Clinical Presentation, Pathological Spectrum, and Outcomes of Alcoholic Cirrhosis-Related Immunoglobulin A Nephropathy.

Introduction: Immunoglobulin A nephropathy (IgAN) associated with cirrhosis is frequent but often overlooked because it is largely considered silent. Until now, little has been known about their presentation and outcomes. Methods: We conducted a retrospective multicenter study on patients with kidney biopsy-proven cirrhosis-related IgAN (cirrhosis-IgAN), diagnosed between 2009 and 2022. We mixed them up with 83 primary IgAN (pIgAN) diagnosed during the same period, using a partitioning clustering approach, to determine common clinicopathological profiles. Results: All the 46 patients with cirrhosis-IgAN had an excessive alcoholic consumption. Clinical presentation was severe with acute kidney injury (AKI) in 79%; alternative causes of AKI was found in 62% of cases. Three clinicopathological clusters were identified as follows: the first one represented chronic involvement, the second one could be assimilated to mild disease, and the third one corresponded to a membranoproliferative glomerulonephritis (MPGN) pattern and was associated with heavy proteinuria and intrinsic AKI (without alternative causes). Whereas the first 2 clusters were equally distributed between pIgAN and cirrhosis-IgAN, the third was more frequent in patients with cirrhosis. The cumulative mortality rate in cirrhosis-IgAN was 26% and 46% at 1-year and 3-years, respectively. Steroid exposure and moderate or severe AKI were associated with higher mortality and steroid exposure was associated with the occurrence of severe infection. Conclusion: Our results suggest that high AKI incidence is related to extrinsic causes in most cases but can also be driven by IgA-dominant MPGN in a subset of patients. Steroid use was associated with infectious disease and mortality. Further studies are needed to clarify the role of immunosuppressive treatment in cirrhosis-IgAN patients.

Standard Deviation vs. Gini Coefficient: Effects of Different Indicators of Classroom Status Hierarchy on Bullying Behavior.

Classroom status hierarchy (the degree to which popularity is unequally distributed in a classroom) has often been examined as a predictor of bullying. Although most research has relied on an operationalization of status hierarchy as the classroom standard deviation (SD) of popularity, other fields (e.g., sociology, economics) have typically measured resource inequality using the Gini coefficient. This multilevel study examines the concurrent and prospective associations of both status hierarchy indicators (referred to as SD-hierarchy and Gini-hierarchy) with peer-reported bullying, controlling for key variables (i.e., the structure of the classroom status hierarchy, average classroom level of popularity). The final sample included 3017 students (45.3% self-identified as a boy; T1 Mage = 13.04, SD = 1.73, approximately 93% born in Finland) from 209 classrooms. Concurrently, classroom SD-hierarchy was positively, linearly associated with bullying, whereas there was a curvilinear (inverted U) association between Gini-hierarchy and bullying. No significant longitudinal associations were found. The findings suggest that Gini-hierarchy provides unique information beyond the SD-hierarchy.

The longitudinal role of classroom defending norms in victims' psychological adjustment, causal attributions, and social comparisons.

Frequent exposure to victimization by peers is related to greater psychological problems. It is often assumed that peer victimization is associated with fewer psychological problems in classrooms where defending victims of bullying is common (i.e., a norm). The few studies testing this claim have been cross-sectional and have produced mixed findings. The current preregistered study examined whether the prospective link between victimization and psychological adjustment (i.e., depressive symptoms and self-esteem) was moderated by classroom defending norms. Moreover, we aimed to explain why defending norms may have either beneficial or adverse effects on victims' adjustment, by focusing on two cognitive processes: victims' causal attributions and social comparisons. Three waves of data were collected among 3,470 Finnish fourth- to ninth-grade students from 227 classrooms (Mage = 13.04, 50.1% girls). Multilevel regression analyses showed that nonvictimized youth benefited from high defending norms, whereas victims' psychological adjustment did not vary as a function of defending norms. Therefore, no mediation analyses were conducted. Nonpreregistered additional analyses indicated that stable victims had greater psychological problems and higher self-blame over time in classrooms with higher defending norms. Thus, even though the majority of students seem to profit from defending norms, this might not be true for those who most urgently need help. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Is there really a healthy context paradox for victims of bullying? A longitudinal test of bidirectional within-and between-person associations between victimization and psychological problems.

The finding that victims' psychological problems tend to be exacerbated in lower-victimization classrooms has been referred to as the "healthy context paradox." The current study has put the healthy context paradox to a strict test by examining whether classroom-level victimization moderates bidirectional within- and between-person associations between victimization and psychological adjustment. Across one school year, 3,470 Finnish 4th to 9th graders (Mage = 13.16, 46.1% boys) reported their victimization, depressive symptoms, anxiety, and self-esteem. Three types of multilevel models (cross-lagged panel, latent change score, and random-intercept cross-lagged panel) were estimated for each indicator of psychological adjustment. Findings indicated that the healthy context paradox emerges because classroom-level victimization moderates the prospective effect of victimization on psychological problems, rather than the effect of psychological problems on victimization. In classrooms with lower victimization, victims not only experience worse psychological maladjustment over time compared to others (between-person changes), but also higher maladjustment than before (absolute within-person changes).

Effects of the KiVa anti-bullying program on defending behavior: Investigating individual-level mechanisms of change.

Given that defending victimized peers might help discourage bullying behavior and prevent its harmful consequences, various anti-bullying programs have attempted to increase defending behavior among participating children. However, the cognitions that underlie the effectiveness of interventions in increasing defending remain unknown. Data for this randomized controlled trial (RCT) of the KiVa anti-bullying program were collected in Finnish primary schools at baseline, after 5 months of implementation, and after 9 months of implementation and were used to examine the possible mediating role of seven psychological factors (empathy for the victim, feelings of responsibility to intervene, self-efficacy for defending, negative attitudes towards victims, and outcome expectations that defending would decrease or stop the bullying, be beneficial for one's status, and not increase one's risk of being victimized). Analyses conducted on a sample of 5731 children (baseline Mage = 11 years; 51% girls) revealed that the positive effects of KiVa on defending behavior after 9 months of implementation could partly be explained by the positive effects of the program on two factors (i.e., feelings of responsibility to intervene and expectations that the defending would make the bullying decrease or stop) after 5 months of implementation. This study provides information regarding the individual-level factors that anti-bullying interventions can target to successfully promote defending of victimized peers in primary schools.

Does defending affect adolescents' peer status, or vice versa? Testing the moderating effects of empathy, gender, and anti-bullying norms.

This study examined bidirectional associations between students' bully-directed defending behavior and their peer status (being liked or popular) and tested for the moderating role of empathy, gender, and classroom anti-bullying norms. Three waves of data were collected at 4-5-month time intervals among 3680 Finnish adolescents (Mage = 13.94, 53.0% girls). Cross-lagged panel analyses showed that defending positively predicted popularity and, to a larger degree, being liked over time. No moderating effect of empathy was found. Popularity was more strongly predictive of defending, and defending was more strongly predictive of status among girls than among boys. Moreover, the positive effects of both types of status on defending were-albeit to a limited extent-stronger in classrooms with higher anti-bullying norms.

Peer victimization and empathy for victims of bullying: A test of bidirectional associations in childhood and adolescence.

Anti-bullying interventions often assume that knowing how it feels to be bullied increases empathy for victims. However, longitudinal research on actual experiences of bullying and empathy is lacking. This study investigated whether within-person changes in victimization predicted changes in empathy over 1 year using random-intercept cross-lagged panel models. Self- and peer-reported victimization, and cognitive and affective empathy for victims were measured in a sample of 15,713 Finnish youth (Mage  = 13.23, SDage  = 2.01, 51.6% female; 92.5% had Finnish-speaking parents; data was collected in 2007-2009 when information about participants' race/ethnicity was not available due to ethical guidelines for the protection of personal information). Results indicated small, positive longitudinal associations from victimization to cognitive empathy. Implications for empathy-raising interventions are discussed.

Very Low Dose Anti-Thymocyte Globulins Versus Basiliximab in Non-Immunized Kidney Transplant Recipients.

The choice between Basiliximab (BSX) or Anti-Thymocyte Globulin (ATG) as induction therapy in non-immunized kidney transplant recipients remains uncertain. Whilst ATG may allow steroid withdrawal and a decrease in tacrolimus, it also increases infectious complications. We investigated outcomes in non-immunized patients receiving a very low dosage of ATG versus BSX as induction. Study outcomes were patient/graft survival, cumulative probabilities of biopsy proven acute rejection (BPAR), infectious episode including CMV and post-transplant diabetes (PTD). Cox, logistic or linear statistical models were used depending on the studied outcome and models were weighted on propensity scores. 100 patients received ATG (mean total dose of 2.0 mg/kg) and 83 received BSX. Maintenance therapy was comparable. Patient and graft survival did not differ between groups, nor did infectious complications. There was a trend for a higher occurrence of a first BPAR in the BSX group (HR at 1.92; 95%CI: [0.77; 4.78]; p = 0.15) with a significantly higher BPAR episodes (17% vs 7.3%, p = 0.01). PTD occurrence was significantly higher in the BSX group (HR at 2.44; 95%CI: [1.09; 5.46]; p = 0.03). Induction with a very low dose of ATG in non-immunized recipients was safe and associated with a lower rate of BPAR and PTD without increasing infectious complications.

Development and Validation of the Adolescent Defending Behaviors Questionnaire Among Chinese Early Adolescents.

This study aimed to clarify the multidimensionality of defending by developing and validating the Adolescent Defending Behaviors Questionnaire (ADBQ) in a sample of Chinese adolescents. Results of Study 1 (N = 824, Mage = 11.25) indicated that a five-factor model, comprising (a) assertive defending, (b) aggressive defending, (c) comforting victims, (d) reporting to authority, and (e) tactical defending, yielded a good fit to the data. Study 2 (N = 1,086, Mage = 11.18) established ADBQ's reliability (α = .78-.93) and construct validity: the five defending dimensions were differentially associated with cognitive and affective empathy, aggression, sociability, peer preference, and victimization. Together, the results suggest that the ADBQ is a psychometrically valid and reliable instrument for assessing the multidimensionality of defending.

Does defending victimized peers put youth at risk of being victimized?

Defending peers who have been bullied is often thought to put defenders at risk of becoming victimized themselves. The study investigated the concurrent and prospective associations between defending and (peer- and self-reported) victimization, and examined popularity and classroom norms as potential moderators. Participants included 4085 Finnish youth (43.9% boys; Mage  = 14.56, SD = .75; 97% born in Finland). Concurrently, defending was positively associated with self-reported victimization in classrooms with high bullying-popularity norms (b = .28, SE = .16). Defending was negatively associated with peer-reported victimization in classrooms with high defending-popularity norms (b = -.07, SE = .03). Defending was not significantly associated with future victimization, suggesting that it is generally not a risk factor for victimization.

Primary Graft Function and 5 Year Insulin Independence After Pancreas and Islet Transplantation for Type 1 Diabetes: A Retrospective Parallel Cohort Study.

In islet transplantation (ITx), primary graft function (PGF) or beta cell function measured early after last infusion is closely associated with long term clinical outcomes. We investigated the association between PGF and 5 year insulin independence rate in ITx and pancreas transplantation (PTx) recipients. This retrospective multicenter study included type 1 diabetes patients who underwent ITx in Lille and PTx in Nantes from 2000 to 2022. PGF was assessed using the validated Beta2-score and compared to normoglycemic control subjects. Subsequently, the 5 year insulin independence rates, as predicted by a validated PGF-based model, were compared to the actual rates observed in ITx and PTx patients. The study enrolled 39 ITx (23 ITA, 16 IAK), 209 PTx recipients (23 PTA, 14 PAK, 172 SPK), and 56 normoglycemic controls. Mean[SD] PGF was lower after ITx (ITA 22.3[5.2], IAK 24.8[6.4], than after PTx (PTA 38.9[15.3], PAK 36.8[9.0], SPK 38.7[10.5]), and lower than mean beta-cell function measured in normoglycemic control: 36.6[4.3]. The insulin independence rates observed at 5 years after PTA and PAK aligned with PGF predictions, and was higher after SPK. Our results indicate a similar relation between PGF and 5 year insulin independence in ITx and solitary PTx, shedding new light on long-term transplantation outcomes.

What Should I do and Who's to blame? A cross-national study on youth's attitudes and beliefs in times of COVID-19.

The COVID-19 crisis has had a major impact on youth. This study examined factors associated with youth's attitudes towards their government's response to the pandemic and their blaming of individuals from certain risk groups, ethnic backgrounds, and countries or regions. In a sample of 5,682 young adults (Mage = 22) from 14 countries, lower perceived burden due to COVID-19, more collectivistic and less individualistic values, and more empathy were associated with more positive attitudes towards the government and less blaming of individuals of certain groups. Youth's social identification with others in the pandemic mediated these associations in the same direction, apart from the COVID-19 burden on attitudes, which had a positive indirect effect. No evidence of country-level moderation was found.

Bidirectional Associations of Prosocial Behavior with Peer Acceptance and Rejection in Adolescence.

As most studies on the link between peer status and prosocial behavior are cross-sectional, conducted with children, and operationalize status as the difference between acceptance and rejection, it remains unclear whether peer acceptance and rejection are consequences or prerequisites of prosocial behavior in adolescence. To fill this gap, this study examines the bidirectional associations of prosocial behavior with peer acceptance and peer rejection with data collected at 3 time points, 6 months apart, in a sample of 660 early Chilean adolescents (M = 12.94, SD = 0.62; 55.1% boys). Cross-lagged panel analyses showed that prosocial behavior positively predicted future peer acceptance, whereas peer acceptance had no significant effect on future prosocial behavior. The association between rejection and prosocial behavior was negative and bidirectional between Time 1 and Time 2. When a new academic year began, between Time 2 and Time 3, prosocial behavior negatively predicted rejection, whereas rejection in the previous grade level was positively associated with prosocial behavior at the beginning of the next grade. Multi-group panel analyses did not detect significant differences between boys and girls in the cross-lagged associations of prosociality with peer acceptance and peer rejection. The results suggest that acting prosocially can make adolescents better liked by their peers and highlight the possible importance of the transition to a new academic year for the prosocial behavior of previously rejected students. Implications for future research on peer relations are discussed.

Time-Limited Therapy with Belatacept in Kidney Transplant Recipients.

INTRODUCTION: In kidney transplant recipients, belatacept is usually pursued indefinitely after it has been started. In the setting of the belatacept shortage and after having evaluated the benefit-risk ratio, we established a strategy consisting of time-limited belatacept therapy/transient calcineurin inhibitor withdrawal, whose results are analyzed in that study. METHODS: We considered all the kidney transplant recipients that had been switched from conventional immunosuppressive therapy to belatacept and then for whom belatacept has been withdrawn intentionally. Furthermore, in the first 8 patients, we assessed changes in peripheral blood mononuclear cells (PBMC) transcriptome using RNAseq before and 3 months after belatacept withdrawal. RESULTS: Over the study period, 28 out of 94 patients had belatacept intentionally withdrawn including 25 (89%) switched to low-dose CNI. One rejection due to poor compliance occurred. The eGFR after 12 months remained stable from 48 ± 19 mL.1.73 m-2 to 46 ± 17 mL.1.73 m-2 (p = 0.68). However, patients that resumed belatacept/withdrew CNIs (n = 10) had a trend towards a better eGFR comparing with the others (n = 15): 54 ± 20 mL.1.73 m-2 vs. eGFR 43 ± 16 mL.1.73 m-2, respectively (p = 0.15). The only factor associated with belatacept resumption was when the withdrawal took place during the COVID-19 outbreak. Transcriptome analysis of PBMCs, did not support rebound in alloimmune response. CONCLUSIONS: These findings underpin the use of belatacept as part of a time-limited therapy, in selected kidney transplant recipients, possibly as an approach to allow efficient vaccination against SARS-CoV-2.