Transplant candidates who accept a kidney labeled increased risk for disease transmission (IRD) accept a low risk of window period infection, yet those who decline must wait for another offer that might harbor other risks or never even come. To characterize survival benefit of accepting IRD kidneys, we used 2010-2014 Scientific Registry of Transplant Recipients data to identify 104 998 adult transplant candidates who were offered IRD kidneys that were eventually accepted by someone; the median (interquartile range) Kidney Donor Profile Index (KDPI) of these kidneys was 30 (16-49). We followed patients from the offer decision until death or end-of-study. After 5 years, only 31.0% of candidates who declined IRDs later received non-IRD deceased donor kidney transplants; the median KDPI of these non-IRD kidneys was 52, compared to 21 of the IRDs they had declined. After a brief risk period in the first 30 days following IRD acceptance (adjusted hazard ratio [aHR] accept vs decline: 2.06 , P = .008) (absolute mortality 0.8% vs. 0.4%), those who accepted IRDs were at 33% lower risk of death 1-6 months postdecision (aHR 0.67 , P = .006), and at 48% lower risk of death beyond 6 months postdecision (aHR 0.52 , P < .001). Accepting an IRD kidney was associated with substantial long-term survival benefit; providers should consider this benefit when counseling patients on IRD offer acceptance.
SummaryBackgroundMale circumcision reduces men’s risk of acquiring HIV and
some sexually transmitted infections from heterosexual exposure, and is
essential for HIV prevention in sub-Saharan Africa. Studies have also
investigated associations between male circumcision and risk of acquisition
of HIV and sexually transmitted infections in women. We aimed to review all
evidence on associations between male circumcision and women’s
health outcomes to benefit women’s health programmes.MethodsIn this systematic review we searched for peer-reviewed and grey
literature publications reporting associations between male circumcision and
women’s health outcomes up to April 11, 2016. All biomedical (not
psychological or social) outcomes in all study types were included. Searches
were not restricted by year of publication, or to sub-Saharan Africa.
Publications without primary data and not in English were excluded. We
extracted data and assessed evidence on each outcome as high, medium, or low
consistency on the basis of agreement between publications; outcomes found
in fewer than three publications were indeterminate consistency.Findings60 publications were included in our assessment. High-consistency
evidence was found for five outcomes, with male circumcision protecting
against cervical cancer, cervical dysplasia, herpes simplex virus type 2,
chlamydia, and syphilis. Medium-consistency evidence was found for male
circumcision protecting against human papillomavirus and low-risk human
papillomavirus. Although the evidence shows a protective association with
HIV, it was categorised as low consistency, because one trial showed an
increased risk to female partners of HIV-infected men resuming sex early
after male circumcision. Seven outcomes including HIV had low-consistency
evidence and six were indeterminate.InterpretationScale-up of male circumcision in sub-Saharan Africa has public health
implications for several outcomes in women. Evidence that female partners
are at decreased risk of several diseases is highly consistent. Synergies
between male circumcision and women’s health programmes should be
explored.FundingUS Centers for Disease Control and Prevention and Jhpiego
The purpose of this study was to measure metabolic changes in mesenchymal stem cells (MSCs) placed in osteogenic medium by autofluorescence spectroscopy. MSCs were plated in stem cell-supporting or osteogenic medium and imaged. Shift from the basic growth environment to the inductive osteogenic environment was confirmed by reverse transcription-polymerase chain reaction. Reduced pyridine nucleotides were detected by exciting near 366 nm and measuring fluorescence at 450 nm, and oxidized flavoproteins were detected by exciting at 460 nm and measuring fluorescence at 540 nm. The ratio of these fluorescence measurements, reduction-oxidation (redox) fluorometry, is a noninvasive measure of the cellular metabolic state. The detected pyridine nucleotide to flavoprotein ratio decreased upon transitioning from the stem cell to the differentiated state, as well as with increasing cell density and cell-cell contact. MSC metabolism increased upon placement in differentiating medium and with increasing cell density and contact. Redox fluorometry is a feasible, noninvasive technique for distinguishing MSCs from further differentiated cells.
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