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Objective: To report a single-center 10-year experience of outcomes of kidney transplantation in African Americans (AAs) vs Caucasian Americans (CA) and to propose ways in which to improve kidney transplant outcomes in AAs, increased access to kidney transplantation, prevention of kidney disease, and acceptance of organ donor registration rates in AAs. Methods: We compared outcomes of deceased donor (DD) and living donor (LD) renal transplantation in AAs vs CAs in 772 recipients of first allografts at our transplant center from January 1995 to March 2004. For DD and LD transplants, no significant differences in gender, age, body mass index, or transplant panel reactive antibody (PRA) existed between AA and CA recipients. Results: Primary diagnosis of hypertension was more common in AA, DD, and LD recipients. Significant differences for DD transplants included Medicaid insurance in 23% AA compared with 7.0% CA (P <.0001) and more frequent diabetes mellitus type 2 in AAs (15% vs 4.1%, P = .0009). Eighty-three percent of AAs had received hemodialysis compared with 72% of CAs (P = .02). AAs endured significantly longer pretransplant dialysis (911 ± 618 vs 682 ± 526 days CA, P = .0006) and greater time on the waiting list (972 ± 575 vs 637 ± 466 days CA, P <.0001). In DD renal transplants, AAs had more human leukocyte antigen (HLA) mismatches than CAs (4.1 ± 1.4 vs 2.7 ± 2.1, P <.0001). Mean follow-up for survivors was 7.1 ± 2.5 years. Among LD transplants, graft survival and graft function were comparable for AAs and CAs; however, among DD transplants, graft function and survival were substantially worse for AAs (P = .0003). In both LD and DD transplants, patient survival was similar for AAs and CAs. Conclusion: Our data show that AAs receiving allografts from LDs have equivalent short- and long-term outcomes to CAs, but AAs have worse short- and long-term outcomes after DD transplantation. As such, we conclude that AAs should be educated about prevention of kidney disease, the importance of organ donor registration, the merits of LD over DD, and encouraged to seek LD options. [ABSTRACT FROM AUTHOR]

Synthetic peptide and peptido-mimetic filaments and tubes represent a diverse class of nanomaterials with a broad range of potential applications, such as drug delivery, vaccine development, synthetic catalyst design, encapsulation, and energy transduction. The structures of these filaments comprise supramolecular polymers based on helical arrangements of subunits that can be derived from self-assembly of monomers based on diverse structural motifs. In recent years, structural analyses of these materials at near-atomic resolution (NAR) have yielded critical insights into the relationship between sequence, local conformation, and higher-order structure and morphology. This structural information offers the opportunity for development of new tools to facilitate the predictable and reproducible de novo design of synthetic helical filaments. However, these studies have also revealed several significant impediments to the latter process – most notably, the common occurrence of structural polymorphism due to the lability of helical symmetry in structural space. This article summarizes the current state of knowledge on the structures of designed peptide and peptido-mimetic filamentous assemblies, with a focus on structures that have been solved to NAR for which reliable atomic models are available. [ABSTRACT FROM AUTHOR]

We describe the co-assembly of two different building units: collagen-mimetic peptides and DNA origami. Two peptides CP++ and sCP++ are designed with a sequence comprising a central block (Pro-Hyp-Gly) and two positively charged domains (Pro-Arg-Gly) at both N- and C-termini. Co-assembly of peptides and DNA origami two-layer (TL) nanosheets affords the formation of one-dimensional nanowires with repeating periodicity of ~10 nm. Structural analyses suggest a face-to-face stacking of DNA nanosheets with peptides aligned perpendicularly to the sheet surfaces. We demonstrate the potential of selective peptide-DNA association between face-to-face and edge-to-edge packing by tailoring the size of DNA nanostructures. This study presents an attractive strategy to create hybrid biomolecular assemblies from peptideand DNA-based building blocks that takes advantage of the intrinsic chemical and physical properties of the respective components to encode structural and, potentially, functional complexity within readily accessible biomimetic materials. [ABSTRACT FROM AUTHOR]

To understand Black men’s healthcare and social needs and determine if the resources that healthcare systems offer meet expectations. We surveyed men who had previously participated in at least one Minority Men’s Health Fair in Cleveland, Ohio. In this descriptive study, we spoke with men up to three times (i.e., phases) between May and October 2020 by email and/or telephone. Phase 1 was a needs assessment survey. Phase 2 involved outreach to those who identified a need to provide a resource. Phase 3 determined whether the resource met individuals’ needs. We described the demographic characteristics of the survey respondents, the percentage of men reporting a need and wanting a resource, and whether the resource resolved their need. Of the 768 men contacted, 275 completed the survey (36% response rate). The majority of respondents were 50–69 years old, identified as Black, and had at least a bachelor’s degree. Eighty-five percent reported a need, of which wellness, financial, and healthcare access were among the top-reported needs. Among the men identifying a need, 35% were interested in a resource. Resources that were provided for employment, behavioral health, oral health, vision, or wellness needs were deemed insufficient. A few individuals reported that resources for food/personal hygiene, financial support, health care access, annual health screening, and medication met their needs. Among men with healthcare and social needs, only a fraction were interested in a resource, and fewer reported that the resource met their needs. These results warrant a greater understanding of what constitutes a resolution of healthcare and social needs from patients’ perspectives. [ABSTRACT FROM AUTHOR]

Purpose: This study compared a novel self-management (TargetEd MAnageMent Intervention [TEAM]) versus treatment as usual (TAU) to reduce stroke risk in African American (AA) men.Design: Six-month prospective randomized controlled trial with outcomes evaluated at baseline, 3 months, and 6 months.Setting: Academic health center.Participants: Thirty-eight (age < 65) AA men who had a stroke or transient ischemic attack and a Barthel index score of >60 were randomly assigned to TEAM (n = 19) or TAU (n = 19).Intervention: Self-management training, delivered in 1 individual and 4 group sessions (over 3 months).Measures: Blood pressure, glycosylated hemoglobin (HbA1c), lipids, medication adherence, weight, and standardized measures of health behaviors (diet, exercise, smoking, substances), depression, and quality of life. Qualitative assessments evaluated the perspectives of TEAM participants.Analysis: T tests for paired differences and nonparametric tests. Thematic content qualitative analysis.Results: Mean age was 52.1 (standard deviation [SD] = 7.4) and mean body mass index was 31.4 (SD = 7.4). Compared to TAU, TEAM participants had significantly lower mean systolic blood pressure by 24 weeks, and there was also improvement in HbA1c and high-density lipoprotein cholesterol ( P = .03). Other biomarker and health behaviors were similar between groups. Qualitative results suggested improved awareness of risk factors as well as positive effects of group support. [ABSTRACT FROM AUTHOR]

Renal transplantation has profound improvements in mortality, morbidity, and overall quality of life compared to renal replacement therapy. This report aims to illustrate the use of ex-vivo partial nephrectomy in a patient with a renal angiomyolipoma prior to living donor transplantation. The surgical outcomes of the donor nephrectomy and recipient transplantation are reported with 2 years of follow-up. Both the donor and recipient are healthy and without any significant comorbidities. In conclusion, urologic techniques such as partial nephrectomy can be used to expand the living donor pool in carefully selected and well informed transplant recipients. Our experience demonstrated a safe and positive outcome for both the recipient and donor, and is consistent with other reported outcomes in the literature. [ABSTRACT FROM AUTHOR]

Objective: To report a novel surgical approach of transvaginal hybrid natural orifice transluminal surgery (NOTES) living donor nephrectomy. We conceptualized this approach by incorporating 2 existing concepts: laparoendoscopic single-site surgery and NOTES. Materials and Methods: After thorough consent and under institutional review board approval, a 61-year-old woman volunteered to donate her kidney through hybrid transvaginal NOTES. Under general anesthesia, she was placed in a modified right lateral decubitus position. A SILS port and an 8-mm trocar were placed through the same umbilical incision. The GelPoint port was placed transvaginally via the posterior fornix, and the robot was docked. After dissection of the left kidney in preparation for extraction, the robot was undocked, and the retrieval bag was inserted through the GelPoint port. The graft was bagged before vessel stapling and extracted without breaching the bag. The kidney was delivered to the perfusion table with a clean pair of gloves without contamination with the bag exterior. Results: Donor nephrectomy was successfully completed without conversion or perioperative complications. The total operative time was 240 minutes, the warm ischemic time was 5.8 minutes, and the estimated blood loss was 75 mL. No complications occurred and extra ports were not needed. The patient was discharged after an uneventful 48-hour stay. Her creatinine was 1.0 mg/dL at 4 weeks of follow-up. The recipient was given pulse steroids for biopsy-proven acute rejection, and her serum creatinine was 1.16 mg/dL at 4 weeks postoperatively. Conclusion: Transvaginal hybrid NOTES robotic donor nephrectomy is feasible. Additional advances in robotic technology are awaited for development of this approach and to foster its clinical application. [ABSTRACT FROM AUTHOR]

BACKGROUND: Prostate cancer is the most frequently diagnosed malignancy in men in the United States, with evenhigher prevalence and death rates among black men. The authors sought to compare trends in prostate-specific anti-gen (PSA), age, and prostate-cancer detection among black and white men in our region during a 16-year period.METHODS: This was a retrospective study of patient archives between 1990 through 2006. Data collection wasaccomplished by examining patients' charts and electronic medical records. Data from 5570 patients, of whom 911were black, were analyzed statistically by testing and comparing parameters over time. RESULTS: During this 16-year period, mean age at the time of initial diagnostic prostate biopsy did not change in either group, despite what wehad believed about the effects of patient education and screening campaigns. However, prostate-cancer detectionrates did decrease during the time period studied. Over time, the authors also observed significant decreases in thesensitivity and specificity of PSA as a screening tool. Indeed, analysis of more recent cases demonstrated a positivepredictive value comparable to a coin toss. While Gleason scores remained relatively stable over time, reporting ofprostate intraepithelial neoplasia (PIN) and inflammation increased. CONCLUSIONS: Using lower PSA thresholds, promoting younger screening age, and increasing efforts to educate the public have not seemed to influence age attime of diagnostic testing, which may reflect other factors such as usefulness of screening, physician referral patterns,patient compliance, and other sociodemographic issues. The usefulness of PSA as a screening tool appears to bediminishing. [ABSTRACT FROM AUTHOR]

OBJECTIVE To investigate the effect of placing a prophylactic drain during renal transplantation on the incidence of lymphocele, wound complication and deep venous thrombosis (DVT) in renal transplant recipients induced with sirolimus vs calcineurin inhibitors (CNI), as sirolimus-based immunosuppression is a risk factor for the formation of fluid collections after transplantation. PATIENTS AND METHODS We analysed 165 consecutive adult renal transplant patients at our institution between January 2004 and February 2005. Group 1 (84) did not receive an intraoperative drain and group 2 (81) did. Recipients were analysed within each group based on immunosuppression (sirolimus or CNI) and whether they had wound complication, fluid collection, lymphocele treatment, or DVT. RESULTS In group 1 and 2, respectively, the wound complication rate was 22.6% vs 13.6% ( P = 0.134), the fluid collection rate 45.2% vs 16.% ( P < 0.001), the lymphocele treatment rate 19.0% vs 2.5% ( P = 0.001) the DVT rate 14.3% vs 4.9% ( P = 0.043) the fluid collection rate (for CNI) 26.5% vs 16.0% ( P = 0.246), the lymphocele treatment rate (for CNI) 5.9% vs 0% ( P = 0.084), the fluid collection rate (sirolimus) 58.0% vs 16.1% ( P < 0.001) and lymphocele treatment rate (sirolimus) 28% vs 6.5% ( P = 0.018). Multivariate analysis of risk factors for fluid collection showed significance for no drain (odds ratio 3.30, P = 0.002), associated wound complication (2.41, P = 0.041) and sirolimus (2.48, P = 0.015). CONCLUSIONS Placing a drain during transplantation decreased the incidence of fluid collection, lymphocele treatment and DVT. The reduction of fluid collection and lymphocele were significant for patients treated with sirolimus. We recommend placing a drain in patients undergoing induction with sirolimus-based immunosuppression. [ABSTRACT FROM AUTHOR]

Objectives: To perform a retrospective study to determine the clinical utility of Doppler ultrasonography (DUS) and to determine its role in the management of transplant renal artery stenosis (TRAS). Methods: Patients undergoing DUS between January 1998 and January 2001 for clinical suspicion of TRAS were included in the study. A total of 51 patients were divided into two groups according to the peak systolic velocity. Additional management was based on the clinical and DUS findings and their congruence. Patients were followed up and their outcome was analyzed. Results: Of the 51 patients who entered the study, 26 were in the low probability group (LPG) and 25 in the high probability group (HPG). Nine patients in the LPG underwent additional investigations; eight underwent magnetic resonance angiography and one angiography. Of these 9 patients, 6 had stenosis, 4 of whom required angiography. In total, 5 patients from the LPG underwent angioplasty, and 4 of them had stenosis (1 with TRAS, 2 with common iliac artery stenosis, and 1 with renal artery ostial stenosis). Three patients underwent angioplasty and 2 of them improved. In the HPG, 20 of 25 patients underwent additional investigations, including magnetic resonance angiography in 12 and angiography in 8, with stenosis in 15 patients. Of the HPG, 13 of 25 patients underwent angiography, with 10 requiring angioplasty--8 for TRAS and 2 for adjacent renal artery stenosis, with improvement in 8 patients. Congruent clinical and DUS findings were highly predictive of significant stenosis more amenable to improvement. Conclusions: The results of our study have shown that high-probability DUS and congruent clinical findings are likely to identify a significant stenosis that is amenable to treatment. Low-probability DUS findings do not eliminate the possibility of stenosis, but intervention in this group is less likely to result in improvement. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To assess the patterns of early functional recovery and long-term function in laparoscopic and open procured live donor nephrectomy (LDN) kidneys, highlighting the radionuclide scan as an additional tool for assessment, because of concerns regarding renal functional recovery after laparoscopic LDN. Methods: We reviewed the donor and recipient records of 101 laparoscopic and 35 open LDNs performed between August 1997 and September 2001. Data were collected on demographic, immunologic, and intraoperative variables and ureteral/vascular complications. Delayed renal function recovery in recipients was evaluated by serum creatinine greater than 2.5 mg/dL on postoperative day 5, dialysis in first postoperative week, and two renographic criteria—the time to peak activity and the time to one-half peak activity on postoperative day 5. Long-term outcomes were evaluated by serum creatinine at 1, 3, 6, and 12 months and 2 and 3 years, creatinine clearance at 1 year, and patient and allograft survival. Results: Donor and recipient age, sex, body mass index, and number of HLA mismatches did not differ between the two groups. The mean operating room time and blood loss were comparable. No differences were found in the early functional parameters (renography, creatinine at postoperative day 1 and 5, or dialysis in week 1) or long-term outcome (patient and graft survival, creatinine, and rejection at 1 year and patient and graft survival at 1, 2, and 3 years). Conclusions: Early recovery of graft function, longer term renal function, and 3-year patient and allograft survival are similar for live donor kidneys obtained by either a laparoscopic or an open surgical technique. [Copyright &y& Elsevier]

Abstract: Introduction: The introduction of the microemulsion formulation of cyclosporine (CsA) (Neoral – NEO) has been shown to provide improved absorption and less intrapatient variability than the previous formulation (Sandimmune – SIM) in kidney transplant recipients. It has been suggested that the use of the microemulsion formulation results in less acute rejection, and therefore permits better long-term transplant outcomes. Our aim was to determine whether the microemulsion formulation of cyclosporine has reduced the long-term (5 yr or more) rates of chronic rejection (allograft nephropathy) in a renal transplant population. Methods: The study population included 792 (508 cadaveric and 284 living donor) transplants performed in 786 patients at the Cleveland Clinic Foundation and its affiliate hospitals between July 1, 1987 and July 1, 1998. Patients who were less than 18-yr-old or had less than 12 months of graft function were excluded from the analysis. Over 90% of the cadaveric and 11% of the live donor recipients were given an induction antibody. A total of 591 patients were given the SIM formulation and 201 the NEO formulation of cyclosporine. Additional maintenance therapy included either azathioprine or mycophenolate mofetil, and steroids. All patients were followed to graft loss, death, or return to dialysis. The NEO group was followed until December 2001. The diagnosis of acute rejection was biopsy confirmed in >92% of cases. Chronic rejection was identified by clinical and biopsy criteria. Demographic and clinical data was collected from medical records, interviews, and phone contact with patients and treating physicians. Results: The mean follow-up was 84 ± 31 months for the SIM group, and 54 ± 14 months for the NEO group. At 70 months there was no significant difference (p = 0.17) – actuarial patient survival between the SIM (90.7%) vs. the NEO (93%) treated patients. In addition, at 70 months there was no... [ABSTRACT FROM AUTHOR]