Hasil untuk "Miscellaneous systems and treatments"

Tuğba Özcan, Ebru Dizdar, Ufuk Akkurt et al.

Objective: Adherence to immunosuppressive medication is critical for the successful maintenance of kidney transplant therapy. Patients’ health perceptions are influenced by their lived experiences and cultural contexts. This study aimed to examine the impact of health perception on adherence to immunosuppressive medication among kidney transplant patients.Methods: This descriptive, correlational, and cross-sectional study was conducted in a private hospital located in western Turkey. The data were collected from 165 kidney transplant patients aged between 19 and 69. The data collection tools included a Sociodemographic Data Collection Form, the Perception of Health Scale, and the Immunosuppressive Medication Adherence Scale. Data were analyzed using simple linear regression analysis.Results: The mean scores of the participants on the Perception of Health Scale and the Immunosuppressive Medication Adherence Scale were 53.84 ± 10.04 and 48.18 ± 5.60, respectively. It was found that the level of health perception explained 8.8% of the variance in adherence to immunosuppressive medication (F = 16.909, p < 0.001, R² = 0.094, Adjusted R² = 0.088).Conclusion and Recommendations: The study revealed that 8.8% of the variation in adherence to immunosuppressive medication was associated with health perception levels. Identifying health perception levels before kidney transplantation could help predict the risk of nonadherence to immunosuppressive medication, thereby preventing a significant proportion of rejections. Nursing interventions should focus on enhancing patients' health perception by addressing the focus on Center of Control sub-dimension and considering cultural contexts and beliefs.

Xunkang Tian

This study investigates the identification of marginal treatment responses within multi-valued treatment models. Extending the hyper-rectangle model introduced by Lee and Salanie (2018), this paper relaxes restrictive assumptions, including the requirement of known treatment selection thresholds and the dependence of treatments on all unobserved heterogeneity. By incorporating an additional ranked treatment assumption, this study demonstrates that the marginal treatment responses can be identified under a broader set of conditions, either point or set identification. The framework further enables the derivation of various treatment effects from the marginal treatment responses. Additionally, this paper introduces a hypothesis testing method to evaluate the effectiveness of policies on treatment effects, enhancing its applicability to empirical policy analysis.

Raphael Römer, Peter Ashwin

Tipping behavior can occur when an equilibrium of a dynamical system loses stability in response to a slowly varying parameter crossing a bifurcation threshold, or where noise drives a system from one attractor to another, or some combination of these effects. Similar behavior can be expected when a multistable system is forced by a chaotic deterministic system rather than by noise. In this context, the chaotic tipping window was recently introduced and investigated for discrete-time dynamics. In this paper, we find tipping windows for continuous-time nonlinear systems forced by chaos. We characterize the tipping window in terms of forcing by unstable periodic orbits of the chaos, and we show how the location and structure of this window depend on the relative timescales between the forcing and the responding system. We illustrate this by finding tipping windows for two examples of coupled bistable ODEs forced with chaos. Additionally, we describe the dynamic tipping window in the setting of a changing system parameter.

Shirley Telles, Dipak Chetry, Acharya Balkrishna

Background: Yoga breathing influences cortical activity and, hence, cortico-efferent sensory activity. Previously, slow yoga breathing influenced the components of mid-latency auditory evoked potentials. Objective: The present study aimed to compare middle latency auditory evoked potentials (MLAEPs) recorded during (i) High-frequency yoga breathing (HFYB), (ii) Breath awareness (BAW), and (iii) Quiet rest (QR) as a control in experienced yoga practitioners. Materials and Methods: The MLAEPs were recorded before, during, and after the practice of HFYB compared to an equal duration of BAW and QR in 22 university students whose ages ranged from 18 to 28 years, recorded from the vertex referenced to linked earlobes and the ground electrode on forehead. Results: The peak amplitude of the Pa wave was significantly increased during HFYB compared to before HFYB (repeated measures ANOVA, post hoc analysis with least significant difference, P < 0.05). During BAW, the peak amplitude of the Na wave was significantly increased compared to before BAW (P < 0.05). During QR, the peak latency of “Pa” and “Nb” waves was significantly increased compared to before QR (P < 0.01). Conclusions: The findings suggest that changes in MLAEPs during HFYB, BAW, and QR were different and distinct. Both interventional sessions appear to increase the recruitment of neural resources in the primary auditory cortex, whereas QR appears to slow transmission within the thalamic reticular projection to the cortex. Generalizing the findings is restricted by the sample being confined to male experienced practitioners of yoga breathing.

Francis Fatoye, Olusegun Joshua Daramola, Olufemi Oyeleye Oyewole et al.

Abstract Background Illness perception may influence the coping behaviors of patients. There is a lack of tools to measure this construct among Yoruba speakers. Therefore, we translate, cross-culturally adapt and determine the reliability and the validity of the Yoruba version of the Brief Illness Perception Questionnaire (BIPQ-Y). Methods The translation and cross-cultural adaptation process was according to Beaton criteria. The psychometric testing of the BIPQ-Y was carried out among 28 consenting patients with low back pain attending a university teaching hospital, while only 10 of them participated in the reliability test. The convergent and discriminant validity of the BIPQ-Y was carried out using the Fear Avoidance Belief Questionnaire and Quadruple Visual Analogue scale. Confirmatory factor analysis was to assess construct validity. Results The mean age of the respondents was 47 ± 15.3 years. The concurrent validity of the BIPQ-Y was excellent (r = 0.996) for the total score of BIPQ-Y while the internal consistency was moderate (α = 0.52). The test–retest of BIPQ-Y yielded excellent results with item intra-class correlation coefficient (ICC) ranging between 0.833 and 0.973 and an overall ICC of 0.889. For the confirmatory analysis of the BIPQ-Y, the factor loading for the eight items ranged from − 0.071 to 0.799 and the composite reliability was good with a score of 0.68. Conclusion The BIPQ-Y demonstrated excellent psychometric properties that are satisfactory with standards, and it is recommended for assessing illness perceptions of patients with chronic low back pain among the Yoruba-speaking populations.

Flávia Arantes Táparo, Maria Fernanda Barboza Cid

Introdução: O campo da saúde mental infantojuvenil é composto por diversos núcleos profissionais, dentre os quais se encontra a Terapia Ocupacional. Objetivos: identificar a perspectiva de terapeutas ocupacionais envolvidos na atenção psicossocial de crianças e adolescentes sobre o núcleo profissional da Terapia Ocupacional no campo da saúde mental infantojuvenil e analisar como profissionais não terapeutas ocupacionais envolvidos na atenção psicossocial de crianças e adolescentes descrevem a prática de terapeutas ocupacionais no referido campo. Procedimentos metodológicos: estudo qualiquantitativo, desenvolvido em duas fases. Fase 1: participaram 107 profissionais atuantes no campo da saúde mental de crianças e adolescentes, os quais responderam um questionário online. Fase 2: participaram 32 profissionais, por meio de quatro grupos focais virtuais. Os dados de ambas as fases foram analisados com o software Iramuteq®. Resultados: Foram identificadas aproximações entre os saberes e práticas do núcleo da Terapia Ocupacional e as diretrizes da atenção psicossocial de crianças e adolescentes, que sustentam o campo da saúde mental infantojuvenil, dentre as quais: a prática do acolhimento, valorização das identidades, ampliação da autonomia e participação social e construção de projetos de vida. Conclusões: O estudo evidencia a potência da Terapia Ocupacional para a construção do cuidado no campo da saúde mental infantojuvenil.

Yasemin Deniz, Damla Ertekın, Dılek Cokar

Abstract Purpose The study aimed to investigate whether there is a difference in pulmonary function between individuals with forward head posture and those with neutral head posture. Methods A systematic search was conducted using the ResearchGate, PubMed, and Scholar databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The eligibility criteria for the studies were that they investigated the relationship between Forward Head Posture (FHP) and Forced Vital Capacity (FVC) and/or Forced Expiratory Volume in one second (FEV1). Results A total of four comparison studies and two correlation studies met the inclusion criteria for this study. Across these four studies, encompassing a total of 115 participants, the observed reduction range for FVC was between -0.25 L and -0.81 L, while the reduction values for FEV1 ranged from -0.16 to -0.93 L. According to the results of the correlation studies, a positive correlation was observed between craniovertebral angle (CVA) and dynamic pulmonary volumes. Conclusion The existing evidence indicates that FHP can potentially cause abnormalities in pulmonary function. In this context, it is suggested that individuals with FHP should be monitored for changes in pulmonary function.

Ana Beatriz Santos Reis, Maiara de França Gomes, Marjorie Ester Dias Maciel

Introdução: A violência sexual contra a mulher se configura como a forma mais atroz de violência de gênero e traz repercussões tanto na sua saúde física quanto na mental. Os profissionais da saúde devem ser qualificados para atender mulheres vítimas dessa violência. Objetivo: Relatar a experiência de residentes enfermeiras no atendimento a mulheres vítimas de abuso sexual. Relato da experiência: Profissionais residentes do segundo ano da Residência de Enfermagem em Obstetrícia vivenciaram o atendimento a mulheres vítimas de violência sexual, em um Pronto Atendimento Ginecológico de Hospital Universitário. O primeiro caso atendido foi de uma idosa indígena de 61 anos, cujo suposto agressor seria o próprio filho. O segundo atendimento foi a uma jovem de 19 anos, portadora de transtorno mental. Embora os contextos sociais das vítimas sejam diferentes, ambas têm em comum aspectos que as colocam em situação de vulnerabilidade social. Esses atendimentos se deram durante estágio na emergência ginecológica e após as residentes terem cursado as disciplinas de “Ética, cidadania, direitos humanos e reprodutivos” e “Mulher e relações de gênero”. Conclusão: A experiência de atendimento em situações de violação de direitos vivenciadas por residentes, no período de formação profissional, permitiu o desenvolvimento de competências específicas do núcleo da Enfermagem, relacionadas ao exame físico e emprego de protocolo estabelecido pelo Ministério da Saúde, e de competências transversais como empatia, tomada de decisão e trabalho em equipe. Foi uma experiência de educação na saúde que relacionou teoria e prática, promovendo a reflexão sobre o papel da aprendizagem em serviços envolvendo o cuidado a mulheres vítimas de violência sexual.

Ali Rasteh, Raghavendra Palayam Hari, Hao Guo et al.

The upper mid-band (or FR3, spanning 6-24 GHz) is a crucial frequency range for next-generation mobile networks, offering a favorable balance between coverage and spectrum efficiency. From another perspective, the systems operating in the near-field in both indoor environment and outdoor environments can support line-of-sight multiple input multiple output (MIMO) communications and be beneficial from the FR3 bands. In this paper, a novel method is proposed to measure the near-field parameters leveraging a recently developed reflection model where the near-field paths can be described by their image points. We show that these image points can be accurately estimated via triangulation from multiple measurements with a small number of antennas in each measurement, thus affording a low-cost procedure for near-field multi-path parameter extraction. A preliminary experimental apparatus is presented comprising 2 transmit and 2 receive antennas mounted on a linear track to measure the 2x2 MIMO channel at various displacements. The system uses a recently-developed wideband radio frequency (RF) transceiver board with fast frequency switching, an FPGA for fast baseband processing, and a new parameter extraction method to recover paths and spherical characteristics from the multiple 2x2 measurements.

Eric Volkmann, Alena Brändle, Daniel Durstewitz et al.

Data-driven inference of the generative dynamics underlying a set of observed time series is of growing interest in machine learning and the natural sciences. In neuroscience, such methods promise to alleviate the need to handcraft models based on biophysical principles and allow to automatize the inference of inter-individual differences in brain dynamics. Recent breakthroughs in training techniques for state space models (SSMs) specifically geared toward dynamical systems (DS) reconstruction (DSR) enable to recover the underlying system including its geometrical (attractor) and long-term statistical invariants from even short time series. These techniques are based on control-theoretic ideas, like modern variants of teacher forcing (TF), to ensure stable loss gradient propagation while training. However, as it currently stands, these techniques are not directly applicable to data modalities where current observations depend on an entire history of previous states due to a signal's filtering properties, as common in neuroscience (and physiology more generally). Prominent examples are the blood oxygenation level dependent (BOLD) signal in functional magnetic resonance imaging (fMRI) or Ca$^{2+}$ imaging data. Such types of signals render the SSM's decoder model non-invertible, a requirement for previous TF-based methods. Here, exploiting the recent success of control techniques for training SSMs, we propose a novel algorithm that solves this problem and scales exceptionally well with model dimensionality and filter length. We demonstrate its efficiency in reconstructing dynamical systems, including their state space geometry and long-term temporal properties, from just short BOLD time series.

Adamu Muhammad, Luteino Lorna Hamman, Samaila Musa Chiroma et al.

Objectives: Epilepsy is a neurological condition characterized by repeated seizures attributable to synchronous neuronal activity in the brain. The study evaluated the effect of acetone extract of Adansonia digitata stem bark (ASBE) on seizure score, cognition, depression, and neurodegeneration as well as the level of Gamma-Aminobutyrate acid (GABA) and glutamate in Pentylenetetrazol-kindled rats. Methods: Thirty-five rats were assigned into five groups (n = 7). Groups 1-2 received normal saline and 35 mg/kg PTZ every other day. Groups 3-4 received 125 mg/kg and 250 mg/kg ASBE orally while group 5 received 5 mg/kg diazepam daily for twenty-six days. Group 3-5 received PTZ every other day, 30 mins after ASBE and diazepam. Results: The results showed that Pentylenetetrazol (PTZ) induces seizure, reduces mobility time in force swim test and decreases the normal cell number in the brain. It also significantly decreases (p < 0.05) catalase, superoxide dismutase and reduced glutathione activities compared to the ASBE pre-treated rats. Pre-treatment with ASBE reportedly decreases seizure activities significantly (p < 0.05) and increases mobility time in the force swim test. ASBE also significantly elevate (p < 0.05) the normal cell number in the hippocampus, temporal lobe, and dentate gyrus. Conclusion: ASBE reduced seizure activity and prevented depression in PTZ-treated rats. It also prevented neurodegeneration by regulating glutamate and GABA levels in the brain as well as preventing lipid peroxidation.

Tae Il Kim

Since the first successful establishment of organoids from adult intestinal stem cells, organoid technology has rapidly developed. With advances in normal organoid technology, intestinal disorders, such as colorectal tumors and inflammatory bowel disease, have been major target diseases for patient-derived organoid (PDO) development. PDO biobanking for colorectal cancer has subsequently been developed, and some reports have shown the possibility of using PDO models to predict anticancer drug responses. However, to apply these models to real-world practice, we need more long-term clinical follow-up data from further large-scale PDO biobanks, as well as advanced technology for more rapid and efficient PDO establishment. In addition, in the field of regenerative medicine, the implantation of healthy intestinal PDOs to refractory tissue defects could be a new treatment strategy to accelerate the healing and repair of mucosal defects. This PDO technology could also be applied to inflammatory bowel diseases and serve as a very useful model for drug development via high-throughput screening of useful candidate drugs.

Zhiwei Liu, Xiaokuan Qin, Kai Sun et al.

Objective: To assess the effectiveness and safety of manipulation intervention for degenerative lumbar spondylolisthesis (DLS). Methods: This is a systematic review and meta-analysis. A full-scale retrieval method was performed until February 1, 2021, including nine databases. The homogeneity of different studies was summarized using the Review Manager. The quality of studies was determined with the Cochrane risk-of-bias tool. The evidence quality was graded with the Grading of Recommendations, Assessment, Development, and Evaluations approach. Results: A total of 6 studies involving 524 participants were included. The review demonstrated that manipulation has statistically significant improvements for treating DLS according to Japanese Orthopedic Association scores (mean difference, 3.76; 95% confidence interval, 2.63 to 4.90; P < .001) and visual analog scale scores (mean difference, −1.50; 95% confidence interval, −1.66 to −1.33; P < .001) compared to the control group. One study reported that the difference in the Oswestry Disability Index between the traction group and the combination of manipulation and traction group was statistically significant (P < .05), while another reported that manipulation treatment can significantly improve the lumbar spine rotation angle on X-ray images compared with the baseline data (P < .05). Moreover, the manipulation group (experimental group) had fewer adverse events than the lumbar traction group (control group). Conclusion: Manipulation intervention is more effective and safer for DLS. Nevertheless, large-scale randomized controlled trials are required to confirm the current conclusions.

Jie Zhan, Yirang Ai, Lechang Zhan et al.

Background: Post-stroke shoulder-hand syndrome (SHS) is a common complication after stroke. To date, there is still a lack of consistently effective and good patient compliance methods for SHS. Methods: Fifty patients with SHS were included in this study. Patients in the control group received rehabilitation training (RT) for 2 weeks; each session was 30 min, 1 time per day, and 5 times per week. Patients in the observation group were additionally given Bo's abdominal acupuncture (BAA) with the same frequency and duration. The primary outcome was the change value in the VAS score from baseline to 2 weeks. The secondary outcomes measured were motor function of the upper limb, shoulder range of motion, ADL, and swelling volume. Results: Compared with baseline values, the mean VAS score at 2 weeks was reduced by 3.68 in the observation group and by 1.92 in the control group, with a difference between the two groups of 1.84 (P < 0.001); the mean MBI score at 2 weeks increased by 10.44 in the observation group and by 4.79 in the control group, with a difference between the two groups of 5.84 (P = 0.032); the mean swelling volume at 2 weeks decreased by 9.64 in the observation group and by 3.29 in the control group, with a difference between the two groups of 6.48 (P < 0.001). BAA-related adverse events were not found during the study. Conclusions: BAA combined with RT is superior to RT alone in improving shoulder pain, swelling, and ADL in post-stroke SHS patients. Trial Registration: ChiCTR2100045464 (www.chictr.org.cn).

Liliaokeawawa Cothren, Gianluca Bianchin, Emiliano Dall'Anese

This paper considers the problem of controlling a dynamical system when the state cannot be directly measured and the control performance metrics are unknown or partially known. In particular, we focus on the design of data-driven controllers to regulate a dynamical system to the solution of a constrained convex optimization problem where: i) the state must be estimated from nonlinear and possibly high-dimensional data; and, ii) the cost of the optimization problem -- which models control objectives associated with inputs and states of the system -- is not available and must be learned from data. We propose a data-driven feedback controller that is based on adaptations of a projected gradient-flow method; the controller includes neural networks as integral components for the estimation of the unknown functions. Leveraging stability theory for perturbed systems, we derive sufficient conditions to guarantee exponential input-to-state stability (ISS) of the control loop. In particular, we show that the interconnected system is ISS with respect to the approximation errors of the neural network and unknown disturbances affecting the system. The transient bounds combine the universal approximation property of deep neural networks with the ISS characterization. Illustrative numerical results are presented in the context of control of robotics and epidemics.

Giorgos Prionistis, Costas Vournas

The increasing penetration of Distributed Energy Resources (DER) in the distribution network creates new challenges in the operation of both the transmission and the distribution network. However, the controllability of the converter interfaced devices (CIG), also unveils opportunities for flexible operation and provision of ancillary services with or without economic incentives. The main scope of this work is to create a framework in order to calculate the operational flexibility of an Active Distribution Network and use it to address a centralized Optimal Power Flow Problem by the Transmission System Operator, and in particular the Voltage Stability Margin maximization. Two different approaches are proposed to calculate the Flexibility Region (FR) in the PQ plane, and the centralized optimization is applied to simple and more complex transmission test systems and feeder configurations.

Manudeep Bhuller, Henrik Sigstad

We study what two-stage least squares (2SLS) identifies in models with multiple treatments under treatment effect heterogeneity. Two conditions are shown to be necessary and sufficient for the 2SLS to identify positively weighted sums of agent-specific effects of each treatment: average conditional monotonicity and no cross effects. Our identification analysis allows for any number of treatments, any number of continuous or discrete instruments, and the inclusion of covariates. We provide testable implications and present characterizations of choice behavior implied by our identification conditions.

Giritharan Vijay Iswaran, Ramin Vakili, Mojdeh Khorsand

Power system robustness against high impact low probability events is becoming a major concern. To depict distinct phases of a system response during these disturbances, an irregular polygon model is derived from the conventional trapezoid model and the model is analytically investigated for transmission system performance, based on which resiliency metrics are developed for the same. Furthermore, the system resiliency to windstorm is evaluated on the IEEE reliability test system (RTS) by performing steady state and dynamic security assessment incorporating protection modelling and corrective action schemes using the software Power System Simulator for Engineering (PSS/E). Based on the results of steady state and dynamic analysis, modified resiliency metrics are quantified. Finally, this paper quantifies the interdependency of operational and infrastructure resiliency as they cannot be considered as discrete characteristics of the system.

Tsung-Hung Yao, Zhenke Wu, Karthik Bharath et al.

Accurate identification of synergistic treatment combinations and their underlying biological mechanisms is critical across many disease domains, especially cancer. In translational oncology research, preclinical systems such as patient-derived xenografts (PDX) have emerged as a unique study design evaluating multiple treatments administered to samples from the same human tumor implanted into genetically identical mice. In this paper, we propose a novel Bayesian probabilistic tree-based framework for PDX data to investigate the hierarchical relationships between treatments by inferring treatment cluster trees, referred to as treatment trees (Rx-tree). The framework motivates a new metric of mechanistic similarity between two or more treatments accounting for inherent uncertainty in tree estimation; treatments with a high estimated similarity have potentially high mechanistic synergy. Building upon Dirichlet Diffusion Trees, we derive a closed-form marginal likelihood encoding the tree structure, which facilitates computationally efficient posterior inference via a new two-stage algorithm. Simulation studies demonstrate superior performance of the proposed method in recovering the tree structure and treatment similarities. Our analyses of a recently collated PDX dataset produce treatment similarity estimates that show a high degree of concordance with known biological mechanisms across treatments in five different cancers. More importantly, we uncover new and potentially effective combination therapies that confer synergistic regulation of specific downstream biological pathways for future clinical investigations. Our accompanying code, data, and shiny application for visualization of results are available at: https://github.com/bayesrx/RxTree.

A. kodzo-grey venyo

Various tumours of primary malignant tumours of the kidney exist bot the most common type of primary malignant tumour of the kidney is renal cell carcinoma (clear cell carcinoma of the kidney tend to be encountered most often globally. The biological behaviour of a kidney tumour tends to depend upon the size of the tumour, the histological grade and stage of the tumour. Most kidney tumours that are very small (less than 7 cm) and localized to the kidney of low-grade histopathology pattern tend not to be aggressive or develop further so these days a number of patients who have small low-grade / low stage renal tumours tend to be offered expectant management of regular periodical radiology imaging and if there is any subsequent evidence of increase in the size of small localized kidney tumours, then patients who have these tumours tend to be offered treatment of curative intent. Larger localised kidney tumours that are clear cell / renal cell carcinoma tend to be treated by surgical complete excision of the tumour with the undertaking of partial nephrectomy or radical complete nephrectomy, Individuals who have locally advanced tumours tend to be treated by means of radical nephrectomy plus excision of the lymph nodes within the para-renal and para-aortic region plus adjuvant radiotherapy plus / chemotherapy. Some of the treatment options that have been used form the management of metastatic renal cell carcinoma do include surgery, immunotherapy, targeted treatment, radiotherapy, and chemotherapy. Some of the systemic font-line treatment options which are available include: immune check point inhibitor based combination (IBC) treatment with the inclusion of pembrozulimab / axitinib, nivolumab / pilimumab, as well as avelimab / axitinib. It has been iterated that with unusual exceptions, the utilization of monotherapy with vascular growth factor tyrosine kinase inhibitors or mTOR inhibitors have been considered not to be appropriate options of treatment with regard to the front-line setting. Some of the immunotherapy strategies that are utilized do include: cancer vaccines, oncolytic viruses, adoptive transfer of ex vivo activated T as well as natural killer cells and administration of antibodies or recombinant proteins which either co-stimulate cells or bloc the so-called immune checkpoint pathways. The success of many immunotherapy treatment options recently, including monoclonal antibody blocking of cytotoxic T lymphocyte-associated protein 4 (CTLA-4) as well as programmed cell death protein 1 (PD1), had boosted the development of immunotherapy and this has been ensued by description of new therapeutic targets and schemes that combine various immunology agents at a fast pace. Despite the confirmed efficacy of frontline IBC in the treatment of renal cell carcinomas, majority of the patients would eventually require the need to undergo additional options of treatment and based upon this oncologists have been advised to take into consideration this knowledge carefully when they are switching to other forms of treatment, especially with regard to situations of intolerable drugs or apparent progression of disease. Considering that the biological behaviour of kidney malignant tumours depend upon the size, the histological cell type, the histological grade and stage of tumour, oncologists and urologists have tended to use different treatment options in the management of advanced / metastatic kidney tumours. There are many common side effects of the various immunotherapy treatment options that are common and there are also rare and serious side effects and complications associated with immunotherapy which clinicians and patients need to know about. Various immunotherapy options have been used over recent years in the management of various malignant kidney tumours but it does appear that immunotherapy tends to be beneficial to the management of high risk kidney tumour groups when as well as in the setting of advanced / metastatic kidney tumours.Nevertheless, Immunotherapy does tend to be associated with a number of side effects including nephropathy and it is important for clinicians to be aware of all the complications and complications associated immunotherapy of advanced / metastatic tumours of the kidney. Considering that radical surgical excision of localised tumours tends to be very effective and associated with good long-term prognosis, it would not be very necessary under most circumstances in utilizing immunotherapy to treat such cases. However, immunotherapy has been demonstrated to be associated with improved prognosis when compared with treatment of advanced / metastatic kidney tumours that had been undertaken earlier when immunotherapy was not available. Even though there is evidence to suggest the usefulness of immunotherapy in the treatment of cancers side effects and common as well as rare complications do occur and because these complications and side effects tend to be non-specific, a high index of suspicion would be required to quickly establish the diagnosis. Side effects of PD-1 inhibitors could include fatigue, cough, nausea, itching, skin rash, loss of appetite, constipation, joint pain, high blood pressure abdominal pain and diarrhoea. More serious side effects occur less often, but are possible. These drugs work by removing the brakes on the body’s immune system. Sometimes the immune system starts attacking other parts of the body, which can cause serious problems in the lungs, intestines, liver, hormone-making glands (like the thyroid), kidneys, the nervous system or other organs. In some people these side effects can be life threatening. Other possible side effects include: flu-like symptoms (fever, chills, muscle aches), nausea, low blood pressure, fluid build-up within the lungs, breathing difficulties, kidney damage, heart attacks, intestinal bleeding, rapid heartbeat, mental changes, neurological side-effects within the central and peripheral nervous system. These side-effects tend not to be uncommon; nevertheless, they tend to be clinically relevant to the management of patients which clinicians need to be aware of. Some of the neurological side effects of immunotherapy that tend to be found do include: multiple sclerosis-type syndromes, Guillain-Barré syndromes, neurasthenic syndromes, as well as various infections of the peripheral nervous system and muscular system, such as myopathies and necrotising myopathies. There is generally no clear cut prevention of complication and side effect strategy for immunotherapy, other than the better selection of patients for immunotherapy. Suppression of the immune system with utilization of immunosuppressive medicaments such as corticosteroids has tended to be the main therapeutic strategy for neurological side effects of immunotherapy. Nevertheless, there is the possibility that a patient’s cancer would progress while receiving immunosuppressants. Intravenous immunoglobulins or plasmapheresis could also be utilized; nevertheless, there has tended not to be clear recommendations or consensus opinion on treatment of these side effects. There is need for the undertaking of a global multi-centre studies to ascertain the effect of immunotherapy in the management of the various types of kidney tumour to enable a consensus opinion to be established on the role of immunotherapy for the various types of kidney tumour and not only clear cell carcinoma of the kidney. The ensuing article on immunotherapy in malignant tumours of the kidney is divided into two parts: (A) Overview which has discussed miscellaneous aspects of kidney tumours and (B) Miscellaneous narrations and discussions related to case reports, case series, and studies related to immunotherapy of various kidney tumours.