bluuebunny/crossref_metadata_2025 huggingface dataset:
Flea beetles in spring oilseed rape differ in phenology and habitat choices for reproduction and overwintering—Implications for pest management
Authors: Boetzl Fabian A. , Malsher Gerard , Bommarco Riccardo , Lundin Ola
Published: October 2024

Spring oilseed rape is severely affected by early season herbivory of various flea beetle species. Flea beetle pest management strategies with less reliance on conventional chemical insecticides are direly needed. However, the current knowledge of flea beetle ecologies and life cycles is insufficient to design and inform such strategies effectively.

Using a combination of pitfall and emergence traps, we followed the life cycles of flea beetles in 13 spring oilseed rape fields in south central Sweden, measuring densities in three sampling seasons: spring activity at crop seedling stage, summer emergence of the new generation, and emergence of overwintered adults in the following spring in the adjacent grassy field margins.

We found a strong positive relationship between densities of emerging Phyllotreta atra, P. striolata and P. undulata in summer and their densities earlier in spring. Flea beetle assemblage composition differed across the seasons, driven by changes in the relative abundances of different species. While assemblages emerging in summer were filtered for species reproducing in spring oilseed rape, assemblages emerging from the grassy field margins in the following spring were again more heterogeneous.

Spring activity peaks and summer emergence peaks differed among species, with P. vittula having an earlier activity peak and emerging earlier than most other species.

This knowledge of spatiotemporal habitat use can contribute to a more effective flea beetle management in spring oilseed rape. Especially summer emergence in the fields became apparent as a so far unexplored point in time to control flea beetle pests.
The implicit market price of soil erosion: An estimation using a hedonic model with spatial spillovers
Authors: Caffera Marcelo , Lavín Felipe Vásquez , Barrientos Manuel , Anza Daniel Rodríguez , Carrasco‐Letelier Leonidas
Published: October 2024

We estimate the implicit market price of soil erosion using quarterly data of 2824 agricultural farms traded in Uruguay between 2000 and 2014. A unique feature of our estimation is that we allow for possible spatial spillovers. We find evidence of a negative and statistically significant association between erosion and land values. On average, an additional loss of 1% of the original topsoil due to erosion is associated with a direct (own) decrease of .24% in the per‐hectare price of agricultural land (P‐value: .012, 95% CI: −.0042, −.0005). In 2023 dollars, this is equivalent to a decrease of USD 8.7 in the average price per hectare, or USD 1130 in the price of the average farm. In terms of tons of soil, the average value is $.24 a ton. Finally, considering the 50 km radius of our spatial model, the value of losing 1% of topsoil is $15.8 million. The value of our estimates is sensitive to our measure of erosion and our specification of the spatial‐temporal weighting matrix, but the statistical association is robust.
Applying support vector machines to a diagnostic classification model for polytomous attributes in small‐sample contexts
Authors: Li Xiaoyu , Dong Shenghong , Guo Shaoyang , Zheng Chanjin
Published: October 2024

Over several years, the evaluation of polytomous attributes in small‐sample settings has posed a challenge to the application of cognitive diagnosis models. To enhance classification precision, the support vector machine (SVM) was introduced for estimating polytomous attribution, given its proven feasibility for dichotomous cases. Two simulation studies and an empirical study assessed the impact of various factors on SVM classification performance, including training sample size, attribute structures, guessing/slipping levels, number of attributes, number of attribute levels, and number of items. The results indicated that SVM outperformed the pG‐DINA model in classification accuracy under dependent attribute structures and small sample sizes. SVM performance improved with an increased number of items but declined with higher guessing/slipping levels, more attributes, and more attribute levels. Empirical data further validated the application and advantages of SVMs.
Landscapes on the edge
Authors: Sherren Kate
Published: October 2024

Many landscapes are on the edge literally, particularly here on the Atlantic Coast of Canada. But landscapes everywhere are on the edge metaphorically: on the edge of change. Tackling the collective challenges we face, and redefining a “good life” in these new circumstances, will likely transform the places and landscapes that we care about. Yet change is hard and it is felt unevenly across space and social strata. We often instinctively feel that the landscapes of the present should dominate the future—an idea I've been calling “climax thinking”—but in many cases, those current landscape settings solve old problems and cause new ones. Drawing on recent empirical Atlantic research about renewable energy and coastal adaptation, this lecture explores some of the cultural shifts required to reimagine our landscapes and to meet the challenges ahead, identifying key roles for geographers along the way.
Horizontal Guided Bone Regeneration of the Posterior Mandible to Allow Implant Placement: 1‐Year Prospective Study Results
Authors: Lorenz Jonas , Ghanaati Shahram , Aleksic Zoran , Milinkovic Iva , Lazic Zoran , Magić Marko , Wessing Bastian , Grotenclos Ramona Schleich , Merli Mauro , Mariotti Giorgia , Bressan Eriberto , De Stavola Luca , Sader Robert
Published: October 2024

Objective

Assess whether horizontal ridge augmentation with guided bone regeneration (GBR) using deproteinized bovine bone mineral (DBBM), autologous bone, and a resorbable collagen membrane supports successful implant placement.

Materials and Methods

This open, prospective, single‐cohort, multicenter clinical study included patients with ridge defects that required GBR prior to implant insertion. The primary endpoint was radiologically assessed bone gain after 8 months post‐GBR, measured at the center of planned implant sites. Secondary endpoints included implant survival and success, marginal bone levels (MBLs), MBL changes, and soft tissue health.

Results

Of 45 patients evaluated 8 months post‐GBR, nine experienced dehiscence in the first 3 weeks of the healing period. GBR led to radiologically determined mean bone width gain of 4.0 ± 1.5 mm and 4.8 ± 1.7 mm, measured 1 and 3 mm from the top of the crest, respectively, allowing successful implant placement in 44 patients (97.8%). The cumulative implant survival and success rates were 98.9% and 95.5%, respectively. MBLs were stable: −1.18 ± 0.64 mm at definitive prosthesis placement (DPP) and − 1.07 ± 0.74 mm at 1 year. Soft tissue health and esthetics (plaque and bleeding indices, papilla, keratinized mucosa, and pink esthetic score) improved from DPP to 1 year. Patients were highly satisfied with implant function and esthetics, and their oral health‐related quality of life improved.

Conclusions

GBR using DBBM and a collagen membrane offered a safe and effective treatment option for horizontal ridge augmentation sufficient to support implant‐based tooth rehabilitation.

Trial Registration

Registered at ClinicalTrials.gov NCT03028922 (registrations sites, as above listed affiliations, first posted January 23, 2017)
Riboflavin supplementation in children with riboflavin transporter deficiency type 2 does not stop disease progression based on long‐term follow‐up
Authors: Bertini Enrico , Massey Keith
Published: October 2024

This commentary is on the original article by Fennessy et al. on pages 405–415 of this issue.
Estimates of Effective Number of Breeders Identify Drivers of Decline in Mid‐Atlantic Brook Trout Populations
Authors: Robinson Zachary L. , Coombs Jason A. , Hudy Mark , Nislow Keith H. , Whiteley Andrew R.
Published: October 2024

Brook Trout (Salvelinus fontinalis) populations have experienced marked declines throughout their native range and are presently threatened due to isolation in small habitat fragments, land use changes, and climate change. The existence of numerous, spatially distinct populations poses substantial challenges for monitoring population status (e.g., abundance, recruitment, or occupancy). Genetic monitoring with estimates of effective number of breeders (Nb) provides a potentially powerful metric to complement existing population monitoring, assessment, and prioritization. We estimated Nb for 71 Brook Trout habitat units in mid‐Atlantic region of the United States and obtained a mean Nb of 73.2 (range 6.90–493). Our modeling approach tested whether Nb estimates were sensitive to differences in habitat size, presence of non‐native salmonids, base flow index, temperature, acidic precipitation, and indices of anthropogenic disturbance. We found significant support for three of our hypotheses including the positive influences of available habitat and base flow index and negative effect of temperature. Our results are consistent with presently observed and predicted future impacts of climate change on populations of this cold‐water fish. Importantly, these findings support the use of Nb in population assessments as an index of relative population status.
The Erosion of Seasonality in Avian Communities
Authors: Curley Shannon R. , Ramírez‐Garofalo José R. , Acosta Alamo Marlen , Manne Lisa L. , Lockwood Julie L. , Veit Richard R.
Published: October 2024

Aim

Seasonality governs species composition at a given place and time. However, the effects of climate and land‐use change can vary by season, altering species composition. These changes can lead to a loss of distinct seasonal community composition, representing a novel form of biotic homogenisation. We ask if breeding and winter bird communities are becoming more similar over time. If so, is homogenisation occurring more rapidly in winter than in the breeding season, and has the presence of individual species changed between seasons?

Location

Northeastern United States.

Time Period

1989–2019.

Major Taxa Studied

Two hundred thirty‐eight bird species.

Methods

We use data from The National Audubon Society's Christmas Bird Count and the North American Breeding Bird Survey to test if winter and breeding bird communities have become more similar (homogenised). We evaluate this change using the Sørensen dissimilarity index, and its components of turnover (species replacement) and nestedness (a subset of a more species rich community) and describe the mechanism in which the seasonal winter and breeding bird communities are changing.

Results

We found that winter and breeding bird communities are homogenising, driven by significant decrease in turnover and a marginal decrease nestedness. When viewing breeding and wintering communities separately, we observe different trends. Breeding communities are becoming more unique with decreasing turnover and nestedness. Winter communities are becoming more similar to each other, with decreasing turnover and nestedness. More breeding species are declining and species that are typically found in the winter and year‐round residents are the main contributors to the homogenisation between seasons.

Main Conclusions

We show for the first time homogenisation between winter and breeding bird communities over time across the northeastern United States. This insight into how individual species are faring between seasons, and how they impact community structure, can be used when implementing conservation measures for maintaining ecological functioning and integrity.
No association between migraine and HLA alleles in a cohort of 13,210 individuals with migraine from the Danish Blood Donor Study
Authors: Tummoszeit Inga Zalia , Olofsson Isa Amalie , Chalmer Mona Ameri , Henriksen Alexander Pil , Aagaard Bitten , Brunak Søren , Bruun Mie Topholm , Didriksen Maria , Erikstrup Christian , Hjalgrim Henrik , Mikkelsen Christina , Mikkelsen Susan , Ostrowski Sisse Rye , Pedersen Ole Birger Vesterager , Quinn Liam , Sørensen Erik , Ullum Henrik , Olesen Jes , Banasik Karina , Hansen Thomas Folkmann , Kogelman Lisette J. A. ,   the DBDS Genomic consortium group
Published: October 2024

Objective

To determine the association between human leukocyte antigen (HLA) alleles and migraine, migraine subtypes, and sex‐specific factors.

Background

It has long been hypothesized that inflammation contributes to migraine pathophysiology. This study examined the association between migraine and alleles in the HLA system, a key player in immune response and genetic diversity.

Methods

We performed a case–control study and included 13,210 individuals with migraine and 86,738 controls. All participants were part of the Danish Blood Donor Study Genomic Cohort. Participants were genotyped and 111 HLA alleles on 15 HLA genes were imputed. We examined the association between HLA alleles and migraine subtypes, considering sex‐specific differences.

Results

We found no association between HLA alleles and migraine, neither overall, nor in the sex‐specific analysis. In the migraine subtype analysis, three HLA alleles were associated with migraine without aura; however, these associations could not be replicated in an independent Icelandic cohort (2191 individuals with migraine without aura and 278,858 controls). Furthermore, we found no association between HLA alleles and migraine with aura or chronic migraine.

Conclusion

We found no evidence of an association between the HLA system and migraine, suggesting that genetic factors related to the HLA system do not play a significant role in migraine susceptibility.
Endogenous choice of environmental corporate social responsibility in a mixed duopoly
Authors: Xu Lili , Zhao Qinghong , Lee Sang‐Ho
Published: October 2024

This paper constructs green managerial delegation contracts in a mixed duopoly wherein either or both public and private firms may adopt environmental corporate social responsibility (ECSR). We demonstrate that the public (private) firm owner positively (negatively) adopts ECSR incentives under Cournot, whereas the incentives are reversed under Bertrand. We also examine an endogenous ECSR choice game and discover that unilateral ECSR adopted by a public firm appears under Cournot, whereas bilateral ECSR where both firms adopt ECSR incentives appears under Bertrand. Our findings show that coordination of competition mode may be harmful to society if both marginal damage and product substitutability are sufficiently high.
Synergies of bioactivities, mechanisms, dietary factors and functional food applications of medicinal insulin plant (Costus pictus D.): a review
Authors: Chandrakar Naveen , Kaur Jaspreet , Banerjee Mamoni
Published: October 2024

Modernisation has significantly altered lifestyles, particularly eating habits, contributing to the increase of chronic diseases, with diabetes mellitus being a predominant metabolic disorder. Medicinal herbs such as Costus pictus (C. pictus), commonly known as the Insulin plant, offer a promising approach to managing these conditions. It is a perennial plant from the Costaceae family rich in proteins, fibres, minerals (K, Ca, Cr, Fe, Mn, Cu, Zn), and bioactive compounds. This review highlighted the plant's potential in mitigating chronic diseases and metabolic disorders due to its diverse bioactivities, including hepatoprotective, anti‐inflammatory, anticancer, antidiabetic, and antioxidant properties. These benefits are primarily attributed to its phytochemicals, mainly flavonoids and phenolic compounds. The antidiabetic mechanism involves suppressing metabolic enzymes essential for carbohydrate metabolism, while its antioxidant activity helps reduce excessive reactive oxygen species (ROS) levels implicated in various diseases. Furthermore, C. pictus can be incorporated into functional foods such as bakery and confectionery products, functional drinks, and edible coatings. We discussed the dietary factors, bioactivities, and underlying mechanisms associated with Costus pictus D., emphasising its applicability in functional food formulations. The synthesis of current research highlights the plant's role in modulating glucose metabolism, enhancing antioxidant defences, and its potential in mitigating diseases such as diabetes. By delving into the synergies between its dietary factors and bioactivities, this review aims to elucidate the multifaceted benefits of Costus pictus D., thereby fostering its integration into sustainable agricultural practises and contributing to public health nutrition.
How doctors can lead the way in their communities: Co‐creation, the Indian community and organ donation registration
Authors: Moloney Gail , Ghelani Dhaval , Lakshmanan Ramanathan , Upcroft Leah , Hutchinson Marie , Norton Maddison , Sutherland Michael , Walker Iain , Rienks Suzanne
Published: October 2024

Background and Aims

Transplant success rates can increase when organs and tissues are matched within ethnic communities, but how well are the processes around organ donation understood by discrete ethnic communities in Australia? We investigated this in relation to one ethnic group, the Australian‐Indian community in Sydney.

Methods

A culturally appropriate survey and dissemination strategy was co‐created with Indian community members through an Advisory Panel. Items were informed by a thematic analysis of cultural beliefs shared through the advisory panel discussions and measured awareness and practices associated with organ donation and transplantation and beliefs about organ donation and registration. Donation information was provided at the end.

Results

Two hundred and thirty‐eight participants completed the survey. Hinduism along with Tamil and Gujarati were the most frequently identified religious and cultural backgrounds. The processes around organ donation were not well known, and Australian Organ Donor Register registration rates were below the national average. Principal component analysis revealed positive, social, medical trust, concerns, and cardiac and brain death belief factors. Doctors played a key role in generating trust in the donation system, decisions about organ donation were embedded in family and community, and family discussion was related to increased registration. Registered participants reported higher scores on medical trust beliefs, which also predicted family discussion.

Conclusion

The information needed to understand the process of organ donation and registration in Australia is not embedded in this community, highlighting the need for programmes to be tailored to each culturally diverse community rather than culturally diverse communites in general. Doctors and the advisory panels are pivotal in this process.
Antibodies in neurological diseases: Established, emerging, explorative
Authors: Li Lucie Y. , Keles Amelya , Homeyer Marie A. , Prüss Harald
Published: October 2024

Within a few years, autoantibodies targeting the nervous system resulted in a novel disease classification. For several of them, which we termed ‘established’, direct pathogenicity has been proven and now guides diagnostic pathways and early immunotherapy. For a rapidly growing number of further anti‐neuronal autoantibodies, the role in disease is less clear. Increasing evidence suggests that they could contribute to disease, by playing a modulating role on brain function. We therefore suggest a three‐level classification of neurological autoantibodies according to the degree of experimentally proven pathogenicity and strength of clinical association: established, emerging, explorative. This may facilitate focusing on clinical constellations in which autoantibody‐mediated mechanisms have not been assumed previously, including autoimmune psychosis and dementia, cognitive impairment in cancer, and neurodegenerative diseases. Based on recent data reviewed here, humoral autoimmunity may represent an additional “super‐system” for brain health. The “brain antibody‐ome”, that is, the composition of thousands of anti‐neuronal autoantibodies, may shape neuronal function not only in disease, but even in healthy aging. Towards this novel concept, extensive research will have to elucidate pathogenicity from the atomic to the clinical level, autoantibody by autoantibody. Such profiling can uncover novel biomarkers, enhance our understanding of underlying mechanisms, and identify selective therapies.
Molecular mechanisms of emerging inflammasome complexes and their activation and signaling in inflammation and pyroptosis
Authors: Pandey Abhimanu , Li Zheyi , Gautam Manjul , Ghosh Aritra , Man Si Ming
Published: October 2024

Inflammasomes are multi‐protein complexes that assemble within the cytoplasm of mammalian cells in response to pathogen‐associated molecular patterns (PAMPs) or damage‐associated molecular patterns (DAMPs), driving the secretion of the pro‐inflammatory cytokines IL‐1β and IL‐18, and pyroptosis. The best‐characterized inflammasome complexes are the NLRP3, NAIP‐NLRC4, NLRP1, AIM2, and Pyrin canonical caspase‐1‐containing inflammasomes, and the caspase‐11 non‐canonical inflammasome. Newer inflammasome sensor proteins have been identified, including NLRP6, NLRP7, NLRP9, NLRP10, NLRP11, NLRP12, CARD8, and MxA. These inflammasome sensors can sense PAMPs from bacteria, viruses and protozoa, or DAMPs in the form of mitochondrial damage, ROS, stress and heme. The mechanisms of action, physiological relevance, consequences in human diseases, and avenues for therapeutic intervention for these novel inflammasomes are beginning to be realized. Here, we discuss these emerging inflammasome complexes and their putative activation mechanisms, molecular and signaling pathways, and physiological roles in health and disease.
HLA‐DQ matching in cadaveric renal transplantation
Authors: Freedman Barry I. , Thacker Leroy R. , Heise Eugene R. , Adams Patricia L.
Published: October 2024

The impact of matching for the human leukocyte antigen (HLA)‐ DQ phenotype in cadaveric renal transplantation is unclear. We analyzed the effect of matching serologically defined HLA‐DQ phenotypes on renal allograft survival in 12,050 first cadaveric renal transplants (recipients were 63.5% white and 36.5% African‐American). Recipients were entered into the South‐Eastern Organ Procurement Foundation (SEOPF) database between 1 October 1987 and 6 June 1995. A series of life table analyses were done to test the equality of survival curves for HLA‐DQ match, both alone and accommodating for differences in recipient race and HLA‐DR match. Cox regression models were then performed to detect differences in allograft survival based upon HLA‐DQ match. Initial adjustments were done by recipient race. Subsequent adjustments were done by recipient and donor race, age and sex, cold ischemia time (CIT), body mass index (BMI), cyclosporine A (CyA) use, peak panel reactive antibody (PRA) titer, year of transplant, presence of diabetes mellitus (DM), and degree of HLA‐A,B and HLA‐DR match as covariates. The effect of varying degrees of HLADQ match on graft survival were similar between the two races (p=0.87). In all recipients, an 8.3% reduction in graft failure was observed for each increase in HLA‐DQ match using the Cox regression model adjusted only for recipient race (p=0.004). A non‐significant 3.0% reduction in graft failure (p=0.38) was observed for each level of increasing HLA‐DQ match when using the Cox regression model adjusted for recipient and donor race, age and sex, CIT, BMI, CyA use, year of transplant, DM, HLA‐A,B and ‐DR match. In this model, superior HLA‐A,B match and HLA‐DR match, recipient and donor age, male donor sex, shorter CIT, white race of recipient, lower peak PRA, CyA use, and absence of DM significantly improved graft survival (all ≤0.004). We conclude that HLA‐DQ matching does not significantly affect cadaveric renal allograft survival once adjusted for other known predictors of graft outcome.
The use of tacrolimus as induction and maintenance immunosuppression in renal cadaveric transplant recipients over the age of 60
Authors: Xenos Eleftherios X. , Ciancio Gaetano , Burke George W. , Roth David , Miller Joshua
Published: October 2024

Renal transplantation is a treatment option that should be considered for the elderly (≥ 60 years old) with end‐stage renal disease. Little is known regarding the use of tacrolimus (as induction and maintenance immunosuppression) in this age group. We report the outcome of kidney transplantation in 21 patients aged 60 years or more with tacrolimus. During the past few years in kidney transplant maintenance immunosuppressive regimens, we have revised our standard general protocol from cyclosporine to tacrolimus‐based therapy for maintenance immunosuppression and for rescue therapy. We also introduced mycophenolate (RS‐61443) while we have continued to use ATGAM/OKT3 as induction regimen in the immediate postoperative period. We treated these renal recipients with tacrolimus and steroids in combination with azathioprine or mycophenolate mofetil without antibody induction. This was well tolerated and not associated with a higher rate of rejection (20%) whereas the potential toxicity of antilymphocyte preparations was avoided.
Immunomagnetic bead cell isolates reduce kidney donor cold ischemia time, STAT crossmatch time and histocompatibility test cost*
Authors: Breton Shelley R. , Breggia Anne C. , Emmons Roberta A. , Szatkowski Michael A. , Mahoney Richard J.
Published: October 2024

The use of immunomagnetic beads for STAT cadaveric crossmatching for renal transplantation reduces test cost by 50%, laboratory work‐up time by 50% and cold ischemia time by 4 h as compared with the nylon wool method of T‐ and B‐lymphocyte separation.
Adjuvant intrapleural amphotericin B therapy for pulmonary mucormycosis in a cardiac allograft recipient
Authors: Kfoury Abdallah G. , Smith Julie C. , Farhoud Hussam H. , Terreros Daniel A. , Stringham James C. , Taylor David O. , Renlund Dale G.
Published: October 2024

Infectious complications after heart transplantation remain a major cause of morbidity and mortality. While many viral, bacterial, and protozoal infections can be successfully treated, fungal infections continue to be challenging. Mucormycosis is a rare infection in heart transplant recipients; however, mortality is exceedingly high. We report a case of cavitary Rhizopus lung infection 2 months after cardiac transplantation. The infection was complicated by inadvertent exposure of the pleural cavity to the fungus during surgical resection. Therapy consisted of standard systemic amphotericin B, surgical excision, and for the first time, the use of adjuvant intrapleural amphotericin B. Cure was achieved with no clinical or radiological evidence of disease at 3 months follow‐up. Rhizopus pulmonary infection is a rare complication of cardiac transplantation. Treatment consists of the triad of systemic anti‐fungal therapy, surgical resection, and control of any underlying predisposing diseases. Adjuvant intrapleural amphotericin B use could also be considered in patients with fungal pneumonias and evidence of chest wall and/or pleural cavity involvement.
Patient death or renal graft loss within 3 yr of transplantation in a county hospital: importance of poor initial graft function
Authors: Shoskes Daniel A. , Avelino Lori , Barba Lilly , Sender Mark
Published: October 2024

Our purpose was to study the factors predictive of graft loss or patient death within 3 yr of renal transplant in a county population. 363 renal transplants performed between 1984 and 1991 at the Harbor‐UCLA Medical Center were reviewed. There were 16 recipients (4%) who died and 76 (21%) who lost their grafts within 3 yr. Known causes of death were cardiac (44%), infection (38%) and malignancy (6%). There was a higher proportion of diabetics (44%), hypertensives (69%) and those with a past cardiac history (38%). There was also a high delayed graft function rate (56%). Of the 76 grafts that failed in the first 3 yr, 14% were due to noncompliance, 20% to grafts that never functioned, 9% to technical problems, 21% to acute rejection, 9% to recurrent disease and 26% to chronic rejection. The noncompliance group were younger (mean 34 yr), and more likely to be a first transplant (90%) and be non‐white (82%). The rejection group was significant for high delayed graft function rate (84%) and frequent and early rejection (76% at least one rejection). We conclude that fair organ allocation requires a balance between equity and utility, but patient death or graft loss within 3 yr benefits neither the patient or society. Patient survival may be improved with diligent cardiac evaluation, particularly in older patients and diabetics. Patient education and monitoring for noncompliance is essential, particularly in young firsttime recipients. Maneuvers to decrease delayed graft function are essential to improve long‐term results.
Importance of decreased heart rate in predicting transplant coronary artery disease
Authors: Gullestad Lars , Ross Heather , Myers Jonathan , Hoang Khanh , Hunt Sharon , Stinson Edward B. , Valantine Hannah A.
Published: October 2024

Studies in animals and humans have demonstrated that an increased heart rate is a predictor for the development of coronary atherosclerosis and overall cardiovascular mortality. In contrast, we have previously reported that the need for pacemaker implantation because of bradycardia in heart transplant recipients is associated with an increased prevalence of transplant coronary artery disease (TxCAD). Hence, the relevance of changes in heart rate to the development of TxCAD remains unclear. Intracoronary ultrasound examinations (ICUS) were therefore analyzed in 130 heart transplant recipients (age 50 ± 11 yr) studied at annual evaluations (3.7 ± 3.0 yr after transplantation). Quantitative ultrasound measurements were obtained by calculating mean coronary artery intimal thickness (MIT) obtained by examination of the left anterior descending artery. The presence of TxCAD was defined as MIT > 0.3 mm. Resting heart rates (HR) were recorded with the patients in the supine position during routine echocardiography. Based on HR recordings, two groups were defined: group 1, HR below; or group 2, HR above the median. TxCAD was detected in 40% of the ICUS studies overall. The prevalence of TxCAD was higher in group 1 (49%) compared with group 2 (33%), p<0.05. There was no significant difference in donor ischemic time or donor gender, recipient age, gender, body weight, CMV status, creatinine, total cholesterol, use of lipid lowering drugs or diltiazem. Donor age and use of β‐blockers were higher in group 1 compared with group 2 (29 ± 10 vs. 25 ± 9 yr, and 15% vs. 5%, for donor age and β‐blocker use, respectively). By multivariate regression analysis only donor age and years after transplantation were independently correlated with TxCAD. After excluding patients taking β‐blockers and diltiazem, the prevalence of CAD was still higher in group 1 (50%) vs. group 2 (34%). In conclusion, transplant coronary artery disease is more prevalent in patients with lower, rather than higher, heart rates. The reason for this is unclear, but may reflect impaired blood flow to the sinoatrial node.
Role of machine perfusion preservation in kidney transplantation from non‐heartbeating donors
Authors: Matsuno Naoto , Sakurai Etsuo , Uchiyama Masami , Kozaki Koichi , Miyamoto Katsuhiko , Kozaki Masami , Nagao Takeshi
Published: October 2024

The shortage of kidneys for transplantation is a universal problem. If the viability of the kidney can be assured, organ procurement from non‐heartbeating donors will be greatly enhanced. This study evaluates the usefulness of machine perfusion preservation parameters as an index of kidney graft viability. We report our experience with 77 non‐heartbeating donor kidneys preserved with machine perfusion technique. Sixty‐eight grafts demonstrated excellent perfusion (mean flow 0.79 ml/min/g) with low vascular resistance (55.4 mmHg/ ml/min/g). Early graft function occurred in all of these kidneys. Nine kidneys demonstrated poor perfusion (mean flow 0.35 ml/min/g) and elevated pressures with high vascular resistance (132.5 mmHg/ml/min/g). Four kidneys with poor perfusion and elevated pressures was discarded after perfusion. The four mates of these discarded at our center were primarily non‐functional when transplanted at another transplant center. All five of the poorly perfused kidneys experienced primary nonfunction. We conclude that the use of quantitative values of perfusion flow (> 0.4 ml/min/g) and no increased pressure pattern allow safe utilization of grafts from non‐heartbeating donors and can predict early postoperative function.
Serial flow cytometric analysis of T‐cell surface markers can be useful in differential diagnosis of renal allograft dysfunction
Authors: Beik A. I. , Morris A. G. , Higgins R. M. , Lam F. T.
Published: October 2024

We examined changes in the circulating T‐cell subsets and their activation to see if consistent changes occur following renal transplantation, during acute rejection episodes (ARE), cytomegalovirus (CMV) infection, and cyclosporine (CsA) nephrotoxicity. Serial blood samples were taken from 28 patients on standard triple immunosuppresion therapy. Using two‐colour flow cytometric analysis, the percentages of CD3+, CD4+, and CD8+ T‐cells were determined, and coexpression of CD25, HLA/DR, and CD45 isoforms used to define their activation status. During ARE and CMV infection, increased levels of circulating CD4+ CD25+, CD8+ HLA/DR+, CD4+ CD45RO+, CD8+ CD45RO+ were observed. The increased levels of CD45RO+ T‐cells were associated with a significant decrease in the percentages of CD45RA+ of both CD4+ and CD8+ T‐cells. No significant changes were seen during CsA nephrotoxicity. The pattern of marker expression seen during ARE and CMV infection was similar to that seen in Con‐ A stimulated T‐lymphocytes from 22 normal controls. We conclude that, the increase in the levels of these surface markers do not differentiate between lymphocyte activation indicative of rejection or infection, but clearly distinguish episodes of CsA nephrotoxicity. These results could be useful in the differential diagnosis of renal allograft dysfunction.
Assessment of function and survival as measures of renal graft outcome following kidney and kidney–pancreas transplantation in type I diabetics
Authors: Douzdjian Viken , Bunke C. Martin , Baillie G. Mark , Uber Lynn , Rajagopalan P. R.
Published: October 2024

Reports on renal graft outcome after kidney‐alone (KA) and simultaneous pancreas‐kidney (SPK) transplants have focused on graft survival instead of function. The aim of this study is to compare renal graft outcome after KA and SPK using graft function and survival as the measures of outcome. The records of 102 transplants performed in type I diabetics from 10/90 to 9/96 were reviewed (SPK 42, KA 60). Serum creatinine (Cr) and calculated glomerular filtration rate (GFR) were used as estimates of graft function. Cr were similar in SPK and KA on day 3 (4.8±2.9 vs. 4.8 2.8 mg/dl, P=0.9) and day 7 (2.5±1.8 vs. 3.0±2.5 mg/dl, P=0.3). GFR was higher KA at 6 months (5718 vs. 5112 ml/min, P = 0.08), 1 yr (55±23 vs. 51±11 ml/ min, P = 0.4) and 3 yr (60±22 vs. 42±16 ml/min, P=0.03). Kidney graft survival was similar in KA and SPK at 1 and 5 yr (87% vs. 89% and 44% vs. 47%, P=0.8). Immunologic failure of the renal graft occurred more frequently in SPK (58% vs. 48%, P = 0.04) whereas death with function was more common in KA (33% vs. 17%, P = 0.04). In KA, risk factors for failure of the renal graft included acute rejection (P 0.008, relative risk or rr = 3.4) and African American recipient (P 0.06, rr = 2.8). In SPK, risk factors included donor age > 40 yr (P 0.05, rr = 5.3) and African American donor (P = 0.03, rr = 4.5). Logistic regression analysis revealed the following risk factors for GFR <50 ml/min at 1 yr: acute rejection (P = 0.03, rr = 2.2) and Cr> 3 mg/dl on day 7 (P=0.06, rr = 2.3). In conclusion, although renal graft survival was similar after KA and SPK, better graft function was observed in KA at 3 yr. Assessment of renal graft function allows us to evaluate outcome from a different perspective than graft survival, and these two measures of outcome complement each other.
Effect of postoperative complications on health and employment following liver transplantation
Authors: Hunt Christine M. , Camargo Carlos A. , Dominitz Jason A. , Bute Barbara Philips , Clavien Pierre‐Main
Published: October 2024

The influence of postoperative complications on employment and health status following orthotopic liver transplantation (OLT) remains elusive. Postoperative complications were scored prospectively using a standardized medical outcome classification in each patient transplanted at Duke University from October 1992 to January 1995. Functional status was evaluated by using the Karnofsky score. Between 12 and 18 months following transplantation, patients were asked to complete mailed questionnaires to assess employment and health status (SF‐36). The response rate was 86% (42 of 49 eligible patients). The mean patient age was 48 yr. Sixteen of 42 patients (38%) exhibited minimal or no postoperative complications, and 62% exhibited moderate to severe postoperative complications. Age, gender, education, UNOS status for severity of disease, insurance status, and Karnofsky score did not correlate with postoperative complications. Postoperative complications did not predict employment post‐transplantation. Paradoxically, patients with minimal or no postoperative complications perceived that their health status was significantly impaired post‐transplantation, as evidenced by a median score of 0 in the rolephysical subscale of the SF‐36, in contrast to those patients with moderate or severe postoperative complications who exhibited a median score of 25 (p <0.01). Similarly, patients with minimal or no postoperative complications had significantly lower scores on the mental health subscale than those with moderate or severe complications, with median score of 60 vs. 78 (p<0.03). The physical functioning subscale was not affected by postoperative complications. Thirteen of 42 (31%) respondents returned to full employment post‐transplantation. Health perceptions differed with respect to employment status post‐transplantation. Patients unemployed post‐transplantation exhibited a median score of 55 in the physical functioning subscale, a value much lower than the median score of 80 in the patients who were employed posttransplantation (p < 0.02). No differences in the role physical or mental health subscales were noted with respect to employment status posttransplantation. Employment status was unaffected by Karnofsky status, indicating that functional status does not predict employment. In conclusion, patients exhibited very poor health perceptions posttransplantation, irrespective of postoperative complications. Prospective evaluation of patients undergoing liver transplantation revealed that medical complications did not affect employment post‐transplantation.
Lipoprotein abnormalities in long‐term stable liver and renal transplanted patients. A comparative study
Authors: Fernández‐Miranda Consuelo , de la Calle Angel , Morales Jose M. , Guijarro Carlos , Aranda Jose L. , Gómez‐Sanz Ramon , Gómez‐Izquierdo Teresa , Larumbe Sagrario , Moreno Enrique , Rodicio Jose L. , del Palacio Angel
Published: October 2024

Hyperlipidemia is a common feature after organ transplantation. Most studies have evaluated the lipid profile in recipients of a particular graft, usually renal. In the present work, we studied the lipid profiles of 30 long‐term stable liver transplant patients (LTP) and compared their pattern with 40 long‐term stable renal transplant patients. (RTP) matched for gender, age, and time from transplantation. There were no significant differences between both groups in body mass index, serum glucose, serum creatinine, or urinary protein excretion. In contrast, RTP had higher pre‐transplant total cholesterol and triglycerides, received higher doses of steroids (both average and cumulative) and had higher cycosplorine blood levels. After a mean time of 60 months after transplantation, RTP exhibited higher levels of total serum cholesterol (226±26 vs. 180 39 mg/dl; p = 0.000 002) and lowdensity lipoprotein (LDL) cholesterol (152±22 vs. 11237 mg/dl; p 0.00001). In contrast, there were no differences between RTP and LTP in high density lipoprotein (HDL) cholesterol, very low density lipoprotein (VLDL) cholesterol, total triglycerides, VLDL triglycerides, or lipoprotein (a) [Lp(a)]. By univariate analysis in the whole group, renal graft, prednisone daily dose, cyclosporine blood levels, pre‐transplant cholesterol, and triglycerides were associated with increased post‐transplant cholesterol levels. By multivariate analysis, prednisone daily dose was the only independent variable predicting increased post‐transplant serum cholesterol levels. The present data show that hypercholesterolemia is more frequent among RTP than among LTP. In addition, our data suggest that corticosteroid therapy, rather than the transplanted organ, may be the major contributor to this difference.
Infection and associated risk factors in the immediate postoperative period of pediatric liver transplantation: A study of 176 transplants
Authors: Garcí Santos , Roque Jorge , Ruz Francisco , González María , Madero Rosario , Alvarado Francisco , Herruzo R
Published: October 2024

Objective. To describe the characteristics of infections occurring in the immediate postoperative period of orthotopic liver transplantation (OLT) in children in a pediatric intensive care unit (PICU) and the associated risk factors. Design. Retrospective cohort study.

Setting. Multidisciplinary 16‐bed pediatric intensive care unit in a tertiary university hospital. Patients. One hundred and thirty‐three pediatric patients (range 6 M to 22 yr) who underwent 176 liver transplantations and were admitted to the pediatric intensive care unit for at least 48 h.

Results. A total of 180 infectious episodes (IE) occurred in 78 (59%) patients who underwent 96 (54.5%) liver transplantations (1.35 IE/patient; 1.02 IE/transplantation). The mean stay was 15.4±1.1 d (mean ±SD) and 22 patients died in the pediatric intensive care unit. One hundred and thiryt‐one IE (72.8%) were bacterial, 31 (17.2%) fungal, and 14 (7.8%) mixed bacterial and fungal. 39% of the IE appeared in the first postoperative week and 27% in the second postoperative week. The most common sites of infection were abdomen (48.3%) and blood stream (26.1%). Bacteria, alone or with fungi, were present in 145 IE (1.1 IE/patient). Gram‐positive aerobic bacteria (63%) predominated over gram‐negative bacteria (54%) and fungi. Fungi were present in 45 IE; 53.4% of the infections occurred in lung (73% yeasts). The risk factors for infection that were identified were related with younger age, lower body weight, longer cold ischemia time, partial graft, and the volume of packed red blood cell transfusions. Infected patients had more postoperative complications and longer stay in the PICU (21±16 vs. 8±6 d), but no increase in mortality. The risk of infection increased 2.38 times with partial grafts and 1.1 times with each intraoperative transfusion of 20 ml/kg of packed red blood cells (RBC). Conclusions. Infection in the immediate postoperative period of pediatric OLT was related with a high morbidity but was not related significantly with increased mortality. The main risk factors for infection in the postoperative period of OLT were related essentially with small recipient size and the inherent complexity of the operation. Routine oropharyngeal decontamination is recommended, as well as early administration of oral nystatin in preoperative intestinal decontamination. The risk of infection increased 2.38 times with partial grafts and 1.1 times with the transfusion of every 20 ml of packed RBC.
Two‐hour cyclosporine level determination is the appropriate tool to monitor Neoral therapy1
Authors: Cantarovich Marcelo , Besner Jean‐Guy , Barkun Jeffrey S , Elstein Eleanor , Loertscher Rolf
Published: October 2024

To assess the safety profile of Neoral dose adjustment using cyclosporine (CSA) trough levels (C0) compared with levels obtained 2 h after the morning dose (C2), 30 stable adult heart transplant patients 1 yr or more after surgery were converted from Sandimmune to Neoral. After a baseline visit (before conversion), initial follow‐up included two visits (2 and 4‐6 wk after conversion). After the first visit. patients were randomized to Group I (CC2: 100‐200 ng/ml) or Group II (CC2: 200‐400 ng/ml). Abbreviated pharmacokinetics were obtained for the estimation of the AUC0‐4h 4 h. Renal function was assessed by serum creatinine and the cimetidine‐modified creatinine clearance. C2 correlated better than C0 with the AUC0‐4h (r = 0.91 vs. 0.63). Initial Neoral dose (mg/kg/d) was similar in both groups (2.8±0.5 and 2.80.8), and was lower in Group II at the second visit (2.0±0.7 vs. 3.0±0.6, p = 0.0001). C2 levels decreased in Group II from 912±438 to 555271 ng/ml (p=0.01), without evidence of acute rejection on endomyocardial biopsies. After the second visit, both groups were monitored with C2, and the range was increased to 300‐600 ng/ml. At the last visit (additional follow‐up of 5±1 months), Neoral dose (mg/ kg/d) was reduced to 2.0±0.3 in Group I (p<0.001) and 1.8 ±0.4 in Group II. Serum creatinine was lower in Group II at the second visit (13859 vs. 168±37 μmol/L, p = 0.01) and was similar in both groups at the last visit. Neoral dose reduction based on C2 levels was not associated with acute rejection. The better correlation with the AUC0‐4h suggests that C2 may be more reliable than C0 for Neoral dose adjustment.
Neuroprotective Effect of Dapsone against Quinolinate‐ and Kainate‐Induced Striatal Neurotoxicities in Rats
Authors: Santamaría Abel , Ordaz‐Moreno Juan , Rubio‐Osornio Moisés , Solís‐Hernández Fausto , Ríos Camilo
Published: October 2024

Wc tested the ability of dapsone, a well‐known antibiotic and antiinflammatory drug, to attenuate both the quinolinic acid (an NMDA agonist of glutamate receptors)‐ and kainic acid (a non‐NMDA agonist of glutamate receptors)‐induced in vivo neurotoxicities in rats. Circling behaviour and striatal γ‐aminobutyric acid (GABA) depiction were considered as behavioural and neurochemical end‐points of brain toxicity. Rotation behaviour, evaluated six days after the intrastriatal injection of quinolinic acid (130±19 ipsilateral turns/hr). was attenuated by doses of 12.5 mg/kg and 25 mg/kg of dapsone (50±9 and 63±9 turns/hr, respectively). Striatal GABA levels (237.3±15.1 μg/g in control rats), found depicted at day 7 after quinolinic acid (98.3±8.6 μg/g), were also protected by dapsone at doses of 12.5 and 25 mg/kg (167.7± 19.5 and 236.4±46.6 μg/g, respectively). No protective effects were observed on quinolinic acid‐induced neurotoxicity, as evaluated by both parameters, at lower doses of dapsone (6.25 and 9.375 mg/kg). The action of dapsone, at the dose of 12.5 mg/kg. was also measured on kainic acid‐induced depletion of the striatal GABA levels. Animals treated with dapsone+kainic acid (182.8±27.1 μg/g) showed significant attenuation of GABA depletion, as compared to rats treated with kainic acid alone (122.2±9.9 μg/g). These findings provide evidences to suggest that dapsone is acting as a neuroprotective agent against excitotoxicily induced by glutamate receptor agonists.