bluuebunny/crossref_metadata_2025 huggingface dataset:
A theoretical model of job retention for home health care nurses
Authors: Ellenbecker Carol Hall
Published: July 2004

Background.  Predicted severe nursing shortages and an increasing demand for home health care services have made the retention of experienced, qualified nursing staff a priority for health care organizations.

Aims.  The purpose of this paper is to describe a theoretical model of job retention for home health care nurses.

Methods.  The theoretical model is an integration of the findings of empirical research related to intent to stay and retention, components of Neal's theory of home health care nursing practice and findings from earlier work to develop an instrument to measure home health care nurses’ job satisfaction.

Discussion.  The theoretical model identifies antecedents to job satisfaction of home health care nurses. The antecedents are intrinsic and extrinsic job characteristics. The model also proposes that job satisfaction is directly related to retention and indirectly related to retention though intent to stay. Individual nurse characteristics are indirectly related to retention through intent to stay. The individual characteristic of tenure is indirectly related to retention through autonomy, as an intrinsic characteristic of job satisfaction, and intent to stay.

Conclusions.  The proposed model can be used to guide research that explores gaps in knowledge about intent to stay and retention among home health care nurses.
Using a Nursing Minimum Data Set with older patients with dementia in an acute care setting
Authors: Park Myonghwa , Delaney Connie , Maas Meridean , Reed David
Published: July 2004

Background.  Many older people with dementia are admitted to acute care settings suffering from comorbidities. These and their treatments can lead to confusion in these patients, adding to their existing cognitive deficits, and this may not be recognized by care staff. The care of such patients is complex and requires multidisciplinary team input. The purposes of the Nursing Minimum Data Set are to describe the nursing care of patients in a variety of settings and to establish comparability of nursing data across clinical populations, settings and time.

Aims.  This paper reports a study to describe the characteristics of hospitalized older patients with dementia and nursing diagnoses and nursing interventions for these patients, and to identify trends in the nursing care provided over a 3‐year period using a Nursing Minimum Data Set from a community hospital in the United States of America.

Methods.  Secondary data analysis was conducted in 2000 on a large clinical discharge data set containing Nursing Minimum Data Set elements. The sample included 597 elders with dementia among a total of 7772 older patients who were discharged between 1996 and 1998.

Results.  The most common comorbidity was hypertension (n = 123, 21%), followed by cardiac dysrhythmias (n = 80, 13%). The most frequent nursing diagnoses were altered health maintenance (n = 419, 84%), knowledge deficit (n = 357, 71%), potential for injury (n = 242, 48%), potential for infection (n = 230, 46%), pain (n = 184, 37%), impaired physical mobility (n = 169, 34%), and altered thought process (n = 144, 29%). The most frequent interventions were discharge planning (n = 340, 68%), surveillance safety (n = 195, 39%), fall prevention (n = 175, 35%), teaching: disease process (n = 166, 33%), learning facilitation (n = 148, 30%), and infection protection (n = 147, 29%).

Conclusions.  The results provide a description of nursing diagnoses and interventions for elders with dementia in an acute care setting using the Nursing Minimum Data Set framework. They identify the need to develop staff education programmes for individualized care of older patients with dementia. In addition, they support the need for continued work on linkage of the nursing care elements of the Nursing Minimum Data Set, including nursing diagnoses, nursing interventions, and nursing‐sensitive outcomes.
The ARIA/EAACI criteria for antihistamines: an assessment of the efficacy, safety and pharmacology of desloratadine
Authors: Bousquet J. , Bindslev‐Jensen C. , Canonica G. W. , Fokkens W. , Kim H. , Kowalski M. , Magnan A. , Mullol J. , Van Cauwenberge P.
Published: July 2004

Background:  The definition of allergic rhinitis and the classification of its severity and treatment have advanced in recent years following the publication of the Allergic Rhinitis and its Impact of Asthma (ARIA) document. The ARIA and the European Academy of Allergology and Clinical Immunology (ARIA/EAACI) have published a set of recommendations that outline the pharmacological and clinical criteria to be met by medications commonly used in the treatment of allergic rhinitis.

Methods:  An international group of experts met to assess the profile of the antihistamine, desloratadine, under the ARIA/EAACI criteria. Data on desloratadine were collected from peer‐reviewed clinical studies and review articles, which were corroborated and augmented by comprehensive public access documents from the European Medicines Evaluation Agency (EMEA).

Results and conclusion:  Based on this systematic review, it was concluded that the efficacy, safety and pharmacology of desloratadine broadly meet the ARIA/EAACI criteria for antihistamines.
Prevalence and immunohistochemical findings of subclinical kidney allograft rejection and its association with graft outcome
Authors: Veronese Francisco V , Noronha Irene L , Manfro Roberto C , Edelweiss Maria I , Goldberg Julio , Gonçalves Luiz F
Published: July 2004

Abstract:  Subclinical acute rejection (SAR) occurs in about 30% of stable renal transplant patients and may be a risk factor for a poor allograft outcome. In the present study, the prevalence and clinical features of subclinical rejection, and the expression of immune activation markers in surveillance graft biopsies were assessed and correlated with late graft outcomes. Protocol biopsies were obtained at 2 and 12 months post‐transplant in 32 and 26 patients, respectively, with stable renal function. The Banff 1997 criteria were used for histological diagnosis. Graft function and survival and proteinuria were assessed during the 36 months of follow‐up. Immunohistochemical evaluation of cell subpopulations and immunoactivation markers were performed on protocol biopsies. The prevalence of SAR at 2 months and of chronic allograft nephropathy (CAN) at 12 months in representative biopsies was 55 and 50%, respectively. Patients with SAR presented mononuclear cell infiltration with an increased expression of CD3, CD4, CD68, IL‐2R and granzyme B. Kidney graft function was significantly worse in patients with SAR at 2 months who had chronic rejection on biopsy at 12 months, but SAR was not associated with a worse graft function, greater proteinuria or a lower graft survival in 3 yr of follow‐up. In conclusion, we found an elevated prevalence of SAR at 2 months after transplantation with an increased expression of activation markers. Although an association of SAR with poor graft outcome was not observed, our results suggest that SAR is an immunologically active process and underscore the importance of protocol biopsies in the surveillance of transplanted kidneys.
Analysis of the cardiovascular risk profile in stable kidney transplant recipients after 50% cyclosporine reduction*
Authors: Wong Waichi , Tolkoff‐Rubin Nina , Delmonico Francis L , Cardarelli Francesca , Saidman Susan L , Farrell Mary Lin , Shih Vivian , Winkelmayer Wolfgang C , Benedict Cosimi A , Pascual Manuel
Published: July 2004

Abstract:  Background:  Long‐term use of cyclosporine (CsA) contributes to post‐transplant cardiovascular disease (CVD). Hence, a reduction in CsA dosage in kidney transplant recipients (KTR) may improve long‐term outcomes. We analyzed the effects of 50% CsA dose reduction on the CVD risk profile in stable KTR.

Method:  Thirty‐one KTR on a regimen of CsA, prednisone and mycophenolate mofetil (MMF) were studied. Patients were randomized to either a) continue their previously determined CsA dose (control group, n = 15) or b) lower their CsA dose by 50% (CsA reduction group, n = 16). Renal function, blood pressure, lipid profile, plasma homocysteine (HCY), C‐reactive protein (CRP), fibrinogen, and uric acid were compared at baseline and at 6 months.

Results:  At 6 months, there was a significant improvement in allograft function, systolic blood pressure, number of anti‐hypertensive medications and serum uric acid levels in the CsA reduction group. No significant decrease in plasma HCY, CRP, fibrinogen or improvement in lipid profile was found. In contrast, in the Control group, there was a significant increase in HCY, uric acid, and triglycerides. No acute rejection occurred in either group.

Conclusions:  A greater reduction in CsA dose could further improve CVD risk profiles, although this may increase the risk of acute or subclinical rejection.
Thromboelastography used to assess coagulation during treatment with molecular adsorbent recirculating system
Authors: Doria Cataldo , Mandalà Lucio , Smith Jan D , Caruana Giuseppe , Scott Victor L , Gruttadauria Salvatore , Magnone Mario , Marino Ignazio R
Published: July 2004

Abstract:  Coagulopathy is a life‐threatening complication of liver cirrhosis. We describe the effect of molecular adsorbent recirculating system (MARS), a cell‐free dialysis technique, on the blood coagulation of cirrhotic patients.

From February 2002 to July 2002, nine patients – five males (55.5%) and four females (44.4%), age 47–70 yr (median 56) – underwent 12 courses (4–7 sessions each) of MARS. Patients were treated for the following indications: six (66.6%) acute‐on‐chronic hepatic failure, three (33.3%) intractable pruritus. Platelet count, prothrombin time (PT), international standardized ratio and thromboelastography were measured before and after each MARS session. Coagulation factors II, V, VII, VIII, IX, X, XI, XII, XIII, von Willebrand, lupus anticoagulant, protein C, protein S, antithrombin III, plasminogen, α2 antiplasmin, d‐dimer, fibrin monomers, complement, and C1 inactivator were measured before and at the end of each MARS treatment.

We found a statistically significant difference (p < 0.05) in the platelet count, PT, all the thromboelastograph variables (reaction and constant time, α angle, and maximal amplitude), factor VIII, von Willebrand, and d‐dimer, when measured before and after MARS.

Previous reports have shown amelioration of blood coagulation following MARS treatments. However, we document that MARS induces coagulopathy through a platelet‐mediated mechanism, whereby platelet may be mechanically destroyed during the passage of blood through the filters and lines. An alternative postulated mechanism is an immune‐mediated platelet disruption – coagulopathy.
The effect of bronchiolitis obliterans syndrome on health related quality of life
Authors: Vermeulen Karin M , Groen Henk , Bij Wim van der , Erasmus Michiel E , Koëter Gerard H , TenVergert Elisabeth M
Published: July 2004

Abstract: Bronchiolitis obliterans syndrome (BOS) is the most important factor limiting long‐term survival after lung transplantation, and has a substantial impact on patients‘ daily life in terms of disability and morbidity. Aim of our study was to examine the effects of BOS on health related quality of life (HRQL) in lung transplantation patients. Data on HRQL from 29 patients who developed BOS at least 18 months earlier were studied longitudinally. HRQL measures were: the Nottingham Health Profile (NHP), the State Trait Anxiety Inventory (STAI), the Self‐rating Depression Scale (ZUNG), and the Index of Well Being (IWB). Furthermore questions concerning activities of daily life and dyspnea were asked. The majority of the patients were male, and the most common diagnosis was emphysema. After the onset of BOS, significantly more restrictions were reported on the dimensions energy and mobility of the NHP. These restrictions appeared to increase over time. After the onset of BOS, STAI scores remained more or less stable and close to the value of the general population. ZUNG scores were significantly higher after the onset of BOS, and patients experienced a lower level of well being than the general population. The percentage of patients that reported to be able to perform activities of daily life without effort declined dramatically after the onset of BOS. Furthermore, the percentage of patients complaining of dyspnea increased after the onset of BOS. In conclusion, our study showed that HRQL was negatively affected by the onset of BOS. However, in spite of these less favorable long‐term results, even patients who develop BOS may at least temporarily benefit from a lung transplantation.
Rapid steroid withdrawal in hepatitis C virus‐positive kidney transplant recipients
Authors: Akalin Enver , Murphy Barbara , Sehgal Vinita , Ames Scott , Daly Lisa , Bromberg Jonathan S
Published: July 2004

Abstract:  The effects of rapid steroid withdrawal (SW) on kidney transplantation (KT) outcome were investigated in 12 HCV+ patients in a prospective cohort study. These results were compared with 17 HCV+ patients who received KT in the prior 2 yr and treated with a standard prednisone taper protocol. SW patients received only 6 d of steroid treatment after transplantation. Eleven received Thymoglobulin and one Basiliximab induction treatment along with a calcineurin inhibitor and mycophenolate mofetil. Patient and graft survival was 92% in SW group (median follow‐up 12 months, range 6–17), and 92 and 82% in the historic control group respectively (median follow‐up 21 months, range 11–27). In the SW and control group, acute rejection rates were 9 and 18%, and mean creatinine levels at last follow‐up 1.30 ± 0.36 and 1.68 ± 0.58 mg/dL respectively. Only two SW patients had an increase in liver function tests during follow‐up (18%), compared with six patients in the control group (43%). This study demonstrates that rapid SW is safe for HCV+ KT recipients, without an increase in acute rejection episodes or liver function abnormalities in the short term.
Risk factors for intraoperative portal vein thrombosis in pediatric living donor liver transplantation
Authors: Cheng Yu Fan , Chen Chao Long , Huang Tung Liang , Chen Tai Yi , Chen Yaw Sen , Takatsuki Mitsuhisa , Wang Chih Chi , Chiu King Wah , Tsang Leo Leung‐chit , Sun Po Lin , Jawan Bruno
Published: July 2004

Abstract: Pathologic changes of the recipient native portal venous system may cause thrombosis of the portal vein, especially in pediatric living donor liver transplantation (LDLT). This study assessed the utility of Doppler ultrasound (US) for the detection of intraoperative portal vein occlusion and identification of predisposing risk factors in the recipients. Seventy‐three pediatric recipients who underwent LDLT at Chang Gung Memorial Hospital, Taiwan, from 1994 to 2002 were included. Preoperative and intraoperative Doppler US evaluation of the portal vein was performed. Age, body weight, native liver disease, type of graft, graft recipient weight ratio (GRWR), type of portal anastomosis, portal velocity, portal venous size and presence of portosystemic shunt were analyzed for statistical significance of predisposing risk factors. Eight episodes of intraoperative portal vein thrombosis, with typical findings of absent Doppler flow in portal vein and prominent hepatic artery with a resistant index lower than 0.5 (p < 0.001), were detected during transplantation, which was then corrected by thrombectomy and re‐anastomosis. Children age ≤1 yr (p = 0.025), weight ≤10 kg (p = 0.024), low portal flow ≤7 cm/s (p = 0.021), portal venous size ≤4 mm (p = 0.001), and GRWR >3 (p < 0.017) were all risk factors for intraoperative portal vein thrombosis. Doppler US is essential in the preoperative evaluation, early detection and monitoring of outcome of the portal vein in liver transplant.
Cytomegalovirus prophylaxis with valganciclovir in kidney, pancreas–kidney, and pancreas transplantation
Authors: Ciancio Gaetano , Burke George W , Mattiazzi Adela , Leibovici Zvi , Dowdy Lorraine , Roth David , Kupin Warren , Rosen Anne , Jorge Delvis , Cirocco Robert E , Miller Joshua
Published: July 2004

Abstract:  Cytomegalovirus, seen in more than 50% of solid organ transplant recipients, is responsible for numerous direct and indirect consequences, including infection with opportunistic pathogens and allograft rejection. Prophylaxis with intravenous ganciclovir has been the gold standard for prevention; however, intravenous treatment is expensive and carries risks of its own. Oral ganciclovir, to be effective, must be given in large, divided doses. Valganciclovir, the valine ester of ganciclovir, at 900 mg/day, provides oral bioavailability equivalent to that of intravenous ganciclovir and superior to that of oral ganciclovir. This retrospective study assessed the efficacy of 3 months prophylaxis with valganciclovir in kidney, simultaneous pancreas–kidney, and pancreas transplantation. Of 161 patients, all of whom received potent immunosuppressive regimens and were followed for a mean of 440 days, only one developed cytomegalovirus infection, at 120 days post‐transplantation. Two patients died, and two others lost their grafts. There were seven incidents of acute rejection. Only seven patients discontinued treatment early, five because of leukopenia. These results suggest that prophylaxis with 900 mg/day of valganciclovir for at least 3 months safely and effectively prevents cytomegalovirus infection in kidney, simultaneous pancreas–kidney and pancreas transplant recipients on highly potent immunosuppression.
Cost‐effectiveness of post‐transplantation quality of life intervention among kidney recipients
Authors: Chang Cyril F , Winsett Rebecca P , Osama Gaber A , Hathaway Donna K
Published: July 2004

Background: The purpose was to demonstrate the cost‐effectiveness of an experimental post‐transplant care program designed to improve kidney transplant recipients’ quality of life (QoL). The intervention program integrated a three‐pronged interdisciplinary approach emphasizing: (i) proactive, patient‐initiated care to prevent transplant‐related morbidities, (ii) employment/vocational counseling, and (iii) enhancement of social support.

Methods: A cost‐effectiveness analysis of a clinical trial was performed comparing QoL and costs in two groups: a retrospective cohort (n = 30) and those who received the experimental interventions (n = 150). Data were collected at baseline, 6 and 12 months. The number of quality‐adjusted ‘treatment‐free days’ was used as the primary outcome. The costs included those for direct intervention, direct inpatient and outpatient post‐transplant health care, and indirect out‐of‐pocket expenses borne by patients.

Results: Patients in the intervention group had more quality‐adjusted treatment‐free days (289 vs. 272 and statistically significant) and lower cost per patient (although not statistically significant). Further, the superior outcome was delivered at an incremental cost of $29 per quality‐adjusted treatment‐free day. A one‐way sensitivity analysis confirmed the robustness of the results.

Conclusion: The experimental post‐transplant care program is both effective and cost‐effective; the superior results are attributed to improved QoL.
Genotype prevalence, viral load and outcome of hepatitis B virus precore mutant infection in stable patients and in patients after liver transplantation
Authors: Ben‐Ari Ziv , Ashur Yaffa , Daudi Nili , Shmilovitz‐Wiess Hemda , Brown Marius , Sulkes Jaqueline , Klein Athalia , Mor Eytan , Tur‐Kaspa Ran , Shouval Daniel
Published: July 2004

Abstract:  Objective:  The precore mutant is detectable in most Israeli patients with persistent hepatitis B virus (HBV) infection. The aim of this study was to determine the prevalence of HBV genotypes, viral load and outcome of precore mutant infection in stable patients and in patients after liver transplantation.

Methods:  The prevalence of HBV genotype and viral load were investigated in 81 patients with HBV precore mutant infection. Of these, 50 patients (40 males, 10 females; mean age 43.4 ± 11.0 yr) underwent liver transplantation and were serum HBV DNA‐negative by hybridization at the time of transplantation. Patients received long‐term HBV immunoprophylaxis and immunosuppression, and lamivudine in cases of graft HBV recurrence. The remaining 31 patients were stable, with serum anti‐HBe‐positivity. Genotypes were tested by restriction fragment length polymorphism of an S gene amplicon. Precore mutations were studied with an INNO‐LiPA probe assay.

Results:  Follow‐up was 46.6 ± 37.7 months. Most of the transplanted group was of Middle Eastern origin (53.6%); the remainder were from Eastern Europe (21.4%), Western Europe and the USA (10.8%), Africa (7.1%), and Asia (7.1%). In the transplanted group, the pre‐transplant HBV genotype D was the most prevalent (96%), while genotype A was found in only 4%. Eleven patients (22%) developed recurrent HBV infection post‐transplantation. There were no differences in genotype distribution between patients with graft reinfection or lamivudine resistance and patients without recurrence. Mean viral load at recurrence was 148.4 × 106 ± 60.4 × 106 copies/mL. The stable group had a similar origin and HBV genotype prevalence, but a lower mean viral load of 12.4 × 106 ± 29.4 × 106 copies/mL (p = 0.007). The prevalence of mutations at the precore region and codon 28 was similar in both groups.

Conclusions:  The chronic precore mutant HBV‐infected patients were characterized as follows: (i) genotype D was the most frequent genotype, (ii) the HBV genotype distribution was similar in patients with stable infection and after liver transplantation, (iii) viral load at recurrence was significantly higher than in stable infection, and (iv) HBV genotype was unrelated to the development of recurrence or lamivudine resistance in the tested population.
Postural hand tremor before and following liver transplantation and immunosuppression with cyclosporine or tacrolimus in patients without clinical signs of hepatic encephalopathy
Authors: Paul Friedemann , Müller Jörg , Christe Walter , Steinmüller Thomas , Poewe Werner , Wissel Jörg
Published: July 2004

Abstract:  Objective:  To assess tremor characteristics and severity in patients with severe liver disease without hepatic encephalopathy and following orthotopic liver transplantation (LTX) and immunosuppresion (IS) with cyclosporin  A (CsA) or tacrolimus (FK 506).

Methods:  A total of 35 consecutive patients were included into the prospective study and serum levels of CsA (n = 29) or FK 506 (n = 6) were monitored following LTX. Tremor characteristics and severity were assessed by two‐blinded raters before and following LTX. In addition, accelerometric recordings were taken before and after LTX, and compared with 16 normal controls without tremor and without clinical signs of hepatic encephalopathy or liver disease. Accelerometry was performed while sitting in a comfortable chair with the forearms supported and included rest and postural condition with and without weight load (500 g) on each hand. Kolmogorov–Smirnov test, paired t‐test and t‐test for independent samples were used for statistical analysis.

Results:  The clinical rating revealed no rest but a mild postural hand tremor before LTX with a significant increase following LTX (p < 0.001). After LTX the mean score of postural tremor was significantly (p < 0.05) higher in patients with plasma levels of >850 ng CsA/ml compared with patients with lower levels. Patients and normal controls showed comparable mean peak frequencies of rest and postural hand tremor. The mean amplitude of postural hand tremor was significantly higher in patients before and after LTX compared with controls. In the majority of patients (89%) and controls (88%), the dominant tremor frequency decreased significantly (>1.5 Hz) when applying a weight load on each hand.

Conclusion:  The present study is the first to describe hand tremor characteristics in patients with severe liver disease without clinical signs of hepatic encephalopathy and in patients following LTX and IS. Compared with normal controls the patients showed a significant postural hand tremor prior and post‐LTX and an increase of mean tremor amplitude following LTX and CsA/FK 506 treatment. The decrease of the dominant tremor frequency with weight load and an increase of tremor amplitude with higher plasma levels of CsA are both indicative of an enhanced physiological or toxic tremor.
Evaluation of 84 elderly donors in renal transplantation
Authors: Rigotti Paolo , Baldan Nicola , Valente Marialuisa , Scappin Sabrina , Furian Lucrezia , Cadrobbi Roberto , Marchini Francesco , Ancona Ermanno
Published: July 2004

Abstract:  Background:  The use of elderly donors (ED) and dual kidney transplantation (DKT) procedures have become common in clinical practice. A correct evaluation of kidneys from ED is crucial to avoid unsuccessful transplantation or the use of DKT when a single transplant (ST) would be equally successful. The aim of this investigation was to assess the role of renal biopsy (RB) in the assessment of kidneys from ED.

Patients and methods:  A total of 84 ED aged ≥ 60 yr were evaluated. In 19 cases, the kidneys were not used, mainly because of atherosclerotic vascular lesions. A histological score (HS) from 0 to 12 was awarded, considering the proportion of glomerulosclerosis, tubular atrophy, interstitial fibrosis, and arterial and arteriolar narrowing. On the basis of the HS, 37 donors were selected for 40 ST and 21 for DKT, three were discarded. All recipients received triple‐drug therapy based on calcineurin inhibitors, mycophenolate mofetil and steroids.

Results:  Primary non‐function was observed in three of 40 ST and one of 21 DKT. Acute tubular necrosis occurred in 22/40 ST and in 11/21 DKT. Acute rejection occurred in 16/40 ST and four of 21 DKT. Renal function was satisfactory in both groups, with 1‐yr S‐Cr = 171 umol/L and 137 umol/L, respectively in the ST and DKT groups. One‐year patient survival was 92% in ST and 100% in DKT; 1‐yr graft function was 87% in ST and 95% in DKT.

Conclusion:  The histological assessment of kidneys from ED enables a correct selection of kidneys for ST or DKT and prevents the transplantation of high‐risk kidneys.
An open randomized study comparing immunosuppression therapy initiated before or after kidney transplantation in haploidentical living recipients
Authors: Câmara Niels Olsen S. , Dias Mônica Felizardo L. , Pacheco‐Silva Alvaro
Published: July 2004

Abstract:  Background:  Acute rejection is the most important risk factor for graft survival. Although many centers start immunosuppressive therapy days before the surgery in living donors, there is no systematic study concerning the possible advantages of this procedure. In this open randomized study, we compared the efficacy and safety of administration of cyclosporine (CSA; Neoral®) and azathioprine before renal transplantation with the administration of the same schema after transplantation, in HLA haploidentical grafts.

Methods:  Sixty renal transplant recipients of an HLA haploidentical allograft from living donors were randomized in two groups: (A) patients that started immunosuppression 3 d before transplantation (n = 30) and (B) those who started the drug schema on the first day after surgery (n = 30). We analyzed the incidence and severity of acute rejection, graft function and infection during the first 3 months after transplantation.

Results:  The group of patients who started immunosuppression before had a mean trough level of CSA (299.70 ± 154.03 ng/mL) in the expected range for an efficacious prevention of acute rejection at the surgery day. Thirteen patients (43.3%) in each group had acute rejection during the follow up (p = 1.00). Two grafts losses (3.3%) occurred, one in each group. Both groups had similar 3‐month rejection‐free graft survival (56.7 and 56.3%). The incidence of infection was also statistical comparable between groups A and B (56.7 vs. 46.7, p = 0.430). Graft function was similar in patients from both groups.

Conclusions:  Pre‐transplant administration of immunosuppression did not reduce the incidence or severity of acute rejection episodes during the first 3 months of transplantation. Immunosuppressive drugs administered before engraftment did not increase the incidence of graft dysfunction or infection.
Risk factors for BK polyomavirus nephritis in renal allograft recipients1
Authors: Rocha Paulo N , Plumb Troy J , Miller Sara E , Howell David N , Smith Stephen R
Published: July 2004

Abstract:  Recurrent episodes of acute rejection (AR) and/or the intense immunosuppression used for their treatment have been proposed as risk factors for BK nephritis (BKN; BK refers to the initials of the first patient from whom this polyomavirus was isolated). To further examine the relationship between AR and BKN, we analyzed all kidney transplants performed at our center between January 1999 and August 2001 (n = 286). After a mean follow‐up of 737 ± 22 d, we identified nine cases of BKN (3.1%). The mean time to diagnosis of BKN was 326 ± 56 d. No patient with BKN had a prior history of AR. During the same period, 62 patients were diagnosed with AR (22%). The mean time to diagnosis of AR was 197 ± 40 d (p = 0.01 vs. time to diagnosis of BKN). Despite aggressive therapy with methylprednisolone and, in some cases, anti‐lymphocyte antibody, none of these patients with AR developed BKN. We compared the baseline characteristics of patients in both groups and found that BKN patients were more likely to be white people (78 vs. 44%, p = 0.05) and male (89 vs. 53%, p = 0.04). Moreover, the mean tacrolimus (TAC) levels before diagnosis were higher in BKN than in AR patients (11.7 ± 0.5 vs. 6.5 ± 0.6 ng/mL, p < 0.001). In summary, our study shows that BKN often occurs in the absence of prior episodes of AR. In addition, our findings suggest that white males exposed to higher TAC levels are at greater risk of developing BKN.
Four‐year follow‐up of a prospective randomized trial of mycophenolate mofetil with cyclosporine microemulsion or tacrolimus following liver transplantation
Authors: Fisher Robert A , Stone James J , Wolfe Luke G , Rodgers Cheryl M , Anderson Melodie L , Sterling Richard K , Shiffman Mitchell L , Luketic Velimer A , Contos Melissa J , Scott Mills A , Ferreira‐Gonzalez Andrea , Posner Marc P
Published: July 2004

Abstract:  Background:  This is a 4‐yr follow‐up of a trial using mycophenolate mofetil (MMF) induction in orthotopic liver transplantation (OLT). The goal of this study was to evaluate a multidrug approach that would reduce both early and long‐term morbidity related to immunosuppression while maintaining an acceptable freedom from rejection.

Methods:  This was a prospective, randomized, intent to treat study designed to compare the primary endpoints of rejection and infection, and secondary endpoints of liver function, renal function, bone marrow function, cardiovascular risk factors, and the recurrence of hepatitis C. Ninety‐nine consecutive patients with end stage liver disease who underwent OLT were randomized to receive either cyclosporine microemulsion (N) (50 patients) or tacrolimus (FK) (49 patients) starting on postoperative day 2, with MMF and an identical steroid taper begun preoperatively.

Results:  Ninety of 99 patients (N 46, FK 44) completed the 4‐yr follow‐up. The overall 4‐yr patient and graft survivals were 93 and 89%, respectively. There was no significant difference in 4‐yr patient (N 96% vs. FK 90%, p = ns) or graft (N, 90% vs. FK, 88%, p = ns) survival between groups. The 4‐yr rejection rate was not significantly different in either arm (N = 34%, FK = 24%; p = 0.28). There were no differences in infection rates in either arm. The patients with hepatitis C had no differences in the viral titers or Knodell biopsy scores between groups. However, in the hepatitis C subgroup (37 patients), the FK patients had a significantly lower rejection rate (p = 0.0097) and a significantly lower clinically recurrent hepatitis C rate (p = 0.05) than the N patients. No difference was seen in the percent of patients weaned off of steroids after 4 yr (N 51%, FK 49%). There were no differences in the incidences of diabetes mellitus and hypertension. When renal dysfunction was analyzed, a significant difference in the number of patients whose creatinine had increased twofold since transplant was seen (N 63%, FK 38%, p = 0.04).

Conclusions:  Use of MMF induction and maintenance following OLT in conjunction with either N or FK and an identical steroid taper, resulted in an acceptable long‐term incidence of rejection and infection, without an increase in long‐term graft or patient morbidity.
Increased arterial stiffness in cyclosporine‐treated lung transplant recipients early after transplantation
Authors: Silverborn Martin , Ambring Anneli , Nilsson Folke , Friberg Peter , Jeppsson Anders
Published: July 2004

Background:  The majority of patients undergoing solid organ transplantation develop hypertension, to which cyclosporine (CsA)‐induced peripheral vasoconstriction may contribute. We hypothesized that CsA‐treated transplant recipients have an increased basal vascular tone and an altered response to nitric oxide. To test this hypothesis arterial resistance, non‐endothelial dependent relaxation and arterial stiffness were investigated in CsA‐treated lung transplant recipients within 18 months after transplantation.

Methods:  In study 1, forearm blood flow (FBF) was measured by venous occlusion plethysmography at baseline and during glyceryl trinitrate (GTN) and N(G)‐monomethyl‐l‐arginine acetate (l‐NMMA) infusion in seven lung transplant recipients and nine healthy subjects. In study 2, arterial stiffness in carotid (CCA) and radial artery (RA) was measured by ultrasound (echo‐tracking) in 10 lung transplant recipients, 12 healthy subjects and six patients waiting for lung transplantation.

Results:  Basal FBF (3.1 ± 0.2 vs. 3.0 ± 0.3 mL/min, p = 0.79) and forearm arterial resistance (36 ± 3 vs. 33 ± 3 mmHg/mL/min, p = 0.60) did not differ between transplant recipients and controls. GTN infusion increased and l‐NMMA decreased blood flow equally in both groups. Transplant recipients had increased arterial stiffness compared to both pre‐transplant patients and healthy subjects (CCA stiffness index 11.7 ± 1.1 vs. 8.5 ± 0.2 and 8.6 ± 0.6, p < 0.05 both; RA stiffness index 14.7 ± 1.5 vs. 8.9 ± 1.3 and 10.6 ± 0.7, p < 0.05 both).

Conclusions:  Forearm blood flow and arterial resistance did not differ between healthy subjects and cyclosporine‐treated lung transplant recipients early after transplantation. Increased arterial stiffness was demonstrated in transplant recipients, which may have implications for future development of transplant hypertension.
Use of a branch patch with the cystic artery in living‐related liver transplantation
Authors: Benedetto Fabrizio Di , Lauro Augusto , Masetti Michele , Cautero Nicola , Quintini Cristiano , Dazzi Alessandro , Ramacciato Giovanni , Risaliti Andrea , Miller Charles M , Pinna Antonio D
Published: July 2004

Abstract:  Technical aspects in living‐related liver transplantation are still under debate: the main pitfall is the arterial reconstruction due to the small diameter and the discrepancy between stumps, with subsequential increased risk of arterial thrombosis. The gold standard is the microsurgical technique, that reports the lowest risk of thrombosis, but it is a time consuming procedure requiring a long training. Our method of choice reconstructing hepatic artery in right lobe is the use of the cystic artery as a branch patch with the recipient hepatic artery by loop magnification, saving time and with a low incidence of hepatic artery thrombosis.
Afferent and Efferent Connections of the Nucleus Geniculatus Lateralis Ventralis Demonstrated by WGA‐HRP in the Chick
Authors: Hu M. , Naito J. , Chen Y. , Ohmori Y. , Fukuta K.
Published: July 2004

Fibre connections of the chick nucleus geniculatus lateralis ventralis (GLv) were investigated using the axonal tracing method with wheat germ agglutinin conjugated to horseradish peroxidase (WGA‐HRP). After an injection of WGA‐HRP into the GLv, many labelled neurons were observed in layer i of the stratum griseum et fibrosum superficiale (SGFS) in the ipsilateral tectum opticum (TO) and in the nucleus lentiformis mesencephali (LM). In the TO‐GLv projection, cells of origin were located in the deeper part of layer i of the TO and were topographically distributed along the direction from the rostrodorsal part to the caudoventral part of the TO relating to a rostrocaudal axis of the GLv. In the LM‐GLv connection, the dorsal and ventral parts of the LM connected reciprocally with the rostral and caudal halves of the GLv, respectively. In contrast, in the GLv efferent connection, labelled axon terminals spread widely in the ipsilateral area pretectalis without any clear topographical arrangement.
Die Blutgefäße der Urniere (Mesonephros) des Hausrindes (Bos taurus), eine korrosionsanatomische Untersuchung
Authors: Vollmerhaus B. , Reese S. , Roos H.
Published: July 2004

The blood vessels of the bovine mesonephros – a corrosion cast study

Using scanning electron microscopy plastoid corrosion cast specimens of the mesonephros of 30–45‐day‐old bovine foetuses were investigated. The studies showed that the blood vessels of the mesonephros are organized in two separate networks similar to these of the teleosts and amphibians. The glomerula mesonephrica originate from the aorta implying that they belong to the high pressure system. The tubuli mesonephrici are surrounded by a filamentous independent capillary network which is shown for the first time in these studies. This capillary network originates from the caudal cardinal veins and represents a mesonephric portal system with a relatively low blood pressure. The blood from the two capillary networks diverts into terminal veins and into the subcardinal veins. The questions of haemodynamics in the mesonephros are discussed.
Mate Choice Copying in Female Humpback Limia (Limia nigrofasciata, Family Poeciliidae)
Authors: Munger Lisa , Cruz Alexander , Applebaum Scott
Published: July 2004

Mate choice copying is a mechanism of non‐independent mate choice that has important implications for models of evolution and sexual selection. In this study, we examined copying behavior in female humpback limia (Limia nigrofasciata). In three experiments, we allowed a focal female to choose between two males on opposite sides of an aquarium, then repeated the choice trial with the following modifications: (i) with no model female, (ii) with a model female added adjacent to the initially non‐preferred male, or (iii) with the model female adjacent to the initially preferred male. In the absence of other females, focal females displayed consistent mate preferences, measured as a significantly higher amount of time spent near the preferred male in both parts of the trial. When a model female was added adjacent to the initially non‐preferred male, focal females spent significantly more time near that male than they had in the first part of the trial, and significantly less time near the male they had initially preferred. When we placed the model female next to an initially preferred male as a control, the time spent by the focal female with the initially preferred or initially non‐preferred male did not change significantly. We conclude that female mate choice copying may be important in humpback limia, causing focal females to spend more time in preference zones of males they had not at first preferred.
The Effect of Previous Experience Over Control of Access to Food and Light on the Level of Frustration‐Induced Aggression in the Domestic Hen
Authors: Haskell Marie J. , Coerse Nancy C. A. , Taylor Polly Anna E. , McCorquodale Caroline
Published: July 2004

Animals have been shown to respond to frustration with increased aggression and activity. Aversive environmental conditions are also known to affect reaction to frustrating events. One pertinent and aversive environmental factor that has been shown to affect aggression is exposure to uncontrollable rewards and punishments. Although used largely in experimental contexts, this situation is similar to that found in modern intensive farming systems, where environmental and social conditions are largely controlled. The aim of this experiment was to determine if previous experience of lack of control influences the expression of aggression and frustration in domestic hens (Gallus gallus). The two treatment groups of hens used had previously been exposed to control (C) or lack of control (LC) over access to food and light, additional to a restricted regime, continuously for 9 wk. Dominant‐subordinate pairs of birds were tested under water deprivation. After training, the pairs were tested for two rotations of 4:3 d of free access to the water followed by a thwarting trial. Dominant birds showed significantly more aggression in thwarting trials compared with non‐thwarting trials. While there was no main effect of treatment on the aggression shown during non‐thwarting trials, an interaction between treatment and trial type (thwarting and non‐thwarting) indicated that the LC group showed a smaller rise in aggression from non‐thwarting to thwarting trials than the C birds did. However, there was a great deal of variation shown between birds in the amount of aggression. As the home pen conditions were set up to model those found in commercial practice, this possibility that a lack of control leads to some degree of learned helplessness in intensively farmed animals needs to be considered further as it has serious negative implications for animal welfare.
The Role of Lateral Blue Spots in Intrasexual Relationships Between Male Iberian Rock‐Lizards, Lacerta monticola
Authors: López Pilar , Martín José , Cuadrado Mariano
Published: July 2004

Vertebrate males often show breeding colours that may function as reliable signals of status in intrasexual competition. In many lacertid lizards, males show a conspicuous row of small but distinctive blue spots that runs along their body side on the outer margin of the belly. However, no study has examined the role of these blue spots. We first analysed in a field population of the Iberian rock lizard, Lacerta monticola, the relationships between number of blue spots and some morphological traits, which are known to be related to males’ fighting ability. The number of spots seems to be an character showing ontogenetic change as large (generally older) males showed more blue spots than small (generally younger) males. Males with a higher body condition also showed a higher number of blue spots. Thus, a higher number of blue spots may be used to signal size, age or body condition. Many contiguous blue spots would result in a visual artefact consisting of a continuous blue band, which might be a reliable size‐ or condition‐dependent signal in some social contexts. We further examined in the laboratory whether male characteristics are related to dominance status. In males with similar body size or age, those with relatively larger heads were more dominant, whereas the number of blue spots was not important. Moreover, the number of blue spots in nature was not related to relative head size. Finally, we experimentally manipulated the presence and the number of blue spots of intruding males, and examined the aggressive response of resident males. Intruder individuals manipulated to cover all their blue spots received a lower amount of aggression. However, males with different numbers of manipulated blue spots received a similar number of aggressive responses. These results suggest that, during agonistic encounters, the presence of blue spots, but not their number, may elicit aggressiveness. Thus, blue spots may serve to identify an individual as an adult male, and to enhance body size of larger males.
IMPACT OF OXIDATIVE STRESS ON NEURONAL SURVIVAL
Authors: Taylor Juliet M , Crack Peter J
Published: July 2004

1. Reactive oxygen species and oxidative state are slowly gaining acceptance in having a physiological relevance rather than just being the culprits in pathophysiological processes. The control of the redox environment of the cell provides for additional regulation in relation to signal transduction pathways. Conversely, aberrant regulation of oxidative state manifesting as oxidative stress can predispose a cell to adverse outcome.

2. The phosphatidylinositol 3‐kinase/akt pathway is one such pathway that is partially regulated via oxidative state and, in an oxidative stress paradigm such as ischaemic–reperfusion injury, may be inactivated, which can lead to exacerbation of cell death.

3. Activation of nuclear factor (NF)‐κB has been associated with oxidative stress. The role of NF‐κB in neuronal cell death is widely debated, with major studies highlighting both a pro‐ and anti‐apoptotic role for NF‐κB, with the outcome being region, stimulus, dose and duration specific.

4. Oxidative state plays a key role in the regulation and control of numerous signal transduction pathways in the cell. Elucidating the mechanisms behind oxidative stress‐mediated neuronal cell death is important in identifying potential putative targets for the treatment of diseases such as stroke.
COMPARISON OF ANGIOTENSIN II‐INDUCED BLOOD PRESSURE AND STRUCTURAL CHANGES IN FISCHER 344 AND WISTAR KYOTO RATS
Authors: Blanc Jocelyne , Lacolley Patrick , Laurent Stéphane , Elghozi Jean‐Luc
Published: July 2004

1. The purpose of the present study was to evaluate the blood pressure (BP) response, the BP and heart rate (HR) components of the startle reaction and the structure of the carotid artery and the aorta during chronic infusion of angiotensin (Ang) II in Fischer 344 (F344) compared with Wistar Kyoto (WKY) rats, two in‐bred normotensive contrasted strains.

2. Osmotic mini‐pumps filled with saline vehicle or AngII (120 ng/kg per min) were implanted subcutaneously in 8‐week‐old normotensive rats and infused for 4 weeks in F344 rats (saline, n = 10; AngII, n = 10) and WKY rats (saline, n = 10; AngII, n = 9). Basal BP, HR and the responses to an acoustic startle stimulus (duration 0.7 s, 115 dB) were recorded in conscious rats. The structure of the carotid artery and aorta was determined in 4% formaldehyde‐fixed arteries.

3. Compared with WKY rats, vehicle‐treated F344 rats had lower bodyweight (BW; 266 ± 7 vs 299 ± 9 g; P < 0.05) and heart weight (0.80 ± 0.02 vs 0.98 ± 0.04 g; P < 0.05) and higher aortic systolic BP (SBP; 131 ± 1 vs 123 ± 5 mmHg; P < 0.001) and diastolic BP (98 ± 3 vs 89 ± 2 mmHg; P < 0.001). In F344 rats, compared with the WKY rats, the wall thickness/BW ratio was increased in the carotid artery (156 ± 9 vs 131 ± 6 nm/g; P < 0.05) and abdominal aorta (264 ± 13 vs 217 ± 12 nm/g; P < 0.05) and decreased in the thoracic aorta (246 ± 13 vs 275 ± 8 nm/g; P < 0.05). There was no difference in elastin and collagen density. Angiotensin II differentially enhanced BP in both strains: (SBP: 163 ± 5 and 132 ± 4 mmHg in F344 and WKY rats, respectively; Pstrain × treatment < 0.05). Circumferential wall stress was increased in the aorta of F344 rats compared with WKY rats (1176 ± 39 vs 956 ± 12 kPa (P < 0.001) and 1107 ± 42 vs 813 ± 12 kPa (P < 0.001) in thoracic and abdominal aortas, respectively). The startle response was amplified in F344 rats, with enhanced increases in SBP and pulse pressure (PP) and bradycardia compared with responses of WKY rats (+44 ± 9 mmHg, +10 ± 2 mmHg and −40 ± 17 b.p.m., respectively, in F344 rats vs+28 ± 4 mmHg, + 4 ± 2 mmHg and −19 ± 10 b.p.m. in WKY rats, respectively; Pstrain < 0.05 for BP and PP). The startle response was not affected by AngII.

4. These results indicate a higher BP producing an increase in wall thickness in F344 rats compared with WKY rats. We propose that an increase in sympathetic nervous activity causes these haemodynamic differences, as suggested by the excessive increase in BP during an acoustic startle stimulus. Angiotensin II increased BP in F344 rats, but did not exaggerate the increase in BP during the startle reaction.