RESUMO
Prophylactic ureteric stenting in renal transplantation reduces major urological complications; however, morbidity is related to the indwelling duration of a stent. We aimed to determine the optimal duration for stents in this clinical setting. Patients (aged 2-75 years) from six UK hospitals who were undergoing renal transplantation were recruited and randomly assigned to either early stent removal at 5 days (without cystoscopy) or late removal at 6 weeks after transplantation (with cystoscopy). The primary outcome was a composite of stent-related complications defined as pain, visible hematuria, migration, fragmentation, and urinary tract infections (UTIs) within 3 mo of transplantation. Between May 2010 and Nov 2013, we randomly assigned 227 participants, with 205 included in the final analysis of the primary outcome. Stent-related complications were significantly higher in the late versus early stent removal groups (36 of 126 [28.6%] vs. 6 of 79 [7.6%]; p < 0.001). The majority of stent complications consisted of UTIs, with an incidence of 31 of 126 (24.6%) in the late group compared with 6 of 79 (7.6%) in the early group (p = 0.004). We found early stent removal on day 5 significantly reduced stent-related complications and improved quality of life in the first 3 mo after transplantation (ISRCTN09184595).
Assuntos
Remoção de Dispositivo , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Qualidade de Vida , Stents/efeitos adversos , Ureter/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Seguimentos , Taxa de Filtração Glomerular , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Humanos , Falência Renal Crônica/cirurgia , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Fatores de Tempo , Transplantados , Infecções Urinárias/prevenção & controle , Adulto JovemRESUMO
We and others have previously described signatures of tolerance in kidney transplantation showing the differential expression of B cell-related genes and the relative expansions of B cell subsets. However, in all of these studies, the index group-namely, the tolerant recipients-were not receiving immunosuppression (IS) treatment, unlike the rest of the comparator groups. We aimed to assess the confounding effect of these regimens and develop a novel IS-independent signature of tolerance. Analyzing gene expression in three independent kidney transplant patient cohorts (232 recipients and 14 tolerant patients), we have established that the expression of the previously reported signature was biased by IS regimens, which also influenced transitional B cells. We have defined and validated a new gene expression signature that is independent of drug effects and also differentiates tolerant patients from healthy controls (cross-validated area under the receiver operating characteristic curve [AUC] = 0.81). In a prospective cohort, we have demonstrated that the new signature remained stable before and after steroid withdrawal. In addition, we report on a validated and highly accurate gene expression signature that can be reliably used to identify patients suitable for IS reduction (approximately 12% of stable patients), irrespective of the IS drugs they are receiving. Only a similar approach will make the conduct of pilot clinical trials for IS minimization safe and hence allow critical improvements in kidney posttransplant management.
Assuntos
Biomarcadores/metabolismo , Rejeição de Enxerto/diagnóstico , Sobrevivência de Enxerto/imunologia , Tolerância Imunológica/imunologia , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Adulto , Idoso , Linfócitos B/efeitos dos fármacos , Linfócitos B/imunologia , Linfócitos B/metabolismo , Estudos de Casos e Controles , Feminino , Seguimentos , Taxa de Filtração Glomerular , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/metabolismo , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Tolerância Imunológica/efeitos dos fármacos , Falência Renal Crônica/complicações , Falência Renal Crônica/cirurgia , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To investigate whether public knowledge, attitudes, desire for social distance and reported contact in relation to people with mental health problems have improved in England during the Time to Change (TTC) programme to reduce stigma and discrimination 2009-2015. METHODS: Using data from an annual face-to-face survey of a nationally representative sample of adults, we analysed longitudinal trends in the outcomes with regression modelling using standardised scores of the measures overall and by age and gender subgroups. RESULTS: There were improvements in all outcomes. The improvement for knowledge was 0.17 standard deviation units in 2015 compared to 2009 (95% CI 0.10, 0.23); for attitudes 0.20 standard deviation units (95% CI 0.14, 0.27) and for social distance 0.17 standard deviation units (95% CI 0.11, 0.24). Survey year for 2015 vs. 2009 was associated with a higher likelihood of reported contact (OR 1.32, 95% CI 1.13, 1.53). Statistically significant interactions between year and age suggest the campaign had more impact on the attitudes of the target age group (25-45) than those aged over 65 or under 25. Women's reported contact with people with mental health problems increased more than did men's. CONCLUSION: The results provide support for the effectiveness of TTC.
Assuntos
Transtornos Mentais/psicologia , Opinião Pública , Adolescente , Adulto , Idoso , Inglaterra , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Distância Psicológica , Caracteres Sexuais , Estigma Social , Adulto JovemRESUMO
Research suggest that Hispanics in the U.S. are disproportionately affected by the consequences of intimate partner violence. Nevertheless, few intimate partner violence prevention interventions have been developed to address the unique needs and preferences of this population. The Partnership for Domestic Violence Prevention is a community-based participatory research project that assessed the needs and preferences for prevention programs for Hispanics in Miami-Dade County. Nine focus groups with domestic violence service providers, victims and general community members were conducted (N = 76). Four major themes emerged from the focus groups. These included immigrants and teens as the highest priority groups to target in prevention efforts, culture as a double-edged sword, the system that helps and hurts the victim, and the need for wide-scale prevention programs that would reach Hispanics systematically. The results from this study have important implications for the development of intimate violence prevention interventions targeting Hispanics in the U.S.
Assuntos
Violência Doméstica/prevenção & controle , Hispânico ou Latino/psicologia , Adulto , Pesquisa Participativa Baseada na Comunidade , Cultura , Violência Doméstica/etnologia , Violência Doméstica/psicologia , Feminino , Florida , Grupos Focais , Necessidades e Demandas de Serviços de Saúde , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto JovemRESUMO
A high body mass index (BMI) is commonly used as an index of overweight and obesity. There is persistent evidence of high heritability for variation in BMI, but the effects of common environment appear inconsistent across different European countries. Our objective was to compare genetic and environmental effects on BMI in a sample of twins from two different European countries with distinct population and cultural backgrounds. We analysed data of adult female twins from the Netherlands Twin Register (222 monozygotic [MZ] and 103 dizygotic [DZ] pairs) and the Murcia Twin Register (Spain; 202 MZ and 235 DZ pairs). BMI was based on self-reported weight and height. Dutch women were taller and heavier, but Spanish women had a significantly higher mean BMI. The age related weight increase was significantly stronger in the Spanish sample. Genetic analyses showed that genetic factors are the main contributors to variation in height, weight, and BMI, within both countries. For height and weight, estimates of genetic variances did not differ, but for height, the estimate for the environmental variance was significantly larger in Spanish women. For BMI, both the genetic and the environmental variance components were larger in Spanish than in Dutch women.
Assuntos
Índice de Massa Corporal , Característica Quantitativa Herdável , Adulto , Estatura/genética , Peso Corporal/genética , Feminino , Variação Genética , Humanos , Países Baixos , Sistema de Registros , Espanha , Gêmeos Dizigóticos , Gêmeos MonozigóticosRESUMO
BACKGROUND: Several studies indicate that changes in cerebrospinal fluid (CSF) composition depend on the disease stage and reflect modification of brain energy metabolism (BEM). Also, it has been reported that a decline in cognitive functions may be mitigated by incorporating nutraceuticals in the diet. OBJECTIVE: Assuming the beneficial effect of nutraceuticals on BEM and oxidative damage, the aim of this study was to determine if the administration of a nutraceutical compound results in changes of select CSF biomarkers in healthy adult Beagle dogs. METHODS: Two separate CSF and blood samples were obtained from 11 healthy adult Beagle dogs, before and after 50 days of treatment with a veterinary combined nutraceutical. CSF analysis included a total nucleated cell count, total protein, glucose, sodium, chloride, potassium, pyruvate, and lactate concentrations, and calculation of lactate/pyruvate ratio. CBC and serum biochemistry were also performed. The Wilcoxon test was used to analyze the significance of the changes after nutraceutical treatment. RESULTS: All studied variables remained within reference intervals, before and after treatment. A significant increase in CSF sodium and glucose concentration, and a decrease in lactate levels, was observed after treatment (P < .05), and the lactate/pyruvate ratio was decreased after treatment (P = .05). In serum, sodium and chloride concentrations were significantly increased (P < .05), and creatinine concentration was significantly decreased (P < .05) after treatment. CONCLUSIONS: After 50 days of treatment with a nutraceutical compound, CSF glucose, sodium, and lactate concentrations, and L/P ratio were significantly different, suggesting an influence of nutraceuticals' administration on CSF composition.
Assuntos
Encéfalo/efeitos dos fármacos , Suplementos Nutricionais , Animais , Biomarcadores/metabolismo , Encéfalo/metabolismo , Cloretos/líquido cefalorraquidiano , Transtornos Cognitivos/prevenção & controle , Creatinina/líquido cefalorraquidiano , Doenças do Cão/prevenção & controle , Doenças do Cão/psicologia , Cães , Metabolismo Energético/efeitos dos fármacos , Feminino , Glucose/líquido cefalorraquidiano , Lactatos/líquido cefalorraquidiano , Masculino , Ácido Pirúvico/líquido cefalorraquidiano , Sódio/líquido cefalorraquidianoAssuntos
Doenças Cardiovasculares/complicações , Retinopatia Hipertensiva/diagnóstico , Doenças Retinianas/etiologia , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/patologia , Angiografia Coronária , Humanos , Retinopatia Hipertensiva/patologia , Masculino , Doenças Retinianas/patologiaRESUMO
No disponible
Assuntos
Humanos , Masculino , Idoso , Angina Instável/complicações , Cateterismo/instrumentação , Cateterismo/métodos , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco , Tropicamida/uso terapêutico , Retina/patologia , Retina , Ecocardiografia/métodos , Oftalmoscopia/métodos , Oftalmoscopia , Angioplastia/métodos , Angioplastia , Retina/anatomia & histologia , Retina/fisiopatologiaRESUMO
In most assessment instruments, distinct items are designed to measure a trait, and the sum score of these items serves as an approximation of an individual's trait score. In interpreting group differences with respect to sum scores, the instrument should measure the same underlying trait across groups (e.g., male/female, young/old). Differences with respect to the sum score should accurately reflect differences in the latent trait of interest. A necessary condition for this is that the instrument is measurement invariant. In the current study, the authors illustrate a stepwise approach for testing measurement invariance with respect to sex in a four-item instrument designed to assess disordered eating behavior in a large epidemiological sample (1,195 men and 1,507 women). This approach can be applied to other phenotypes for which group differences are expected. Any analysis of such variables may be subject to measurement bias if a lack of measurement invariance between grouping variables goes undetected.