BACKGROUND Non-adherence to immunosuppressant therapy (IST) is a major risk factor for graft rejection. Limited reports are available regarding the prevalence of non-adherence to IST in kidney transplant recipients (KTRs) as well as the predictors and barriers of non-adherence. MATERIAL AND METHODS The study included ambulatory KTRs, ≥18 years of age, with a functional kidney, from January 2017 to November 2018. The primary outcome was the prevalence of non-adherence, assessed with 1) A telephone interview to complete the Arabic-translated and validated Immunosuppressant Therapy Adherence Instrument Scale (ITAS) and 2) IST serum blood levels within therapeutic levels. The secondary outcomes were the barriers to adherence using the validated Immunosuppressant Therapy Barriers of Adherence Scale (ITBS). RESULTS We enrolled 102 of 141 patients screened. The mean±SD for age, body mass index, and the baseline of the estimated glomerular filtration rate were 45.5±15.6 years, 29.1±6 kg/m², and 72.7±21.9 ml/min/1.73 m², respectively. The prevalence of non-adherence was 5.9%, 95% CI (2.19-12.36%) and 14.7%, 95% CI (8.47-23.09%) using the ITAS and the average blood serum drug levels, respectively. The concordance of the 2 methods demonstrated an agreement of 81.3%, kappa of 0.01, and 95% CI (-0.16 to 0.18). The median, interquartile range (IQR) for ITBS, and uncontrollable and controllable barriers for adherence were 21, (18-25), 15, (12-18), and 6, (5-8), respectively. CONCLUSIONS The current study demonstrated a low to moderate prevalence of non-adherence to IST in KTRs. The barriers for adherence with IST necessitate additional targeted interventions to manage and optimize therapeutic and clinical outcomes.BACKGROUND The rate of femoral neck shortening after internal fixation for femoral neck fracture is high and this complication reduces the function of the affected lower limb. The aim of this study was to design a bidirectional compression-limited sliding screw (BCLSC) that can achieve a full balance between retaining the sliding pressure of the ends of and maintaining the length of the femoral neck. MATERIAL AND METHODS We constructed a 3-dimensional model of a Pauwels III femoral neck fracture and models of 3 internal fixation methods (3 cannulated screws [3CS], dynamic hip screw [DHS]+CS, and BCLSC) by finite element analysis (FEA).The finite element model simulated the loading of the human body when standing on 1 leg. Displacement and stress distribution of the models were calculated based on an axial stress of 600 N. RESULTS The peak von Mises stress (VMS) values of fracture ends in the 3CS, DHS+CS and BCLSC groups were 94.687 MPa, 26.375 MPa and 45.698 MPa; the peak VMS values of internal fixed stress were 451.53 MPa, 174.45 MPa, and 337.34 MPa; the peak VMS values of the lateral femoral wall were 70.021 MPa, 53.033 MPa, and 20.009 MPa; maximum displacements of the femoral head were 1.4482 mm, 1.3813 mm, and 1.3889 mm; and the internal fixed displacement peaks were 4.1134 mm, 3.91 mm, and 4.1004 mm, respectively. CONCLUSIONS The FEA showed that compared with the CS, the new BCLSC showed better performance in resisting shearing force for Pauwels III femoral neck fracture, with better mechanical properties. These data provide a basis for further experiments and clinical application.BACKGROUND Leclercia adecarboxylata is a gram-negative rod, which is normally found in water and food. It is an emerging pathogen that affects immunocompromised patients, including patients with hematological malignancies or those receiving chemotherapy. Generally, L. adecarboxylata is considered a low-virulence pathogen with an excellent susceptibility profile, but some strains may be resistant to multiple antibiotics, such as b-lactams. Moreover, L. adecarboxylata is usually isolated as a part of polymicrobial cultures in immunocompetent individuals, but there have been cases where it was the only isolate. CASE REPORT A 74-year-old woman who was non-immunosuppressed and had multiple comorbidities was admitted with acute decompensated heart failure due to pneumonia. She was treated with multiple courses of antibiotics including amoxicillin-clavulanate and ciprofloxacin for pneumonia, but her infection worsened, and she had cardiopulmonary arrest. After resuscitation, she was stable for several days but suddenly became confused and hypotensive. The septic screen showed L. adecarboxylata bacteremia without a clear source, which was treated successfully with meropenem for 14 days. After the meropenem course, the patient developed diarrhea and was found to have severe Clostridium difficile infection. https://www.selleckchem.com/products/nutlin-3a.html She did not respond to oral vancomycin and intravenous metronidazole and died. CONCLUSIONS This case illustrated an infection in a non-immunosuppressed individual by an organism that is considered an opportunistic pathogen, mainly affecting immunocompromised patients. The patient's blood culture grew L. adecarboxylata, which was sensitive to all antibiotics but resolved with meropenem treatment. Owing to increasing L. adecarboxylata infections, we recommend further studies to understand the organism's pathogenesis, risk factors, and resistance pattern.Transnasal transsphenoidal (TNTS) pituitary surgery is associated with short-lived but intense nociceptive stimuli which cause substantial hemodynamic perturbations that may increase blood loss and impair visualization of the surgical field. This systematic review aimed to critically appraise the clinical evidence for the efficacy and safety of various anesthetic techniques, other pharmacological modalities, and supplementary interventions by assessing intraoperative systemic hemodynamics, use of adjunct medications, quality of the surgical field, intraoperative blood loss, and recovery profiles in patients undergoing TNTS pituitary surgery. Relevant randomized clinical trials and observational studies were identified in a systematic literature search; 16 studies (13 randomized clinical trials, 3 observational studies) enrolling a total of 907 patients were identified for inclusion in this review. Propofol provided more potent hemodynamic control compared with volatile anesthetics with a sparing effect on the need for additional drugs to blunt hemodynamic responses.