Making sense of the spectrum of glomerular disease associated with complement dysregulation

Over recent years, complement has emerged as a major player in the development of a number of glomerular diseases, including atypical haemolytic uraemic syndrome, membranoproliferative glomerulonephritis and the recently described C3 glomerulonephritis. Some patients and pedigrees show overlapping features of these conditions. Intriguingly, a few complement gene mutations are common to different disease phenotypes. In this review, we explore the evidence for complement dysregulation in these diseases and the clinical interface between them, and present a hypothesis to explain the variable phenotype associated with dysregulation of the alternative complement pathway.     

Impact of adverse pancreatic injury at surgical procurement upon islet isolation outcome

The consequence of a pancreas injury during the procurement for islet isolation purpose is unknown. The goal of this work was to assess the injuries of the pancreata procured for islet isolation, and to determine their effect on the islet yield. Between January 2007 and October 2013, we prospectively documented every injury of the pancreata processed in our centre for islet isolation. Injuries involving the main duct were classified as major, the others as minor. Donors’ characteristics and islet yields were compared between the groups of injuries. A pancreas injury was identified in 42 of 452 pancreata received for islet isolation (9.3%). In 15 cases, the injury was major (3.3% of all pancreata). Although a minor injury did not affect the islet yield, a major injury was significantly associated with unfavourable outcomes (postpurification mean islet equivalent of 364 ± 181, 405 ± 190 and 230 ± 115 × 10³ for absence of injury, minor injury and major injury, respectively). A major injury was significantly more prevalent in lean and short donors. We recommend assessing the quality of the pancreas in the islet isolation centre before starting the isolation procedure. Each centre should determine its own policy based on its financial resources and on the wait list.     

A theory of dependent-care: a corollary theory to Orem's theory of self-care

Dependent-care has its origins in people's requirements for regulatory care. The foundations for dependent-care are found in the ability of individuals to provide their required care. First introduced as a corollary to self-care, this work emerged through a process of reading and discussion. Models that support the theory of dependent-care are identified. Premises are stated. There is elaboration of the conceptualizations representing the work that has been done. There are still elements that need further development, such as specifying the enabling abilities of dependent-care agency and verifying and formalizing the various elements presented.     

Effect of a single 30-minute treatment of high voltage pulsed current on edema formation in frog hind limbs.

The purpose of this study was to investigate the effect of a single treatment of high voltage pulsed current (HVPC) on edema formation. Twenty-four frogs were anesthetized, and both hind limbs of each frog were traumatized by impact. Limb volumes were measured by water displacement immediately before and after trauma and at predetermined intervals for 24.0 hours posttrauma. One limb of each frog was randomly selected to receive 30 minutes of continuous, 120-pulse per second, cathodal HVPC at voltages 10% less than motor threshold levels. Data were analyzed by an analysis of variance for repeated measures. Sources of significant differences were determined by paired t tests (probability values determined by Bonferroni adjustment). A single 30-minute application of HVPC significantly curbed edema formation for between 4.0 and 7.5 hours following treatment (ie, volumes of treated limbs were significantly less than those of untreated limbs). These results suggest that regimens currently applied to humans (ie, one treatment per day or three times per week) may be insufficiently aggressive to provide sustained treatment effects.     

Improved survival with hospitalists in a pediatric intensive care unit

OBJECTIVE: To compare the survival of patients in a teaching hospital pediatric intensive care unit in which residents provided after-hours in-house coverage with survival in the same unit with hospitalists providing this coverage. DESIGN: Retrospective cohort study. SETTING: Pediatric intensive care units in two teaching hospitals that are managed by the same group of academic pediatric intensivists, one of which transitioned from the traditional resident-staffed model to a hospitalist-staffed model for after-hours in-house coverage. PATIENTS: All pediatric patients admitted to the study pediatric intensive care unit and to the control pediatric intensive care unit from April 1997 through March 1998, the resident era, and from October 1998 through September 1999, the hospitalist era. INTERVENTIONS: Multivariate analysis, with survival as the dependent variable and era (hospitalist vs. resident) as an independent variable, was used to compare odds of survival during the hospitalist era with that of the resident era, adjusted for severity of illness. Multivariate linear regression was used to compare length of stay during the hospitalist era with that of the resident era, adjusted for severity of illness. Pediatric Risk of Mortality scores and those diagnostic categories typically associated with higher mortality rates also were included as independent variables in both analyses to adjust for severity of illness. MEASUREMENTS AND MAIN RESULTS: Multivariate analysis yielded an estimated odds ratio of survival of 2.8 for the hospitalist era compared with the resident era (p = .013), and our analysis supported an independent association between survival and hospitalist era. Multivariate linear regression showed that length of stay, also adjusted for severity of illness, during the hospitalist era was 21.1 hrs shorter than during the resident era (p = .013). Neither survival nor length of stay was significantly associated with era at the control hospital. CONCLUSION: Improved survival with hospitalists, rather than residents, providing after-hours care when an intensivist is not in house suggests that the quality of care of critically ill patients is improved when more experienced physicians are providing bedside care. Shorter length of stay with the hospitalist model also may reflect improved quality of care.     

An exploratory Delphi study on the integration of disabled students into physiotherapy education

Objectives

The introduction of the Disability Discrimination Act (DDA) IV (1995) in the UK requires universities to ensure that they do not discriminate against disabled students. The objectives of this study were to achieve consensus on the attributes required for a competent physiotherapist, and to explore implementation of the DDA into physiotherapy education.

Design

An exploratory study was performed using the Delphi technique. Respondents were asked to comment on the skills required to be a physiotherapist, and the implementation of the DDA during the admission process.

Setting and participants

Participation was invited from all physiotherapy admission tutors working on pre-registration physiotherapy courses in England (n = 43). Twenty of these consented to be involved, and 13 completed the whole study.

Method

The Delphi study consisted of three questionnaires administered sequentially; the results from one questionnaire forming the basis of the next. On analysis of the third questionnaire, consensus and saturation had been achieved.

Results

The admission tutors showed strong consensus (92%) on the skills necessary to be a physiotherapist, although there was some debate about sensory and physical abilities. Participants were uneasy about the level of support for staff and their knowledge of support systems for disabled students. Respondents also expressed concern over the level of support for disabled students. The possibility of conditional qualification for disabled students was discussed.

Conclusion

Standards set out by the professional bodies could be used to enable disabled students to self-assess their abilities prior to application for courses. Disability support systems within universities need to include physiotherapy tutors.     

Leptin reverses insulin resistance and hepatic steatosis in patients with severe lipodystrophy

Lipodystrophy is a rare disorder that is characterized by selective loss of subcutaneous and visceral fat and is associated with hypertriglyceridemia, hepatomegaly, and disordered glucose metabolism. It has recently been shown that chronic leptin treatment ameliorates these abnormalities. Here we show that chronic leptin treatment improves insulin-stimulated hepatic and peripheral glucose metabolism in severely insulin-resistant lipodystrophic patients. This improvement in insulin action was associated with a marked reduction in hepatic and muscle triglyceride content. These data suggest that leptin may represent an important new therapy to reverse the severe hepatic and muscle insulin resistance and associated hepatic steatosis in patients with lipodystrophy.