[Shared decision-making using outcome information: qualitative research among patients]. / Samen beslissen met ROM als informatiebron: kwalitatief onderzoek onder cliënten.

BACKGROUND: In the period 2019-2022, eight mental health care organizations have been working on the development and implementation of shared decision-making (SDM) using routine outcome monitoring (ROM) as a source of information. AIM: To obtain insight in needs and experiences of patients among SDM using ROM, and to investigate which implementation approach this requires. METHOD: Explorative, qualitative research consisting of semi-structured interviews and focusgroups with patients (n = 101) treated by mental health care organizations across the Netherlands. RESULTS: Patients reported SDM as important. Generic aspects (listening, trust, complete information and equal input) and customization (connecting to the need for help, and for every decision meta-communication about the roles of patients, relatives and clinicians and the way of giving information) were equally important. Patients valued ROM as source of information during SDM, providing that questionnaires are not too long, are related to the problems and results are discussed. CONCLUSION: SDM using ROM is as yet not widely implemented in mental health care. This requires continuous stimulation and evaluation. Implementation requires (re)training clinicians and supporting patients by relatives, peer experts and psycho-education. Patients appreciate ROM as an aid in SDM; access to their own ROM is helpful here.

A multi-center retrospective cohort study defines the spectrum of kidney pathology in Coronavirus 2019 Disease (COVID-19).

Kidney failure is common in patients with Coronavirus Disease-19 (COVID-19), resulting in increased morbidity and mortality. In an international collaboration, 284 kidney biopsies were evaluated to improve understanding of kidney disease in COVID-19. Diagnoses were compared to five years of 63,575 native biopsies prior to the pandemic and 13,955 allograft biopsies to identify diseases that have increased in patients with COVID-19. Genotyping for APOL1 G1 and G2 alleles was performed in 107 African American and Hispanic patients. Immunohistochemistry for SARS-CoV-2 was utilized to assess direct viral infection in 273 cases along with clinical information at the time of biopsy. The leading indication for native biopsy was acute kidney injury (45.4%), followed by proteinuria with or without concurrent acute kidney injury (42.6%). There were more African American patients (44.6%) than patients of other ethnicities. The most common diagnosis in native biopsies was collapsing glomerulopathy (25.8%), which was associated with high-risk APOL1 genotypes in 91.7% of cases. Compared to the five-year biopsy database, the frequency of myoglobin cast nephropathy and proliferative glomerulonephritis with monoclonal IgG deposits was also increased in patients with COVID-19 (3.3% and 1.7%, respectively), while there was a reduced frequency of chronic conditions (including diabetes mellitus, IgA nephropathy, and arterionephrosclerosis) as the primary diagnosis. In transplants, the leading indication was acute kidney injury (86.4%), for which rejection was the predominant diagnosis (61.4%). Direct SARS-CoV-2 viral infection was not identified. Thus, our multi-center large case series identified kidney diseases that disproportionately affect patients with COVID-19 and demonstrated a high frequency of APOL1 high-risk genotypes within this group, with no evidence of direct viral infection within the kidney.

A new Rhopalomeris species (Diplopoda: Glomerida: Glomeridae), and notes on the phylogenetic relationships between glomeridans in Vietnam.

A new pill millipede, Rhopalomeris nagao sp. nov., is described from Vietnam. It is recognized by the following combination of characters: antennal tip with numerous sensory cones; telopods with short prefemoral and femoral trichosteles, with long, straight and acute tuberculiform femoral process, and with shorter lobuliform tibial process; syncoxial lobe being slightly concave medially, syncoxial horns being longer than lobe. A fragment of the cytochrome c oxidase subunit I (COI) gene is also provided for the new species. The K2P genetic distance of the COI between the new species and other Vietnamese glomeridans is from 10.7% to 16.9%. Two genera, Hyperglomeris and Hyleoglomeris, are considered to be non-monophyletic, but more data and samples will be needed for confirmation.

Treatment Outcome, Duration, and Costs: A Comparison of Performance Indicators Using Data from Eight Mental Health Care Providers in The Netherlands.

Assessing performance of mental health services (MHS) providers merely by their outcomes is insufficient. Process factors, such as treatment cost or duration, should also be considered in a meaningful and thorough analysis of quality of care. The present study aims to examine various performance indicators based on treatment outcome and two process factors: duration and cost of treatment. Data of patients with depression or anxiety from eight Dutch MHS providers were used. Treatment outcome was operationalized as case mix corrected pre-to-posttreatment change scores and as reliable change (improved) and clinical significant change (recovered). Duration and cost were corrected for case mix differences as well. Three performance indicators were calculated and compared: outcome as such, duration per outcome, and cost per outcome. The results showed that performance indicators, which also take process variability into account, reveal larger differences between MHS providers than mere outcome. We recommend to use the three performance indicators in a complementary way. Average pre-to-posttreatment change allows for a simple and straightforward ranking of MHS providers. Duration per outcome informs patients on how MHS providers compare in how quickly symptomatic relief is achieved. Cost per outcome informs MHS providers on how they compare regarding the efficiency of their care. The substantial variation among MHS providers in outcome, treatment duration and cost calls for further exploration of its causes, dissemination of best practices, and continuous quality improvement.

[ROM for the elderly: a prospective cohort study of the outcomes on the HoNOS 65+ in various diagnostic groups]. / ROM bij ouderen: een prospectief cohortonderzoek naar de uitkomsten op de HoNOS 65+ bij verschillende diagnosegroepen.

BACKGROUND: Routine outcome monitoring (rom) provides us with opportunities to study treatment outcome in daily clinical practice and to learn from the results.
AIM: To assess the changes that occur in the psychological and social functioning of patients in geriatric psychiatry who are suffering from substance dependence, mood disorder, anxiety disorder, psychotic disorder, or personality disorder.
METHOD: We analysed data relating to 1,810 patients (aged 60-101) from nine mental health care organisations that together form SynQuest cv. The total scores and item scores on the Health of the Nation Outcome Scales for older people (Honos 65+) at the beginning and end of treatment were also analysed and were linked to the diagnosis.
RESULTS: Patients improved significantly (es=0.8). The degree of improvement depended on the patient's principal diagnosis; patients with a mood or anxiety disorder improved the most (es=1.0 and 0.8). The degree of improvement varied per Honos 65+ item. In particular, patients with 'depressive problems' and 'other mental and behavioral problems' showed considerable improvement.
CONCLUSION: Many older patients benefited from the treatment they received in gerontopsychiatry departments. This helps to give elderly patients with psychiatric disorders hope for the future. The scores on the individual items of the Honos 65+ can help clinicians to tailor treatment to the patient's specific problems and to monitor and evaluate treatment outcome in conjunction with the patient.

Laminarin favorably modulates gut microbiota in mice fed a high-fat diet.

We investigated the anti-obesity effects of the potential prebiotic, laminarin, on mice fed a high-fat diet. A metagenomics approach was applied to characterize the ecological and functional differences of gut microbiota among mice fed a normal diet (CTL), a high-fat diet (HFD), and a laminarin-supplemented high-fat diet (HFL). The HFL mice showed a slower weight gain than the HFD mice during the laminarin-feeding period, but the rate of weight gain increased after the termination of laminarin supplementation. Gut microbial community analysis showed clear differences between the CTL and HFD mice, whereas the HFL mice were between the two. A higher abundance of carbohydrate active enzymes was observed in the HFL mice compared to the HFD mice, with especially notable increases in glycoside hydrolase and polysaccharide lyases. A significant decrease in Firmicutes and an increase in the Bacteroidetes phylum, especially the genus Bacteroides, were observed during laminarin ingestion. Laminarin ingestion altered the gut microbiota at the species level, which was re-shifted after termination of laminarin ingestion. Therefore, supplementing laminarin could reduce the adverse effects of a high-fat diet by shifting the gut microbiota towards a higher energy metabolism. Thus, laminarin could be used to develop anti-obesity functional foods. Our results also suggest that laminarin would need to be consumed regularly in order to prevent or manage obesity.

Influence of seawater intrusion on microbial communities in groundwater.

Groundwater is the sole source of potable water on Jeju Island in the Republic of (South) Korea. Groundwater is also used for irrigation and industrial purposes, and it is severely impacted by seawater intrusion in coastal areas. Consequently, monitoring the intrusion of seawater into groundwater on Jeju is very important for health and environmental reasons. A number of studies have used hydrological models to predict the deterioration of groundwater quality caused by seawater intrusion. However, there is conflicting evidence of intrusion due to complicated environmental influences on groundwater quality. Here we investigated the use of next generation sequencing (NGS)-based microbial community analysis as a way to monitor groundwater quality and detect seawater intrusion. Pristine groundwater, groundwater from three coastal areas, and seawater were compared. Analysis of the distribution of bacterial species clearly indicated that the high and low salinity groundwater differed significantly with respect to microbial composition. While members of the family Parvularculaceae were only identified in high salinity water samples, a greater percentage of the phylum Actinobacteria was predominantly observed in pristine groundwater. In addition, we identified 48 shared operational taxonomic units (OTUs) with seawater, among which the high salinity groundwater sample shared a greater number of bacterial species with seawater (6.7%). In contrast, other groundwater samples shared less than 0.5%. Our results suggest that NGS-based microbial community analysis of groundwater may be a useful tool for monitoring groundwater quality and detect seawater intrusion. This technology may also provide additional insights in understanding hydrological dynamics.

Efficacy of computed tomography for abdominal stab wounds: a single institutional analysis.

PURPOSE: There are several diagnostic tools to support the decision for abdominal stab wounds. The aim of this study is to evaluate the ability of computed tomography (CT) to facilitate decisions on the initial management in patients with anterior abdominal stab wounds. METHODS: The medical records of all 118 patients who sustained abdominal stab wounds from March 2004 to January 2012 were reviewed retrospectively. RESULTS: The average age of patients was 41 years, and 84 (71%) patients were male. Ten patients underwent an immediate laparotomy due to hemodynamic instability, peritonitis, or definite evisceration. The other 108 patients underwent CT scans, and 91 patients had positive CT findings, leading to performance of laparotomy in 82 patients. One patient underwent a non-therapeutic laparotomy. Seventeen patients had negative CT results; however, seven patients underwent early laparotomy according to the attending surgeon's decision using serial physical examination or other diagnostic tools. The sensitivity of the CT scan was 94.2%, and the positive-predictive value was 98.8%. CONCLUSIONS: CT can be used efficiently along with physical examination as an initial diagnostic tool in patients with abdominal stab wounds. However, there can be missed injuries, then surgeon should consider other diagnostic methods.

Analysis of swine fecal microbiota at various growth stages.

Recent obesity studies in humans and rodents have suggested that host weight gain is significantly associated with energy harvesting efficiency which is regulated by gut microbiota. Antibiotic growth promoters have been banned as feed additives in many countries. In this study, we aimed to provide knowledge of swine fecal microbiota by analyzing bacterial 16S rRNA gene sequences. Our results showed that swine fecal bacterial composition varied at each growth stage. Bacteroidetes decreased as the swine gained weight and unclassified genera significantly increased at later growth stages. Operational taxonomic unit (OTU) distribution analysis showed that the bacterial community difference was most significant between growers and finishers, while analysis of shared OTUs indicated a greater proportion of common species between growers and finishers. The differential abundance test between growers and finishers detected that nearly half of the species were shared OTUs, suggesting that differential abundance of each bacterial species predominantly controls bacterial community differences. Although functions of these bacteria are yet to be identified, understanding differences in fecal microbiota between each growth stage will provide additional insights for further studies related to swine gut microbiota.

[Schatzki ring as a symptom of gastroesophageal reflux disease].

OBJECTIVE: To determine the importance of a symptom of Schatzki ring. MATERIAL AND METHODS: The results of examining 95 patients aged 62-92 years with the symptoms of dyspepsia in the Netanya State Geriatric Center (Israel) in 1994-2004 were analyzed. Standard X-ray study of the upper digestive tract was complemented by provocation tests. The length of an X-ray-negative area (XNA) between barium in the esophagus and stomach and the width in the lower esophagus were measured. RESULTS: Only 2 (2%) of the 95 patients were found to have normal function of the gastroesophageal junction (GEJ). Two patients with a drastic esophageal narrowing due to reflux esophagitis were excluded. The remaining (91) patients were divided into 2 groups. The width of the esophagus was less than 2 cm and 2 cm or more in 64 (70%) and 27 (30%) patients, respectively. In weak GEJ, there was esophageal dilatation above the XNA. When in a horizontal position, this portion of the esophagus evacuates its contents into the stomach as a result of ampullary function. It is proximally closed by contracting the functional proximal sphincter (PS). When the ampulla contracts, its pressure increases up to the threshold. This causes the XNA to be closed and the ampulla to inject its contents into the stomach. The wider was the ampulla, the shorter the XNA was. Schatzki ring was detected in 20 (22%) of the 91 patients with gastroesophageal reflux disease (GERD). It was always at the level of the PS. CONCLUSION: The so-called sliding esophageal hernia is an esophageal ampulla measuring more than 2 cm in wide. The presence of the esophageal ampulla despite its size suggests that the GEJ is incompetent and GERD is present. Schatzki ring occurs at the level of the PS due to reflux esophagitis.

Hypotonic stress induces RANKL via transient receptor potential melastatin 3 (TRPM3) and vaniloid 4 (TRPV4) in human PDL cells.

Bone remodeling occurs in response to various types of mechanical stress. The periodontal ligament (PDL) plays an important role in mechanical stress-mediated alveolar bone remodeling. However, the underlying mechanism at the cellular level has not been extensively studied. In this study, we investigated the effect of shear stress on the expression of bone remodeling factors, including receptor activator of nuclear factor-kappa B (NF-κB) ligand (RANKL) and osteoprotegerin (OPG), as well as its upstream signaling pathway in primary human PDL cells. We applied hypotonic stress to reproduce shear stress to PDL cells. Hypotonic stress induced the messenger RNA (mRNA) and protein expression of RANKL but not OPG. It also increased intracellular Ca(2+) concentration ([Ca(2+)]i). Extracellular Ca(2+) depletion and nonspecific plasma membrane Ca(2+) channel blockers completely inhibited the increase in both [Ca(2+)]i and RANKL mRNA expression. We identified the expression and activation of transient receptor potential melastatin 3 (TRPM3) and vaniloid 4 (TRPV4) channels in PDL cells. Pregnenolone sulfate (PS) and 4α-phorbol 12, 13-didecanoate (4α-PDD), which are agonists of TRPM3 and TRPV4, augmented Ca(2+) influx and RANKL mRNA expression. Both pharmacological (2-aminoethoxydiphenyl borate [2-APB], ruthenium red [RR], ononetin [Ono], and HC 067047 [HC]) and genetic (small interfering RNA [siRNA]) inhibitors of TRPM3 and TRPV4 reduced the hypotonic stress-mediated increase in [Ca(2+)]i and RANKL mRNA expression. Our study shows that hypotonic stress induced RANKL mRNA expression via TRPM3- and TRPV4-mediated extracellular Ca(2+) influx and RANKL expression. This signaling pathway in PDL cells may play a critical role in mechanical stress-mediated alveolar bone remodeling.

Effects of antibiotic growth promoter and characterization of ecological succession in Swine gut microbiota.

Ever since the ban on antibiotic growth promoters (AGPs), the livestock death rate has increased owing to pathogenic bacterial infections. There is a need of developing AGP alternatives; however, the mechanisms by which AGP enhances livestock growth performance are not clearly understood. In this study, we fed 3-week-old swine for 9 weeks with and without AGPs containing chlortetracycline, sulfathiazole, and penicillin to investigate the effects of AGPs on swine gut microbiota. Microbial community analysis was done based on bacterial 16S rRNA genes using MiSeq. The use of AGP showed no growth promoting effect, but inhibited the growth of potential pathogens during the early growth stage. Our results showed the significant increase in species richness after the stabilization of gut microbiota during the post-weaning period (4-week-old). Moreover, the swine gut microbiota was divided into four clusters based on the distribution of operational taxonomic units, which was significantly correlated to the swine weight regardless of AGP treatments. Taxonomic abundance analysis indicated a negative correlation between host weight and the abundance of the family Prevotellaceae species, but showed positive correlation to the abundance of the family Spirochaetaceae, Clostridiaceae_1, and Peptostreptococcaeae species. Although no growth performance enhancement was observed, the use of AGP inhibited the potential pathogens in the early growth stage of swine. In addition, our results indicated the ecological succession of swine gut microbiota according to swine weight. Here, we present a characterization of swine gut microbiota with respect to the effects of AGPs on growth performance.

[Criteria for admitting patients with anorexia nervosa as inpatients to a general hospital; survey among internists]. / Criteria voor opname van volwassenen met anorexia nervosa op een interne afdeling van een algemeen ziekenhuis; enquête onder internisten.

BACKGROUND: Anorexia nervosa (an) is associated with a number of life-threatening complications. Sometimes there are good reasons for admitting an anorexia nervosa patient to a general hospital for treatment as an inpatient. Therefore, there needs to be optimal collaboration between psychiatrists treating the patient and the medical staff at the general hospital. AIM: To obtain insight into the admission criteria and other possible factors that play a role in the physician's decision to admit a patient with anorexia nervosa for inpatient treatment in a general hospital. METHOD: Internists and residents-internal medicine completed a questionnaire about admission criteria and, where applicable, about threshold values for these criteria. The physicians were also asked to judge two case vignettes. In addition, they were questioned about other factors that influenced their views on the admission of patients with anorexia nervosa to a general hospital and about their attitude to this patient-group, their experience of treating patients with anorexia nervosa and their awareness of a need for a guideline. The data were collected at the annual Dutch congress for internists at Maastricht. RESULTS: In total 78 congress attendees responded to the questionnaire; 47% were internist and 53% were resident-in-training. Agreement was greatest with regard to the following admission criteria (top 5): 1. serum potassium (threshold value <2.5 mmol/l was the criterion selected most); 2. arrhythmia; 3. hypoglycemia; 4. heart rate (threshold value <40 bpm was chosen most); 5. prolonged qt interval on an ECG. According to the two fictitious cases, the reason for admitting a patient with anorexia nervosa with milder symptoms was influenced by 'attitude'. Half of the respondents pointed out that the patient's cooperation plays a role in the decision to admit a patient with an eating disorder. CONCLUSION: Respondents reached a consensus regarding several admission criteria but the threshold values they gave varied substantially. Attitude towards the patient-group can sometimes influence the decision to admit a patient with anorexia nervosa to a general hospital. Internists and residents-in-training indicated they require detailed, carefully compiled guidelines which take into consideration the expected results and which emphasise the importance of obtaining the patient's cooperation.

Set-up uncertainty during breast radiotherapy. Image-guided radiotherapy for patients with initial extensive variation.

PURPOSE: The aim of this work was to establish a customized strategy for image-guided radiotherapy during whole breast irradiation. Risk factors associated with extensive errors were assessed. METHODS AND MATERIALS: A series of 176 consecutive breasts in 174 patients were retrospectively assessed. Electronic portal images from 914 medial and 807 lateral directions were reviewed. On the basis of the chest wall, the deviations between the simulation and each treatment were measured. The systematic (Σ) and random error (σ) of population, and the planning target volume (PTV) margin (2 Σ + 0.7σ) were calculated for each direction. Extensive set-up errors were defined as the fraction over the PTV margins in any direction. For extensive set-up errors, χ(2) tests and logistic regression analyses were conducted. RESULTS: The medial and lateral PTV margins for the right-left, superior-inferior, and anterior-posterior axes and the rotation of collimator were 2.6 and 2.4 mm, 4.6 and 4.6 mm, and 3.1 and 3.3 mm and 2.8 and 2.9 ° and cut-off values for extensive errors were 3, 5, and 4 mm and 3 °, respectively. In χ(2) tests, tumor in upper outer quadrant (p = 0.012) and chest wall thickness ≥ 2.0 cm (p = 0.003) for medial portals and age group (p = 0.036) for lateral portals were associated with extensive errors. In multivariate tests, the extensive error on the initial fraction had a high probability of extensive set-up errors in both medial (OR = 4.26, p < 0.001) and lateral portals (OR = 3.07, p < 0.001). CONCLUSION: In terms of the set-up uncertainty during breast irradiation, patients with extensive error in the initial treatment should be closely observed with serial image-guided radiotherapy.

Robotic thyroid surgery using bilateral axillo-breast approach: personal initial experience over two years.

AIM: Although endoscopic thyroid surgery is gaining wide acceptance, however, manual endoscopic operation also has shown several limitations. The advent of robotic surgical systems, such as the da Vinci surgical system (Intuitive Surgical, Mountain View, CA, USA), is expected to make it possible to overcome some limitations of manual endoscopic operation. Herein we report a single surgeon (H.Y.K.)'s initial two-year experience of new robotic thyroid operations using the bilateral axillo-breast approach (BABA), the approach which has definite advantages and recently has been widely used for the traditional endoscopic thyroid surgery. METHODS: Between July 2008 and July 2010, 93 patients underwent robotic thyroid surgery using the BABA, with the da Vinci-S surgical system, at the Korea University Anam Hospital, Seoul, Korea. The data on the patients' clinicopathological characteristics, operation types, operation times, surgical results, postoperative hospital stays and complications were collected in a prospective manner, and later evaluated. RESULTS: Seventy-two total thyroidectomies with or without central neck dissections mostly for the papillary carcinomas, twenty lobectomies with or without central neck dissections for the minute ­ smaller than 0.5 cm in their maximal diameter ­ papillary carcinomas, follicular neoplasms and benign tumors, and a bilateral subtotal lobectomy for the multinodular goiter were performed robotically. There was no conversion of robotic procedure to traditional endoscopic or open procedure. The mean total operation time was 288.5±48.0 minutes. The mean number of retrieved lymph nodes by the central neck dissection was 5.1±1.97 (range, 0-12). The mean hospital stay of the patients was 2.8±1.2 days. And the mean postoperative 3rd month serum thyroglobulin level in patients undergone total thyroidectomy was 0.3±0.14 ng/mL (range, 0.08-1.95). Three (3.2%) patients suffered from transient hoarseness postoperatively, but all of them recovered in three months. Transient hypocalcemias were observed in 17 out of 72 (23.6%) patients who had undergone total thyroidectomy, but none of them left permanent. No other complication, such as bleeding, infection, neither fluid collection, was observed. CONCLUSION: Our initial surgical results of robotic thyroid surgery using BABA demonstrate the feasibility and safety of the procedure in the treatment of benign tumors and early differentiated carcinomas.

[The method of radiographic examination anorectal area].

PURPOSE: Puborectal muscle (PRM) plays an important role in the continence. Its function is impaired in chronic constipation, fecal incontinence, especially after anorectal surgery. Assessment of PRM condition by the measurement of anorectal angle is not precise, the defecography requires special equipment and is associated with high doses of radiation. The purpose of this study is to propose another method of evaluation of anorectal function free of the above mentioned disadvantages. MATERIAL AND METHODS: The analysis of 475 studies of patients of all ages, including 79 without pathology anorectal area and 396 patients with different pathologies was done. They were examined by a method that differs from the usual barium enema by placing of radiopaque marker near the anus. RESULTS AND DISCUSSION: The weakness of PRM manifested by penetration of barium into the anal canal behind the tip of the enema. The prominent shortening of the anal canal, compared to age-related normal figures indicates the PRM failure. The finding of the anal canal shortening has the same diagnostic value as the perineum distendion revealed by defecography. The proposed method is simple, accurate, and does not apply large dose of radiation.

Translation and validation of the Revised-Algase Wandering Scale (community version) among Korean elders with dementia.

The purpose of this study was to examine the psychometric properties of a Korean translated version of the Revised Algase Wandering Scale, community version (K-RAWS-CV) among persons with dementia in Korea. A cross-sectional survey design was used. After established equivalence of the instrument using back-translation and a field test, 69 community dwelling family caregivers described the wandering behavior of their family members with dementia. The overall mean of the K-RAWS-CV was 1.73 (SD=0.61, range=1-3.87). Means of each subscale ranged from 1.44 (meal-time impulsivity, MI) to 2.04 (escape behavior, EB). The reliability alpha for the overall scale was 0.96 with reliabilities for subscales ranging from 0.82 (negative outcome, NO) to 0.93 (persistent walking, PW). The correlation between the overall K-RAWS-CV and each subscale ranged from 0.52 (overall and NO) to 0.82 (overall and PW) with a mean value of 0.66. Pearson's correlations between the level of cognitive impairment and each subscale of the K-RAWS-CV demonstrated significant, moderate relationships ranging from -0.24 (MI, RW, and MMSE) to -0.39 (PW, EB and MMSE). Mean differences between wanderers and non-wanderers were statistically significant for the K-RAWS-CV overall and all subscale except for MI. Results support the validity and reliability of the K-RAWS-CV overall and the six subscales.

Nuclear factor {kappa}B inactivation in the rat liver ameliorates short term total warm ischaemia/reperfusion injury.

BACKGROUND: In hepatic ischaemia/reperfusion injury, activated liver macrophages (Kupffer cells) are dominantly regulated by a transcription factor, nuclear factor kappaB (NFkappaB), with respect to expression of inflammatory cytokines, acute phase response proteins, and cell adhesion molecules. AIMS: We assessed whether inactivation of NFkappaB in the liver could attenuate total hepatic warm ischaemia/reperfusion injury. METHODS: We studied rats with hepatic overexpression of inhibitor kappaBalpha super-repressor (IkappaBalpha SR) caused by a transgene introduced using an adenoviral vector. Hepatic ischaemia/reperfusion injury was induced under warm conditions by total occlusion of hepatoduodenal ligament structures for 20 minutes, followed by reperfusion. Controls included uninfected and control virus (AdLacZ) infected rats. RESULTS: IkappaBalpha SR was overexpressed in Kupffer cells as well as in hepatocytes, blocking nuclear translocation of NFkappaB (p65) into the nucleus after reperfusion. Gene transfection with IkappaBalpha SR, but not with LacZ, markedly attenuated ischaemia/reperfusion injury, suppressing inducible nitric oxide synthase and nitrotyrosine expression in the liver. Moreover, no remarkable hepatocyte apoptosis was detected under IkappaBalpha SR overexpression. CONCLUSIONS: Adenoviral transfer of the IkappaBalpha SR gene in the liver ameliorates short term warm ischaemia/reperfusion injury, possibly through attenuation of hepatic macrophage activation.