Older donors and kidney transplantation

Reluctance to use kidneys from older donors (>50 years of age) is based on reports of inferior results. We reviewed our experience with 45 kidneys transplanted from older donors. Primary nonfunction, immediate graft function, and 1-, 2- and 3-year graft survival rates were similar to those obtained with kidneys transplanted from donors aged between 20 and 40 years. Renal function at 1 year (as measured by serum creatinine) was poorer in kidneys from older donors. No beneficial effect with respect to graft survival was noted with cyclosporin therapy compared to conventional immunosuppression; however, the numbers are small. We conclude that kidneys from older donors are a valuable source for transplantation.     

'THOUGH THIS BE MADNESS YET THERE IS METHOD IN'T'1

ABSTRACT Freud's paper on the Schreber Case is considered from a contemporary perspective drawing on the object relations theorists. Some of Winnicott's ideas are used to illustrate how one might understand Schreber's predicament today. Although Freud's views on the role of repressed homosexual longings in the aetiology of Schreber's illness are not endorsed his prescience in the search for meaning in the patient's discourse is applauded.     

Renal transplantation performed across a positive crossmatch: A single centre experience

The importance of certain positive crossmatches (CM⁺) in kidney transplantation remains controversial. Fifty consecutive kidney transplants were performed across a CM⁺ between Jan. 1990 – April 1994. In 19 cases there was an isolated B-cell CM⁺ (Group I), in 24 an historic T-cell IgM CM⁺ (Group II) and in 7 an historic T-cell IgG CM⁺ (Group III). Comparing groups I:II:III: early acute rejection affected 32%, 42%, 57% of grafts; mean serum creatinine at 3 months was 166, 150, 229 umol/l (p<0.05); 1 yr graft survival was 95 per cent, 96 per cent, 71 per cent (p=0.09). In group III both graft losses were in the setting of an additional current B-cell CM⁺. Conclusions: Transplantation performed in either the presence of an isolated B-cell CM⁺ or in the presence of an historic T-cell IgM CM⁺ was associated with acceptable outcomes at 1 yr. An historic T-cell IgG CM⁺ was confirmed as a contraindication to transplantation in most circumstances, especially when coupled with a current B-cell CM⁺.     

Synthesis and properties of (D)- and (L)-lactide stereocopolymers using the system achiral Schiff's base/aluminium methoxide as initiator

The polymerization of lactides with various D /L enantiomeric compositions using achiral Schiff's base/aluminium methoxide as initiator (SALENAlOCH₃) in dichloromethane solution at 70°C is reported. The conversion was kept below 70% in order to limit transesterification reactions. The polymers obtained after precipitation show a narrow molecular weight distribution (ratio of weight- to number-average molecular weights M _w/M _n = 1,1–1,2) and an optical rotation higher than that expected from the optical purity of the starting monomers. The examination of the thermal properties reveals that whatever their enantiomeric composition all the prepared polymers are crystalline. This unusual behavior is explained by an end-chain propagation mechanism producing stereocopolymers with long enantiomeric sequences, i.e., increased isotacticity as substantiated by an examination of the microstructure of the polymers by means of ¹³C nuclear magnetic resonance. A stereocomplex formation was observed for stereocopolymers with optical purities below 40%.     

Proliferative retinal diseases: myofibroblasts cause chronic vitreoretinal traction.

Myofibroblasts are contractile cells having features intermediate between those of the fibroblast and smooth muscle. Myofibroblasts in preretinal membranes may cause retinal traction in proliferative retinal diseases. In this study, we demonstrate the presence of a chronically contractile subpopulation of myofibroblasts in pre-retinal membranes. Apha smooth muscle actin or desmin, both markers of the myogenically differentiated and chronically contractile subpopulation could be detected in a large majority of the examined membranes. Our findings may serve to explain the cellular basis of vitreoretinal traction in proliferative vitreoretinopathy and proliferative diabetic retinopathy.     

Understanding what works--and why--in quality improvement: the need for theory-driven evaluation.

Clinicians who are asked to participate in quality improvementprogrammes in healthcare organizations are often heard to askfor the evidence that they ‘work’. By that, theyoften mean they want randomized controlled trials, which showthat accreditation, or credentialing, or criterion-based audit,or adverse event monitoring, or continuous quality improvementprogrammes, or whatever approach is being used cause meaningfuland worthwhile improvements in the quality of care [1]. Whenthey learn that there are relatively few experimental studiesof quality improvement interventions [2], and those which doexist often show weak or moderate effects at best, this stateof affairs is sometimes used to argue that it is not worthwhile     

Murine Dendritic Cells Pulsed In Vitro with Toxoplasma gondii Antigens Induce Protective Immunity In Vivo

The activation of a predominant T-helper-cell subset plays a critical role in disease resolution. In the case of Toxoplasma gondii, the available evidence indicates that CD4⁺ protective cells belong to the Th1 subset. The aim of this study was to determine whether T. gondii antigens (in T. gondii sonicate [TSo]) presented by splenic dendritic cells (DC) were able to induce a specific immune response in vivo and to protect CBA/J mice orally challenged with T. gondii cysts. CBA/J mice immunized with TSo-pulsed DC exhibited significantly fewer cysts in their brains after oral infection with T. gondii 76K than control mice did. Protected mice developed a strong humoral response in vivo, with especially high levels of anti-TSo immunoglobulin G2a antibodies in serum. T. gondii antigens such as SAG1 (surface protein), SAG2 (surface protein), MIC1 (microneme protein), ROP2 through ROP4 (rhoptry proteins), and MIC2 (microneme protein) were recognized predominantly. Furthermore, DC loaded with TSo, which synthesized high levels of interleukin-12 (IL-12), triggered a strong cellular response in vivo, as assessed by the proliferation of lymph node cells in response to TSo restimulation in vitro. Cellular proliferation was associated with gamma interferon and IL-2 production. Taken together, these results indicate that immunization of CBA/J mice with TSo-pulsed DC can induce both humoral and Th1-like cellular immune responses and affords partial resistance against the establishment of chronic toxoplasmosis.