 consecutive renal transplants in 2 years, 50 (52%) were living donor grafts. Donor demographics, treatment plans, length of stay (LOS), charges, and complications were reviewed. Donors included 27 women and 23 men aged 22 to 61 (mean 42.2) years; 33 were living related and 17 living unrelated donors. Racial distribution included 1 Hispanic, 2 Asian, 8 black, and 39 white donors. Pretransplant evaluation defined renal anatomy and function (minimal creatinine clearance 75 cc/min). Hospital admission occurred the morning of donation. Nephrectomy under general anesthesia entailed an anterior flank, extra‐retroperitoneal approach (no rib resection); and postoperative epidural pain control was standard. Progressive early ambulation and pulmonary self‐care optimized recovery. The 50 donors were hospitalized for 2 (n=7), 3 (n=18), 4 (n=15), 5 (n=6), and 6‐8 (n=4) days (mean LOS: 3.74 ± 0.17, range 2‐8 days). The mean charge for donor hospitalization was $15,415 $397 (range $10,808‐$29,579). One major intraoperative hemorrhage required transfusion; 1 patient was readmitted for wound drainage and pneumonia treated medically. While 40 of 50 patients (80%) were hospitalized for 4 days or less, there was no readmission because of short hospital stay. One early graft loss (3 days) occurred from technical problems; all others gained excellent life sustaining function. Three additional kidneys failed from rejection, noncompliance, and systemic coagulopathy. One recipient died at 8 months (CVA) with normal renal function. Current strategies for successful living kidney donation are thorough patient and family education, ambulatory preoperative testing. morning of surgery admission, and discharge planning beginning before hospitalization. Excellent outcomes may be accompanied by a brief LOS, epidural pain management, and liberal use of willing and healthy related and unrelated living donors.
The role of CD11b/CD18 mediated neutrophil adhesion in complement deficient xenograft recipients
Authors: Jakobs Frank M. , Davis Elizabeth A. , Qian Zhiping , Liu David Y. , III William M. Baldwin , Sanfilippo Fred
Published: October 2024

Hyperacute rejection (HAR) of discordant xenografts is dependent on local complement activation. The formation of a functional complex of the complement components C5b‐9 (membrane attack complex, MAC) causes endothelial injury and activation leading to coagulation and inflammation. In PVG rats which selectively lack the C6 component of complement, the MAC complex is not formed, whereas early split products of the complement cascade are produced normally. We reported previously that HAR is averted in C6 deficient xenograft recipients, and that subsequent accelerated acute rejection (AAR) can be delayed by inhibition of CD11b/CD18 (Mac‐1) dependent neutrophil adhesion using leumedin, a member of a novel class of anti‐inflammatory agents. Here we report the in vivo effects of a dose‐response study using 2 new members of another class of Mac‐1 directed agents designated nactins. Discordant cardiac xenografts from Hartley guinea pigs were heterotopically grafted into PVG(C6‐) and PVG(C6+) rats. Experimental animals were divided into 3 groups receiving leumedin (group 1) or nactin (groups 2 and 3). Control animals received intravenous saline solution only. All C6(+) rats rejected their grafts hyperacutely within 10 to 15 min, irrespective of mode or dosage of treatment. C6 deficient controls rejected grafts within 17.7 ± 3.5 h (n = 10). Treatment with leumedin/nactin prolonged graft survival up to 61.0 ± 4.7 h (n = 4‐6), with dose dependent differences in effectiveness among the 3 compounds tested. Histology showed that treatment was associated with less edema, hemorrhage, and neutrophil infiltrate at 2, 6, and 12 h. The marked decrease in hemorrhage seen in nactin‐treated animals may reflect an interaction of Mac‐1 with blood coagulation factors. Our data confirm that the neutrophil adhesion pathway is involved in AAR, especially when complement mediated injury due to MAC is restricted.
Multicultural issues in organ transplantation: the influence of patients' cultural perspectives on compliance with treatment
Authors: Prieto Loreto R. , Miller David S. , Gayowski Timothy , Marino Ignazio R.
Published: October 2024

The potential influence of racially or ethnically diverse cultural perspectives on patient compliance with post‐transplant treatments is discussed. Domains of competency regarding culturally sensitive clinical practice are outlined to assist providers in better understanding the perspectives that may influence the views and behavior of culturally diverse patients.
Commercially motivated renal transplantation: results in 540 patients transplanted in India
Authors:   The Living Non‐Related Renal Transplant Study Group
Published: October 2024

Commercial renal transplantation is widely condemned on moral and ethical grounds. Moreover, previous studies involving small numbers of patients, mostly from tertiary care centers, have reported poor patient and graft survival. The Living Non‐Related Renal Transplant Study Group was established to determine the overall results and complications in a large number of patients who received this type of transplantation in India. In this study we retrospectively collected data from 22 centers on 540 patients who had received commercial renal transplantation (CRT) in India between 1978 and 1993. The data collected included demographic characteristics of patients, the primary renal disease, dialysis and pretransplant data, immunosuppressive regimen, rejection episodes, post‐transplant data, as well as patient and graft outcomes. Results were compared with those of 75 recipients of emotionally related renal transplantation (ERT) performed in two participating institutions in the Middle East. Among the 540 patients, 7.5% were younger than 20 yr of age and 14.2% were 50 yr of age or older. After adjusting for several variables, the 1‐, 3‐, and 5‐yr patient survival rates in the CRT were 97, 94, and 92%, and in the ERT 95, 91, and 91% respectively (p=0.4921). The corresponding rates for graft survival were 90, 81, and 72%, and 90, 86, and 83%, respectively (p=0.5336). There was a higher incidence of human immune deficiency virus (HIV) infection (4.6% vs. 0% p=0.053), and hepatitis B virus (HbsAg) infection rate (8.1% vs. 1.4% p=0.03) in CRT. In conclusion, patient and graft survival rates in recipients of commercial renal transplantation are similar to those in recipients of emotionally related transplantation done in our institutions. However, the incidence of serious infections with HIV and HbsAg is significantly higher.
IgM antibodies in renal transplantation
Authors: McCalmon Robert T. , Tardif Gilman N. , Sheehan Moira A. , Fitting Katherine , Kortz Warren , Kam Igal
Published: October 2024

A prospective final crossmatch with patient serum and donor lymphocytes using the complement‐dependent cytotoxicity assay to identify any preformed anti‐donor antibody is required for kidney transplantation. The presence of pre‐existing antibody may lead to hyperacute rejection of the transplanted kidney. Certain anti‐donor antibodies have previously been shown to be ineffective in promoting hyperacute rejection, such as IgM autoantibodies and non‐specific IgM lymphocytotoxic antibodies. In this report, we present evidence that IgM HLA alloantibody specific to the donor does not lead to hyperacute rejection and produces graft survival results equivalent to transplants with negative pre‐transplant final crossmatches. Forty‐eight (48) of 402 patients transplanted over an 8 yr period were transplanted across a positive final crossmatch due to IgM antibodies. alone. Three patients exhibited IgM autoantibodies and 26 patients demonstrated non‐specific IgM antibodies to lymphocytes. In 15 patients, following a detailed serum screening analysis, a significant correlation (r>0.9, p<0.001) was observed between HLA Class I antigens and the presence of corresponding IgM alloantibodies. Five of these patients were subsequently transplanted despite a positive final crossmatch that was clearly demonstrated to be the result of IgM alloantibody to donor HLA Class I specificities. All of these patients continue to have graft function. These results suggest that hyperacute rejection is not mediated by any type of IgM antibody to donor lymphocytes and that kidney transplantation when only IgM antibody is present against donor lymphocytes represents a reasonable opportunity for a safe transplant and successful long‐term graft survival.
Outcome of coronary artery bypass surgery in diabetic transplant candidates
Authors: Manske Connie L. , Nelluri Satyanarayana , Thomas William , Shumway Sara J.
Published: October 2024

Insulin‐dependent diabetic (IDDM) patients with end‐stage renal disease and coronary artery stenoses ≥ 75% have a poor prognosis. However, information is lacking on the morbidity and mortality of the coronary artery bypass operation in this group. We studied 30 consecutive IDDM transplant candidates undergoing a bypass operation to determine the incidence of complications and long‐term outcome. Perioperative mortality was 3% and the complication rate was 60%. During follow‐up. five patients experienced six myocardial infarctions, the majority within six months of operation. Twenty‐one patients. underwent successful kidney transplantation after the bypass operation. Overall patient survival was 80%, 73%, and 66% at 1, 2 and 4 yr. In summary, the coronary artery bypass procedure in IDDM transplant candidates has a high morbidity, but the long‐term outcome is good. Appropriately counseled IDDM transplant candidates with coronary artery disease should be considered for coronary revascularization and subsequent transplantation.
Successful treatment of post‐transplant lymphoproliferative disorder with interferon‐alpha and intravenous immunoglobulin1
Authors: Cantarovich Marcelo , Barkun Jeffrey S. , Forbes R. D. Clarke , Kosiuk John P. , Tchervenkov Jean I.
Published: October 2024

We report on the use of interferon‐alpha (INF‐α) and highdose non‐specific intravenous immunoglobulin (IVIg) in 2 patients (a 60‐yr‐old female and a 65‐yr‐old male) who developed post‐transplant lymphoproliferative disorder (PTLD) 2 and 8 months after heart and liver transplantation, respectively. Both patients had received immunosuppression with ATG, CSA, azathioprine, and prednisone. The first patient did not receive additional immunosuppression with biological agents. The second patient developed 3 steroid‐resistant acute rejection. episodes requiring OKT3 (cumulative dose 100 mg) and ATG (cumulative dose 3450 mg). The first patient presented with nodules involving the liver, spleen, lungs and nasophar, ynx. The second patient presented with subcutaneous and liver nodules, as well as pert‐portal and para‐aortic lymphadenopathies. The histological diagnosis was diffuse B‐cell PTLD in both patients. Despite reduction of immunosuppression, a progression of lesions was observed in both patients over 5 months and 2 months, respectively. The first patient received INF‐α (2 × 106 IU, s.c. 3 times/wk) and IVIg (0.5 g/kg i.v. every 15 d) for.4 months, while the second patient received the same therapy for 12 and 7 months, respectively. Complete disappearance of all lesions was observed after 3 months of therapy in the first patient and after 7 months of therapy in the second patient, as assessed by CT scan. PTLD remains in remission 47 and 33 months after therapy, respectively. Our preliminary results suggest that the combination of INF‐α and IVIg can be an effective therapy for PTLD which does not respond to reduction of immunosuppression.
Application of in situ hybridization technique for quantitative assessment of ongoing symptomatic Epstein‐Barr virus infection after living related liver transplantation
Authors: Egawa Hiroto , Oh‐ishi Tsutomu , Arai Takashi , Inomata Yukihiro , Uemoto Shinji , Asonuma Katsuhiro , Kinchi Tetsuya , Okajima Hideaki , Matsui Akira , Kawashima Naomi , Martinez Olivia M. , Tanaka Koichi
Published: October 2024

For quantitative assessment of ongoing symptomatic Epstein‐Barr virus (EBV) infection in pediatric recipients of liver transplantation, we determined the number of peripheral blood mononuclear cells (PBMC) infected by EBV by in situ hybridization (ISH) and related the results with clinical courses of those patients. Twenty‐four patients had symptomatic EBV infection between February 1995 and March 1996. Blood samples were obtained from these 24 patients at the time of acute phase, from 13 of them during convalescence, and 37 pediatric patients before transplantation. ISH was performed on the PBMC and polymerase chain reaction (PCR) on DNA from whole blood. Oligonucleotide probes for ISH were chosen from coding sequences of EBV‐encoded small nuclear RNA 1 (EBER1). Results of ISH were reported in a number of cells expressing EBER1/5 × 104 PBMC (#EBER1). Fever, diarrhea, upper respiratory symptoms, pleural effusion, ascites, lymphadenopathy, and lymphoproliferative disease (LPD) accompanied with EBV infection proven by serology, viralspecific stain or PCR were regarded as EBV related diseases (EBVD). All samples with positive # EBER1 were accompanied by positive EBV PCR. # EBERI was 68.2±144.9 (mean ± SD) ranging from 0 to 621 in the acute phase, 0.20±0.41 ranging from 0 to 2 in the convalescence phase, 0.27 ± 0.77 in 23 preoperative patients with positive serology, and 0 in all 14 preoperative patients with negative serology. The #EBERI in ongoing EBVD was significantly greater than that of patients in convalescence or before transplantation. Patients with #EBERI greater than 10 had a significantly lower chance of convalescence and a higher mortality than patients with #EBER 1 less than 10. We conclude that # EBERI could be a specific and quantitative marker of EBVD and might predict progression to LPD.
Prognostic value of dipyridamole thallium‐201 screening to minimize perioperative cardiac complications in diabetics undergoing kidney or kidney‐pancreas transplantation
Authors: Mistry Bhargav M. , Bastani Bahar , Solomon Harvey , Hoff Judy , Aridge Della L. , Lindsey Lisa M. , Schmid Sandra , Chaitman Bernard R. , Garvin Paul J.
Published: October 2024

To minimize perloperative cardiac events, we utilize a screening protocol consisting of intravenous dipyridamole thallium‐201 myocardial imaging (DPT), with the selective use of coronary angiography based on the presence of reversible defect(s) on DPT test. A retrospective study was performed to determine the prognostic value of this protocol and to identify any clinical parameters predictive of an abnormal DPT test. To accomplish this, a detailed chart analysis of 176 consecutive kidney (n = 89) and kidney‐pancreas (n = 87) transplant. recipients who had undergone pretransplant DPT testing was performed. The results of the DPT test were interpreted as normal in 111, fixed defect in 15, and reversible defect(s) in 50 patients. Forty‐two of the 50 patients with reversible defect(s) underwent coronary angiography. Twelve of the 27 patients with significant coronary artery disease (CAD, 50% stenosis in one or more coronary arteries) underwent pretransplant revascularization and the remaining 15 were treated medically. Cardiac events (documented acute myocardial infarction or sudden cardiac death) within 6 wk of transplant were stratified by the results of this protocol. Also, various clinical parameters were compared between patients with normal and abnormal (fixed and reversible defect) DPT tests. Only one of the 111 (0.9%) transplant recipients with a normal DPT test had a perioperative cardiac event. None of the 15 (0%) patients with a fixed defect and none of the 15 (0%) patients with reversible defect(s), but a nonsignificant (<50% narrowing) coronary angiogram, had a perioperative cardiac event. Three of the 27 (11.1%) patients with reversible defect(s) and significant disease on coronary angiography, who had undergone pre‐transplant revascularization or were managed medically, had perioperative coronary event. Of 14 recipients parameters analyzed, age 50 yr was the only variable predictive of an abnormal DPT test. We conclude that the incidence of perioperative cardiac events in patients with a normal or fixed defect, or reversible defect(s) but a nonsignificant (<50% narrowing) coronary angiogram is very low, indicating the high correlation of these findings on DPT and an uneventful (cardiac) post‐transplant course. The incidence of perioperative cardiac complications amongst the high‐risk transplant recipients with reversible defect(s) and significant CAD on coronary angiogram may be minimized by appropriate preoperative medical management or revascularization. None of the clinical variables except age > 50 yr was predictive of an abnormal DPT test.
Use of a donor aortic cross for arterial reconstruction of the pancreaticoduodenal allograft
Authors: de Miranda Marcelo Perosa , Genzini Tércio , Gil Antonio Otero , Tacconi Marcos , Gama‐Rodrigues Joaquim
Published: October 2024

Combined liver‐pancreas procurement generally requires back bench reconstruction of the arterial blood supply with a donor Y‐iliac graft to the pancreas graft.

A modified vascular reconstruction that uses donor aortic cross including the brachiocephalic trunk and the left carotid artery as a single arterial patch is presented. This is useful when iliac grafts are unavailable or are being used as an alternative technique.