Standardized risk-stratified cardiac assessment and early posttransplant cardiovascular complications in kidney transplant recipients.

Introduction: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in kidney transplant recipient (KTR). There is a dearth of standardized guidelines on optimal cardiovascular evaluation of transplant candidates. Methods: This single-center cohort study aims to determine the effectiveness of our standardized risk-stratified pretransplant cardiovascular screening protocol, which includes coronary angiography (CAG), in identifying advanced CVD, the proper pretransplant management of which could lead to a reduction in the incidence of major cardiac events (MACE) in the early posttransplant period. Results: Out of the total 776 KTR transplanted between 2017 and 2019, CAG was performed on 541 patients (69.7%), of whom 22.4% were found to have obstructive coronary artery disease (CAD). Asymptomatic obstructive CAD was observed in 70.2% of cases. In 73.6% of cases, CAG findings resulted in myocardial revascularization. MACE occurred in 5.6% (N = 44) of the 23 KTR with pretransplant CVD and 21 without pretransplant CVD. KTR with posttransplant MACE occurrence had significantly worse kidney graft function at the first year posttransplant (p = 0.00048) and worse patient survival rates (p = 0.0063) during the 3-year follow-up period compared with KTR without MACE. After adjustment, the independent significant factors for MACE were arrhythmia (HR 2.511, p = 0.02, 95% CI 1.158-5.444), pretransplant history of acute myocardial infarction (HR 0.201, p = 0.046, 95% CI 0.042-0.970), and pretransplant myocardial revascularization (HR 0.225, p = 0.045, 95% CI 0.052-0.939). Conclusion: Asymptomatic CVD is largely prevalent in KTR. Posttransplant MACE has a negative effect on grafts and patient outcomes. Further research is needed to assess the benefits of pretransplant myocardial revascularization in asymptomatic kidney transplant candidates.

Forest Manners Exchange: Forest as a Place to Remedy Risky Behaviour of Adolescents: Mixed Methods Approach.

This paper evaluates the impact of the forest environment on aggressive manifestations in adolescents. A remedial educative programme was performed with 68 teenagers from institutions with substitute social care with diagnoses F 30.0 (affective disorders) and F 91.0 (family-related behavioural disorders), aged 12-16 years. Adolescents observed patterns of prosocial behaviour in forest animals (wolves, wild boars, deer, bees, ants, squirrels and birds), based on the fact that processes and interactions in nature are analogous to proceedings and bonds in human society. The methodology is based on qualitative and quantitative research. Projective tests (Rorschach Test, Hand Test, Thematic Apperception Test) were used as a diagnostic tool for aggressive manifestations before and after forest therapies based on Shinrin-yoku, wilderness therapy, observational learning and forest pedagogy. Probands underwent 16 therapies lasting for two hours each. The experimental intervention has a statistically significant effect on the decreased final values relating to psychopathology, irritability, restlessness, emotional instability, egocentrism, relativity, and negativism. Forest animals demonstrated to these adolescents ways of communication, cooperation, adaptability, and care for others, i.e., characteristics without which no community can work.