Challenges in decision-making support processes regarding living kidney donation: A qualitative study

Wada Y., Ueno T., Umeshita K., et al. Challenges in decision-making support processes regarding living kidney donation: A qualitative study. Journal of Renal Care , (2024); https://doi.org/10.1111/jorc.12494.Background: Previous studies on decision-making of living kidney donors have indicated issues regarding donors' autonomy is inherent in decision-making to donate their kidney. Establishing effective decision-making support that guarantees autonomy of living kidney donor candidates is important. Objectives: The aim of this study was to identify the difficulties in the decision-making support when clinical transplant coordinators advocating for the autonomy of donor candidates of living donor kidney transplantation and to identify the methods to deal with these difficulties. Design: A qualitative descriptive study. Participants: Ten clinical transplant coordinators supporting living kidney donors. Approach: Semi-structured interviews were conducted using an interview guide. The modified grounded theory approach was utilised to analyse. Results: Three categories related to difficulties were as follows: issues inherent to the interaction between coordinators, donor candidates and their families; issues regarding the environment and institutional background in which coordinators operate; and emotional labour undertaken by coordinators in the decision-making support process. Additionally, five categories related to methods were as follows: assessing the autonomy of donor candidates based on the coordinators nursing experience; interventions for the donor candidates and their family members based on the coordinators nursing experience; smooth coordination with medical staff; clarifying and asserting their views as coordinators; and readiness to protect the donor candidates. Conclusion: The involvement of highly experienced coordinators with excellent and assertive communication skills as well as the ability to reflect on their own practices is essential. Moreover, we may need to fundamentally review the transplant community, where power domination is inherent

Abnormal Tei index predicts poor left ventricular mass regression and survival after AVR in aortic stenosis patients

SummaryBackgroundA Tei index is known to reflect overall cardiac performance including systolic and diastolic function in a variety of heart disease. We investigated the relationship between preoperative Tei index and postoperative left ventricular (LV) mass regression and survival after aortic valve replacement (AVR) for aortic valve stenosis (AS).MethodsOne hundred fifty-four patients with AS were classified into a group with abnormal (Abn) LV function (n=47, 0.45≤Tei index) and a group with normal (Nor) LV function (n=107, Tei index<0.45). The pre- and postoperative echocardiographic variables including LV dimension, LV wall thickness, and LV mass regression as well as 6-year survival were compared between the two groups.ResultsThere was a significant difference in both absolute and relative LV mass index (LVMI) regression (P=0.004 and 0.0007). Multiple linear regression analysis revealed that the preoperative LVMI, Tei index, and follow-up period were independent predictors of LVMI regression after AVR. Thirteen patients died (valve-related death in 5). Although the overall survival rate in the Nor-LV group (92.8%) was significantly better than that in the Abn-LV group (71.6%), there was no significant difference in survival free from valve-related death.ConclusionsPreoperative Tei index can be one of the significant predictors of LVMI regression and overall survival after AVR

Centrifuge Model Tests of Tieback Anchors and Drainage Pipes for Stabilization of Slopes under Earthquake Loads

Tieback anchors are widely used for the stabilization of natural and manmade slopes in Japan. The interactions between tieback anchors and slopes under seismic loading need to be understood to develop rational design concepts and installation methods in earthquake prone areas. We conducted centrifuge model tests to examine the characteristics of dynamic and residual loads on tieback anchors installed in slopes subjected to seismic loads. If the model slope contained a saturated zone, circular failure occurred even with pre-tensioned tieback anchors, and the amplitude of the oscillating loads on the tieback anchors was very high. This suggested that excess pore water pressure may cause the design capacity of the anchors to be exceeded, depending on the stability of the slope and intensity of the earthquake. Additional tests were therefore conducted with model slopes with drainage pipes installed (perforated plastic tubes). The drainage pipes significantly reduced pore water pressure, which in turn enhanced the stability of the slope and reduced the loads on the tieback anchors. We conclude that installation of drainage pipes in earthfill slopes would enable the selection of smaller ground anchors and potentially reduce overall construction costs

Up-regulation of microRNA-21 correlates with lower kidney cancer survival.

BackgroundMicroRNA-21 is up-regulated in a variety of cancers like, breast, colorectal, lung, head and neck etc. However, the regulation of miR-21 in renal cell carcinoma (RCC) has not yet been studied systematically.Methods and resultsWe measured miR-21 levels in 54 pairs of kidney cancers and their normal matched tissues by real-time PCR. The expression level of miR-21 was correlated with 5 year survival and the pathological stage. Functional studies were done after inhibiting miR-21 in RCC cell lines. We studied in vitro and in vivo effects of the chemo preventive agent genistein on miR-21 expression. In 48 cases (90%), miR-21 was increased. All patients with low miR-21 expression survived 5 years, while with high miR-21 expression, only 50% survived. Higher expression of miR-21 is associated with an increase in the stage of renal cancer. Functional studies after inhibiting miRNA-21 in RCC cell lines show cell cycle arrest, induction of apoptosis and reduced invasive and migratory capabilities. Western blot analysis showed an increase in the expression of p21 and p38 MAP kinase genes and a reduction in cyclin E2. Genistein inhibited the expression of miR-21 in A-498 cells and in the tumors formed after injecting genistein treated A-498 cells in nude mice besides inhibiting tumor formation.ConclusionsThe current study shows a clear correlation between miR-21 expression and clinical characteristics of renal cancer. Thus we believe that miR-21 can be used as a tumor marker and its inhibition may prove to be useful in controlling cancers with up-regulated miR-21

SFQ counter-based precomputation for large-scale cryogenic VQE machines

The variational quantum eigensolver (VQE) is a promising candidate that brings practical benefits from quantum computing. However, the required bandwidth in/out of a cryostat is a limiting factor to scale cryogenic quantum computers. We propose a tailored counter-based module with single flux quantum circuits in 4-K stage which precomputes a part of VQE calculation and reduces the amount of inter-temperature communication. The evaluation shows that our system reduces the required bandwidth by 97%, and with this drastic reduction, total power consumption is reduced by 93% in the case where 277 VQE programs are executed in parallel on a 10000-qubit machine.Comment: 7 pages, 5 figures, 3 tables. Accepted by DAC'24 WIP poster sessio