bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between antibiotic use and cardiovascular diseases in metabolic dysfunction‐associated steatotic liver disease: A nationally representative retrospective cohort study
Authors: Kang Ju Hyun , Park Sun Jae , Jeong Seogsong , Park Young Jun , Kim Hye Jun , Song Jihun , Choi Jiwon , Park Sangwoo , Kim Jaewon , Lee Hyeokjong , Chang Jooyoung , Son Joung Sik , Park Sang Min
Published: September 2024

Aim

Various subcategories for steatotic liver disease (SLD) were proposed globally. Previous studies suggested a heightened risk of cardiovascular diseases (CVD) with prolonged antibiotic exposure and metabolic dysfunction‐associated SLD (MASLD), respectively. This study investigates the impact of antibiotic usage on CVD in MASLD patients.

Methods

From the Korean National Health Insurance Service database, 276 520 adults aged 40 and older were included. Antibiotic exposure was defined by the cumulative prescription days and the number of classes. Participants were categorized into no SLD and MASLD groups. Hepatic steatosis was defined by using the fatty liver index ≥60. From 2013 to 2019, 16 197 CVD cases were recorded. A multivariate Cox model, adjusting for covariates, assessed adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD risk associated with MASLD and antibiotic prescriptions.

Results

The group with ≥91 days of antibiotics prescribed and MASLD showed a significantly increased risk of CVD (aHR, 1.56; 95% CI, 1.39–1.74) compared with antibiotic non‐users without SLD. Furthermore, the group with ≥4 classes of antibiotics prescribed and MASLD had an elevated risk of CVD (aHR, 1.49; 95% CI, 1.34–1.66) compared with antibiotic non‐users without SLD. Consistent results were observed in several sensitivity analyses.

Conclusions

Our study identified prolonged antibiotic exposure may be a factor that increases the risk of CVD in MASLD patients. These findings suggest an epidemiological basis for the therapeutic application of antibiotics in MASLD patients, and emphasize the need for further studies to deepen the understanding of these intricate relationships.
SCAWA scales: A new digital tool for wrinkles clinical grading based on AI
Authors: Rengot Juliette , Prestat‐Marquis Elodie , Aime Ingrid , Campos Jean‐Robert , Camel Etienne , François Ghislain
Published: September 2024

Objective

Clinical assessment of wrinkle depth is essential for efficacy evaluations of anti‐ageing products. Standardized photographic scales, representative of different wrinkle depths are often used by experts to assign subjects reliable grades. These tools, based on real pictures, usually exist as hard copies (printed books or sheets) for in vivo gradings. Our project aims at developing a methodology to create digital standardized computer‐generated scales, allowing photograph and real‐life gradings, and providing raters with greater comfort, accessibility, and flexibility in their construction, thanks to the artificial intelligence significative contribution.

Methods

A completely new approach, based on machine learning, allows the creation of Standardized ColorFace® AI‐based Wrinkle Assessment (SCAWA) scales. Instead of using real photographs, the scale images are computer‐generated. A generative adversarial network (GAN) is trained to create realistic wrinkle samples that are finely controllable by exploring the GAN latent space. Finally, the scale images are selected among hundreds of artificial images depicting natural wrinkle appearances, such as the illustrated wrinkle evolution is well‐detailed (small gaps between grades), morphologically stable, and mathematically linear according to a criterion of wrinkle conspicuous depth.

Results

The created 12‐point scale for crow's feet wrinkle evaluation on ColorFace® pictures is proven to be realistic, linear, and robustly and accurately usable for photograph assessments. The scale coherence in terms of image ranking has been validated, as well as its reliability and acceptability in real conditions of use. Additionally, the wrinkle grades obtained by the SCAWA scale are well correlated (R = 0.94) with the ones obtained by the Skin Aging Atlas on the same pictures. The AI methodology and digital format brought also interesting side results, such as an enhanced harmonization between experts and a higher representativeness, that is, a decrease of out‐of‐range pictures.

Conclusion

SCAWA scale makes the most of machine learning to provide an innovative digital tool to ease wrinkles in visual assessment of pictures, while optimizing linearity, homogeneity, and accuracy aspects. The experts' enthusiastic feedback about the scale format and quality is promising regarding the adaptation of the methodology to other signs and a larger distribution of this tool in the market of cosmetic product efficacy assessment.
The effect of renal transplantation and treatment with cyclosporin A on the prevalence of Raynaud's phenomenon
Authors: Davenport A.
Published: September 2024

The prevalence of Raynaud's syndrome was assessed in 100 consecutive renal allograft recipients treated with cyclosporin monotherapy who were then converted to prednisolone and azathioprine. Prior to transplantation 56% were symptomatic for Raynaud's, following transplantation 36% improved, but with the introduction of cyclosporin 39% developed de novo symptoms. After withdrawl of cyclosporin symptoms improved in 89%, and withdrawal was associated with an increase in glomerular filtration rate from 67±7 ml/min/1 73 m2 (mean±sem) to 79 ± 7 (p<0.05) and a reduction in plasma creatinine, from 167± 17 μmol/1 to 148 ± 11 (p<0.05) and serum bilirubin from 13±1 μmol/1 to 10±0.5 (p<0.05) and alkaline phosphatase from 13.5± 1 KAu/dl to 10.6 ± 0.6 (p<0.05). This suggests that cyclosporin not only has an effect on increasing vascular resistance in the major blood vessels but also affects the microcirculation. Nifedipine, which has been shown to reduce some of the side effects of cyclosporin, reduced the prevalence of Raynaud's following transplantation.
The effect of transfusions on renal allograft survival in the cyclosporine era: A single center report
Authors: Egidi M. Francesca , Scott David H. , Corry Robert J.
Published: September 2024

The potential efficacy of prior transplant transfusions on graft survival in the cyclosporine era has been reported from several centers which are reconsidering their transfusion policy. The purpose of this study has been to evaluate the results obtained in a large series of first kidney transplant patients (N = 284) treated with cyclosporine. Our past experience showed a beneficial effect of blood transfusions in cadaveric renal transplants on conventional immunosuppression. Forty‐eight patients never received blood transfusions, 85 patients received 1‐2 transfusions, 72 patients received 3‐5 transfusions and 79 patients received more than 5 transfusions in their pre‐transplant periods. We did not show an obvious beneficial effect of prior blood transfusions in improving 1‐ and 2‐ycar patient and graft survival. In fact, no statistically significant differences were found among any of the groups depending upon the transfusion status. In the transfused group, graft survival rates were 81.4% (I year) and 77.8% (2 years) while in the non‐transfused group they were 81.2% (1 year) and 78.4% (2 years) (p = n.s.). The patients who rejected had a significantly lower graft survival in the transfused group as compared to the non‐transfused group. On the other hand, the transfused patients without rejection episodes experienced the best graft survival, suggesting a beneficial transfusion effect. We conclude that since it is impossible to determine which patients will not reject, pre‐transplant transfusions under certain circumstances might be harmful, or at least not beneficial. We would recommend restricting transfusions in cyclosporine‐tested patients only in cases of therapeutic necessity.
Sequential Tc99m mercaptoacetyl‐triglycine (MAG3) renography as an evaluator of early renal transplant function
Authors: Carmody E. , Greene A. , Brennan P. , Donohue J. , Carmody M. , Keeling F.
Published: September 2024

A prospective study was carried out to evaluate the role of sequential Tc99m MAG3 renography in assessing transplant function in the early post‐operative period. Twenty patients were included in the study. Studies were performed on all patients at intervals of 48‐72 hours until discharge. There were 11 clinically diagnosed episodes of rejection, 9 of which were correctly diagnosed using MAG3 renography. Six episodes of rejection were diagnosed prior to the onset of clinical symptoms. Two patients with graft infarction were correctly diagnosed. Six patients had evidence of transient renographic abnormalities in the immediate post‐operative phase which were not associated with clinical symptoms, all of these resolved spontaneously on subsequent examinations and were presumed to be related to resolving acute tubular necrosis (ATN). The perfusion index was of no discriminatory value in this study. Sequential Tc99m MAG3 renography is highly sensitive but entirely nonspecific in the evaluation of pathology in the transplant kidney. Rejection in an uncomplicated transplant can be readily detected in many cases well in advance of clinical manifestations. This study demonstrates that Tc99™ MAG3 renography is certainly equal to Tc99m DTPA renography or Iodine 131 renography in assessing early transplant function. However, Tc99m MAG3 exposes the patient to considerably less radiation and the images are of superior quality.
Adverse events associated with OKT3 immunosuppression in the prevention or treatment of allograft rejection
Authors: Kreis Henri
Published: September 2024

OKT3 is an effective and potent agent for the induction of immunosuppression as well as for the treatment of allograft rejection in transplant recipients. A complex set of symptoms, known as the cytokine release syndrome, occurs in almost all patients following the first dose of OKT3. This reaction is characterized by severe flu‐like symptoms involving, according to the initial randomized trial of OKT3, fever (73%). chills (57%), dyspnea (21%), chest pain and lightness (14%), vomiting (13%), nausea (11%), wheezing (11%), and tremor (10%). Symptoms usually begin 45 to 60 minutes after administration of OKT3 and last for 2 to 48 hours. Symptoms are lessened by pretreatment with corticosteroids, acetaminophen, and antihistamines. Reactions to subsequent doses of OKT3 generally are less severe and rarely occur after the first few doses. Although uncommon, severe reactions, including pulmonary edema, hypertension/hypotension, thromboses, aseptic meningitis, and seizures have occurred following administration of OKT3. Infections remain the primary cause of morbidity and mortality among patients treated with OKT3, particularly infections caused by herpesviruses. In the trial cited above, approximately 68% of OKT3‐treated patients and 65% of steroid‐treated patients developed infections within 45 days of treatment. Infection data from studies comparing various other immunosuppressive agents with OKT3 show similar rates for these agents in both induction and rejection therapy studies with no pattern of significant differences. Studies using trimethoprim‐sulfamethoxazole or acyclovir and immune globulin for prophylaxis ofPneumocystis cariniipneumonia and viral infections, respectively, have lowered the incidence of these infections. As with other potent immunosuppressive agents, OKT3 therapy has been associated with the development of malignant disorders. In an international study involving 37600 allograft recipients treated with OKT3, 154 malignancies were reported, including 142 that were classified as posttransplant lymphoproliferative disorder.
Recombinant human erythropoietin in renal transplant recipients with renal anemia
Authors: Traindl Otto , Barnas Ursula , Franz Martina , Falger Susanna , Klauser Renate , Kovarik Josef , Graf Helmut
Published: September 2024

Thirty‐seven kidney graft recipients with chronically declining transplant function accompanied by renal anemia were treated with recombinant human erythropoietin for 3 months. In all these patients anemia improved and mean hemoglobin levels increased from 7.67±1.26 g/dl to 9.83± 1.94 g/dl (p<0.01). Mean creatinine increased from 4.23± 1.82 to 4.62 ±2.42 (p<0.05) but the progression of transplant failure was not influenced when compared with pretreatment values obtained at least 6 months before study entry. Mean blood pressure levels were not altered but 12 patients required additional antihypertensive medication.
A new operative technique of paratopic positioning of pediatric en bloc kidneys for transplantation
Authors: Kirste G. , Blümke M. , Krumme B. , Pisarski P. , Hauenstein K. K. , Farthmann E. H.
Published: September 2024

Technical difficulties and insufficient renal mass have been reasons not to use en bloc‐removed kidneys from organ donors under the age of 3 years. We developed a new technique of paratopic positioning of en bloc‐removed kidneys with a prolonging interpositional graft of donor aorta and vena cava. With transperitoneal approach, anastomosis directly to the recipient's aorta and vena cava can be performed. Using this technique, 7 patients have been transplanted so far. They were choosen out of a list of possible recipients according to HLA‐match. body weight and blood pressure. All patients had primary function. Anastomosis and renal vessels were controlled by color duplex ultrasound imaging and angiography. Patients developed a stable kidney function. There were no surgical complications except a thrombosed kidney in 1 patient. With the new technique described, transplantation of en bloc‐removed kidneys from donors under the age of 3 years can be performed with a low rate of technical complications. Donors of this age should be considered not only as potential liver donors but as kidney donors as well.
A randomized, placebo‐controlled trial with anti‐interleukin‐2 receptor antibody for immunosuppressive induction therapy after liver transplantation
Authors: Langrehr Jan M. , Glanemann Matthias , Guckelberger Olaf , Klupp Jochen , Neumann Ulf , Machens Christine , Lohmann Rüdiger , Knoop Michael , Lobeck Hartmut , Schlag Helmut , Keck Heinrich , Settmacher Utz , Bechstein Wolf‐Otto , Neuhaus Peter J.
Published: September 2024

The introduction of quadruple induction therapy after liver transplantation with the murine anti‐interleukin‐2 receptor (IL‐2R) antibody (BT563) has decreased the incidence of serious side effects, such as tachycardia, hypertension, rash, fever and nausea since it does not lyse its target cell. To investigate the immunosuppressive efficacy of BT563, a placebo‐controlled trial was performed and BT563 was added to the standard triple induction after liver transplantation.

Forty consecutive recipients of primary orthotopic liver transplants (OLT) (median age 47 yr [range 18‐65]) were randomized. All patients received triple immunosuppression with cyclosporine A (CyA), prednisolone (PRED) and azathioprine (AZA). In addition, 19 patients received BT563 (Biotest, Dreieich, Germany) at a dose of 10 mg/d from day 0 until day 12. The remaining 21 patients received a placebo infusion at the same days after transplantation. Minimal follow‐up for all patients was 3 yr.

Patient survival at 3 yr was 74% in the BT563 group and 90% in placebo group. Similar results were observed for graft survival. Two acute rejection episodes were detected in the BT563 group and 9 acute rejections (5 steroid‐resistant) were observed in the placebo group (p< 0.034). The incidences of sepsis, pneumonia, cholangitis, urinary tract infections as well as cytomegalo‐virus (CMV) infections were similar in both groups. Side effects of the BT563 therapy and/or post‐transplant lymphoproliferative disease (PTLD) were not detected.

Quadruple induction therapy with BT563 significantly reduces the incidence of rejection episodes after liver transplantation, while infectious complications and/or PTLD is not increased. Therefore, the anti‐IL2 receptor antibody BT563 constitutes a safe and efficient addition to the immunosuppressive induction regimen following OLT.
Multimodal treatment for hepatocellular carcinoma on cirrhosis: the role of chemoembolization and alcoholization before liver transplantation
Authors: Troisi R , Defreyne L , Hesse UJ , Praet M , Decruyenaere J , De Hemptinnea B
Published: September 2024

The results of combined trans‐arterial chemoembolization (TAE) and percutaneous ethanol injection (PEI) followed by liver transplantation for hepatocellular carcinoma (HCC) are described. Fourteen patients (G2) with tumour stages I‐III received a mean of 2 times TAE and 4 times PEI prior to transplantation. Six patients (G1) received no pre‐transplant therapy. Tumor size reduced from 37±16 to 28±16 mm and α‐FP from 339±1057 to 224±711 ng/mL (p = n.s.). On histopathologic examination (G2 vs. G1) a 100% necrosis of the tumour nodules was seen in 80 vs. 0% (p = 0.001); 60‐90% in 3 vs. 1 and 10‐50% in 3 vs. 2. Eighty six percent of nodules in G2 and 36% in GI had a tumour capsule (p = 0.02). After a median follow‐up of 26 months (3–60), 2 patients in G1 developed a recurrence of HCC as compared to 0 in G2 (p = 0.0005). The actuarial patient disease‐free survival after 48 months was 82% in G2 and 65% in Gl. It is concluded that combined treatment with TAE and PEI is inducing necrosis in HCC associated with improved patient disease‐free survival following liver transplantation.
Two low‐dose OKT3 induction regimens following renal transplantation – clinical experience at a single center
Authors: Oh Henry K , Provenzano Robert , Tayeb Jakaku , Satmary Nancy , Jones Bruce
Published: September 2024

Experience with quadruple‐drug induction therapy with two regimens of low‐dose OKT3 in renal transplant patients was evaluated. Group I received 5.0 mg OKT3 in the operating room and on day 1, followed by 2.5 mg/d for a total dose and duration of 40 mg and 14 d, respectively, and group II received 14 d of OKT3 2.5 mg/d (a total dose of 35 mg). Rejection episodes developed in 21% of patients: 29% of group I vs. 17% of group II. In groups I and II, the mean number of days until first rejection was 134 and 119 d, respectively, and delayed graft function was observed in 24 vs. 13% of patients, respectively. Cytokine release syndrome was noted in 95% of group I patients and in 78% of group II patients. The overall incidence of infections did not differ significantly between the two groups; however, the incidence of oral candidiasis was higher in group II (30 vs. 11% in group I, p = 0.021) and the incidence of herpes simplex virus infection was higher in group I (13 vs. 1% in group II, p = 0.015). The average length of hospital stay was 6.7 d in group I and 6.2 d in group II. The current pharmacy charge for a 2.5‐mg vial of OKT3 is 28% lower for a 5.0‐mg vial. Our study suggests that by using either low‐dose OKT3 regimen renal transplant patients can be safely treated with shortened hospital stays, lower pharmacy costs, and without increased incidence of graft loss or patient morbidity.
Peritoneal metastasis of intracranial glioblastoma via a ventriculoperitoneal shunt preventing organ retrieval: case report and review of the literature
Authors: Fecteau Annie H , Penn Israel , Hanto Douglas W
Published: September 2024

The case of patient with glioblastoma metastatic to the peritoneal cavity 9 months after ventriculoperitoneal shunt surgery precluding cadaver organ procurement is presented. Even though central nervous tumors rarely metastasize spontaneously, the literature indicates that systemic metastases are related to previous surgical procedures and especially shunt surgery. Central nervous tumors have been known to metastasize to lungs, liver, and kidneys and could be transmitted through transplanted organs as shown in the Cincinnati tumor registry. The transplant surgeon should be alerted to this possibility and thorough search for metastases should be undertaken before considering primary brain tumor patients as donors.
Diltiazem modulates cyclosporin A induced renal hemodynamic effects but not its effect on plasma endothelin‐1
Authors: Åsberg Anders , Christensen Hege , Hartmann Anders , Berg Knut Joachim
Published: September 2024

Cyclosporin A (CSA) has been reported to induce major acute renal hypoperfusion that may be antagonised by calcium channel blockers. The vasoconstrictive peptide endothelin‐1 (ET‐1) has been proposed as a mediator of CSA induced hypoperfusion. We investigated the acute effects of the new CSA formulation (Sandimmun Neoral) in 8 renal transplant patients on triple immunosuppressive therapy before and following slow‐release diltiazem treatment in a dose of 90‐120 mg b.i.d for 4 weeks. CSA significantly increased mean arterial blood pressure by 6±2 mmHg (p<0.05) during the first 3 h after administration. This effect was abolished by diltiazem treatment, also reducing blood pressure by 12±3 mmHg (p<0.05) 3‐9 h after administration. CSA administration induced a maximum reduction in renal blood flow of 20±8% (p <0.05) 5 h after ingestion and a concomitant reduction in glomerular filtration rate of 18±7% (p <0.05). The filtration fraction increased by a maximum of 13±7% (p <0.05) after 4 h as did the calculated fractional proximal reabsorption by 14±4% (p < 0.05). All these acute renal effects were abolished by diltiazem administration. Concurrent with the maximum renal hemodynamic effects. plasma ET‐1 was elevated with a peak increase of about 40% 4‐5 h after CSA ingestion. Diltiazem treatment had no effect on the increase in plasma ET‐1 following CSA administration. These findings suggest that CSA induced acute vasoconstriction and renal hypoperfusion are mediated by ET‐1 and that diltiazem treatment abolishes these pharmacodynamic effects of CSA despite persistent increase of plasma ET‐1 levels.
A prospective study of the predictive value of polymerase chain reaction assay for cytomegalovirus in asymptomatic kidney transplant recipients
Authors: Benedetti Enrico , Mihalov Michael , Asolati Massimo , Kirby John , Dunn Ty , Raofi Vandad , Fontaine Magali , Pollak Raymond
Published: September 2024

Cytomegalovirus (CMV) infection carries the potential for high morbidity in transplant recipients. The institution of pre‐emptive therapy prior to the onset of clinical disease on the basis of CMV‐polymerase chain reaction (PCR) is very attractive. We prospectively studied 52 asymptomatic kidney transplant recipients to test the hypothesis that serial CMV‐PCR assays during the first 3 months post‐transplant would identify patients at risk for CMV disease. Twenty‐three patients (44.2%) had positive CMV‐PCR tests at least once; 2 (8.6%) developed CMV. None of the 29 patients continuously negative for CMV‐PCR developed CMV disease. CMV‐PCR status did not influence patient and graft survival or the incidence of acute rejection. We conclude that while a substantial number of kidney transplant recipients become positive for CMV‐PCR in the early post‐transplant period, only a minority will develop CMV disease. Negative CMV‐PCR assay is an accurate negative predictor for CMV disease but the value of CMV‐PCR as a guide for pre‐emptive anti‐CMV therapy in kidney transplant recipients appears limited.
Use of tacrolimus eliminates acute rejection as a major complication following simultaneous kidney and pancreas transplantation
Authors: Peddi V Ram , Kamath Suresh , Munda Rino , Demmy Ann M , Alexander J Wesley , First M Roy
Published: September 2024

This retrospective study illustrates the efficacy of tacrolimusbased immunosuppression following simultaneous kidney and pancreas transplantation. Between March 1995 and December 1996, 24 simultaneous kidney and pancreas transplant recipients received tacrolimusbased maintenance immunosuppression. All patients received sequential therapy with an antilymphocyte agent, azathioprine, prednisone and tacrolimus. The dose of tacrolimus was adjusted to achieve a whole blood trough level of 8‐15 ng/mL (IMx). The mean follow‐up was 25 months with a median of 26 months (range 12‐33 months). A rise in serum creatinine of > 20% over baseline was investigated with a renal biopsy, after mechanical causes for renal dysfunction had been excluded. Mean serum creatinine concentrations at 3, 6, 12, 18 and 24 months post‐transplantation were 1.1, 1.2, 1.3, 1.3 and 1.3 mg/dL respectively. The blood glucose concentrations at the corresponding time period were 115, 94, 95, 93 and 95 mg/dL. Four pancreas allografts were lost (three in the immediate post‐transplant period due to thrombosis, and one following iliac artery repair for aneurysm). Transient hyperglycemia requiring treatment was seen in 3 patients. There were four (17%) acute rejection episodes one of the pancreas allograft alone and three involving the kidney. At a mean follow‐up of 25 months, the patient survival and renal allograft survival were 100%, with pancreas allograft survival rate of 78.4% (Kaplan‐Meier analysis). Nine (37.5%) patients had evidence of tacrolimus toxicity on renal histology. In conclusion, tacrolimus‐based maintenance immunosuppression is associated with stable renal and pancreas allograft function, with freedom from acute rejection in 83% of patients.
Relative risk of post‐transplant renal thrombosis in patients with antiphospholipid antibodies1
Authors: Vaidya Smita , Wang Chu Chi , Gugliuzza Christine , Fish Jay C
Published: September 2024

Introduction

Antiphospholipid antibody syndrome (APAS) is a condition associated with recurrent arterial and venous thrombosis, recurrent abortions, and thrombocytopenia either with or without lupus. In this study we have evaluated the impact of APAS on the renal transplant outcome of 174 patients.

Method

Patients' APAS status was determined by the presence of anticardiolipin antibodies (ACA) and a history of clotting disorders. Serum samples from each patient were tested for the presence of ACA by the ELISA method. Transplant outcomes were monitored for 1 yr.

Results

Of 174 patients, 78 received renal transplants. Six of these 78 patients had APAS as evidenced by either recurrent microrenal angiopathy (2 patients), thrombocytopenia (1 patient) or frequent A‐V shunt thrombosis (3 patients) along with high titers of ACA of IgM, IgG, or both subtypes at the time of their transplants. Each of these 6 patients thrombosed their renal allografts within a week of their transplants. The other 72 transplanted patients with no APAS were all doing well ≥1 yr post‐transplant. The association between APAS and post‐transplant renal thrombosis among these patients is highly significant (p <0.0001). In contrast, no association was discerned between post‐transplant thrombosis and prior sensitization to HLA

Conclusion

Our data demonstrates that patients with APAS are at high risk for development of post‐transplant renal thrombosis.
Kaposi's sarcoma after renal transplantation in Turkey
Authors: Ecder ST , Sever  , Yildiz A , Türkmen A , Kayacan SM , Kiliçaslan I , Koçak T , Eldegez U
Published: September 2024

In this report, incidence and clinical characteristics of Kaposi's sarcoma (KS) were retrospectively analyzed among renal transplant recipients who were being followed‐up in the outpatient clinic of the Istanbul School of Medicine. Between October 1983 and December 1997, 17 cases of KS were diagnosed among 557 patients (3%). Of the total 25 post‐transplant malignancies, KS was the most common tumor, representing a rate of 68%. Diagnosis was suspected with typical skin lesions and was confirmed by biopsy. Gastroduodenal endoscopy was applied to 7 patients in order to assess gastrointestinal tract involvement. Of the total number of patients diagnosed with KS 14 were male and 3 female, with the mean age of 40±15 (range 13‐68) yr. The mean duration between the date of transplantation and diagnosis of KS was 15.9±20.3 (range 1‐65) months. The lesions were limited to the skin in 13 patients, while skin and gastrointestinal tract were involved in 2 patients and generalized disease was noted in 2 patients. The initial therapeutic approach was to withdraw cyclosporine and to reduce azathioprine. In the case of progression of the lesions azathioprine was also stopped. Besides, surgical excision of the lesions, radiotherapy and/or chemotherapy were performed according to the clinical picture. Remission was observed in 14 patients after this therapy protocol. The 2 patients with gastrointestinal involvement and 1 patient with generalized KS died in spite of the above‐mentioned therapeutic interventions. One of the patients on remission died of pneumonia. It was concluded that KS carried a high risk of morbidity and mortality in renal transplant recipients, and tapering of immunosuppression, especially withdrawal of cyclosporine, affected the prognosis favorably.
Reducing the length of stay after kidney transplantation — the intensive outpatient unit
Authors: Shapiro Ron , Jordan Mark L , Scantlebury Velma P , Vivas Carlos , Gritsch H Albin , Fox‐Hawranko Lisa , Doyle Howard R , Johnson Lee Brun , Fenton Regina , Painter Lisa , Keefer‐Wolf Kristine , Redman Charleeda , McCauley Jerry , Fung John J , Hakala Thomas R , Starzl Thomas E , Simmons Richard L
Published: September 2024

The need to reduce the costs associated with the initial hospitalization for kidney transplantation has led to the development of outpatient facilities in which patients can be seen on a daily basis. The implementation of a kidney transplant intensive outpatient unit (IOPU) is described. Prior to the opening of the IOPU, the median and mean lengths of stay after kidney transplantation in our program were 14.0 and 18.9 d, respectively. Subsequent to the opening of the IOPU, the median and mean lengths of stay after kidney transplantation have gradually decreased and are currently 5.0 and 7.5 d, respectively. The median inpatient cost of transplantation, excluding organ acquisition charges, has decreased by 54%, from $25516 to $11616. Patient satisfaction has exceeded 80%. The IOPU represents an effective means of reducing the cost associated with transplantation, without sacrificing the quality of care.
Limitations of pediatric donor kidneys for transplantation
Authors: Yagisawa Takashi , Kam Igal , Chan Laurence , Springer James W , Dunn Sue
Published: September 2024

Background

The shortage of grafts for kidney transplantation (Tx) has resulted in an expansion of criteria for pediatric donors. However, the limitations of pediatric donors for kidney Tx are not yet clearly established. We investigated the outcomes of recipients with pediatric kidney grafts from Colorado to elucidate the state of pediatric kidney grafts distributed in the nation and to clarify the limitations of pediatric donor kidneys for Tx.

Methods

Between January 1989 and July 1997, 675 organ donors in Colorado were utilized for Tx. Fifty‐seven of these (8.4%) were 10 yr old or younger. Thirty‐two of the 57 pediatric donors provided kidneys for 50 recipients both inside and outside Colorado. Forty‐four of the 50 recipients were followed and are available for this study.

Results

Graft survival rates were 85.6, 77.3, 71.3 and 65.4% for 1, 2, 3 to 5, and 6 yr of follow‐up, respectively. Thirteen recipients lost the grafts, including three graft losses within 2 wk, due to primary nonfunction, venous and arterial thrombosis. The mean serum creatinine value in 31 recipients with functioning grafts was 1.3±0.4 mg/dL at the time with follow‐up of 45.9±28.3 months (5‐96 months). Six grafts from 13‐month to 3‐yr‐old donors were transplanted en‐bloc and 5 of these have survived. Four of the 5 single grafts from 3 to 5‐yr‐old donors have functioned. Of the 33 grafts from donors aged 6‐10 yr. including 30 single and 3 en‐bloc grafts, 22 were still functioning. With respect to donor weight, 4 of the 5 en‐bloc grafts from donors weighting 9‐15 kg, and 6 of the 7 single and the 1 en‐bloc grafts from donors weighing 15‐20 kg were still functioning. Cold ischemic time (CIT) within 37.5 h was not associated with early graft outcome.

Conclusions

The kidneys from donors 1‐3 yr old and/or weighing 9‐15 kg could be successfully transplanted en‐bloc and those from donors more than 3 yr old and/or weighing 15 kg were best transplanted by single grafts.
Identification of diagnostic biomarkers and immune cell profiles associated with COPD integrated bioinformatics and machine learning
Authors: Zhu Zirui , Zeng Zhuo , Song Baichen , Chen Huishan , Zeng Huiqing
Published: September 2024

This retrospective transcriptomic study leveraged bioinformatics and machine learning algorithms to identify novel gene biomarkers and explore immune cell infiltration profiles associated with chronic obstructive pulmonary disease (COPD). Utilizing an integrated analysis of metadata encompassing six gene expression omnibus (GEO) microarray datasets, 987 differentially expressed genes were identified. Further gene ontology and pathway enrichment analyses revealed the enrichment of these genes across various biological processes and pathways. Moreover, a systematic integration of two machine learning algorithms along with pathway‐gene correlations identified six candidate biomarkers, which were validated in a separate cohort comprising six additional microarray datasets, ultimately identifying ADD3 and GNAS as diagnostic biomarkers for COPD. Subsequently, the diagnostic efficacy of ADD3 and GNAS was assessed, and the impact of their expression levels on overall survival was further evaluated and quantified in the validation cohort. Examination of immune cell subtype infiltration found increased proportions of cytotoxic CD8+ T cells, resting and activated NK cells, along with decreased M0 and M2 macrophages, in COPD versus control samples. Correlation analyses also uncovered significant associations between ADD3 and GNAS expression and infiltration of various immune cell types. In conclusion, this study elucidates crucial COPD diagnostic biomarkers and immune cell profiles which may illuminate the immunopathological drivers of COPD progression, representing personalized therapeutic targets warranting further investigation.
Out of Sight, Out of Mind? UK–EU Member States Bilateralism as an Enabler of Europeanisation
Authors: Wolff Sarah , Carrapico Helena , Piquet Agathe
Published: September 2024

Whilst an extensive scholarship has questioned the role of the United Kingdom in multilateral and mini‐lateral venues, less attention has been devoted to the signature of 24 bilateral declarations between the United Kingdom and EU member states from 2021 to 2023. Bilateralism has indeed been one of the preferred UK strategies to achieve foreign policy co‐ordination with EU member states post‐Brexit. Questioning the intentionality of the United Kingdom in initiating and investing these arrangements, we find that despite the clear attempts to deEUise its foreign policy, we are also not witnessing purposes of de‐Europeanisation that would imply a repudiation of European shared values, a divergence from common priorities and an end to social encounters between UK and EU member states' officials. Instead, through a frame analysis of these declarations and interviews, we highlight that bilateralism has enabled continued Europeanisation, even though to a lesser extent in comparison with the pre‐Brexit situation. Closer relations with European capitals are thus enabling Europeanisation of UK foreign policy to persist. In other words, we conclude that whilst there has been, on the side of the United Kingdom, a repudiation of the EU as a political entity, there has been no rejection of common European values and priorities, which remain shared with EU member states.
Neonatal diabetes mellitus around the world: Update 2024
Authors: Barbetti Fabrizio , Deeb Asma , Suzuki Shigeru
Published: September 2024

Neonatal diabetes mellitus (NDM), defined as diabetes with an onset during the first 6 months of life, is a rare form of monogenic diabetes. The initial publications on this condition began appearing in the second half of the 1990s and quite surprisingly, the search for new NDM genes is still ongoing with great vigor. Between 2018 and early 2024, six brand new NDM‐genes have been discovered (CNOT1, FICD, ONECUT1, PDIA6, YIPF5, ZNF808) and three genes known to cause different diseases were identified as NDM‐genes (EIF2B1, NARS2, KCNMA1). In addition, NDM cases carrying mutations in three other genes known to give rise to diabetes during childhood have been also identified (AGPAT2, BSCL2, PIK3R1). As a consequence, the list of NDM genes now exceeds 40. This genetic heterogeneity translates into many different mechanism(s) of disease that are being investigated with state‐of‐the‐art methodologies, such as induced pluripotent stem cells (iPSC) and human embryonic stem cells (hESC) manipulated with the CRISPR technique of genome editing. This diversity in genetic causes and the pathophysiology of diabetes dictate the need for a variety of therapeutic approaches. The aim of this paper is to provide an overview on recent achievements in all aspects of this area of research.
The ethics of performance care: A pragmatic feminist analysis of policy for singing voice rehabilitation
Authors: Brown Jenna
Published: September 2024

Introduction

This paper uses pragmatic feminist poststructuralism to explore how ethical theory is applied to singing voice rehabilitation by specialist singing teachers.

Methods

A critical literature review examines the relationship between traditional and feminist ethical theories and their potential impact on practice. Themes have been extracted from the literature to create an intersectional feminist poststructural analysis framework, facilitating a document analysis of the foundations of three policy documents currently available to singing voice rehabilitation specialists. Poststructural deconstructivism was applied to thematic analysis to consider the impact of ethical theories on policy and practice.

Findings

Policies we found to be rooted in traditional enlightenment ethics, with a focus on hyper‐rationality, androcentrism and legalism. Person‐centred care ethics was found to be lacking in all documents. Contrary to best‐practice recommendations documents failed to provided practical guidelines for practitioners.

Conclusion

Findings indicate adopting an intersectional feminist ethical policy could improve existing documents via a move from legislation and authority towards care and reflexivity.
The interplay of negative urgency and cognitive reappraisal in couples' communication conflict
Authors: Poole Emma J. , Broos Hannah C. , Timpano Kiara R. , Doss Brian D.
Published: September 2024

Little is known about the individual factors that potentiate communication conflict in romantic relationships. This study examined the main and interactive effects of two types of emotion regulation in 1240 couples enrolled in an online relationship intervention. Results revealed that higher levels of actors' communication conflict were associated with actors' greater negative urgency and lower cognitive reappraisal. Furthermore, actors' cognitive reappraisal acted as an inhibitor of communication conflict, but only for actors with low levels of negative urgency. Partner effects on perceived actor conflict followed a similar pattern. There was no evidence that the emotion regulation of one partner moderated the effect of the emotion regulation of the other. These results highlight the importance of considering the contribution of couples' emotion regulation in the etiology of their communication conflict and selecting interventions that best match their emotion regulation needs.
Oral feeding practices in medically complex infants receiving prolonged high‐flow nasal cannula support: A retrospective cohort study
Authors: Cox Emily , Chawla Jasneek , Moore Madison , Schilling Sandra , Cameron Miriam , Clarke Sally , Johnstone Chelsea , Marshall Jeanne
Published: September 2024

Aim

To characterise the feeding profile and care pathway for infants receiving prolonged high‐flow nasal cannula (HFNC) respiratory support for management of a chronic condition at one facility from January to December 2021.

Methods

Data regarding medical history, HFNC admission details (reason for HFNC, HFNC duration, flow rate), feeding outcomes and speech pathology care were collected from electronic records of HFNC‐dependent infants (requiring HFNC ≥2–3 L/kg for ≥5 consecutive days). Infants with acute respiratory conditions (e.g. bronchiolitis) were excluded.

Results

This study included 24 participants (median corrected age at admission 5.3 weeks, range −6 to 18.6). Of these, 15 (60%) had a condition/s that affected more than one body system (e.g. congenital diaphragmatic hernia), requiring the care of multiple specialities. Median length of HFNC use was 37.5 days (range 11–188). Twenty (83.3%) infants were referred for speech pathology (SLP) input while on HFNC support. For those referred, frequency of SLP input was variable (0–3 sessions/week), and HFNC support requirements were the most common barrier to SLP intervention (n = 9, 45%). Twelve (54.5%) infants demonstrated improvement in their primary feeding method by discharge; however, only two (9.1%) infants were discharged on full oral feeds.

Conclusions

This study demonstrates variability in oral feeding management in infants with prolonged HFNC‐dependence at our centre. Respiratory support with HFNC was identified as a barrier to progressing oral feeding. Further research is required to determine if oral feeding can be safely undertaken in this cohort. This is imperative to ensure that long‐term feeding outcomes are not negatively impacted by current practice.
Gender differences in factors associated with rural health care practice in Minnesota
Authors: Woldegerima Selam , Fritsma Teri , Henning‐Smith Carrie , Rosenberg Mark , Olson Andrew P. J.
Published: September 2024

Purpose

To understand gender differences in factors affecting rural health care workforce to inform the development of effective policies and recruitment strategies to address rural health care workforce shortages.

Methods

A cross‐sectional survey of health care professionals (including Advanced practice registered nurses (APRNs), physicians, physician assistants (PAs), and registered nurses (RNs)) in Minnesota was administered by the Minnesota Department of Health from October 18, 2021, to July 25, 2022, during their professional license renewal. The main outcome was whether or not the respondent was practicing in a rural area. The effects of factors associated with rural practice were estimated using binary logistic regression models, and subsequently subgroup analysis was conducted by gender across the four health care professions.

Findings

Results show that although there were significant gender differences in some factors (growing up in a rural area and family considerations were more likely to influence women's decisions than men's, whereas men were more likely to be influenced by the prospect of having autonomy and broad scope of practice than women), these differences became insignificant when the four health care professionals were analyzed separately suggesting that overall gender differences observed were almost entirely explained by profession differences.

Conclusions

Gender differences do not significantly influence the factors impacting rural practice. However, being raised in a rural environment emerges as the most influential predictor of rural practice underscoring the importance of involving rural residents of all genders in health care practice.
Phylogenetic reconstruction of Didymocarpus and related genera in Gesneriaceae with establishment of two new genera
Authors: Liu Fang‐Pu , Han Meng‐Qi , Li Peng‐Wei , Wang Yin‐Zheng
Published: September 2024

The genus Didymocarpus Wall. is a core group of the subfamily Didymocarpoideae in Gesneriaceae with a complex taxonomic history. It has long been controversial to delimit Didymocarpus and its allies. We conducted phylogenetic reconstructions with high‐density sampling of Didymocarpus and related genera by using four nuclear ribosomal DNAs (external transcribed spacer [ETS], internal transcribed spacer [ITS], 18S, 26S) and five chloroplast DNAs (atpB‐rbcL, rpl16, rps16, trnH‐psbA, and trnL‐F). The results indicated that neither Didymocarpus nor Allocheilos are monophyletic. Based on molecular phylogenetic and morphological analyses, we delimitated the range of the Didymocarpus sensu stricto (s. str.) with two‐section division, and established a new genus Palmatiboea for species originally placed in Didymocarpus. This genus is remarkably distinguished from Didymocarpus s. str. not only in molecular phylogeny and morphology but also in its specific geographic distribution, in that it is found only in Southeast China. In addition, we proposed a new monotypic genus Hequnia for Allocheilos guangxiensis that is completely isolated in phylogeny, consistent with a range of remarkably distinctive morphological characteristics. Our results clarify the systematics of Didymocarpus and the delimitation between it and related genera with establishment of two new genera.
International medical graduates' social connections: A qualitative study
Authors: Al‐Haddad Mo , Jamieson Susan , Germeni Evi
Published: September 2024

Introduction

Social connections in the host country improve International Medical Graduates' (IMGs') well‐being, intercultural competence and performance at work but is an issue that has been largely overlooked in the academic literature and policy discussions. The aim of this study was to better understand the social connections that IMGs form by exploring this phenomenon in a UK context.

Methods

IMGs and UK Medical Graduates (UKMGs) practising in Scotland were invited to participate. This was a qualitative study using online semi‐structured interviews for data collection and reflexive thematic analysis.

Results

Forty‐one participants were recruited (24 IMGs and 17 UKMGs), selected with maximum variation in terms of gender, ethnicity, speciality, grade and country of primary medical qualification. Twenty‐one (58%) of the participants had experience working in other parts of the UK.

Five themes were identified: (i) overcoming early isolation, IMGs strove to overcome their initial social isolation which harmed their mental well‐being; (ii) where connections are made, IMGs form social connections mainly at work and within their religious communities; (iii) seeds of segregation, some IMGs found themselves outside tight UK native friendship groups. Alcohol was a socially exclusive activity for some IMGs, as were other host country cultural norms. Exclusion led IMGs to form social connections with other IMGs or other ‘outsider’ groups; (iv) degrees of Discrimination, discrimination and racism were experienced by some IMGs. Discrimination was individual, structural and institutional, and (v) “Open (ing) the door”, participants described interventions at organisational, departmental, and individual levels to improve IMGs' ability to form social connections.

Discussion

This study highlighted the challenges that IMGs face when trying to form social connections. More emphasis needs to be placed on promoting an environment where social connections, in particular between IMGs and host country natives, can flourish.
Mainshock–aftershock sequence simulation via latent space encoding of generative adversarial networks
Authors: Xu Zekun , Shen Jiaxu , Wu Huayong , Chen Jun
Published: September 2024

Aftershocks (ASs) following strong mainshocks (MSs) can exacerbate structural damage or lead to collapse. However, the scarcity of recorded data necessitates reliance on artificial sequences, which have difficulty in characterizing the time‐frequency correlation between MSs and ASs. This study innovatively converts the AS time history prediction into an image translation task, exploiting the invertible transformation between accelerograms and time‐frequency representations. An encoder–decoder neural network is developed to encode the MS information into the latent space of a pre‐trained generative adversarial network, enabling accurate AS predictions through the decoder. The integration of seismic parameters further improves the AS prediction performance. Comparative analyses demonstrate that the proposed method outperforms the traditional ones on accuracy and robustness and reproduces the non‐stationarity of ASs.