bluuebunny/crossref_metadata_2025 huggingface dataset:
Preventing hypothermia during continuous veno‐venous haemodiafiltration: a randomized controlled trial
Authors: Rickard Claire M. , Couchman Bronwyn A. , Hughes Marissa , McGrail Matthew R.
Published: July 2004

Background.  Continuous veno‐venous haemodiafiltration is a common form of dialysis used in intensive care units. Unfortunately, patients often experience hypothermia as a side‐effect of the therapy because of the necessity for extracorporeal blood flow. Intensive care nurses aim to prevent hypothermia developing. Intravenous fluid warmers are sometimes added to the dialysis circuit in an attempt to maintain patient temperature. However, the efficacy of this method has not been previously studied.

Aim.  This paper reports a study to investigate whether intravenous fluid warmers prevent hypothermia during continuous veno‐venous haemodiafiltration.

Method.  A prospective randomized controlled trial was carried out in the intensive care unit of a metropolitan, tertiary‐referral, teaching hospital. After Ethics Committee approval, 60 circuits in continuous veno‐venous haemodiafiltration mode (200 mL/minute blood flow, 1 L/hour countercurrent dialysate, 3 L/hour pump‐controlled ultrafiltration and prefilter fluid replacement of 1·7–2·0 L/hour) were studied. Circuits were randomized to have either an intravenous fluid warmer set at 38·5°C on the dialysate and 1 L/hour of replacement fluid lines or no fluid warmer. Patient core temperature was recorded at baseline and then hourly. Hypothermia was defined as a core temperature <36·0°C.

Results.  Mean core temperature loss did not vary between circuits with or without a fluid warmer (0·92°C vs. 1·11°C, P = 0·339). Survival analysis found no difference in hypothermia incidence between groups (log rank = 0·47, d.f. = 1, P = 0·491). Lower baseline temperature (RR 0·142, 95% CI 0·044, 0·459, P = 0·001) and female gender (RR 0·185, 95% CI 0·060, 0·573, P = 0·003) were significant risks for hypothermia.

Conclusions.  Intravenous fluid warmers used as described do not prevent hypothermia during continuous veno‐venous haemodiafiltration. Female patients and those with a low–normal baseline temperature are most likely to become hypothermic during this form of dialysis. Further research is needed to address effective ways of preventing hypothermia in critically ill patients receiving continuous renal replacement therapies.
Health issues of aboriginal female adolescents in Taiwan
Authors: Chen Mei‐Yen , James Kathy , Liao Jenny
Published: July 2004

Background.  The mortality rate and prevalence for some chronic diseases are higher for aborigines compared with the rest of the Taiwanese population. Health professionals in many countries have been concerned with the health of aborigines, but specific health policies for native adolescents have been neglected.

Aims.  This paper reports a study comparing the general health status of aborigines and non‐aborigine female adolescents, based on school enrolment health examinations.

Methods.  A cross‐sectional prevalence study with between group comparison was conducted. School enrolment health files were accessed between September 2000 and June 2001. A total of 320 selected female aboriginal students were compared with 237 non‐aborigines.

Results.  With the exception of eye problems, general health status was inferior for the aboriginal female adolescent students. They had lower mean red blood cell volumes, lower haemoglobin concentrations, more oral decay, a greater prevalence of hepatitis B virus carriers and were more likely to be overweight.

Conclusions.  It seems reasonable to suggest that health intervention strategies specific for indigenous adolescents should be provided. The design of these strategies should target lifestyle modification and provision of more accessible health information. Health professionals, and particularly nurses, are in a prime position to offer advice and support to this group.
Interpretations of stillbirth
Authors: Hsu Min‐Tao , Tseng Ying‐Fen , Banks Janet M. , Kuo Ling‐Lih
Published: July 2004

Background.  Continuity is a major concept in the father–son domain of the Han Chinese value system in Taiwan. Aspects of continuity may include structure, interactions and other facets of family; however, providing descendants is the keystone of women's reality in these families. In a culture in which death is seen as a taboo subject and the unborn child has not been recognized as a real baby, losing a long‐expected child at the end of pregnancy becomes a great challenge to women who have experienced stillbirth.

Aim.  The aim of this paper is to report a study exploring Taiwanese mothers’ interpretations of stillbirth, and their unique sociocultural context.

Method.  An interpretive ethnographic approach was used. Over a two and a half‐year period, 20 women who had experienced such losses after at least 20 weeks of pregnancy were interviewed to find out how they interpreted their babies’ deaths. Interview data were analysed thematically.

Findings.  The four major themes identified were: ‘loss of control’, ‘broken dream’, ‘shattered self’ and ‘something wrong with me’. Interpretations of stillbirth among Taiwanese women indicate a strong sense of incompleteness and personal failure, triggering reactions in terms of not only maternal identity, but also female cultural roles. Many interviewees blamed themselves for the deaths of their unborn children, a viewpoint resulting in excessive guilt feelings.

Conclusion.  Culturally bound taboos against talking about death, participating in death‐related events, and expressing grief in public affect the adaptation and grieving processes of Taiwanese women who have had a stillbirth. Nurses should, therefore, make an effort to listen to the perspectives of such patients in order to assist them with coming to terms with their loss. As part of their education, nurses require information on cultural beliefs so that they can provide appropriate care to grieving mothers.
Priority setting in clinical nursing practice: literature review
Authors: Hendry Charles , Walker Anne
Published: July 2004

Background.  Time is a valuable resource. When nurses experience demands on their services which exceed their available time, then ‘rationing’ must occur. In clinical practice such rationing requires practitioners to set priorities for care.

Aims.  The aim of this paper is establish what is currently known about priority setting in nursing, including how nurses set priorities and what factors influence this.

Method.  CINAHL, Medline, ASSIA, and PsychLit databases for the years 1982–2002 were searched, using the terms (clinical decision‐making or problem‐solving or planning) and (setting priorities or prioriti*). The publications found were used in a selective, descriptive review.

Findings.  Priority setting is an important skill in nursing, and a skill deficit can have serious consequences for patients. Recent studies have suggested that it is a difficult skill for newly qualified nurses to acquire and may not be given sufficient attention in nurse education. Priority setting can be defined as the ordering of nursing problems using notions of urgency and/or importance, in order to establish a preferential order for nursing actions. A number of factors that may impact on priority setting have been identified in the literature. These include: the expertise of the nurse; the patient's condition; the availability of resources; ward organization; philosophies and models of care; the nurse–patient relationship; and the cognitive strategy used by the nurse to set priorities. However, very little empirical work has been conducted in this area.

Conclusions.  Further study of priority setting in a range of clinical practice settings is necessary. This could inform both practice and education, promote better use of limited resources and maximize patient outcomes.
Emancipation in decision‐making in women's health care
Authors: Wittmann‐Price Ruth A.
Published: July 2004

Background.  Emancipation as a nursing concept is derived from a long‐standing history of social oppression and is easily addressed by both critical social theory and feminist theory. It is the apparent concept to describe a phenomenon witnessed in nursing when caring for women in the decision‐making process about health care issues. Emancipation has been recognized by expert clinical observation.

Aim.  The aim of this paper is to define the concept of emancipation for possible future application to nursing practice for the promotion of humanistic nursing care in women's health, specifically applied to the decision‐making process.

Method.  A literature search was carried out using the CINAHL database and the keywords nursing and emancipation, and covering the period 1985–2003. The Rodgers and Knafl (2000) method of concept analysis was then used to derive a conceptual meaning of emancipation that benefits patient care as well as professional nursing development. Emancipation is broken down into antecedents, attributes and consequences. Related concepts are also explored, compared and discussed to synthesize relevant characteristics.

Findings.  This concept analysis identifies emancipation in decision‐making as a nursing phenomenon by discussing the antecedent of oppression and exploring the identified attributes: (a) empowerment, (b) personal knowledge, (c) social norms, (d) reflection and (e) flexible environment. The consequence of emancipation is free choice. It is a futuristic concept with strong historical ties in need of exploration and development within the context of women's health care in relation to decision‐making.

Conclusions.  The concept model illustrates emancipated decision‐making, with its five attributes in relation to oppression as a non‐linear phenomenon. Areas for further study include the exploration of the contribution of each critical attribute and its relationship to emancipated decision‐making, and the decision‐making process in relation to patient satisfaction and how long the person continues to adhere to the decision. Also the professional nursing role in promotion of emancipated decision‐making is virtually unexplored, but is an important concept in the paradigm of shared decision‐making about health care alternatives.
Attitudes towards hospitalized older adults
Authors: McLafferty Isabella , Morrison Frederic
Published: July 2004

Background. A number of studies have explored nurses’ attitudes toward older people. However many of those have produced inconclusive results. Moreover dated attitudinal measures have been used to answer a broad range of questions relating to older people.

Aim. The aim of this paper is to report a study examining whether negative attitudes and beliefs toward older adults persist.

Methods. Focus group interviews were used identifying factors which may influence attitudes and beliefs both negatively and positively. Nine Registered Nurses from care of older adult areas, four from acute areas, six nurse teachers, and 17 nursing students participated in the study. Ten themes were identified from the findings.

Findings. The findings show that the student nurses had varying experiences in older adult settings. Some of which had the effect of turning them away from the specialty. However, nurses who worked with older adults were very positive about their work and the nursing opportunities they had to offer student nurses. They were rather critical of the content of the pre‐registration curriculum, which they perceived to over‐rely teaching the negative aspects of ageing, and there was also criticism of the currency of teachers’ knowledge. Nurses who worked in acute settings also did not escape criticism, in that they were identified as attributing a lack of sense of humour to older adults. The limitations include the small sample size although it is congruent with qualitative research.

Conclusions. All nursing staff need to be more aware of their influence on the attitudes of student nurses toward older people. Good practice includes the ability to demonstrate that older people in hospital settings are valued. Nurse teachers need to review the way they prepare students for this specialist work in order to avoid inadvertently conveying negative attitudes.
Anxiety and self‐consciousness in patients with minor facial lacerations
Authors: Tebble Nicola J. , Thomas David W. , Price Patricia
Published: July 2004

Background.  Although minor facial injuries are relatively common, their psychological impact is an area neglected in the literature. For physiologically major injuries (such as facial cancers, burns and fractures), the face has been suggested to be a psychologically significant area of the body and disfigurement has been found to have numerous potential social consequences for patients.

Aims.  This paper reports the findings of an inquiry that explored the psychological impact of minor facial injuries and the influence of patient and scar characteristics in relation to self‐consciousness and anxiety levels.

Method.  Data were collected in 2001 in an accident and emergency unit from patients with a visible laceration over 1·5 cm that was treatable in an outpatient setting. The Derriford Appearance Scale (with general and social self‐consciousness subscales) and the State‐Trait Anxiety Inventory were administered to 63 patients 1 week later; data on 50 patients were also available 6 months after the injury.

Results.  Larger scar size, living alone and aetiology of injury were significantly related to self‐consciousness and anxiety levels, although gender, age, socio‐economic group, location of scar, satisfaction with appearance and number of scars were not. General self‐consciousness improved at 6 months but social self‐consciousness and anxiety remained the same. Patient factors were not related to changes in general self‐consciousness over time.

Conclusions.  Minor facial scars can have significant psychological impact for some people. Awareness training for health professionals, social skills training for affected patients and a patient information leaflet are recommended.
The Euribor Futures Market: Efficiency and the Impact of ECB Policy Announcements
Authors: Bernoth Kerstin , Hagen Jürgen von
Published: July 2004

For an effective and smooth monetary policy, it is important that interest rate expectations are in line with central bank policy intentions. The predictability of money market interest rates is, therefore, an indicator of transparency and clarity in the communication of monetary policy and of the effectiveness of monetary policy implementation.

In this paper, we analyse three aspects of the predictability of money market rates in the European Monetary Union (EMU). The first is the efficiency of the three‐month Euribor interest rate futures markets. The second aspect is the effect of ECB policy announcements on the volatility of Euribor futures rates, and the third aspect is the effect of ECB policy announcements on the prediction error contained in Euribor futures rates. We find that the new Euro money markets were able to predict short‐term rates well. Our results suggest that the ECB communication of monetary policy has worked well during the first years of EMU and that the predictability of ECB policy decisions seems to have improved over time. ECB Council decisions still cause some surprises, but their effect on volatility is small.
Identifying the Role of Moral Hazard in International Financial Markets
Authors: Kamin Steven B.
Published: July 2004

Considerable attention has been paid to the possibility that large‐scale IMF‐led financing packages may have distorted incentives in international financial markets, leading private investors to provide more credit to emerging market countries, and at lower interest rates, than might otherwise have been the case. Yet, prior attempts to identify such distortions have yielded mixed evidence, at best. This paper makes three contributions to our ability to assess the empirical importance of moral hazard in international financial markets. First, it is argued that, because large international ‘bail‐outs’ did not commence until the 1995 Mexican crisis, financial indicators prior to that time could not have reflected a significant degree of this type of moral hazard. Therefore, one test for the existence of moral hazard is that the access of emerging markets to international credit is significantly easier than it was prior to 1995. Second, the paper argues that because private investors expect large‐scale IMF‐led packages to be extended primarily to economically or geo‐politically important countries, moral hazard, if it exists, should lead these countries to have easier terms of access to credit than smaller, non‐systemically important countries. Finally, in addition to looking at bond spreads, the focus of earlier empirical analyses of moral hazard, the paper also examines trends in capital flows to gauge the access of emerging market countries to external finance. Looking at the evidence in light of these considerations, the paper concludes that there is little support for the view that moral hazard is significantly distorting international capital markets at the present time.
An Empirical Analysis of Inflation in OECD Countries
Authors: Ihrig Jane , Marquez Jaime
Published: July 2004

During the 1990s, many OECD countries had declining rates of inflation while their unemployment rates were also falling, something that on the surface seemed at odds with the Phillips curve relationship between inflation and unemployment. For the USA, these seemingly contradictory developments have been reconciled in terms of two factors: (1) an acceleration in productivity and (2) structural changes in labour markets that lowered the natural unemployment rate (NAIRU). Here we ask whether comparable forces were at work in 19 other industrial countries. We find that productivity advancements were the main structural factor reducing inflation only in the USA. In other industrial countries, persistent labour‐market slack was the main factor exerting downward pressure on inflation. This persistence stemmed, in part, from structural reforms that lowered the NAIRU while the unemployment rate was declining. Ireland, New Zealand and Norway were three countries where labour‐market reforms helped to push inflation down dramatically.
Structural Traps, Politics and Monetary Policy
Authors: Dugger Robert H. , Ubide Angel
Published: July 2004

Structural conditions pose a challenge to monetary policy, as the example of Japan shows. In this paper we develop the concept of structural trap, where the interplay of long‐term economic development incentives, politics, and demographics results in economies being unable to efficiently reallocate capital from low‐ to high‐return uses. The resulting macroeconomic picture looks like a liquidity trap – low GDP growth and deflation despite extreme monetary easing. But the optimal policy responses are very different and mistaking them could lead to perverse results. The key difference between a liquidity trap and a structural one is the role of politics. We show how, in the Japanese case, longstanding economic incentives and protections and demographic trends have resulted in a political leadership that resists capital reallocation from older protected low‐return sectors to higher‐return newer ones. If the Japanese case is instructive, in a structural trap, extremely loose monetary policy perpetuates deflation and low GDP growth, because unproductive but politically important firms are allowed to survive and capital reallocation is prevented. By preventing the needed reduction in excess capacity, a structural trap condemns reflationary policies to failure by making the creation of credible inflation expectations impossible. Faced with a structural trap, an independent central bank with a price stability mandate should adopt a monetary policy stance consistent with restructuring. If political resistance is high, monetary policy decision makers will need to keep nominal rates high enough to ensure that capital reallocation takes place at an acceptable pace.
Risk factors for cardiovascular disease in pediatric renal transplant recipients
Authors: Silverstein Douglas M.
Published: July 2004

Abstract: About 1,000 children develop end‐stage renal disease (ESRD) each year in the United States and about 5,000 children are currently receiving dialysis. Children who develop ESRD are eligible to receive renal replacement therapy, including renal transplantation. There are inherent risks associated with transplantation, including renal insufficiency, infections, post‐transplant lymphoproliferative disorder, and cardiovascular disease (CVD). Potential risk factors for CVD in pediatric renal transplant recipients include renal insufficiency, hyperlipidemia, hyperhomocysteinemia, inflammation, malnutrition, anemia, and hyperglycemia/insulin resistance. Despite evidence that many children may possess various risk factors for CVD post‐renal transplantation, there are very few studies that have attempted to assess the link between these risk factors and CVD in pediatric renal transplant recipients.
Hypertension and end‐organ damage in pediatric renal transplantation
Authors: Mitsnefes Mark M.
Published: July 2004

Abstract:  The prevalence of hypertension in pediatric patients with renal transplant (Tx) has not changed for the last three decades, remaining at 50–80%. Long‐standing and uncontrolled hypertension is associated with the development of end‐organ damage including allograft dysfunction, early cardiomyopathy and premature atherosclerosis. Aggressive treatment of elevated BP is an essential part of Tx care with the goal to delay graft failure and prevent the development of symptomatic cardiovascular disease in young recipients of renal Tx.
Impact of non‐compliance on outcome after pediatric kidney transplantation: An analysis in racial subgroups
Authors: Jarzembowski Tomasz , John Eunice , Panaro Fabrizio , Heiliczer Jonathan , Kraft Kerri , Bogetti Diego , Testa Giuliano , Sankary Howard , Benedetti Enrico
Published: July 2004

Abstract:  Renal transplantation is the therapy of choice for children with end‐stage renal disease. Despite excellent patient survival, long‐term graft survival is poor, especially in the African‐American (AA) population. This article addresses non‐compliance as a major cause of late‐term graft loss in the pediatric population. Between July 1995 and September 2002, a total of 50 pediatric kidney transplants were performed at our institution. We have analyzed data for 44 of these kidney transplants. Twelve recipients were AA, 14 Caucasian (C) and 18 Hispanic (H). The remaining six patients of different racial origin were not included in this analysis. The mean age of the recipients was 10.9 yr (range 1.7–17.8). Thirty‐one were cadaveric and 13 were living donor transplants. We analyzed creatinine level and graft and patient survival at 1, 3 and 5 yr post‐transplant. Compliance was evaluated based on trends in cyclosporine levels, attendance to clinic visits, individual interviews and unexplained late graft dysfunction. One‐ and 3‐yr patient survival rates were 100% for all racial groups, except the 3‐yr patient survival rate for C, which was 86%. One and 3‐yr graft survival rates for AA, C and H were 92 and 67%, 86 and 79% and 100 and 100%, respectively. However, at 5 yr, we found that AA recipients had a significantly higher rate of graft loss when compared to both H and C recipients (42 vs. 95 vs. 71%, respectively). Non‐compliance was the main factor, accounting for 71% of cases of late graft loss. In conclusion, non‐compliance is a problem of great importance in the pediatric transplant population, particularly in AA recipients, where it plays a major role in late‐term graft loss.
Long‐term renal function in pediatric liver and heart recipients
Authors: Alonso Estella M.
Published: July 2004

Abstract: Long‐term survivors of pediatric liver and heart transplantation are at risk for progressive renal dysfunction as a result of chronic exposure to calcineuron inhibitors. This class of drugs causes alterations in renal perfusion that can result in irreversible renal injury including afferent arteriopathy, glomerulosclerosis, tubular atrophy and interstitial fibrosis. Approximately 3–6% of pediatric liver and heart recipients will develop end stage renal failure. A much larger percentage has chronic renal insufficiency and hypertension. Children with significant renal compromise in the pretransplant period and those with significantly elevated serum creatinine levels during the first post‐transplant year may be at the highest risk to develop irreversible renal injury in long‐term follow‐up. Serum creatinine is a poor screening tool as it rises late in the course when the injury may no longer be reversible. Strategies to minimize long‐term exposure to calcineuron inhibitors may reduce the prevalence of renal insufficiency in this vulnerable population.
Osseous complications of pediatric transplantation
Authors: Saland Jeffrey M.
Published: July 2004

Abstract: Adult stature and peak bone mass are achieved through childhood growth and development. Multiple factors impair this process in children undergoing solid organ transplantation, including chronic illness, pretransplant osteodystrophy, use of medications with negative impact on bone, and post‐transplant renal dysfunction. While growth delay and short stature remain common, the most severe forms of transplant‐related bone disease, fracture and avascular necrosis, appear to have become less common in the pediatric age group. Osteopenia is very prevalent in adult transplant recipients and probably also in pediatrics, but its occurrence and sequelae are difficult to study in these groups due to methodological shortfalls of planar densitometry related to short stature and altered patterns of growth and development. Although the effect on lifetime peak bone mass is not clear, data from adult populations suggest an elevated long‐term risk of bone disease in children receiving transplants. Optimal management of pretransplantation osteodystrophy, attention to post‐transplant renal insufficiency among both renal and non‐renal transplant patients, reduction of steroid dose in select patients, and supplementation with calcium plus vitamin D during expected periods of maximal bone loss may improve bone health. Careful research is required to determine the role of bisphosphonate therapy in pediatric transplantation.
Renal transplantation in patients with IgA mesangial glomerulonephritis
Authors: Ponticelli Claudio , Traversi Lara , Banfi Giovanni
Published: July 2004

Abstract: Most patients with IgA nephritis are suitable candidates for renal transplantation. In about 33% of patients the disease may recur after transplantation, although there are differences in the various series because of the different criteria for biopsy, the different length of follow‐up and the different ethnicities. Living donation, genetic factors and time of progression of original disease have been found to be related with the risk of recurrence by some investigators, but these associations were not confirmed by other studies. The graft survival in patients with IgA nephritis is similar or even better than that observed with other renal diseases. The available data indicate that recurrence has a little impact on the 10‐yr graft survival. However, a minority of patients may show a rapid progressive course after recurrence. Little information is available on the impact of recurrence in the very long term. There is no established treatment for preventing or treating the recurrence of IgA nephritis.
Glomerular albumin permeability as an in vitro model for characterizing the mechanism of focal glomerulosclerosis and predicting post‐transplant recurrence
Authors: Ghiggeri Gian Marco , Artero Mary , Carraro Michele , Candiano Giovanni , Musante Luca , Bruschi Maurizio , Zennaro Cristina , Ginevri Fabrizio , Caridi Gianluca , Faccini Luigi , Perfumo Francesco , Gusmano Rosanna
Published: July 2004

Abstract:  The putative mechanisms of proteinuria in idiopathic focal glomerulosclerosis and of its post‐transplant recurrence are discussed. It is proposed that a balance between circulating factors with permeability activity on glomeruli and putative inhibitors play a key role. The characterization of inductors is currently in progress; most inhibitors appear to be apolipoproteins (mainly apoJ and apo E) but we cannot exclude other substances. The goal is now to evaluate the concentration of both inducers and inhibitors of glomerular permeability in vivo. Permeability activity in plasma of patients with FSGS with and without recurrence of the disease may be evaluated by an in vitro functional essay with isolated glomeruli. Published data on permeability activity evaluated with this method in different proteinuric states gave, however, controversial results and this test cannot be readily considered of clear clinical utility.

Only the definitive characterization and quantification in vivo of the different molecules that play a role in FSGS may furnish adequate answer.
The pediatric nephrotic syndrome spectrum: Clinical homogeneity and molecular heterogeneity
Authors: Schachter Asher D.
Published: July 2004

Abstract:  Idiopathic nephrotic syndrome is the most common glomerular disorder of childhood. Recurrence of nephrotic syndrome immediately following renal transplantation is rapid, results in a high rate of graft loss, and represents the most severe form of nephrotic syndrome. This review discusses the molecular heterogeneity of pediatric nephrotic syndrome across the spectrum of disease activity. A schema is offered for a molecular approach to pediatric nephrotic syndrome, including immune‐mediated and structural/genetic factors.
Recurrent and de novo disease after renal transplantation: A report from the Renal Allograft Disease Registry
Authors: Hariharan Sundaram , Savin Virginia J
Published: July 2004

Abstract:  Recurrent and de novo disease is an increasing problem and is known to negatively impact transplant graft survival. Immunosuppressive medications have not had an impact on the prevalence of recurrent and de novo disease. Renal Allograft Disease Registry (RADR) was established to study the prevalence, impact and risk factors for the development of recurrent and de novo disease. Retrospective and prospective study on recurrent disease is discussed in this manuscript.
Outcomes after renal transplantation for FSGS in children
Authors: Baum Michelle A.
Published: July 2004

Abstract:  Focal segmental glomerulosclerosis (FSGS) is the primary diagnosis resulting in end‐stage renal disease in approximately 12% of children receiving renal transplantation. Recurrent FSGS after transplantation is unpredictable and clear risk factors have not been identified. Post‐transplantation, the incidence of acute tubular necrosis requiring dialysis is higher in children with FSGS compared with other diagnoses and may represent immediate severe recurrence. Graft survival is decreased in children with FSGS compared with other primary diagnoses, and the impact is greatest in recipients of living donor transplants. Graft loss caused by recurrent FSGS is significantly higher in living donor transplants compared with cadaveric donor transplants in children. Compared with adults, the impact of FSGS on graft survival appears to be greatest in children. White recipient race is associated with a higher risk of graft loss from recurrent FSGS. Efforts to elucidate the mechanisms of recurrent FSGS and to understand risk factors based on genetics, potential circulating cytokines and permeability factors, age and race must move forward before we can significantly impact outcomes in renal transplantation for FSGS.
Allograft diabetic nephropathy may progress to end‐stage renal disease
Authors: Salifu Moro O. , Nicastri Anthony D. , Markell Mariana S. , Ghali Halim , Sommer Bruce G. , Friedman Eli A.
Published: July 2004

Abstract:  Mesangial expansion and glomerular basement membrane thickening characteristic of diabetic nephropathy recur in diabetic recipients of renal allografts from non‐diabetic donors but progression to renal failure is minimally documented. Three female renal allograft recipients (aged 40, 62 and 73 yr), who developed end‐stage renal disease (ESRD) due to recurrent diabetic nephropathy (two patients) and de novo diabetes (one patient) are reported. Onset of proteinuria, uncontrolled hypertension, azotemia, renal allograft pathologic findings and the need for hemodialysis were analyzed. None of the kidney donors (one cadaver, two living related) had known diabetes or perturbed glucose metabolism pre‐transplantation. The three patients presented had different varieties of diabetes; type 1, type 2 and new onset diabetes after transplantation (NODAT). In each subject, proteinuria was detected by dipstick at a mean of 8.3 yr (range 8–9) post‐transplantation and increased to the nephrotic range (3.7–4.8 g/day) inducing hypoalbuminemia and azotemia. A histopathologic diagnosis of allograft diabetic nephropathy was made in a mean of 11.7 yr (range 10–14), based on glomerular basement membrane thickening, nodular and diffuse intercapillary glomerulosclerosis, arteriolosclerosis, and tubular atrophy with marked tubular basement membrane thickening characteristic of advanced diabetic nephropathy. All three patients manifested uremia and resumed hemodialysis. Two patients died from sepsis within 2 months and one patient died 2.5 yr later after resumption of maintenance hemodialysis. We infer that recurrent or de novo diabetic nephropathy in renal allografts follows a clinical decade‐long course irrespective of diabetes. Reports of ESRD due to allograft diabetic nephropathy (ADN) have been limited because of shorter survival of diabetic transplant recipients and few kidney biopsies performed in patients with chronic allograft dysfunction. The occurrence of allograft diabetic nephropathy in some, but not all patients, however, suggests that individual genetic variability modulates disease expression.
The essence of living parental liver donation – donors’ lived experiences of donation to their children
Authors: Forsberg Anna , Nilsson Madeleine , Krantz Marie , Olausson Michael
Published: July 2004

Abstract:  The use of living parental liver donors will continue and probably increase because of lack of cadaveric livers for paediatric transplantation and the excellent graft survival of parental livers. Therefore, it is important for the health care professionals involved in living parental liver donation to understand the experience of being a liver donor. The aim of this study was to investigate the expressed deeper feelings of parents who donated a part of their liver to their own child. The study took the form of in‐depth interviews with 11 donors. All donors were biological parents of the recipient, nine fathers and two mothers. The interpretive phenomenology method was used, and interpretive analysis was carried out in three interrelated processes in line with Benner. Data collection was guided by the researcher's preliminary understanding of the donor experience from being involved in the surgery and care of the donors as well as the paediatric recipients. However, the research question was approached from the perspective of holistic care for the donor. In this study, the essence of living parental liver donation was found to be the struggle for holistic confirmation. There were three categories leading to this central theme; the total lack of choice, facing the fear of death and the transition from health to illness. There was total agreement among the respondents that there is no choice when it comes to the question of donation. The findings in this study stress the importance of organizing the parental liver donation programme with as much focus on the donor as on the child. Based on the results of this study, several clinical implications are suggested for the formation of guidelines for living parental liver donation.
Treatment of osteopenia and osteoporosis in renal transplant children and adolescents
Authors: El‐Husseini Amr A. , El‐Agroudy Amgad E. , El‐Sayed Moharam F. , Sobh Mohamed A. , Ghoneim Mohamed A.
Published: July 2004

Abstract:  Successful renal transplantation corrects many of the metabolic abnormalities associated with the development of renal osteodystrophy, but despite a well‐functioning graft osteopenia, growth failure, spontaneous fractures, and avascular necrosis remain prevalent in adult and pediatric kidney recipients. A paucity of information exists regarding the effects of different therapies to prevent and treat bone loss in the renal transplant recipients. We constructed a design to study the effect of different modalities of treatment on bone mass in our renal transplant children. Among 93 patients who underwent renal transplantation at the age of 17 yr or less and were subjected to dual‐energy X‐ray absorptiometry (DEXA), we blindly randomized 60 patients who had osteopenia or osteoporosis (T‐score = −1 by DEXA) in a prospective study. Their mean age at time of transplantation was 13.4 ± 4.3 yr. The mean duration after transplantation was 48 ± 34 months. The patients were classified randomly into four groups. Each group consisted of 15 patients: group 1 was the control group, group 2 received oral alfacalcidol 0.25 μg daily, group 3 received oral alendronate 5 mg daily, and group 4 received 200 IU/day nasal spray calcitonin. Parameters of bone turnover, calcium metabolism, and DEXA were measured before and after 12 months of treatment duration. The characteristics of all groups were comparable at the beginning of the study. At the lumber spine, bone mass density decreased from −2.4 to −2.8 in group 1, increased from −2.3 to −0.5 in group 2, from −2.3 to −1.9 in group 3, and from −2.3 to −1.0 in group 4. The four groups had similar patient profiles, serum creatinine, intact parathyroid hormone, osteocalcin, and deoxypyridinoline. This study confirmed the value of alfacalcidol and antiresorptive agents in the treatment of osteopenia and osteoporosis in young renal transplant recipients .These therapies were safe, tolerable, simple to administer and potentially applicable to other renal transplant patients.
Improvement in renal function and rejection control in pediatric liver transplant recipients with the introduction of sirolimus
Authors: Casas‐Melley Adela T. , Falkenstein Kathleen P. , Flynn Louise M. , Ziegler Valerie L. , Dunn Stephen P.
Published: July 2004

Abstract:  Calcineurin inhibitors have dramatically improved the outcomes of pediatric liver transplantation. However, calcineurin inhibitor use is associated with a 50% reduction in glomerular filtration rate in the first year post‐transplant. Nephrotoxicity can be difficult to manage, especially in the pediatric population. We hypothesized that the addition of an mTOR inhibitor with decreased calcineurin inhibitor levels might improve or prevent renal insufficiency and improve control of rejection. A retrospective chart review was performed on the patients treated with sirolimus who had undergone an orthotopic liver transplant between January 2000 and February 2003. Thirty‐eight patients were identified. Mean age was 8.6 yr. Fourteen patients were male and 24 were female. Mean weight was 30.3 kg. The most common indications for starting sirolimus were rejection (42%) and renal impairment (29%). Seventy‐three percent of patients begun on sirolimus remain on the medication. Those with renal impairment (11 patients) showed improvement in their creatinine levels from a mean baseline of 1.3 to 0.8 mg/dL. Their calculated creatinine clearance (Schwartz formula) improved from 63.7 to 84.8 mL/min (p = 0.03). Patients started on sirolimus for rejection showed significant improvement in hepatocellular enzymes despite a reduction in the tacrolimus level from 12.2 to 7.5 ng/mL. The mean alanine aminotransferase level improved from 221 to 100 units/L (p = 0.02), and the mean aspartate aminotransferase improved from 121 to 99 units/L (p = 0.59). Addition of sirolimus to a tacrolimus‐based regimen with lower target tacrolimus levels improved liver function in patients with rejection. Addition of sirolimus significantly improved renal function as shown by creatinine level and calculated creatinine clearance in those children with renal impairment. The effect of combined immunosuppressant treatment with tacrolimus and sirolimus on long‐term renal function needs to be evaluated.
Liver retransplantation in an infant requiring cavoportal hemi transposition
Authors: Verran Deborah , Crawford Michael , Stormon Michael , Shun Albert
Published: July 2004

Abstract: Historically inability to achieve portal inflow to the liver allograft operatively was felt to be a contraindication to orthotopic liver transplantation (OLTx). Cavoportal hemi transposition has been utilized more recently in adult OLTx recipients but rarely in pediatric recipients. Here we report the case of a 10‐month‐old male with biliary atresia, who required urgent retransplantation with anin situsplit cadaver donor allograft for failure of his first liver allograft from portal vein thrombosis. At the time of retransplantation, cavoportal hemi transposition was required to effect portal vein inflow to the allograft because of extensive thrombosis of the recipients portomesenteric venous system.
The use of multiple transbronchial biopsies as the standard approach to evaluate lung allograft rejection
Authors: Faro Albert , Visner Gary
Published: July 2004

Abstract:  Flexible bronchoscopy with transbronchial biopsy (TBB) is routinely performed in adult and pediatric lung transplant recipients. The clinical signs and symptoms of acute cellular rejection (ACR) are often identical to those of infection. TBB is a fairly sensitive and specific tool in which to diagnose ACR and can be performed safely in children of all ages. The utility of TBB is unquestioned during periods of worsening clinical symptoms. The utility of TBB for routine surveillance of the allograft remains unproven. The data suggests that during the first 4–6 months post‐transplant there is a high incidence of clinically silent ACR. The significance of subclinical rejection in lung transplantation is unknown. Randomized, controlled trials are required to determine if multiple surveillance TBB, can impact the incidence of obliterative bronchiolitis.
Effects of various densities of Ophiostoma ips inoculations on Pinus sylvestris in north‐western Spain
Authors: Fernández M. M. F. , García A. E. , Lieutier F.
Published: July 2004

The aim was to determine the inoculation density above which Scots pine (Pinus sylvestris) is overcome by the blue‐stain fungus Ophiostoma ips that is associated with the bark beetle Ips sexdentatus. In north‐western Spain, stems of 16 Scots pines were inoculated at various densities (0, 400, 800 or 1600 inoculi/m2) along circumferential 100 or 150 cm wide inoculation belts. Each inoculum consisted of a 5 mm diameter cylinder of malt extract agar colonized by the fungus. Three months later, all trees were harvested and trunk resinosis and foliage colour were visually assessed. The percentage of healthy, desiccated, resin soaked, and blue‐stained sapwood, as well as growth productivity indices, were calculated from stem disks cut from within the inoculated zone of each tree. Sapwood‐specific hydraulic conductivity (Ks) of each tree was measured in the middle of the inoculated zone. All parameters of tree vigour changed dramatically to the worse when inoculation densities were above 400 inoculi/m2, and foliage changed from green to yellow‐green or yellow when an inoculation density of 800 instead of 400 was used. The percentage loss of sapwood‐specific conductivity (PLC) increased from 30 to 90% and the percentage of healthy, conductive sapwood dropped from 85 to 35% at 800 inoculi/m2. No effect of the width of the inoculation belt was observed, and there was no relationship between tree productivity indices and the level of resistance. A non‐linear negative relationship was found between PLC and the percentage of healthy sapwood. It is concluded that tree resistance was overcome and that trees were going to die when the inoculation density was ≥800 inoculi/m2.
Role of Eucalyptus globulus wound wood extractives: evidence of superoxide dismutase‐like activity
Authors: Eyles A. , Davies N. W. , Mitsunaga T. , Mihara R. , Mohammed C.
Published: July 2004

Superoxide dismutase‐like activity of crude Eucalyptus globulus extracts obtained from new wound wood was measured using the water‐soluble tetrazolium salt (WST)‐1 assay. This in vitro assay determined the activity of superoxide radicals scavenging in a xanthine oxidase system. The 50% inhibition (IC50) of formazan formation was estimated for fractionated samples and purified compounds isolated from the crude wound wood extract, i.e. engelitin and pedunculagin. Standards of gallic acid and pentagalloyl glucose were also measured. Fraction II as well as the compounds pentagalloyl glucose and pedunculagin showed the highest levels of antioxidant activity. Subsequent analysis of fraction II by high‐performance liquid chromatography (HPLC) coupled with negative ion electrospray mass spectrometry revealed the fraction to be dominated by hydrolysable tannins including pedunculagin, di‐, tri‐ and tetragalloylglucoses. These preliminary results provide some evidence for an antioxidant role of secondary metabolites in tree wound repair and defence.
Effectiveness of treatment of Norway spruce stumps with Phlebiopsis gigantea at different rates of coverage for the control of Heterobasidion
Authors: Berglund M. , Rönnberg J.
Published: July 2004

The natural establishment of the root and butt rot causing fungus Heterobasidion annosum s.l. on Norway spruce (Picea abies) thinning stumps treated with Phlebiopsis gigantea was investigated on seven sites in southern Sweden. The trees were cut during summertime and the stumps were treated with different patterns simulating the effect of mechanical stump treatment with a single‐grip harvester. Sampling was conducted 3 and 12 months after treatment. At both samplings, the best control was obtained when 100% of the stump surface was covered by P. gigantea: in contrast, untreated control stumps showed the highest incidences of H. annosum s.l. infection at both sampling times. However, 30 and 26% of the fully covered stumps at the first and second samplings, respectively, were diseased, and question the efficacy of treating Norway spruce stumps with this biological control agent in Sweden.
Sphaeropsis shoot blight and altered nutrition in red pine plantations treated with paper mill waste sludge
Authors: Stanosz G. R. , Trobaugh J. , Guthmiller M. A. , Stanosz J. C.
Published: July 2004

During 1993 progressive, severe shoot blight and canker disease in crowns of mature, merchantable red pines (Pinus resinosa) in central Wisconsin was noted in plantations in which paper mill waste sludge previously had been applied. For eight treated plantations and six non‐treated plantations, incidence of shoot blight attributed to the pathogenic fungus Sphaeropsis sapinea (syn. Diplodia pinea) was quantified during 1993 or 1994. Foliage and soil samples also were collected for analyses. Sphaeropsis shoot blight was more frequent in treated plantations than in the non‐treated stands (means of 81% of trees and 10.2% of shoots compared with 7% of trees and 0.1% of shoots, respectively). Consistent with other reports of damage caused by some diseases of conifers in situations of altered host nutrition, mean foliar N concentrations were higher in treated plantations (1.61%) than non‐treated plantations (1.31%) (p < 0.001). Mean foliar Zn, Mn, Cu, and Al concentrations were lower in treated plantations than non‐treated plantations, and mean soil P, Ca, and Mg concentrations were higher in treated plantations than non‐treated plantations.