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A living donor (LD) kidney transplant is the best treatment for kidney failure, but LDs safety is paramount. We sought to evaluate our LDs cohort's longitudinal changes in estimated glomerular filtration rate (eGFR). We retrospectively studied 320 LDs submitted to nephrectomy between 1998 and 2020. The primary outcome was the eGFR change until 15 years (y) post-donation. Subgroup analysis considered distinct donor characteristics and kidney function reduction rate (%KFRR) post-donation [-(eGFR6 months(M)-eGFRpre-donation)/eGFRpre-donation*100]. Donors had amean age of 47.3 ± 10.5 years, 71% female. Overall, LDs presented an average eGFR change 6 M onward of +0.35 mL/min/1.73 m²/year. The period with the highest increase was 6 M-2 Y, with a mean eGFR change of +0.85L/min/1.73 m²/year. Recovery plateaued at 10 years. Normal weight donors presented significantly better recovery of eGFR +0.59 mL/min/1.73 m²/year, compared to obese donors -0.18L/min/ 1.73 m²/year (p = 0.020). Noteworthy, these results only hold for the first 5 years. The subgroup with a lower KFRR (<26.2%) had a significantly higher decrease in eGFR overall of -0.21 mL/min/1.73 m²/year compared to the groups with higher KFRR (p < 0.001). These differences only hold for 6 M-2 Y. Moreover, an eGFR<50 mL/min/1.73 m² was a rare event, with ≤5%prevalence in the 2-15 Y span, correlating with eGFR pre-donation. Our data show that eGFR recovery is significant and may last until 10 years post-donation. However, some subgroups presented more ominous kidney function trajectories. [ABSTRACT FROM AUTHOR]

A living donor kidney transplant (LDKT) is the best treatment for ESRD. A prediction tool based on clinical and demographic data available pre‐KT was developed in a Norwegian cohort with three different models to predict graft loss, recipient death, and donor candidate's risk of death, the iPREDICTLIVING tool. No external validations are yet available. We sought to evaluate its predictive performance in our cohort of 352 pairs LKDT submitted to KT from 1998 to 2019. The model for censored graft failure (CGF) showed the worse discriminative performance with Harrell's C of.665 and a time‐dependent AUC of.566, with a calibration slope of.998. For recipient death, at 10 years, the model had a Harrell's C of.776, a time‐dependent AUC of.773, and a calibration slope of 1.003. The models for donor death were reasonably discriminative, although with a poor calibration, particularly for 20 years of death, with a Harrell's C of.712 and AUC of.694 with a calibration slope of.955. These models have moderate discriminative and calibration performance in our population. The tool was validated in this Northern Portuguese cohort, Caucasian, with a low incidence of diabetes and other comorbidities. It can improve the informed decision‐making process at the living donor consultation joining clinical and other relevant information. [ABSTRACT FROM AUTHOR]

Background: The global scarcity of organs for kidney transplants (KTs) has led to the increased acceptance of living donors (LDs) with minor abnormalities to increase the donor pool.. We sought to evaluate the effects of some of these LDs' clinical characteristics (older age, borderline renal function, hypertension, dyslipidemia, smoking, and obesity) on graft outcomes. Methods: We studied 352 recipients of LDKTs (1998–2020). Firstly, considering the recipients and KT variables, we identified relevant predictors of overall and censored graft failure (GF). Then, adjusting for these predictors, we explored LD variables as predictors of overall and censored GF in a multivariable Cox model. Results: The recipients from LD with higher eGFR (≥90 mL/min/1.73 m2) had significantly better overall and censored graft survival GS) at 15 y after KT (respectively, 67 and 75% vs. 46 and 46%, p < 0.001). Importantly, none of the remaining LD factors which were evaluated (hypertension, dyslipidemia, smoking, proteinuria, and obesity) were independent predictors of GF. In recipients from LDs < 50 y, having an eGFR < 90 was an independent predictor of overall GF [adjusted HR (95%CI) of 2.578 (1.120–5.795)] and censored GF [adjusted HR (95%CI) of 3.216 (1.300–7.959)], compared to recipients from LDs with eGFR ≥ 90. Contrarily, when donors were older, no difference in the risk of GF was observed between eGFR categories. Conclusion: In our cohort, lower pre-donation eGFR had an impact on GS only in younger LDs. An age-adjusted eGFR cutoff may be pursued for improved donor admissibility. [ABSTRACT FROM AUTHOR]

Background: Vascular calcification is an ever-more-common finding in protocoled pre-transplant imaging in living kidney donors. We intended to explore whether a connection could be found between the Agatston calcification score, prior to kidney donation, and post-donation renal function. Methods: This is a retrospective analysis of 156 living kidney donors who underwent living donor nephrectomy between January 2010 and December 2016. We quantified the total calcification score (TCaScore) by calculating the Agatston score for each vessel, abdominal aorta, common iliac, and renal arteries. Donors were placed into two different groups based on their TCaScore: <100 TCaScore group and ≥100 TCaScore group. The relationship between TCaScore, 1-year eGFR, proteinuria, and risk of 1 measurement of decreased renal function (eGFR < 60 mL/min/1.73 m2) over 5 years of follow-up was investigated. Results: The ≥100 TCaScore group consisted of 29 (19%) donors, with a median (interquartile range) calcification score of 164 (117–358). This group was significantly older, 56.7 ± 6.9 vs. 45.5 ± 10.6 (p < 0.001), had a higher average BMI (p < 0.019), and had a lower preoperative eGFR (p < 0.014). The 1-year eGFR was similarly diminished, 69.9 ± 15.7 vs. 76.3 ± 15.5 (p < 0.048), while also having an increased risk of decreased renal function during the follow-up, 22% vs. 48% (p < 0.007). Conclusions: Our study, through univariate analyses, found a relationship between a TCaScore > 100, lower 1-year eGFR, and decreased renal function in 5 years. However, a higher-than-expected vascular calcification should not be an excluding factor in donors, although they may require closer monitoring during follow-up. [ABSTRACT FROM AUTHOR]

A predictive model to estimate post-donation glomerular filtration rate (eGFR) and risk of CKD at 1-year was developed from a Toulouse-Rangueil cohort in 2017 and showed an excellent correlation to the observed 1-year post-donation eGFR. We retrospectively analyzed all living donor kidney transplants performed at a single center from 1998 to 2020. Observed eGFR using CKD-EPI formula at 1-year post-donation was compared to the predicted eGFR using the formula eGFR (CKD-EPI, mL/min/1.73 m² ) = 31.71+ (0.521 × preoperative eGFR) − (0.314 × age). 333 donors were evaluated. A good correlation (Pearson r = 0.67; p < 0.001) and concordance (Bland-Altman plot with 95% limits of agreement −21.41–26.47 mL/min/1.73 m² ; p < 0.001) between predicted and observed 1-year post-donation eGFR were observed. The area under the ROC curve showed a good discriminative ability of the formula in predicting observed CKD at 1-year postdonation (AUC = 0.83; 95% CI: 0.78–0.88; p < 0.001) with optimal cutoff corresponding to a predicted eGFR of 65.25 mL/min/1.73 m² in which the sensibility and specificity to predict CKD were respectively 77% and 75%. The model was successfully validated in our cohort, a different European population. It represents a simple and accurate tool to assist in evaluating potential donors. [ABSTRACT FROM AUTHOR]

• The most common causes of dropout were donor-related causes, specifically withdrawal from the program, the presence of a medical contraindication, and the presence of an alternative donor. • Identifying measures to minimize withdrawal is essential to increase the potential donor pool. • Adequate information and support in-person or by telemedicine in these cases is essential to reduce dropouts. • Kidney-paired exchange and ABO incompatibility programs are underdeveloped tools that can increase living donation by around 30%. A living donor (LD) kidney transplant is the best therapeutic option for end-stage kidney disease. Potential donors must undergo multiple analyses and the rates of live donation can be as low as 8% to 18%. Here, we report on the live kidney donor program in our unit with emphasis on the reasons why potential donors do not proceed to donation. We performed a single-center retrospective study of all potential kidney donors with a first LD appointment at Centro Hospitalar Universitário do Porto between January 2016 and December 2020. In our cohort there were 395 potential donors. From the potential donors who finished assessment, 131 were approved for donation and 239 dropped out. After assessment, 104 (28.1%) recipients received a living kidney transplant, 24 of which received a living kidney transplant through the kidney paired exchange program. The individuals who did not proceed to the surgery (n = 239) had a median age of 46.5 years, 64.4% were female, and 34 pairs were ABO-incompatible. The most frequent donor-recipient relationships were spouses, siblings and parents. The 2 most important causes of dropout were due to medical, surgical or psychological contraindications and the donor's voluntary withdrawal. When we evaluated the variables most related to dropout, they were not because of being a spouse and ABO incompatibility. When compared to other studies, we showed a relatively higher rate of successful live donations, possibly aided by the presence of cross-over transplantation. Targeted education and support at an earlier stage of the donor assessment process may lead to a better engagement and lower probability of early dropout. [ABSTRACT FROM AUTHOR]

The 2023 revision of the Energy Performance of Building Directive underlines the need to consider the whole life cycle emissions for buildings. The decarbonization targets could not be achieved if reduction of energy demand in the operational phase is accompanied by a high energy resource use in the whole life. This paper proposes a novel investigation of an energy renovation project, involving both building envelope components and space heating system. The adopted method is based on the life cycle assessment, in the variant cradle-to-gate with options, to analyze and compare the design data achieved through an analysis of product (embodied) and use (operational) stages. Different solutions for energy improvement of the building performance are identified, and the scenario with the lowest embodied energy was found to be more energy efficient globally. The most effective scenario, with energy and CO 2 savings of 39% and 40% is characterized by a weight of embodied energy and emissions of 6.5% and 6.9%, respectively. Given the rise of the weight of the embodied energy in the whole life cycle of future buildings, the life cycle assessment will become crucial for sustainable design and in the transition to an energy-efficiency built environment. [Display omitted] • The impact of life cycle analysis in the process of energy efficiency is investigated. • The "cradle-to-gate" with options approach is implemented. • The efficiency of walls and windows involves the greater use of energy resources. • The most energy-efficient scenarios from an operational and non-operational point of view are different. • The scenario identified in the analysis of A1-A4 phases allows a higher total energy saving. [ABSTRACT FROM AUTHOR]

The construction sector has become an important target for reducing carbon emissions and energy consumption and for kerbing resource depletion, because of its relevance in all these important areas. Many of the current energy related policies have their focus on new buildings but, due to the low rates of replacement of the existing building stock, it is crucial that the low energy performances of these buildings are improved. Most of these buildings, due to design and construction constraints, may not be able to reach the new energy efficiency standards, which many times involve complex construction works. Nevertheless, the achievement of significant reductions in energy consumption and carbon emissions may not always require a highly efficient solution for the envelope. Other solutions, combining energy efficiency measures and the use of renewable energy, are also possible. In this context, the key research problem addressed in Annex 56 was to understand how far it is possible to go with energy conservation and efficiency measures and from which point the measures to foster renewable energy use become more economical taking into account the local context and the many restrictions the existing buildings face. Thus, a new methodology was developed to be used in the decision making process for energy related building renovation, allowing to find a cost-effective balance between energy consumption, carbon emissions and overall added value achieved in the renovation process. The methodology developed within IEA EBC Annex 56 project aims at defining, assessing and comparing energy renovation activities in a cost-effective way, optimizing the energy use and the carbon emissions reduction, mainly in residential buildings but also in non-residential buildings without complex HVAC technologies. The methodology explores the full range of cost-effective reduction of carbon emissions and energy use and takes into account also the additional benefits and the overall added value achieved by the building within the renovation process. [ABSTRACT FROM AUTHOR]

The reduction of the energy consumption and carbon emissions in the building sector is an important target for actions to mitigate the climate changes and different actions are being carried out to promote a transition to a low carbon built environment. However, present standards are mainly focused on new buildings which may result counter-productive in existing ones, due to their technical, functional and economic constraints. One of the most common problems in the current way of assessing building renovation scenarios is that only energy savings and cost are considered, disregarding additional benefits. Many studies, based on real cases, have already highlighted the relevance of these so-called co-benefits, which can be felt at the building level (and therefore they should be considered in the definition of the renovation measures) and also at the level of society. The present investigation has been developed under the scope of IEA EBC Annex 56 project, and a method to integrate co-benefits in the evaluation of the renovation scenarios towards both the nearly-zero emissions and the nearly-zero energy objectives is proposed. It has been applied to case-studies from several European countries and based on subsequent findings recommendations for policy makers and professional owners are presented. [ABSTRACT FROM AUTHOR]

The fundamental differences between the dimensions of sustainable development have been identified by researchers and many assessment tools have been developed in several countries. This paper introduces the development of a methodology for determining the weight of each dimension employed in sustainable construction assessment through the use of assessment tools that use the Brazilian indicators of sustainable development in accordance with the Commission on Sustainable Development, and also through the utilization of a database provided by the Brazilian Geography and Statistics Institute (IBGE). Firstly, the Sustainability Panel tool was employed to reveal separately the status of dimensions in sustainable development (environmental, social and economic) and then it was made a statistical analysis of the results for each region in Brazil (north, northeast, midwest, southeast and south). The solution presented in this paper aims to reduce the inconsistencies found in the adjustments of the assessment tools considering regional differences based on political actions included in governmental agencies. [ABSTRACT FROM AUTHOR]

The International Energy Agency established an Implementing Agreement within the Energy in Buildings and Communities Program to undertake research and provide an international focus on “Cost Effective Energy and Carbon Emissions Optimization in Building Renovation” (EBC Annex 56). The project aims at developing a new methodology to enable cost effective renovation of existing buildings while optimizing energy consumption and carbon emissions reduction. Several case studies were gathered to develop and validate the methodology, and a selection of “Shining Examples” was made to encourage decision makers to promote efficient and cost effective renovations. This paper presents the results of the analyses made on these Shining Examples. [ABSTRACT FROM AUTHOR]

The building sector is responsible for consuming approximately 40% of the final energy in Europe. However, more than 50% of this consumption can be reduced through energy-efficient measures. Our society is facing not only a severe and unprecedented environmental crisis but also an economic crisis of similar magnitude. In light of this, EU has developed legislation promoting the use of the Cost-Optimal (CO) method in order to improve building energy efficiency, in which selection criteria is based on life cycle costs. Nevertheless, studies show that the implementation of energy-efficient solutions is far from ideal. Therefore, it is very important to analyse the reasons for this gap between theory and implementation as well as improve selection methods. This study aims to develop a methodology based on a cost-effectiveness analysis, which can be seen as an improvement to the CO method as it considers the investment willingness of stakeholders in the selection process of energy-efficient solutions. The method uses a simple graphical display in which the stakeholders’ investment willingness is identified as the slope of a reference line, allowing easy selection between building solutions. This method will lead to the selection of more desired – from stakeholders’ point of view – and more energy-efficient solutions than those selected through the CO method. [ABSTRACT FROM AUTHOR]

Background: Special low protein foods (SLPF) are essential in the nutritional management of patients with phenylketonuria (PKU). The study objectives were to: 1) identify the number of SLPF available for use in eight European countries and Turkey and 2) analyse the nutritional composition of SLPF available in one of these countries.Methods: European Nutritionist Expert Panel on PKU (ENEP) members (Portugal, Spain, Belgium, Italy, Germany, Netherlands, UK, Denmark and Turkey) provided data on SPLF available in each country. The nutritional composition of Portuguese SLPF was compared with regular food products.Results: The number of different SLPF available in each country varied widely with a median of 107 [ranging from 73 (Portugal) and 256 (Italy)]. Food analysis of SLPF available from a single country (Portugal) indicated that the mean phenylalanine content was higher in low protein baby cereals (mean 48 mg/100 g) and chocolate/energy bars/jelly (mean 41 mg/100 g). The energy content of different foods from a sub-group of SLPF (cookies) varied widely between 23 and 96 kcal/cookie. Low protein bread had a high fat content [mean 5.8 g/100 g (range 3.7 to 10)] compared with 1.6 g/100 g in regular bread. Seven of the 12 SLPF sub-groups (58 %) did not declare any vitamin content, and only 4 (33 %) identified a limited number of minerals.Conclusions: Whilst equal and free access to all SLPF is desirable, the widely variable nutritional composition requires careful nutritional knowledge of all products when prescribed for individual patients with PKU. There is a need for more specific nutritional standards for special low protein foods. [ABSTRACT FROM AUTHOR]

Abstract: Due to the high energy consumption associated with the building sector, several legal documents with the aim of promoting energy efficiency have emerged in recent years, e.g. the Directive 2002/91/EC on the energy performance of buildings (EPBD) and its recast on 19 May 2010, Directive 2010/31/EU. The EPBD led many countries to adjust their own building energy-related regulations. The Portuguese thermal regulation for residential buildings, “Regulamento das Características do Comportamento Térmico de Edifícios (RCCTE)”, is a part of the transposition of the EPBD to Portuguese law. The main objective of this paper is to analyse the RCCTE in order to study the influence of some parameters considered important to the energy efficiency of buildings on energy performance and on the final energy certification rating. [Copyright &y& Elsevier]

Abstract: The building sector is an energy intensive sector, with great potential to reduce energy needs and environmental pollution. Several measures are being taken to increase the energy efficiency and avoid energy consumption in this sector. A recent trend is the nearly zero energy buildings, which was already adopted by some of the latest regulations, such as the 2010 recast of the European Performance of Buildings Directive (EPBD). However, to reach these goals, especially considering the existing building stock, new retrofit solutions are required, which must be well adapted to the specific building stock needs, and ensure that the building retrofit can achieve the nearly zero energy buildings standards. This paper presents a new prefabricated retrofit module solution for the facades of existing buildings, and also the steps taken to optimise its performance, which includes a judicious choice of materials, 3D modelling, cost–benefit analysis, use of different simulation tools for performance optimisation and prototyping. It is also shown the implementation of the retrofit module within an integrated retrofit approach, whose final goal was to obtain a building with the minimum possible energy consumption and greenhouse gas emissions. [Copyright &y& Elsevier]

The article discusses a study which analyzed the anthropometric changes in a home-based cohort of older adults in Brazil who participated in the SABE survey. Involved in the study were 1,030 men and women whose anthropometric variables, such as body mass and arm muscle, were assessed. It was found that a negative anthropometric profile was more delayed in women.

Background/Aims: The neurological sequelae resulting from untreated phenylketonuria are diminished by the success of early introduced and continued dietary treatment. Nowadays, nutritional status is gaining importance in the follow-up of these patients. The aim of this work was to study the relevance of prealbumin concentration as biomarker of protein nutritional status of phenylketonuric patients. Methods: We collected data from 69 phenylketonuric patients on food intake, blood prealbumin and blood phenylalanine concentrations. Protein insufficiency was defined as prealbumin z-scores below the 5th percentile of reference population. Additionally, we considered a prealbumin concentration of 20 mg/dl as a threshold level. Results: Nine patients (13%) showed signs of protein insufficiency. When the threshold of 20 mg/dl for prealbumin was used, we found 38 patients (55%) with low prealbumin concentrations. Conclusion: A significant group presented signs of protein insufficiency either using prealbumin z-scores or prealbumin concentration threshold, especially in milder forms of the disease. The results of this seem to confirm the already described threshold level for prealbumin concentration, suggesting that its measurement may be important for nutritional status evaluation, preventing protein insufficiency in milder forms of phenylketonuria. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Proteolytic and cataplerotic sources of hepatic glutamine were determined by 2H NMR analysis of urinary phenylacetylglutamine (PAGN) 2H-enrichments in eight healthy subjects after 2H2O and phenylbutyric acid ingestion. Body water enrichment was 0.49±0.03%. PAGN was enriched to lower levels with significant differences between the various glutamine positions. PAGN position 2 enrichment=0.33±0.02%; 3R=0.27±0.02%; 3S=0.27±0.02% and position 4=0.17±0.01%. Position 3R,S enrichments are conditional with the net conversion of citrate to glutamate and are therefore markers of cataplerosis. From the ratio of positions 3R,S to body water enrichment, 55±3% of hepatic glutamine was derived from cataplerosis and 45±3% from proteolysis. In conclusion, enrichment of PAGN 3R,S hydrogens relative to that of body water reflects the contribution of cataplerotic and proteolytic sources to hepatic glutamine. [Copyright &y& Elsevier]

Looks at the role of nuclear factor-kappa B in mediating alpha v beta 3 integrin-induces endothelial cell survival. Importance of alpha v beta 3 integrins; Details on their involvement in angiogenesis; Factors which influence the growth of proteins; Details on studies conducted on nuclear factor-kappa B.

• Transplant renal artery stenosis is a vascular complication of kidney transplant. • The incidence of artery stenosis is higher in living-donor kidney transplants. • Flash pulmonary edema is a manifestation of renal artery stenosis. • Descriptions of flash edema associated with renal artery stenosis are rare. Transplant renal artery stenosis (TRAS) is a well-recognized vascular complication after kidney transplantation, with an incidence ranging from 1% to 23%. TRAS often presents with clinical features such as refractory hypertension, de novo hypertension, allograft dysfunction, and the presence of a bruit over the graft. A rare manifestation of TRAS is flash pulmonary edema. Here, we present a case of a 37-year-old male who received a living donor kidney. Four years after the transplant, he presented with acute kidney injury, hypertensive crisis, and flash pulmonary edema. Initially, methylprednisolone pulses were administered due to suspicion of acute rejection, which was later ruled out after a kidney graft biopsy. Computed tomography angiography showed findings suggesting stenosis or thrombus in the renal artery. The patient developed sudden acute pulmonary edema, requiring hemodialysis, with notable clinical improvement. Subsequently, stent placement was performed without complications, resulting in the complete recovery of renal function and effective blood pressure control. The incidence of renal artery stenosis is higher in living donor kidney transplantation, mainly due to technical complexities during surgery. Acute presentations, such as flash edema, are exceptionally rare but can occur years after transplantation. Prompt intervention can lead to favorable outcomes. [ABSTRACT FROM AUTHOR]

Simultaneous pancreas‐kidney transplantation (SPKT) is the best treatment for selected individuals with type 1 diabetes mellitus and end‐stage renal disease. Despite advances in surgical techniques, donor and recipient selection, and immunosuppressive therapies, SPKT remains a complex procedure with associated surgical complications and adverse consequences. We conducted a retrospective study that included 263 SPKT procedures performed between May 2000, and December 2022. A total of 65 patients (25%) required at least one relaparotomy, resulting in an all‐cause relaparotomy rate of 2.04 events per 100 in‐hospital days. Lower donor body mass index was identified as an independent factor associated with reoperation (OR.815; 95% CI:.725–.917, p =.001). Technical failure (TF) occurred in 9.9% of cases, primarily attributed to pancreas graft thrombosis, intra‐abdominal infections, bleeding, and anastomotic leaks. Independent predictors of TF at 90 days included donor age above 36 years (HR 2.513; 95% CI 1.162–5.434), previous peritoneal dialysis (HR 2.503; 95% CI 1.149–5.451), and specific pancreas graft reinterventions. The findings highlight the importance of carefully considering donor and recipient factors in SPKT. The incidence of TF in our study population aligns with the recent series. Continuous efforts should focus on identifying and mitigating potential risk factors to enhance SPKT outcomes, thereby reducing post‐transplant complications. [ABSTRACT FROM AUTHOR]

This work aims to evaluate the predictive effect of Social Dominance Orientation, Need for Closure, Attitudes toward Math, Paranormal Beliefs, Religiosity, and Education over General Conspiracy Beliefs (GCB) and Conspiracy Mentality (CM). Two studies were conducted with Brazilian samples. In Study 1, a higher Educational Level and being a female were negatively associated with GCB. In Study 2, Paranormal Beliefs had a positive predictive relationship with CM, while greater Religiosity was associated with lower CM. Future studies should explore the effects of mediators in the relationships found in this study and provide a better conceptualization and operationalization of conspiracy beliefs. [ABSTRACT FROM AUTHOR]

Background: In phenylketonuria (PKU), modified casein glycomacropeptide supplements (CGMP-AA) are used as an alternative to the traditional phenylalanine (Phe)-free L-amino acid supplements (L-AA). However, studies focusing on the long-term nutritional status of CGMP-AA are lacking. This retrospective study evaluated the long-term impact of CGMP-AA over a mean of 29 months in 11 patients with a mean age at CGMP-AA onset of 28 years (range 15-43) [8 females; 2 hyperphenylalaninaemia (HPA), 3 mild PKU, 3 classical PKU and 3 late-diagnosed]. Outcome measures included metabolic control, anthropometry, body composition and biochemical parameters.Results: CGMP-AA, providing 66% of protein equivalent intake from protein substitute, was associated with no significant change in blood Phe with CGMP-AA compared with baseline (562 ± 289 µmol/L vs 628 ± 317 µmol/L; p = 0.065). In contrast, blood tyrosine significantly increased on CGMP-AA (52.0 ± 19.2 μmol/L vs 61.4 ± 23.8 μmol/L; p = 0.027).Conclusions: Biochemical nutritional markers remained unchanged which is an encouraging finding in adults with PKU, many of whom are unable to maintain full adherence with nutritionally fortified protein substitutes. Longitudinal, prospective studies with larger sample sizes are necessary to fully understand the metabolic impact of using CGMP-AA in PKU. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic increased morbidity and mortality worldwide, particularly in the Kidney and Kidney-Pancreas Transplant Recipient (KTR/KPTR) population. Aiming at assessing the absolute and relative excess mortality (EM) in a Portuguese KTR/KPTR cohort, we conducted a retrospective observational study of two KTR/KPTRs cohorts: cohort 1 (P1; n = 2,179) between September/2012 and March/2020; cohort 2 (P2; n = 2067) between March/2020, and August/2022. A correlation between relative and absolute EM and age, sex, time from transplantation and cause of death was explored. A total of 145 and 84 deaths by all causes were observed in P1 and P2, respectively. The absolute EM in P2 versus P1 was 19.2 deaths (observed/expected mortality ratio 1.30, p = 0.006), and the relative EM was 1.47/1,000 person-months (95% CI 1.11-1.93, p = 0.006). Compared to the same period in the general population, the standardized mortality rate by age in P2 was 3.86 (95% CI 2.40-5.31), with a peak at 9.00 (95% CI 4.84-13.16) in P2C. The higher EM identified in this population was associated, mainly, with COVID-19 infection, with much higher values during the second seasonal COVID-19 peak when compared to the general population, despite generalized vaccination. These highlight the need for further preventive measures and improved therapies in these patients. [ABSTRACT FROM AUTHOR]

Abstract Nowadays, in the European Union (EU) the construction rate of new buildings is very low and therefore achieving the EU targets regarding the energy efficiency of the building sector is only possible through the reduction of the energy needs of the existing building stock. A building design based on passive measures is a priority to reduce operational energy consumption but it is not enough to achieve the nearly Zero Energy Building (nZEB) level. Consequently, the design must also consider active systems with high efficiency and the use of renewable energy sources to partially/totally replace the use of non-renewable energy. At this level, solar thermal and photovoltaic panels play an important role, mainly in countries with high levels of solar radiation, as in the Southern European countries. Nevertheless, there are still some barriers to overcome for the broader dissemination of the implementation of these systems. One of the most important is that building owners are not fully aware of the life cycle benefits that these systems have at environmental and economic levels. The best way to raise awareness to these benefits is through the analysis of case studies, highlighting the short or mid-term benefits resulting from the integration of these active solutions. Thus, this paper is aimed at analysing the environmental and life cycle costs of different energy renovation scenarios, assessing the contribution of the solar systems to achieve three levels of energy performance. The study is focused on the energy renovation of a detached single-family house considering the climatic conditions of Porto, Portugal. From the results, it is possible to conclude that, on an annual basis, and for the Portuguese climate, it is possible to overcome, many of the energy needs for acclimatization and preparation of domestic hot water with the integration of these systems. The study also shows attractive economic and carbon payback times resulting from their use. Highlights • Three energy renovation scenarios for a residential building are analysed. • Scenarios include both passive and active measures. • Every renovation scenario has an economic payback time lower than 12 years. • Solar systems have a huge effect in reducing the lifetime CO2 emissions of buildings. • The economic and CO2 PBT of solar systems are less than 1/4 of their lifetime. [ABSTRACT FROM AUTHOR]

Renal artery thrombosis is a devastating complication if not detected early. Cardioembolic disease or surgical and technical complications are frequent causes of renal artery thrombosis. There are some reports of renal artery thrombosis in a renal allograft, but to our knowledge, this is the first case of renal artery thrombosis reported in a kidney donor. [ABSTRACT FROM AUTHOR]

Living kidney donation (LKD) is a preferred treatment option for end-stage chronic kidney disease, but it can also pose potential risks for the donor, including hypertension and end-stage renal disease. Many donors are women of reproductive age who may have concerns about the effects of donation on future pregnancies. The aim of this study was to determine fetal and maternal outcomes in a cohort of pregnancies after LKD and to compare them with pregnancies before LKD. We conducted a retrospective analysis of living kidney donors of childbearing age (<46 years old) at the time of donation who got pregnant after LKD in our center between 1987 and 2020 (N = 13). Clinical data were collected, including demographic characteristics and maternal and fetal outcomes. We observed 16 pregnancies after LKD and 12 pregnancies before LKD in the same group of patients. The rate of gestational hypertension was 12.5% in pregnancies after LKD and 8.3% before LKD (P =.999). There were 13 successful pregnancies after LKD with a mean gestational age of 38.6 ± 1.7 weeks. There were no episodes of acute kidney injury or other complications. The present study suggests that LKD does not have a negative effect on maternal and fetal outcomes. However, caution should be taken due to the small sample size. We agree with the guidelines recommending close monitoring of post-donation pregnancies. [ABSTRACT FROM AUTHOR]

Simultaneous pancreas-kidney transplantation (SPKT) is the treatment of choice for type 1 diabetes patients with end-stage renal disease. Donor characteristics are determinants of graft and patient survival. We aimed to study the impact of donor age on outcomes in SPKT. We retrospectively studied 254 patients submitted to SPKT between 2000 and 2021. Patients were classified as "younger donor" (donor age <40 years) and "older donor" (donor age ≥40 years). Fifty-three patients received grafts from older donors. Pancreas graft survival rates at 1, 5, 10, and 15 years were 89%, 83%, 77%, and 73% in the younger donor group, respectively, and 77%, 73%, 67%, and 62% in the older donor group, respectively (P =.052). Older donors and previous major adverse cardiovascular events (MACEs) were associated with pancreas graft failure at 15 years. Kidney transplant survival (1, 5, 10, and 15 years) was lower in the older donor cohort (94%, 92%, 69%, 60% vs 97%, 94%, 89%, and 84%, respectively; P =.004). Older donor, recipient age, and previous MACE predicted kidney graft failure at 15 years. Patient survival rates at 1, 5, 10, and 15 years were 98%, 95%, 91%, and 81% in the younger donor group, respectively, versus 92%, 90%, 84%, and 72% in the older donor group, respectively (P =.127). The kidney graft survival rate was lower in the older donor group, whereas pancreas graft survival and patient survival did not differ significantly. Multivariate analysis showed that a donor age of ≥40 years was an independent predictor of pancreas and kidney graft failure at 15 years in SPKT patients. [ABSTRACT FROM AUTHOR]

Post-transplant erythrocytosis (PTE) is reported in 8% to 22% of kidney transplant recipients. Few studies have evaluated the prevalence of PTE in simultaneous kidney–pancreas transplantation (SPKT). This study aimed to evaluate the prevalence of PTE in a cohort of SPKT and same-donor single kidney transplant patients and find predictive factors for erythrocytosis development. A single-center retrospective cohort study was performed with 65 SPKT recipients and 65 same-donor single kidney transplant patients. Post-transplant erythrocytosis was defined as a hematocrit persistently >51% without a known cause of erythrocytosis. The PTE prevalence was 23.1% and was more frequent in SPKT patients than in single donor patients (38.5% vs 7.7%; P <.001). The mean time for PTE development was 11.2 ± 13.3 months. In the multivariate model, SPKT was the only predictor for PTE development. De novo hypertension was more frequent in the PTE group (P =.002), but there was no difference in stroke and pancreatic or kidney thrombosis occurrence. Post-transplant erythrocytosis is more common after SPKT than after single kidney transplantation. De novo hypertension was more frequent in the erythrocytosis group, but allograft thrombosis rates. [ABSTRACT FROM AUTHOR]

Spontaneous rupture of the uterine artery is a rare cause of hemoperitoneum during pregnancy. This is a life-threatening condition associated with maternal and fetal mortality. We describe a case of spontaneous rupture of the left uterine artery in a 32-year-old healthy pregnant woman with an uneventful pregnancy. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the thermal and mechanical performances of PET-G thermoplastics with different 3D microstructure patterns and infill densities. The production costs were also estimated to identify the most cost-effective solution. A total of 12 infill patterns were analysed, including Gyroid, Grid, Hilbert curve, Line, Rectilinear, Stars, Triangles, 3D Honeycomb, Honeycomb, Concentric, Cubic, and Octagram spiral with a fixed infill density of 25%. Different infill densities ranging from 5% to 20% were also tested to determine the best geometries. Thermal tests were conducted in a hotbox test chamber and mechanical properties were evaluated using a series of three-point bending tests. The study used printing parameters to meet the construction sector's specific needs, including a larger nozzle diameter and printing speed. The internal microstructures led to variations of up to 70% in thermal performance and up to 300% in mechanical performance. For each geometry, the mechanical and thermal performance was highly correlated with the infill pattern, where higher infill improved thermal and mechanical performances. The economic performance showed that, in most cases, except for the Honeycomb and 3D Honeycomb, there were no significant cost differences between infill geometries. These findings can provide valuable insights for selecting the optimal 3D printing parameters in the construction industry. [ABSTRACT FROM AUTHOR]

Several factors may increase the risk of development of ovarian cancer. In this study, we investigated the relationship between social, genetic, and histopathologic factors in women with ovarian serous cystadenocarcinoma and titin (TTN) mutations, whether the TTN gene mutation may be a predictor, and its impact on mortality and survival in these patients. A total of 585 samples from patients with ovarian serous cystadenocarcinoma were collected from The Cancer Genome Atlas and PanCancer Atlas through the cBioPortal for analysis of social, genetic, and histopathological factors. Logistic regression was used to investigate whether TTN mutation could be a predictor, and the Kaplan–Meier method was applied to analyze survival time. TTN mutation frequency did not differ between age at diagnosis, tumor stage, and race, and was related to increased Buffa hypoxia score (p = 0.004), mutation count (p < 0.0001), Winter hypoxia Score (p = 0.030), nonsynonymous tumor mutation burden (TMB) (p < 0.0001), and reduced microsatellite instability sensor score (p = 0.010). The number of mutations (p < 0.0001) and winter hypoxia score (p = 0.008) were positively associated with TTN mutations, and nonsynonymous TMB (p < 0.0001) proved to be a predictor. Mutated TTN affects the score of genetic variables involved in cancer cell metabolism in ovarian cystadenocarcinoma. [ABSTRACT FROM AUTHOR]

Urinary neutrophil gelatinase-associated lipocalin (uNGAL) has been suggested as potential early marker of delayed graft function (DGF) following kidney transplantation (KTx). We conducted a prospective study in 40 consecutive KTx recipients to evaluate serial changes of uNGAL within the first week after KTx and assess its performance in predicting DGF (dialysis requirement during initial posttransplant week) and graft function throughout first year. Urine samples were collected on post-KTx days 0, 1, 2, 4, and 7. Linear mixed and multivariable regression models, receiver-operating characteristic (ROC), and areas under ROC curves were used. At all-time points, mean uNGAL levels were significantly higher in patients developing DGF (n = 18). Shortly after KTx (3-6 h), uNGAL values were higher in DGF recipients (on average +242 ng/mL, considering mean dialysis time of 4.1 years) and rose further in following days, contrasting with prompt function recipients. Day-1 uNGAL levels accurately predicted DGF (AUCROC = 0.93), with a performance higher than serum creatinine (AUC-ROC = 0.76), and similar to cystatin C (AUC-ROC = 0.95). Multivariable analyses revealed that uNGAL levels at days 4 and 7 were strongly associated with one-year serum creatinine. Urinary NGAL is an early marker of graft injury and is independently associated with dialysis requirement within one week after KTx and one-year graft function. [ABSTRACT FROM AUTHOR]

Abstract: Background: Little is known about the consequences of the special energy enriched diet used to treat patients with phenylketonuria (PKU) in terms of obesity and metabolic syndrome (MetSyn) development. Objective: To investigate the prevalence of overweight and obesity, and its consequences in terms of body composition and MetSyn in early treated patients with PKU compared to controls. Design: A sample of 89 patients with PKU (3–30y; 14.4±6.6y) and 79 controls (3–47y; 16.3±7.9y) were studied. In the fasted state, anthropometric, body composition, blood pressure and analytical parameters [amino acids, glucose, insulin, total and HDL-cholesterol (HDL-c), triglycerides (TG), high sensitivity c-reactive protein and uric acid] were performed. Data on dietary intake was collected. BMI was classified using WHO criteria, while the definition from International Diabetes Federation (IDF) was used for MetSyn. Results: Prevalence of overweight and obesity (32.6% vs. 24.1%; p=0.293), body fat percentage (22% vs. 23.1%, p=0.581) and central obesity (36.9% vs. 36.4%, p=0.999) were comparable to controls. Patients revealed a higher TG/HDL-c (p<0.001). The prevalence of MetSyn was 1.5% and 6.1% in patients and controls, respectively. Patients and not controls with central obesity revealed a further significant increase in TG/HDL-c compared with those without central obesity (p=0.023). Conclusion: Patients and controls were similar in terms of overweight and obesity, body composition and MetSyn. However, the dyslipidemia in patients with PKU in relation to overweight and obesity may help us trying to understand the course and the etiology of MetSyn not only in PKU but also in the general population. [Copyright &y& Elsevier]

From December 2019 to March 2020, China was the epicenter of the SARS‐CoV‐2 infection pandemic, but from that moment on, Europe surpassed China in the number of new cases and deaths related to this novel viral respiratory infection. The emergence of this world pandemic is particularly important for solid organ transplant recipients, who might have an increased risk of mortality, not only due to their chronic immunosuppression status, but also to the cardiovascular risk that correlates with several years of chronic kidney disease. To the extent that there is still a lack of knowledge about the clinical characteristics, evolution, and prognosis of SARS‐CoV‐2 infection in kidney transplant recipients, we will report the first 5 cases diagnosed and followed in our transplant unit, as well as share the therapeutic strategies adopted. [ABSTRACT FROM AUTHOR]

HLA donor‐specific antibodies developed de novo after transplant remain a major cause of chronic allograft dysfunction. Our study main purpose was to determine whether HLA MM, assessed traditionally and by HLA total and AbVer eplet mismatch load (EptMM and EpvMM) assessed with HLAMatchMaker, had impact on dnDSA development after living donor kidney transplantation (LDKT). We retrospectively analysed a cohort of 96 LDKT between 2008 and 2017 performed in Hospital Santo António. Seven patients developed dnDSA‐II and EpvMM and EptMM were greater in dnDSA‐II group compared to the no dnDSA‐II (18.0 ± 8.7 versus 9.9 ± 7.9, p =.041 and 41.3 ± 18.9 versus 23.1 ± 16.7, p =.018), which is not observed for AgMM (2.29 versus 1.56; p =.09). In a multivariate analysis, we found that preformed DSA (HR = 7.983; p =.023), living unrelated donors (HR = 8.052; p =.024) and retransplantation (HR = 14.393; p =.009) were predictors for dnDSA‐II (AUC = 0.801; 0.622–0.981). HLA‐II EpvMM (HR = 1.105; p =.028; AUC = 0.856) showed to be a superior predictor of dnDSA‐II, when compared to AgMM (HR = 1.740; p =.113; AUC = 0.783), when adjusted for these clinical variables. Graft survival was significantly lower within dnDSA‐II patient group (36% versus 88%, p <.001). HLA molecular mismatch analysis is extremely important to minimize risk for HLA‐II dnDSA development improving outcome and increasing chance of retransplant lowering allosensitization. [ABSTRACT FROM AUTHOR]

• A methodology for identifying cost-effective solutions for districts is presented. • The usefulness of the methodology is shown in a Case study located in Portugal. • All the analysed centralised approaches are cost-effective. • A carbon emissions neutral district can be achieved maintaining cost-effectiveness. Building renovation plays a key role in reducing greenhouse gas emissions and achieving the climate protection goals. The district scale approach is one of the most effective approaches to accelerate this process of reducing the energy consumption in the building sector as increasing its renovation rates. In this context, the Energy in Buildings and Communities Programme of the IEA, IEA-EBC started in 2017 the project "Annex 75: Cost-Effective Building renovation at District Level Combining Energy Efficiency and Renewables" aiming to explore optimal opportunities of district renovations from a cost-benefit perspective. IEA Annex 75 is a co-operative effort of participants from 13 different countries: Austria, Belgium, China, Czech Republic, Denmark, Germany, Italy, The Netherlands, Norway, Portugal, Spain, Sweden and Switzerland. In this paper, key elements of the methodology developed in Annex 75 project are presented. This methodology aims to facilitate the identification of optimal solutions in different European countries, enabling to explore similarities and differences amongst them, with a particular focus on the balance between energy efficiency measures and renewable energy measures. After a detailed description of the developed methodology, it is also applied to a case study located in Portugal and results obtained are analysed in detail. The paper demonstrates the usefulness of the methodology for evaluating and identifying optimal solutions in renovations at district scale, as well as for successfully addressing the research questions investigated by the Annex 75 project. They also provide some insights regarding the specific case study, showing that, although district systems are not usual in the current Portuguese context, these centralised solutions in renovations at district level are cost-effective interventions that can lead to significant reductions of greenhouse gas emissions and non-renewable primary energy use. [ABSTRACT FROM AUTHOR]

Summary: Kidney volume has been proven to be a surrogate marker of nephron mass and renal function. We studied 190 donor and recipient pairs undergoing living donor kidney transplantation at our institution during 9 years. Different metrics of donor kidney volume (DKV) were explored: alone or indexed to recipient's anthropometry, as body surface area (BSA). DKV/BSA (min. 49.7; P33rd 77.7; P67th 95.3; max. 176 cm3/m2) was chosen given its higher correlation with eGFR at 1 year, and recipients were divided according to its tertiles (T). The eGFR at 1 year was lower in T1, when compared with T2 (P = 0.015) and T3 (P < 0.001). In a multivariable model, a regression spline revealed that a DKV/BSA lower than 80 was significantly associated with an eGFR at 1 year <60. In the first 6 years, the overall annual eGFR slope was −0.90 ml/min/year. Acute rejection occurred in 19%, 11%, and 0% of patients in T1, T2, and T3, respectively (P < 0.001). DKV/BSA increased stepwise from cellular‐ (n = 12) to antibody‐mediated (n = 7) AR cases and to those without AR (n = 171; P = 0.002; no AR versus cellular AR). Lower DKV/BSA ratio was associated with significantly worse graft function and higher incidence of AR. Hence, it can be a tool for better selection of donors in order to improve graft outcomes, particularly in the setting of multiple potential living donors or kidney paired exchange programs. [ABSTRACT FROM AUTHOR]

The donors' estimated glomerular filtration rate (eGFR) after living nephrectomy has been a concern, particularly in donors with smaller kindeys. Therefore, we developed this retrospective observational study in 195 donors to determine the ability remaining kidney volume indexed to weight (RKV/W) to predict eGFR at 1 year through multivariate linear regression and to explore this relationship between annual eGFR change from 1 to 4 years postdonation evaluated by a linear mixed model. Comparing RKV/W tertiles (T1, T2, T3), RKV/W was a good predictor of 1‐year eGFR which was significantly better in T3 donors. Gender, predonation eGFR, and RKV/W were independent predictors of eGFR at 1‐year. In a subgroup with predonation eGFR < 90mL/min/1.73 m2, a significant prediction of eGFR < 60mL/min/1.73 m2 was detected in males with RKV/W ≤ 2.51cm3/kg. Annual eGFR (ml/min/year) change from 1 to 4 years was + 0.77. RKV/W divided by tertiles (T1–T3) was the only significant predictor: T2 and T3 donors had an annual eGFR improvement opposing to T1. RKV/W was a good predictor of eGFR at 1 year, independently from predonation eGFR. A higher RKV/W was associated with improved eGFR at 1 year. A decline in eGFR on the four years after surgery was only noticeable in donors with RKV/W ≤ 2.13cm3/kg. [ABSTRACT FROM AUTHOR]

An ecological mortar is designed from industrial sub-products, with the objective of utilizing both the slag residues, generated during steel manufacturing processes, and the waste from Polyurethane Foam (PF) panels, generated during refrigerator chamber manufacturing processes. The ecological mortar design involves the dosing of Electric Arc Furnace (EAF) slag, together with finely ground Polyurethane Foam, cement, and additives. An energy efficient prefabricated block is designed with the mortar, for use in construction, and its energy performance is assessed as a material inserted within the envelope of a service sector (hospital) building, either as an exterior skin, or as an enclosing component within the façade interior. The main contribution of this research is the characterization of the thermo-physical and mechanical properties of a new prefabricated panel made with recycled materials. The full characterization of the properties of these new materials is presented and discussed. The new prefabricated panel demonstrates adequate thermo-mechanical characteristics as a substitute for traditional materials, while improving the sustainability of the building. As a secondary objective, the energy behaviour of the new panels when integrated in a real building is presented by means of a case study simulation. The use of computational thermal simulation confirmed that the properties of the prefabricated block influenced the annual thermal demand of the building for heating and cooling. Improvements to the thermal inertia of the building envelope were also confirmed with the inclusion of PF waste, giving the mortar an energy performance that was similar to conventional materials, in such a way that its use in façade construction may be validated, in addition to its environmental benefits, due to it having been manufactured with critical recycled industrial waste such as EAF slag and PF, thereby contributing to both the circular economy and sustainable development. [ABSTRACT FROM AUTHOR]

In simultaneous pancreas-kidney transplantation (SPKT), persistence or recurrence of pancreatic autoantibodies (PAs) has been associated with pancreas graft (PG) autoimmune-driven injury. Our aim was to analyze the impact of PAs on PG survival. Between January 1, 2000, and December 31, 2017, we studied 139 patients with post-SPKT anti–glutamic acid decarboxylase (GAD) autoantibody. Alloimmune (ALI) events were defined as PG rejection and/or de novo donor-specific antibodies (DSA). Hence, 3 groups were defined: patients without ALI events or anti-GAD (n = 42), those with ALI events (n = 14), or those only with autoimmune events (positive for anti-GAD and no ALI events; n = 83). Male sex was predominant (n = 72, 52%). Median age was 35 years (interquartile range: 31-39) and median follow-up was 6-7 years (interquartile range: 4.1-9.2). Regarding anti-GAD positivity post-SPKT (n = 90, 65%), no differences were observed concerning age, sex, anti-HLA antibodies, HLA mismatch number and de novo DSA. ALI events were present in 10% (n = 14). PG survival 15 years post-SPKT was better in patients without immune events (96%) followed by those with ALI (69%) and autoimmune events (63%) (P =.025). Anti-GAD was associated to higher annualized mean Hb1AC (P =.006) and lower mean C-peptide (P =.013). According to pre- and post-SPKT anti-GAD status, conversion from negative to positive was associated to worse (63%) 10-year PG survival (P =.044), compared to persistence of negative (100%) or positive anti-GAD (88%). Anti-islet cell and anti-insulin autoantibodies had no impact. Anti-GAD presence post-SPKT was associated to higher pancreas disfunction and lower PG survival. De novo anti-GAD seems to offer a particular risk of PG failure. • Autoimmune and alloimmune events have a negative impact on pancreas graft survival. • Autoantibody conversion is associated with a high risk of developing insulin-dependent diabetes mellitus after simultaneous pancreas-kidney transplantation. • Worse function of the pancreas graft and lower survival in SPKT are strongly associated to emergence of anti–glutamic acid decarboxylase (GAD). [ABSTRACT FROM AUTHOR]

HLA mismatching is a well known risk factor for worst outcomes in kidney transplantation. In the present study, HLA antigen and eplet mismatches were determined in 151 living donor-recipient pairs transplanted between 2007 and 2014 and rejection episodes and graft survival were evaluated. We found that high HLA-II eplet mismatch load (EpMM ≥ 13, versus low EpMM ≤ 5), was an independent predictor of AMR (adjusted HR = 14.839; P = 0.011), while HLA-II AgMM was not. We also showed that HLA-II EpMM load was a significant better predictor of AMR than AgMM (c- statistic = 0.064; P = 0.023). After discriminating HLA-II into HLA-DR and HLA-DQ loci we demonstrated that high versus low eplet mismatch load for HLA-DR (T3 ≥ 6 versus T = 0–1, p = 0.013) and HLA-DQ (T3 ≥ 7 versus T = 0–1, p = 0.009) are independent predictors for AMR. HLA-II EpMM increased discrimination performance of the classical HLA-II AgMM risk model (IDI, 0.061, 95%CI: 0.005–0.195) for AMR. Compared with AgMM, HLA-II eplet model adequately reclassified 13 of 17 patients (76.5%) with AMR and 92 of 134 patients (68.7%) without AMR (cfNRI, 0.785, 95%CI: 0.300–1.426). Our study evidences that eplet-based matching is a refinement of the classical HLA antigen mismatch analysis in LDKT and is a potential biomarker for personalized assessment of alloimmune risk. [ABSTRACT FROM AUTHOR]

• Thermal, luminous and energy efficiency of single-glass with solar films is assessed. • Experimental data was used to calibrate a simulation model in EnergyPlus program. • Films with internal and external application on the side of the glass were analyzed. • Cooling, heating and lighting energy savings assessed for several solar orientations. • A decision-making framework based on performance criteria is provided. This paper examines the thermal and luminous performance of single-glazed windows with and without solar control films (SCFs) and a venetian blind in actual working conditions. SCF is a passive solution to modify the solar-optical properties of glazing systems, in order to reduce the solar gains and the energy use and to increase the indoor comfort conditions. An experimental campaign was carried out simultaneously in both cooling and heating seasons in two similar office rooms, one with a SCF applied on the internal surface of the glass and the other without any SCF. The experimental data was used to calibrate a model in EnergyPlus and to assess the energy performance of several SCFs with different thermal and optical characteristics for different orientations of the façade. A decision-making framework was applied to identify the potential use of SFCs as retrofitting solutions for single-glazed windows based on energy performance criteria. The results show that SCFs have a real impact in reducing the cooling energy use for South, East and West solar orientations (SCFs with low solar transmittance coefficients show reductions of the cooling energy use up to 86%) due to the reduction of solar gains, while there is an increase in the heating and lighting energy use. [ABSTRACT FROM AUTHOR]

To compare mini-incision donor nephrectomy (MDN) with laparoscopic donor nephrectomy (LDN) performed by the same surgical team, regarding short- and long-term outcomes. Three hundred and five patients, who underwent donor nephrectomy in our institution, through an MDN (n = 141) between January 1998-November 2011 and LDN (n = 164) since June 2010-December 2017, were compared. The mean operative time for MDN (120 ± 29 minutes) was not significantly different when compared to LDN (113 ± 34 minutes), but when comparing the first 50 LDN and the 50 most recent, we found a reduction in the duration of the procedure. Laparoscopic donors had a shorter warm ischemia time (229 seconds vs 310 seconds, P =.01), particularly the 50 most recent, hospital stay (4.3 days vs 5.9 days, P <.001), and postoperative complications (P =.03). The incidence of graft acute tubular necrosis (ATN) was superior in the MDN (89% vs 25%, P <.001), although there was no significant difference regarding first-year serum creatinine (SCr) and glomerular filtration rate (GFR) (SCr 1.38 mg/dL vs SCr 1.33 mg/dL and GFR 63.7 mL/min vs 63.1 mL/min) comparing the 2 groups. Long-term graft survival did not significantly differ between groups. There was also no relationship between postoperative ATN events and long-term graft function. With the growing experience of the high-volume centers and with specialized teams, LDN could be considered the most suitable technique for living donor nephrectomy with better results in short-term results (warm ischemia time, hospital stay, and postoperative complications), without difference in long-term outcomes. [ABSTRACT FROM AUTHOR]

• Overheating regulations and calculation methods in 26 European countries were compared. • Most of the existing calculation methods are outdated and do not fit climate-proof buildings. • France requires a mixed-mode operation of naturally ventilated households. • The UK developed a heatwave-based calculation approach. • Comfort-based, multi-zonal, and time-integrated calculation approaches are needed. With the ongoing significance of overheating calculations in the residential building sector, building codes such as the European Energy Performance of Building Directive (EPBD) are essential for harmonizing the indicators and performance thresholds. This paper investigates Europe's overheating calculation methods, indicators, and thresholds and evaluates their ability to address climate change and heat events. e study aims to identify the suitability of existing overheating calculation methods and propose recommendations for the EPBD. The study results provide a cross-sectional overview of twenty-six European countries. The most influential overheating calculation criteria are listed the best approaches are ranked. The paper provides a thorough comparative assessment and recommendations to align current calculations with climate-sensitive metrics. The results suggest a framework and key performance indicators that are comfort-based, multi-zonal, and time-integrated to calculate overheating and modify the EU's next building energy efficiency regulations. The results can help policymakers and building professionals to develop the next overheating calculation framework and approach for the future development of climate-proof and resilient residential buildings. [ABSTRACT FROM AUTHOR]

Chronic-active antibody-mediated rejection (CAABMR) is associated with poor kidney graft survival and has no clear effective treatment. Forty-one cases of CAABMR were detected in indication graft biopsies and evaluated according to current Banff classification. We investigated the impact of concurrent donor-specific antibodies (DSA) and their characteristics, together with non-adherence regarding immunosuppression on CAABMR histopathological phenotypes and prognosis. Twenty-four (59%) patients had detectable DSA at biopsy, with 15 of them being considered non-adherent. Graft function at biopsy was similar in DSA (+) and (−) patients. DSA (+) patients had significantly higher tubulointerstitial inflammation (i and ti) and acute humoral (g+ptc+v+C4d) composite score than DSA (−). DSA (+)/non-adherent cases presented additionally with increased microvascular inflammation (ptc and v), besides having a distinctively lower ah score. C1q DSA strength was higher ( P  = .046) in non-adherent patients and correlated closely with C4d score ( P  = .002). Lower graft function and ah score, higher proteinuria and ci + ct score, and, separately per each model, DSA (+) (HR = 2.446, P  = .034), DSA (+)/non-adherent (HR = 3.657, P  = .005) and DSA (+)/C1q (+) (HR = 4.831, P  = .003) status were independent predictors of graft failure. CAABMR with concomitant DSA pose a higher risk of graft failure. Adherence should be evaluated, and histopathological phenotyping and DSA characterization may add critical information. [ABSTRACT FROM AUTHOR]

In times of great transition of the European construction sector to energy efficient and nearly zero energy buildings (nZEB), a market observation containing qualitative and quantitative indications should help to fill out some of the current gaps concerning the EU 2020 carbon targets. Next to the economic challenges, there are equally important factors that hinder renovating the existing residential building stock and adding newly constructed high performance buildings. Under these circumstances this paper summarises the findings of a cross-comparative study of the societal and technical barriers of nZEB implementation in 7 Southern European countries. The study analyses the present situation and provides an overview on future prospects for nZEB in Southern Europe. The result presents an overview of challenges and provides recommendations based on available empirical evidence to further lower those barriers in the European construction sector. The paper finds that the most Southern European countries are poorly prepared for nZEB implementation and especially to the challenge/opportunity of retrofitting existing buildings. Creating a common approach to further develop nZEB targets, concepts and definitions in synergy with the climatic, societal and technical state of progress in Southern Europe is essential. The paper provides recommendations for actions to shift the identified gaps into opportunities for future development of climate adaptive high performance buildings. [ABSTRACT FROM AUTHOR]

• Development of an air change rates (ACHs) compliance tool built with a Machine Learning (ML) framework. • Evaluation of its applicability in a representative dataset of a predominantly naturally ventilated residential built stock in the context of southern Europe mild climates. • On the test set, the best regressor showed mean absolute errors (MAE) below 1.02% for all the response variables, while the best classifier presented an average accuracy of 97.32%. • The results are promising for the generalization of the tool as a complementary asset to energy certification programmes. Physical models and probabilistic applications often guide the study and characterization of natural phenomena in engineering. Such is the case of the study of air change rates (ACHs) in buildings for their complex mechanisms and high variability. It is not uncommon for the referred applications to be costly and impractical in both time and computation, resulting in the use of simplified methodologies and setups. The incorporation of airtightness limits to quantify adequate ACHs in national transpositions of the Energy Performance Building Directive (EPBD) exemplifies the issue. This research presents a roadmap for developing an alternative instrument, a compliance tool built with a Machine Learning (ML) framework, that overcomes some simplification issues regarding policy implementation while fulfilling practitioners' needs and general societal use. It relies on dwellings' terrain, geometric and airtightness characteristics, and meteorological data. Results from previous work on a region with a mild heating season in southern Europe apply in training and testing the proposed tool. The tool outputs numerical information on the air change rates performance of the building envelope, and a label, accordingly. On the test set, the best regressor showed mean absolute errors (MAE) below 1.02% for all the response variables, while the best classifier presented an average accuracy of 97.32%. These results are promising for the generalization of this methodology, with potential for application at regional, national, and European Union levels. The developed tool could be a complementary asset to energy certification programmes of either public or private initiatives. [ABSTRACT FROM AUTHOR]

• Application of LCA and LCC to study the viability of applying two envelope air barrier solutions in residential buildings. • Average energy consumption savings in urban terrain almost half of those in rural terrain during the heating season. • The median annualized cost of adopting a fluid air barrier was almost four times that of a mechanically fastened air barrier. • The adoption of MECH solutions is recommended, independently of the heating system the dwelling is equipped with. Assessing singular elements that constitute the air barrier of a building envelope is quite unfeasible in Life Cycle Assessment (LCA). The study of these solutions through this particular scope is often overlooked. Two major aspects contribute to it: the complexity of the relationships between elements and the reduced embodied impact of these materials in the overall construction or retrofitting works. This work uses LCA and Life Cycle Costing (LCC) to study the viability of applying two envelope air barrier solutions in dwellings with excessive air change rates and equipped with different heating systems. The application of air barrier solutions resulted in average energy consumption savings in urban terrain, almost half of those in rural terrain during the heating season. Environmental performance and life cycle costs revealed mechanically (MECH) fastened air barriers to outperform fluid (FLUID) applied ones. The median annualized cost of adopting a FLUID solution was almost four times that of a MECH solution. Dwellings equipped with electric radiators ranked first in the shortest average Energy Payback Period (EPP) and the highest average Reference Service Life (RSL) savings. With the current analysis, the adoption of MECH solutions is recommended, independently of the heating system the dwelling is equipped with. [ABSTRACT FROM AUTHOR]