Tai chi for psychosocial well‐being in older people

Lee LYK, Lee DTF, Woo J. The psychosocial effect of tai chi on nursing home residents. J Clin Nurs 2010; 19: 927–38.     

Single Kidney Transplantation from Young Pediatric Donors in the United States

Kidney transplantation (KTX) from small pediatric donors is performed as single or en bloc. Criteria to determine when to split pediatric donor kidneys and transplant as singles are not well established. Data reported to the Scientific Registry of Transplant Recipient for donors <10 yrs from 1995 to 2007 were reviewed (n = 5079). Donors were categorized by weight group by 5 kg increments and solitary (n = 3503) versus en bloc (n = 1576). The primary outcome was overall graft survival. Results were compared as adjusted hazard ratios (aHR) relative to ideal standard criteria donors (SCDs) (defined as age 18–39 without other risk factors), non‐ideal SCDs (all other SCDs) and expanded criteria donors (age 50–59 with other risk factors or age ≥60). Single KTX from donors ≥ 35 kg conferred a similar risk of graft survival as ideal SCDs. Of donors 10–34 kg, risks of en bloc KTX were similar to ideal and risks of single KTX to non‐ideal SCDs; single and en bloc KTXs had 7.9 and 5.2 graft losses per 100 follow‐up years, respectively. Single KTX from donors >35 kg are similar to ideal SCDs. Single KTX from donors 10–35 kg are similar to non‐ideal SCDs. From a resource perspective, pediatric donors 10–35 kg used as singles offer more cumulative graft years than when used en bloc.     

Outcomes After Transplantation of Deceased-Donor Kidneys with Rising Serum Creatinine

The increasing number of candidates for kidney transplantation and relatively unchanged deceased-donor pool has led to expansion in the criteria for donor acceptability. Outcomes of kidneys from donors with progressively rising creatinine values have not been reported. Patients transplanted between September 2003 and August 2006 with kidneys from donors with peak creatinine levels >2.0 mg/dL were stratified into two groups based on the terminal creatinine and evaluated for outcome: (1) falling creatinine (FC)(n= 27), terminal creatinine at least 0.2mg/dL less than peak, and (2) rising creatinine (RC)(n=24), terminal creatinine = peak. The mean terminal creatinine was significantly higher in the RC group (3.2 +/- 1.3 mg/dL) compared to the FC group (1.9 +/- 0.9 mg/dL)(p<0.0001). Peak creatinine values were similar (RC, 3.2 +/- 1.3; FC, 3.1 +/- 1.3; p=0.6521) between the two groups. Rates of delayed graft function (RC, 24%; FC 32%; p=0.7881) and mean creatinine at follow-up (RC, 1.6 +/- 0.6, FC 1.6 +/- 0.4; p=0.3533) were not significantly different. With a mean follow-up of 287 +/- 274 days, allograft survival was 92% in the RC recipients and 89% in the FC recipients. Under certain conditions, kidneys from donors with rising serum creatinine can be used safely with reasonable early outcomes.     

Correlation of histologic findings on preimplant biopsy with kidney graft survival

Kidney biopsies are being used to evaluate marginal deceased donor organs, but, the literature on the utility of this practice remains conflicting. We re-examined this issue by performing a multivariate analysis of 597 kidney transplant recipients. The presence of moderate arteriosclerosis and/or moderate arteriolosclerosis (MA), defined as ≥25% luminal compromise, was a significant predictor of graft outcome in standard criteria donors (multivariate, P  = 0.01) and in expanded criteria donors (ECD) as defined by UNOS criteria (univariate P  = 0.02). One-, 3-, and 5-year overall allograft survival with MA was 71%, 58%, and 40%, respectively. Increasing degrees of glomerulosclerosis (GS) were associated with earlier graft failure on univariate ( P  = 0.03) but not multivariate analysis ( P  = 0.36). GS > 20% and interstitial fibrosis >25% had a low frequency in the material reviewed, likely reflecting our organ utilization practices, and did not have a demonstrable effect on graft outcome. Clinical parameters independently associated with worse graft function were ECD status ( P  < 0.05), retransplantation ( P  = 0.004), recipient age ( P  < 0.05), and delayed graft function ( P  < 0.0001). Donor vascular disease is an independent risk factor for suboptimal graft survival. Great caution should be exercised in the decision to transplant kidneys with moderate arterial and/or arteriolar luminal narrowing.     

Evaluation of pancreatic allograft dysfunction by laparoscopic biopsy

BACKGROUND: Histologic evaluation of a failing pancreatic allograft is necessary for accurate classification of graft dysfunction. Unlike percutaneous or transcystoscopic techniques, laparoscopic biopsy allows visualization of the allograft in addition to obtaining tissue for histologic examination. METHODS: We retrospectively reviewed all laparoscopic pancreas transplant biopsies performed over a 15-month period ending February 2002. RESULTS: There were 12 laparoscopic pancreas biopsies performed in 11 patients between 6 weeks and 8 years (mean 2.5+/-2.8 years) after transplant. Indications for biopsy were hyperglycemia (n=8), hyperamylasemia (n=3), and graft tenderness (n=1). Adequate tissue was obtained in 11 of 12 biopsies. Two patients received definitive treatment at the time of laparoscopy (pseudocyst debridement, ovarian cyst excision). CONCLUSIONS: Laparoscopic pancreas transplant biopsy allows safe visualization of the allograft and effective specimen retrieval, and in some cases provides the opportunity for therapeutic intervention.     

Molecular and epidemiologic analysis of a county-wide outbreak caused by <Emphasis Type="Italic">Salmonella enterica</Emphasis> subsp. <Emphasis Type="Italic">enterica</Emphasis> serovar Enteritidis traced to a bakery

Background  

An increase in the number of attendees due to acute gastroenteritis and fever was noted at one hospital emergency room in Taiwan over a seven-day period from July to August, 2001. Molecular and epidemiological surveys were performed to trace the possible source of infection.     

Orthotopic liver transplantation from a donor with a history of schistosomiasis

The shortage of liver donors and the increasing number of patients on the waiting list for liver transplantation have led to a widening of the definition of suitable liver donors. In this case report, we describe transplantation of a liver from a 20-year-old brain-dead donor with a past history of schistosomiasis. Careful evaluation for schistosomiasis-related hepatic complications using hepatic function tests, clinical assessment for manifestations of portal hypertension, as well as abdominal ultrasound, and liver biopsy were performed. At 7 months follow-up, the recipient is doing well with normal liver function. Liver transplantation from a donor with a history of schistosomiasis is acceptable in carefully screened cases.     

SCHISTOSOMIASIS VACCINATION HISTORICAL DEVELOPMENT, PRESENT STATUS AND FUTURE PROSPECTS*

50 years of research on killed or live vaccine for schistosomiasis without successful produc- tion of a human schistosomiasis vaccine are reviewed.