1,720,998 research outputs found
Solid Organ Transplantation: Immunology, Indications,Techniques, andEarly Complications
No full textIn Italy, in Europe, and in the world, the kidney transplantation from a living donor
is the main treatment to satisfy the aspiration for a better quality of life of patients
with end-stage renal disease.
There are many reasons why the medical physicians (nephrologists, surgeons,
etc.) suggest patients and their families taking into consideration the option of kidney
donation from living donor instead of applying for the waiting list from deceased
donor. The main arguments can be ascribed to two main points:
The transplantation from a living donor has better clinical results than the transplantation
from deceased donor. This fi rst point is well demonstrated by a recent
study [ 1 ] that compares the transplantation results of completely HLAmismatched
living and completely HLA-matched deceased. The objective of the
study was to evaluate the impact of HLA matching on the outcome of the kidney
transplantation. It demonstrated the risk of graft failure increased proportionally
with the number of HLA mismatches both in deceased donor and living donor
transplantations. At the same time, the relative risk of graft failure for living
donor transplantation (even with six mismatches) is the same as for deceased
donor transplantation with 0–2 mismatches.
The supply of kidneys from donors with brain death is not suffi cient to satisfy the
claim of kidney transplantation both in the present and in the future. In developed
countries (Europe, USA, etc.), there is a constant reduction of donors with brain
death. This is not only in the case of brain traumas, but also in the case with cerebrovascular accidents typical of the old age. In other words, it is no longer
possible to consider the category of “marginal” donors, utilized since more than
20 years, as an unlimited source, but this is a progressively reducing source. This
is because of the enhanced health of elderly people thanks to a more appropriate
lifestyle and to the widespread use of drugs preventing cerebrovascular
diseases.
In some countries (such as Italy, France, Spain, etc.), we observed an organization
delay in the management of transplantation from living donors compared to others
countries (USA, the Netherlands, UK, Sweden, etc.). This may be caused by the different
attitude of doctors in promoting living donor transplantation in its several
forms: direct donations from related donors, unrelated but family donors, and anonymous
samaritan donors and indirect donations (such as crossover or domino).
In those countries where all these options are activated (such as the Netherlands),
the number of living donor transplantations is higher than the number of deceased
donor transplantations. Roodnat et al. [ 2 ] illustrated the successful expansion of the
pool of living donor by alternative living donation programs. The reason of this success
is due to several factors including an effi cient team for the living donor transplantation,
the increasing number of potential donors, and the use of alternative
programs.
It is essential the role of the living donor transplantation since the preliminary
base of the chronic kidney disease (CKD). Starting in the third stage of CKD,
awareness and health education in the patients and in their family are very important
to promote within the family the practice of living donation. The promptness and
effectiveness of this phenomenon allow the preemptive transplantation, which represents
the best solution in clinical and social terms. It is also of great psychological
comfort for the family reaching this goal. How can we ensure the correct understanding of the donation from living donor
at the level of the patient and his/her family? It is important to give a simple and
exhaustive response to the sources of doubts and concerns coming from all the
actors involved: the receiving patient, the potential donors (better if more than one),
the nephrologist, the surgeon, the nurse, the psychologist, etc. There are four main
arguments in favor of living kidney transplantation:
1. The clinical trend (survival, complications, etc.) in case of living donor transplantation
is better than in deceased donor transplantation.
2. The living donor transplantation increases the overall supply of kidney
transplant.
3. It is a safe clinical practice for the donor.
4. It gives the opportunity of preemptive transplantation. It is advisable to arrange a presentation to the enlarged family during two or three
consecutive meetings. Joint meetings with several family groups with their relatives/
patients at the same stage of the disease are of crucial importance. Thanks to such
efforts, the practice of the transplantation from living donor will strengthen in the
Southern Europe Countrie
Mycophenolate Mofetil: A Possible Alternative Treatment for IgA Nephropathy
No full textIgA nephropathy (IgAN) is the most common primary glomerulonephritis in developed countries and a leading cause of chronic kidney disease. IgAN is a mesangial proliferative glomerulonephritis characterized by diffuse mesangial deposition of IgA, often accompanied by the deposition of IgG and the C3 component of complement in a similar distribution. This condition is in most cases oligosymptomatic, often discovered coincidentally. Currently, there is no specific treatment available for IgAN and the use of immunosuppression therapy is debated. Due to immune-mediated pathogenic nature of IgAN, therapy with mycophenolate mofetil (MMF), a potent immunosuppressive agent, could be effective in patients at risk for progressive disease. In this paper, we discuss the case of an IgAN patient treated with MMF at our center, followed by a review of the literature and our previous experience on the potential renoprotective effects of MMF in IgAN patients with different clinical presentation, despite adequate angiotensin blockade and steroid therapy
Hemodiafiltration reduces mortality and prevents comorbidities? Technical innovations to improve hemodynamics and efficacy. [L'emodiafiltrazione riduce la mortalita' e previene le comorbidita'? Innovazioni tecniche per migliorare emodinamica ed efficacia.]
No full textHemodiafiltration (HDF) is a dialysis technique characterized by the combination of diffusive and convective depuration. This allows the removal of both low and medium-high molecular weight toxins, keeping the intradialytic hemodynamic status of the patient more stable. Technical innovations in HDF technology aim to enhance the depurative efficacy of the treatment and reduce intradialytic hypotensive events and intolerance. Among these techniques, mixed HDF, middilution HDF and HFR Aequilibrium have particular innovative significance. Mixed HDF and mid-dilution HDF are clinically indicated to enhance the depurative efficacy of HDF and HFR Aequilibrium may serve to widen the depurative range in patients suffering from the malnutrition-inflammation complex syndrome and intradialytic hypotension or intolerance. Mixed HDF and mid-dilution HDF allow to improve the infusion volumes thanks to the intradialytic modulation of the pre/post-infusion ratio (mixed HDF) or the high-volume intradialyzer pre/postinfusion (mid-dilution HDF). HFR Aequilibrium is based on a) separation between convection (first chamber) and diffusion with body weight decrease (second chamber); b) infusion of endogenous ultrafiltrate purified by resin adsorption; c) use of dialysate sodium and ultrafiltration profiles automatically elaborated by a mathematical model incorporated in the software of the dialysis machine
Increase in Serum Amylase and Resistive Index After Kidney Transplant Are Biomarkers of Delayed Graft Function
No full textBACKGROUND:
Both amylase and resistive index (RI) are routinely measured after kidney transplant and proposed as markers of delayed graft function (DGF).
MATERIAL AND METHODS:
This retrospective cross-sectional study analyzed amylase and RI in 269 renal transplant recipients before and after transplantation, and at discharge. An increase above 20% of total amylase with/without RI>0.7 were evaluated as prognostic markers of DGF, hospitalization length and risk of rejection.
RESULTS:
Serum amylase increase >20% was found in 103/269 (38.3%) patients who showed DGF (45.6% vs. 25.3%, p=0.001) and had lower estimated glomerular filtration rate compared to those with an amylase increase 20% and RI>0.7 was associated with higher DGF occurrence (65% vs. 24%, p<0.001), longer hospital stay, lower eGFR at discharge, and higher risk of rejection.
CONCLUSION:
Patients with concomitant amylase increase >20% and RI>0.7 might require closer monitoring to diagnose DGF early and modify the therapeutic approach accordingly
Hematopoietic Cell and Renal Transplantation in Plasma Cell Dyscrasia Patients.
Full text linkGammopathies, multiple myeloma, and amyloidosis are plasma dyscrasias characterized by clonal proliferation and immunoglobulin overproduction. Renal impairment is the most common and serious complication with an incidence of 20-30% patients at the diagnosis. Kidney transplant has not been considered feasible in the presence of plasma dyscrasias because the immunosuppressive therapy may increase the risk of neoplasia progression, and paraproteins may affect the graft. However, recent advances in clinical management of multiple myeloma and other gammopathies allow considering kidney transplant as a possible alternative to dialysis. Numerous evidence indicates the direct relationship between hematological remission and renal function restoring. The combination of kidney and hematopoietic cell transplant has been reported as a promising approach to reestablish end-organ function and effectively treat the underlying disease. This review describes current protocols used to perform kidney transplantation in patients with plasma dyscrasias
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
- …
