bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pelvic autonomic dysfunction is common in patients with pure autonomic failure
Authors: Vichayanrat E. , Hentzen C. , Simeoni S. , Pakzad M. , Iodice V. , Panicker Jalesh N. 
Published: September 2024

AbstractBackground and PurposePure autonomic failure (PAF) presents primarily as cardiovascular autonomic failure and may phenoconvert to other neurodegenerative disorders. However, the involvement of other autonomic functions has been poorly evaluated. This study aims to characterize genitourinary and bowel dysfunction and explore their relationship with cardiovascular autonomic dysfunction.MethodsPure autonomic failure patients underwent cardiovascular autonomic testing and an assessment of pelvic autonomic dysfunction using urinary, sexual symptoms questionnaires and a bladder diary. Demographic, clinical features and related medical comorbidities were assessed.ResultsTwenty‐five patients (10 males) with PAF were included (mean age 71 ± 8 years; disease duration 13 ± 8 years). 96% (24/25) reported lower urinary tract symptoms, of which overactive bladder symptoms were most commonly reported (n = 23; 92%; median overactive subscore 8, interquartile range [IQR] 3–11), followed by voiding difficulties (n = 19; 76%; median low stream subscore 2, IQR 1–3) using the Urinary Symptom Profile; however, only four (16%) required clean intermittent self‐catheterization. Sexual dysfunction was common (n = 21; 84%) using the Arizona Sexual Experience Scale. Mild faecal incontinence and constipation were reported. 86% (19/22) had nocturnal polyuria (NP) and the median NP index was 47% (IQR 38%–51%; normal range <33%). 77% (10/13) had voiding dysfunction and 31% (4/13) had post‐void residual urine >100 mL. There were no significant correlations between the need for catheterization and the degree of NP with age, disease duration and cardiovascular autonomic parameters (p > 0.05).ConclusionsNocturnal polyuria, genitourinary and bowel symptoms are commonly seen in PAF. The pathophysiology of NP in PAF is most likely multifactorial and may occur independent of cardiovascular autonomic failure.
Management Control Shaping Dialogues: Attaching Differences and Reducing the Scope of Dialogs and Pluralism
Authors: Eriksson Kim , Häyrén Anneli , Wittbom Eva 
Published: September 2024

ABSTRACTIn this article, we study how management control shapes dialogs among actors with different perspectives on the development of infrastructure in Sweden; that is, situations and events where management control “enters” dialogs and influences them. Building on agonistic pluralism and conducting a qualitative study, we identify two roles that management control has in shaping dialogs. One is that management controls attach differences to the dialog, and the other is that management reduces the scope of the dialog. These themes also highlight facilitating and shutting down pluralism and ideas of public value. This study contributes to the previous research that has called for taking pluralism seriously and exploring the role of management control in relation to public values, pluralism, and dialogs. This article provides an understanding of two roles that management control has in shaping dialogs: How ideas of different public values are facilitated and shut down, and how management control contributes to facilitating and shutting down pluralism.
Barriers and Facilitators to Dental Care Services Utilization Among Children With Disabilities: A Systematic Review and Thematic Synthesis
Authors: Al‐Mashhadani Shiamaa , Nasser Mona , Alsalami Anas , Burns Lorna , Paisi Martha 
Published: September 2024

ABSTRACTBackgroundThis systematic review investigates barriers and enablers to dental care utilization by disabled children. Given the high global prevalence of disabilities in children, coupled with poor oral hygiene and a 45% rate of dental caries in this group, developing inclusive oral health strategies is critical. The review aims to synthesize literature on factors affecting oral healthcare improvement for disabled children, identifying barriers, facilitators and knowledge gaps.MethodsThe review was conducted following the Joanna Briggs Institute's methods and reported according to PRISMA guidelines. A comprehensive search spanned multiple databases, considering perspectives from carers, parents, dentists and health professionals. The focus was on studies involving children up to age 17 with disabilities, as defined by WHO, using dental care services. Exclusions included non‐qualitative studies, populations over 18 and nondisabled children. There were no restrictions on publication date or language. Thematic synthesis of the studies extracted themes related to barriers and enablers in oral healthcare for disabled children.ResultsThematic synthesis identified five overarching themes: stigma, communication issues, professional development, oral health education and medical‐dental collaboration. Facilitators included enhancing accessibility and availability of dental care through a holistic approach, improving dental care facility environments and ensuring skilled dental care providers.DiscussionThe review underscores the importance of interprofessional collaboration, improved parent/caregiver education and specialized dental facilities to support children with disabilities. It identifies key barriers and facilitators in dental care, including challenging stereotypes, improving communication between providers and parents, enhancing holistic training and addressing gaps in oral health education and integrated healthcare systems.ConclusionAddressing the complex dynamics of dental care for disabled children is essential for developing inclusive and effective preventive and therapeutic strategies. This review highlights the need for tailored approaches and enhanced support systems to improve oral health outcomes in this vulnerable population.Patient and Public ContributionThe members of the family support department, Middle East and North Africa (MENA) Organization for Rare Disease and Disability who provided the disability voice and contributed to providing input to the review protocol.
Effect of fast‐food environments on children's eating behaviour: A random effect within between analysis within the Generation R Study
Authors: Peeters Thera A. M. , Mölenberg Famke J. M. , Jansen Pauline W. , Groeniger Joost Oude , van Lenthe Frank J. , Beenackers Mariëlle A. 
Published: September 2024

SummaryBackgroundFocussing on appetitive traits associated with obesity, this study aimed to estimate the association between the fast‐food environment and satiety responsiveness, enjoyment of food and food responsiveness.MethodsWe used data from the Generation R Study. We included 2008 children with repeated measurements at the age of 4–10 years old. Three eating behaviour subscales from the Child Eating Behaviour Questionnaire (CEBQ) were used as outcomes. Geographical Information System data were used to map individual‐level exposure to fast‐food outlets within 400 m from home. Random Effect Within Between (REWB) models were used to derive estimates. We tested for moderation of the associations with parental restriction at baseline using the parent‐reported Child Feeding Questionnaire (CFQ).ResultsWe did not find evidence of between‐associations of fast‐food exposure and eating behaviour subscales. Considering within‐associations, an increase in absolute fast‐food exposure was associated with a significant marginal increase in satiety responsiveness (β: 0.02 [95% confidence interval: 0.00–0.03]). No moderation by parental restriction was found.ConclusionsIn environments with ubiquitous fast‐food outlets, an increased exposure to fast‐food outlets does not seem to have a substantial impact on eating behaviour. Further research is needed to better understand how fast‐food exposure contributes to overweight.
Reflections on government‐led social assistance programmes under Zimbabwe's National Social Protection Policy Framework: A social contract lens
Authors: Ncube Tomy , Murray Una 
Published: September 2024

AbstractSocial protection has gained global recognition for its role in addressing poverty, yet delivering social protection remains an intractable challenge for governments in the Global South. In this article, we assess the performance of government‐run social assistance in Zimbabwe. Our assessment begins in 2016 when the National Social Protection Policy Framework (NSPPF) was promulgated to maximize returns on social investments. Utilizing a systematic review approach, we collated literature published between 2016–2023. We find that despite adopting the NSPPF, social protection programming remains a challenge in Zimbabwe. We find that the disbursement of transfers to beneficiaries are delayed, benefits are misaligned with market forces due to inflation, most programmes are run without monitoring and evaluation structures, funding in the sector remains inadequate to reduce poverty and vulnerability, and no grievance and redress mechanisms exist. Our synthesis underscores the need for the refreshment of the social contract in Zimbabwe, a renewal of political will to finance social assistance programmes, engagement to transform policy into action, the expansion of the civic space to ensure citizens effectively participate in calling for social assistance, as well as concerted efforts towards harmonizing existing social assistance programmes. We highlight the need to embed social protection within a human rights‐based framework, and the need for robust monitoring frameworks along with predictable and dedicated financing.
Remittance‐financed social protection programmes for international migrant workers in Latin America
Authors: García Cristina López‐Cancio 
Published: September 2024

AbstractIn recent years in Latin America, a small number of contributory social protection programmes have been extended on a voluntary basis to cover migrant workers, with affiliation financed by these workers’ remittances. That remittances offer a means to finance social protection programmes demonstrates the possibilities presented by international migration not only as regards improving social protection coverage but in contributing towards achieving target 1.3 of the Sustainable Development Goals 2030 Agenda. This article addresses voluntary insurance programmes introduced in Ecuador, Guatemala and Mexico for nationals working abroad and by means of which the families of such international migrant workers can also access health care and benefits in their home countries. In turn, international migrant workers on returning home can gain eligibility for a contributory retirement pension and disability benefits if they satisfy eligibility as well as the contribution conditions.
OKT‐3 monoclonal antibody for severe acute renal allograft rejection
Authors: Roberts R. , Belitsky P. , Cohen A. , MacDonald A. S. , Gupta R. 
Published: September 2024

We treated 12 renal transplant recipients (9 cadaveric and 3 1‐haploidentical) demonstrating severe rejection with OKT‐3 monoclonal antibody. Rejection was confirmed by fine needle aspirate (FNA) or needle biopsy, or both. All had initial immunosuppression induction with low dose oral cyclosporine (CyA) (10 mg/kg/d) and alternate‐day reducing dose prednisone. Of the 12 patients, 10 received OKT‐3 for steroid resistant rejection (SRR), and 2 as primary treatment for accelerated acute rejection (ARR). Eight of 10 SRR and 1 of 2 ARR responded initially. Four of 8 SRR responders had recurrent rejections within 5 d of discontinuing their OKT‐3: 2 responded to traditional high‐dose steroids, 2 required nephrectomy. Seven of 12 transplants (58%) still function after 5 to 10 months – 6 with SRR, 1 with ARR. In 3 of 4 SRR and 1 ARR who did not experience a recurrent rejection, azathioprine (AZA) had been added electively to CyA immediately on discontinuing the OKT‐3. Patients who did not respond to OKT‐3, or re‐rejected on discontinuing the OKT‐3, had histological evidence or interstitial hemorrhage and endothelial intimal reaction. A blastogenic reaction on FNA on completion of OKT‐3 favored recurrent rejection. Three of the first 4 patients had fulminant herpetic and fungal infections. Subsequent patients were treated prophylactically with oral acyclovir and mycostatin and had no further infection. We suggest that (1) OKT‐3 with antimicrobial prophylaxis is safe and effective for SRR, (2) needle biopsy and serial FNA may be predictive of response of recurrent rejections, (3) the addition of AZA to CyA on completion of OKT‐3 may prevent recurrent rejection.
The relevance of transplant aspiration cytology (TAC) for the clinical management of renal allograft recipients
Authors: Surachno S. , van Oers M. H. J. , Kox C. , Wilmink J. M. 
Published: September 2024

To assess the relevance of transplant aspiration cytology (TAC) for the clinical management of renal allograft recipients we analyzed 250 TAC which were performed in 65 unselected renal allograft recipients in the first 2 to 3 wk after grafting. All patients were initially treated with cyclosporin A (4 mg/kg i.v. followed by 10–12 mg/kg orally) with or without low‐dose prednisolone (10 mg daily). From the 250 TAC performed, 196 samples were suitable for analysis. We compared the initial clinical diagnosis (ID) with the aspirate diagnosis (AD) and final clinical diagnosis (FD) which was established retrospectively on the basis of clinical signs and symptoms, laboratory investigations, radiological and other imaging techniques, response to therapeutic measures and in some cases histological picture. The AD was not considered at all in making the ID and FD. FD could be established with certainty in 167/196 cases. In 113/167, ID and AD were in accordance with FD; in 40/167 ID was incorrect while AD was in accordance with FD; in 7/167 ID was correct while AD was incorrect and, in 7/167, both ID and AD were incorrect. So, if AD was regarded as decisive in cases of discrepancy between ID and AD then in 40/54 cases a correct diagnosis and subsequent treatment could be given. In 14 cases AD was incorrect, further analysis shows that this could lead to unnecessary antirejection treatment in 7 cases only.
High‐density lipoprotein‐associated amyloid A protein after liver transplantation: Raised levels in serum and enhanced expression in hepatocytes during rejection
Authors: Maury C. P. J. , Höckerstedt K. , Lautenschlager I. , Scheinin T. M. 
Published: September 2024

Serial measurements of high‐density lipoprotein‐associated serum amyloid A protein (SAA) concentrations were carried out in 9 consecutive patients following liver transplantation. On the basis of clinical findings and repeated fine‐needle aspiration biopsies of the transplants, 11 rejection episodes were diagnosed in these patients. SAA increased significantly during all 11 rejections: peak SAA values ranged from 55 to 265 mg/1 (median 165 mg/l; SAA in healthy control subjects < 5 mg/l, range < 5 to 15 mg/l). A weak positive correlation (rs = 0.58) was found between peak cytology scores and peak SAA levels during rejections. Ten out of the 11 rejections were associated with a concentration of SAA > 80 mg/l. With this cut‐off level, and excluding the surgery‐induced SAA peak occurring on post‐transplant day 2 or 3, there were 2 false positive SAA readings with respect to rejection; 1 of these was associated with a severe septic complication. Immunoperoxidase staining for SAA of the transplant aspiration biopsies showed increased intensity in the hepatocytes during rejection episodes, suggesting that the rejection‐associated increase in SAA production occurs in the graft. The results suggest that serial measurements of SAA may be a useful, noninvasive aid in the detection of acute graft rejection episodes after liver transplantation.
Functional studies on the human transplanted small intestine
Authors: Knutson L , Meurling S. , Wahlberg J. , Ewald O. , Hällgren R. , Tufveson G. 
Published: September 2024

Intestinal transplantation is currently under development for treatment of short bowel syndrome. It was our purpose to examine the release of inflammatory mediators in a 1‐year‐old child with congenital aganglionosis following small intestinal transplantation (ligament of Treitz to colon; ileostomy). After obtaining institutional and parental consent, studies were performed at the 6th, 7th and 8th week after surgery and while the patient was receiving enteral nutrition (human breast milk). Prior to each investigation the ileal mucosa was examined endoscopically and biopsies were obtained. A 3‐cm segment of ileum was isolated between balloons and perfused with an isoosmolar solution at 2 ml/min at 37°C. Effluents were analyzed for: albumin, histamine, hyaluronan (hyaluronic acid), eosinophilic cationic protein (ECP) and PGE2. Although control values were unavailable in infants, data obtained from the adult jejunum served as control. Endoscopically the mucosa revealed loss of valvulae conniventes and progressive aphthous to deep mucosal ulcerations. Histologically this was detected as increased number of mononuclear cells, edema and fibrosis. After transplantation the appearance rate of histamine and ECP were low, but increased progressively. PGE2 was markedly increased at the start of the studies (5566 pg/cm/h compared to 11.7 ±3.0 in controls, mean ± SEM; n = 35), but did not profoundly increase further. Albumin and particularly hyaluronan, however, increased more than 30‐fold versus controls (21 420 pg/cm/h vs controls 669±46, n = 66 and 20 558 ng/cm/h vs controls 660±44, n = 66, respectively) in line with clinical deterioration. We conclude: 1) The technique for segmental intestinal perfusion can be used to monitor inflammatory mediators and mucosal leakage in a small bowel allograft. 2) The transplanted small intestine undergoes progressive ulceration associated with histological fibrosis; and, 3) The excessive accumulation of interstitial hyaluronan can influence water transport and thereby also intestinal circulation.
Outcome of 22 successful pregnancies after liver transplantation
Authors: Wu Anette , Nashan Bjoern , Messner Ute , Schmidt Hartmut H‐J , Guenther Hans‐Heinrich , Niesert Stefan , Pichmayr Rudolf 
Published: September 2024

To evaluate course and outcome of pregnancies in liver transplanted patients and to provide a brief summary on the development of these children, 22 pregnancies and 23 children (1 month‐99 months old) of 16 patients who had been liver transplanted at our institution (mean interval from transplantation to pregnancy 43.1 months) were reviewed. Standard immunosuppressive regimen during pregnancy consisted of cyclosporine A (CyA), tacrolimus (FK), azathioprine (Aza) and/or a low‐dose steroid therapy. CyA and FK whole blood trough levels were monitored on a routinely basis to keep therapeutic range (CyA 80‐150 ng/mL; FK 4‐8 ng/mL).No patient had a graft loss and there were no lethal complications. Beside de novo hypertension (n = 3) and preeclampsia (n = 3) problems during pregnancy included one steroid‐sensitive rejection at 36 wk gestation, one case of tacrolimus toxicity at 24 wk with complete reconstitution, and one case of de novo choledocholithiasis with recurrent cholangitis. Three cases of infections occurred. In total, 23 children, including one set of twins, were born. Terms of gestation (mean = 38.1 wk, ±2.2 SD), deliveries (spontaneous n = 13, cesarean section n = 7, forceps n = 1, vacuum extraction (VE) n = 1) and birth weights (2876 g, ±589.3 SD) were typical. Three pregnancies were preterm, one being a twin pregnancy. Neither congenital malformations nor unusual infections were seen in the children. Postnatal follow‐up revealed appropriate physical growth to date. Psychological development seems to be adequate.Our data indicate that successful pregnancies after liver transplantation (LTX) under careful management by transplant specialists, obstetricians and perinatalogists have a good outcome. So far, neither prenor postnatal child development appear to be influenced by maternal immunosuppressive therapy during pregnancy.
The middle colic vein: an alternative source of portal inflow in orthotopic liver transplantation complicated by portal vein thrombosis
Authors: Rudroff C , Scheele J 
Published: September 2024

BackgroundPortal vein thrombosis (PVT) was previously considered a contraindication to orthotopic liver transplantation (OLT) since adequate portal blood supply is mandatory for graft function and patient survival. Improvements in surgical technique, however, have meant that this problem now can be circumvented in most instances. Nevertheless portal vein thrombosis remains an obstacle in OLT and is associated with increased incidence of primary non‐function and longterm liver failure.MethodsA 55‐yr‐old patient underwent OLT for secondary biliary cirrhosis associated with hepatitis C infection and complicated by long standing PVT. Involvement of the portal, mesenteric, and splenic veins prevented standard portal venous reconstruction. Portal inflow was accomplished by a side‐to‐end anastomosis between the middle colic vein and the donor portal vein.ResultsHepatic reperfusion and subsequent liver function were excellent. Portal blood flow, as measured by color‐enhanced Doppler ultrasound, was normal following surgery until discharge. The post‐operative course was complicated by abdominal wound dehiscence and recurrent cytomegalovirus (CMV) infection. The patient was discharged in good clinical condition, with excellent liver function and patent portal vein 89 d after OLT.ConclusionsThe middle colic vein is a novel, not previously described, source of portal venous inflow for OLT complicated by extensive splanchnic venous inflow thrombosis.
Successful pancreas and kidney transplantation: a view of metabolic control
Authors: Balsells M Fernández , Esmatjes E , Ricart MJ , Casamitjana R , Astudillo E , Cruz L Fernández 
Published: September 2024

BackgroundPancreas and kidney transplantation (PKTx) has become the treatment of choice in uremic patients with insulin‐dependent diabetes mellitus (IDDM). In these patients, the pancreatic graft provides an endogenous source of insulin. However, the determination of its long‐term effect on metabolic control is crucial in order to establish the real efficacy of this treatment in diabetic patients. In this article, we describe the experience of the University of Barcelona in shortand long‐term metabolic control in PKTx recipients. Subjects and methods. We performed seriated determinations of glycosilated hemoglobin (HbA1c) and oral glucose tolerance tests (OGTT) in 55 patients who underwent PKTX at our center from 1983 to 1996 with both grafts functioning for more than 1 yr (mean follow‐up 4.2±2.3 yr). Basal glucose and insulin levels, areas under the curve (AUC) of glycemia and insulinemia after OGTT were analyzed throughout follow‐up, as well as the fasting insulin resistance index (FIRI).ResultsHbA1c levels throughout follow‐up were within the normal range. The OGTT was normal in 80% of the patients 5 yr after transplantation. Hyperinsulinemia was present throughout follow‐up. Over time, no differences were detected in the AUC of glycemia and insulinemia between controls and patients with PKTx. During the evolution, no differences were found in FIRI, in spite of increasing body weight.ConclusionWhen successful, PKTx provides long‐term normalization. of glycemic control, assessed by HbA1c and OGTT, despite the existence of sustained hyperinsulinemia. Our results strongly suggest that PKTX is the most effective treatment for uremic patients with IDDM from a metabolic point of view.