Chronic histological changes in deceased donor kidneys at implantation do not predict graft survival: a single‐centre retrospective analysis

The use of preimplantation kidney biopsies (PIKBs) to aid deceased donor kidney utilization decisions is controversial. Outcomes of transplants that had been biopsied after the decision had been made to implant were analysed, in order to determine the association between chronic histological changes at implantation and graft outcomes. A retrospective analysis of transplants between the year range 2006–2015 was performed. Karpinski scores on biopsies were collected, and graft outcomes were analysed using univariate and multivariable techniques. Also, Karpinski scores from single and dual kidney transplants from older donors were examined to determine if knowledge of the score preoperatively would have altered utilization. Four hundred and eight single kidneys were transplanted. Although kidneys with scores >4 had lower 1‐ and 3‐year median (IQR) estimated glomerular filtration rates (eGFRs) than those scoring 0–4 (51 (37–66) vs. 35 (26–52) ml/min/1.73 m², P < 0.001, and 52 (34–64) vs. 35 (24–52) ml/min/1.73 m², P < 0.001, respectively), there was no significant association between Karpinski score and death‐censored graft survival on univariate or multivariable analyses. The utilization analysis (75 single and 25 dual kidney transplant recipients) suggested that systematic use of PIKBs would have resulted in 29% fewer patients being transplanted. This analysis does not support the systematic use of PIKBs to determine deceased donor kidney utilization.     

Oculopharyngodistal myopathy--a possible association with cardiomyopathy

Oculopharyngodistal myopathy is an uncommon myopathy characterised clinically by cranial and distal limb muscle weakness. Here we describe two siblings with autosomal dominant oculopharyngodistal myopathy apparently associated with dilated cardiomyopathy, which in one case progressed to ventricular hypertrabeculation/non-compaction. Electrocardiographic screening was normal and the cardiomyopathy was detected only with echocardiography. Our findings suggest that patients with oculopharyngodistal myopathy should be screened for cardiomyopathy (with both electrocardiography and echocardiography).     

Design and Fabrication of an Injection Tool for Neuromuscular Microstimulators

The injection of small implants into precisely localized sites within the body is a difficult task usually undertaken by surgeons or interventive radiologists. We have designed, produced and tested a simple tool for implanting BION™ wireless microstimulators as an outpatient office procedure. The ability of BIONs to elicit a desired muscle contraction depends on their placement near the motor fibers that innervate the muscle fibers, providing both the requirement and a means for achieving accurate placement. The implant is preloaded into the tip of the cannula of a two-piece insertion tool made from non-conductive polymers. Trial stimulation pulses are generated by the implant as the tool is manipulated into the desired position. The implant is released by withdrawing the cannula over the implant, preserving both the relative location of the implant’s electrodes with respect to the target and determining its desired axial orientation, which is important for implants containing motion sensors. The BION Insertion Tool has been used for over 30 BION implants in human subjects to date. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis

Background

Chronic pain patients increasingly seek treatment through mindfulness meditation.

Purpose

This study aims to synthesize evidence on efficacy and safety of mindfulness meditation interventions for the treatment of chronic pain in adults.

Method

We conducted a systematic review on randomized controlled trials (RCTs) with meta-analyses using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Quality of evidence was assessed using the GRADE approach. Outcomes included pain, depression, quality of life, and analgesic use.

Results

Thirty-eight RCTs met inclusion criteria; seven reported on safety. We found low-quality evidence that mindfulness meditation is associated with a small decrease in pain compared with all types of controls in 30 RCTs. Statistically significant effects were also found for depression symptoms and quality of life.

Conclusions

While mindfulness meditation improves pain and depression symptoms and quality of life, additional well-designed, rigorous, and large-scale RCTs are needed to decisively provide estimates of the efficacy of mindfulness meditation for chronic pain.

     

EEPP: Conclusions,Implications and Future Directions

Early childhood is an important time for the promotion of healthy development and the prevention of mental disorders in adult life. In the context of the need to understand and design universally accessible promotional and preventative services for children, the European Early Promotion Project (EEPP) was developed as an innovative service implemented and evaluated in five European countries. Previous chapters in this special issue have detailed the components of the project, its outcomes for the primary health care professionals (PHCPs) and the families who were involved, and an evaluation of the costs. Here we draw together the major findings, assess the success of the project and discuss its contribution to the field of primary prevention.     

The Effects of the European Early Promotion Project Training on Primary Health Care Professionals

This chapter explores the effects of the European Early Promotion project training on primary health care professionals, with regard to their knowledge, self-efficacy and ability to identify need in families, and to their satisfaction with the training received. A quasi-experimental group comparison design was developed, in which an Intervention and a Comparison group were assessed twice: the Intervention group before and after the special EEPP training and the Comparison at the same time interval but without the training. Overall results show a tendency for the Intervention group to improve in knowledge and perceived self-efficacy, and a significant improvement in their accuracy of need identification in families, compared with the Comparison group. These results were more prominent in Greece, Serbia and the UK than in Finland and Cyprus, whereas training satisfaction was high in all sites. The results are discussed in terms of their implications for early intervention as well as for training PHCPs to conduct preventative and promotional work with families.     

Assessment of aldehyde dehydrogenase in viable cells

Cytosolic aldehyde dehydrogenase (ALDH), an enzyme responsible for oxidizing intracellular aldehydes, has an important role in ethanol, vitamin A, and cyclophosphamide metabolism. High expression of this enzyme in primitive stem cells from multiple tissues, including bone marrow and intestine, appears to be an important mechanism by which these cells are resistant to cyclophosphamide. However, although hematopoietic stem cells (HSC) express high levels of cytosolic ALDH, isolating viable HSC by their ALDH expression has not been possible because ALDH is an intracellular protein. We found that a fluorescent aldehyde, dansyl aminoacetaldehyde (DAAA), could be used in flow cytometry experiments to isolate viable mouse and human cells based on their ALDH content. The level of dansyl fluorescence exhibited by cells after incubation with DAAA paralleled cytosolic ALDH levels determined by Western blotting and the sensitivity of the cells to cyclophosphamide. Moreover, DAAA appeared to be a more sensitive means of assessing cytosolic ALDH levels than Western blotting. Bone marrow progenitors treated with DAAA proliferated normally. Furthermore, marrow cells expressing high levels of dansyl fluorescence after incubation with DAAA were enriched for hematopoietic progenitors. The ability to isolate viable cells that express high levels of cytosolic ALDH could be an important component of methodology for identifying and purifying HSC and for studying cyclophosphamide-resistant tumor cell populations.