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Abstract Objective : To compare tacrolimus with cyclosporin for immunosuppression in renal transplantation. Design : Meta-analysis of randomised trials of two treatments after kidney transplantation. Identification : Four studies involving 1037 patients. Trials were included if they were randomised, the intervention group received tacrolimus, the control group received cyclosporin, the patients were followed for a minimum of 12 months, and patient survival, graft survival, incidence of acute rejection, need for antilymphocyte treatment, or the prevalence of diabetes mellitus after transplant was reported. Main outcome measures : Pooled estimates of patient mortality, allograft loss, and episodes of acute rejection 1 year after transplantation. Results : The odds ratio for loss of allograft with tacrolimus compared with cyclosporin was 0.95 (95% confidence interval 0.65 to 1.40). The odds ratio for mortality with tacrolimus was 1.07 (0.47 to 2.48). Treatment with tacrolimus was associated with a reduction in episodes of acute rejection (0.52; 0.36 to 0.75), a reduction in the use of antilymphocyte antibodies to treat rejection (0.37; 0.25 to 0.56), and an increased prevalence of diabetes mellitus after transplantation (5.03; 2.04 to 12.36) compared with treatment with cyclosporin. Conclusions : After renal transplantation, immunosuppression with tacrolimus results in a significant reduction in acute rejection compared with cyclosporin. Follow up studies of high methodological quality are needed to determine whether tacrolimus improves long term renal graft survival.

Where treatment options are limited, the role of clinical consultation in providing information and support becomes more important. This study examines the immediate impact of medical consultation on male sub-fertility clinic attender's anxiety, depression, self-blame, information appraisal and perceptions of future fertility. Data were collected pre- and immediately post-consultation. Clinical information and consultation details were recorded. Results showed that anxiety levels were high before consultation. Following consultation anxiety and self-blame were both reduced while depression increased. Despite information about poor prognosis being given during consultation, participants remained overly optimistic about their chances of achieving a pregnancy. It appears that the consultation has a distinct psychological impact and possible mechanisms underlying this are discussed.

Additional file 1. Appendix

Simulation of a black-hole binary system evolved by the SpEC code.

Simulation of a black-hole binary system evolved by the SpEC code.

Additional file 13. Data.

Additional file 3: Table S3. GR methylation in U and C regions for patients by outcome.

Simulation of a black-hole binary system evolved by the SpEC code.

Simulation of a black-hole binary system evolved by the SpEC code.

Simulation of a black-hole binary system evolved by the SpEC code.