Kidney Transplantation Significantly Improves Patient and Graft Survival Irrespective of BMI: A Cohort Study

Obesity and end-stage renal disease (ESRD) are on the increase worldwide. Kidney transplantation is the treatment of choice for ESRD. However, obesity is considered a contraindication for transplantation. We investigated the effect of BMI on mortality in transplanted and patients remaining on the waiting list in the United Kingdom. We analyzed the UK Renal Registry (RR) and the National Health Service Blood and Transplant (NHSBT) Organ Donation and Transplantation data for patients listed from January 1, 2004 to December 31, 2010, with follow-up until December 31, 2011. Seventeen thousand six hundred eighty-one patients were listed during the study period, with BMI recorded for 13 526 (77%). One- and five-year patient survival was significantly better in all BMI bands (<18.5, 18.5-<25, 25-<30, 30-<35, 35-<40, and 40+kg/m(2) ) in the transplant group when compared to those who remained on the waiting list (p < 0.0001). The analyses were repeated excluding live donor transplants and the results were essentially the same. On analyses of patient survival with BMI as a continuous variable or using 5 kg weight bands, there was no cut-off observed in the higher BMI patients where there would be no benefit to transplantation. For transplanted patients (N = 8088), there was no difference in patient or graft survival between the defined BMI bands. Thus, irrespective of BMI, patient survival is improved if transplanted.

The UK Pancreas Allocation Scheme for Whole Organ and Islet Transplantation

In order to develop a national allocation scheme for donor pancreases, factors affecting waiting time and transplant outcomes in the United States (US) and United Kingdom (UK) were analyzed and compared. Blood group, sensitization, dialysis requirement, and whether the patient was waiting for a kidney and pancreas or pancreas alone affected waiting time in both countries; ethnicity and body mass index (BMI) also affected waiting time in the US. Ninety-day pancreas survival was similar in the UK and US, and was poorer for patients receiving a pancreas alone, with older donors, higher BMI and longer duration of ischemia in both countries. Factors affecting outcome, together with published data on factors affecting islet transplantation, informed the development of a points based allocation scheme for deceased donor pancreases in the UK providing equitable access for both whole organ and islet recipients through a single waiting list. Analysis of the allocation scheme 3 years after its introduction in December 2010 showed that the results were broadly as simulated, with a significant reduction in the number of long waiting patients and an increase in the number of islet transplants. There remains a surplus of highly sensitized patients in the waiting list, which the scheme should address in time.

Risk factors associated with the mental health of fathers of children with an intellectual disability in Australia

BACKGROUND

Raising a child with a disability places considerable demands and stress on parents, which can contribute to mental health difficulties. Research has primarily focused on mothers' mental health, and our understanding of the effects on fathers remains limited. The factors that place fathers at increased risk of mental health difficulties are also poorly understood. This study aimed to redress these gaps by reporting on the mental health of a large sample of fathers of children with an intellectual disability (ID) (aged 3-15 years), comparing this to published Australian norms and mothers of children with ID. The second aim of the study was to explore risk factors associated with fathers' mental health.

METHOD

The data for this study come from 315 Australian fathers of children (aged 3-15 years) with ID, who participated in the large-scale evaluation of the Signposts for building better behaviour programme. Fathers completed a range of self-report questionnaires at baseline including the Depression Anxiety Stress Scale (DASS).

RESULTS

Fathers in the present sample reported significantly more symptoms of depression and stress than the Australian normative data, with approximately 6-8% reporting symptoms in the severe to extremely severe range. The strongest predictors of fathers' mental health difficulties were children's behaviour problems, daily stress arising from fathers' own needs and children's care needs, and low parenting satisfaction. Socio-economic factors did not predict mental health difficulties.

CONCLUSION

This study is among one of the first to report the mental health of fathers of children with a disability in Australia. Findings highlight that some fathers of children with ID are at heightened risk of experiencing mental health difficulties, underscoring the importance of the provision of information and interventions to promote their mental health.

First UK use of the iTClamp™ haemorrhage control system: Case report

We present two cases of the use of a new device for external haemorrhage control, the iTClamp™ (Innovative Trauma Care, Inc., Edmonton, Canada). These are the first uses of the devices in the UK and the first times worldwide it has been used to control haemorrhage from the neck.

The changing face of donation in the UK: kidney donation after circulatory death

Affiliated to the Association of Surgeons in Training and the British Transplantation Society, the Carrel Club is the transplant trainee surgical society. The Carrel Club held a joint meeting with the Chapter of Transplant Surgeons, a subsidiary organisation of the British Transplantation Society, at the Manchester Hilton Hotel on 31 January and 1 February 2013. As part of the meeting, ten abstracts were presented. A selection is printed below. The winner of the Best Presentation award was Mr Mownah.

Pancreas transplantation from donors after circulatory death from the United Kingdom

This study reports the comparative short-term results of pancreas transplantation from donors after circulatory death (DCD) (Maastricht III & IV), and pancreases from brainstem deceased donors (DBD). Between January 2006 and December 2010, 1009 pancreas transplants were performed in the United Kingdom, with 134 grafts from DCD and 875 from DBD. DCD grafts had no premortem pharmacological interventions performed. One-year pancreas and patient survival was similar between DCD and DBD, with pancreas graft survival significantly better in the DCD cohort if performed as an SPK. Early graft loss due to thrombosis (8% vs. 4%) was mainly responsible for early graft loss in the DCD cohort. These results from donors with broader acceptance criteria in age, body mass index, premortem interventions, etc. suggest that DCD pancreas grafts may have a larger application potential than previously recognized.

New records of 45 bird species in the desert margins area of the North-West Province, South Africa

New records and possible range extensions are reported on 45 bird species (ca 25% of the 167 species recorded during surveys) in the Bophirima district of the North-West Province, South Africa. The findings were compared with data in The Atlas of Southern African Birds. The main reasons for these new records may be ascribed to the low number of visits during the atlas project, higher precipitation during the time of our observations versus that of the atlas project, and possibly an increased suitability of the area for some bird species due to human habitation. These new records also provide additional information that may be useful in conservation planning, especially in arid areas. Heuningvlei Pan in particular, should be considered for additional conservation measures.

Culture of Neospora caninum in the presence of a Mycoplasma Removal Agent results in the selection of a mutant population of tachyzoites

Mycoplasmas are common contaminants of eukaryotic cells grown in tissue culture. A commercially available Mycoplasma Removal Agent (MRA) was therefore assessed for its effect on tachyzoites of Neospora caninum, in order to determine its suitability for further use in parasite cell cultures. Analyses of tachyzoite and excreted-secreted proteins and antigens by SDS-PAGE and Western blotting show that MRA treatment results in the rapid selection of a mutant population that differs from the control and parental lines in its protein and antigen content. The treatment of N. caninum cultures with MRA is therefore not recommended for the eradication of Mycoplasma.

Nearest-neighbor-atom core-hole transfer in isolated molecules

A new phenomenon sensitive only to next-door-neighbor atoms in isolated molecules is demonstrated using angle-resolved photoemission of site-selective core electrons. Evidence for this interatomic core-to-core electron interaction is observable only by measuring nondipolar angular distributions of photoelectrons. In essence, the phenomenon acts as a very fine atomic-scale sensor of nearest-neighbor elemental identity.

Dramatic nondipole effects in low-energy photoionization: experimental and theoretical study of Xe 5s

The Xe 5s nondipole photoelectron parameter gamma is obtained experimentally and theoretically from threshold to approximately 200 eV photon energy. Significant nondipole effects are seen even in the threshold region of this valence shell photoionization. In addition, contrary to previous understanding, clear evidence of interchannel coupling among quadrupole photoionization channels is found.

Elucidation of potential transmission routes of Campylobacter in New Zealand

Campylobacter is the most commonly reported notifiable disease in New Zealand. The cost of Campylobacter infections in the country during 1994 was estimated as dollar 61.7M although the true cost was probably higher. Investigation of the main environmental reservoirs and routes of transmission to humans is necessary to formulate the most appropriate intervention strategies. This project investigated the reservoirs of Campylobacter in a defined geographical area within New Zealand and compared strains isolated from humans and environmental sources within this area as a prelude to investigating the likely transmission routes to humans. Campylobacter jejuni was commonly found in faeces from dairy cows, beef cattle, sheep and ducks, chicken carcasses, sheep offal and surface waters and C. coli was commonly found in sheep faeces. Preliminary analysis of Penner types was suggestive of transmission to humans from dairy and beef cattle and possibly from sheep.

Plant development: Two sides to organ asymmetry

Three gene families have been identified which interact to polarize plant lateral organs. The results suggest that organ polarity is initially determined by a signal from the shoot tip which specifies adaxial organ identity and results in repression of abaxial identity, thereby aligning the polarity of organs with the stem.

The revised Sign and Symptom Check-List for HIV (SSC-HIVrev)

Symptom management for persons living with HIV/AIDS is recognized as an extremely important component of care management. This article reports on the continuing validation of the revised Sign and Symptom Check-List for Persons With HIV Disease (SSC-HIVrev). The initial validation study used a combined sample of 933 HIV-positive persons and concluded that the validity and reliability of the instrument were adequate to measure patients' self-report of HIV-related signs and symptoms. The revised scale includes items to measure gynecological-related symptoms and the impact of lipodystrophy (body fat redistribution) due to antiretroviral therapy on patients' symptom experience. The scale structure (factor analysis) and reliability estimates were recalculated in a new sample of 372 HIV-positive persons. Based on reviewing the clusters of items, factor loadings, reliability estimates, and clinical interpretability, an 11-factor solution was determined that explained 73.3% of the variance. Of the retained factors, 4 had eigenvalues less than 1, yet they explained significant amounts of variance in the rotated sums of squares loading (5.0%, 4.3%, 4.3%, and 3.6%, respectively), the reliability estimates were good, and the factors had clinical meaning. The revised scale (SSC-HIVrev) has three parts: Part 1 consists of 45 items that clustered into 11 factor scores along with a total score, with reliability estimates ranging from .76 to .91; Part 2 consists of 19 HIV-related symptoms that do not cluster into factor scores but may be of interest from a clinical perspective; and Part 3 consists of 8 items related to gynecological symptoms for women. These 8 items were submitted to a principal components factor analysis with varimax rotation (n = 118 HIV-positive women), and a 1-factor solution explained 71.8% of the variance, with a reliability estimate of .94. The psychometric properties of the SSC-HIVrev are presented.

TheHandlebarsgene is required withPhantasticafor dorsoventral asymmetry of organs and for stem cell activity inAntirrhinum

In angiosperms, individual lateral organs and whole flowers may develop asymmetrically along their dorsoventral axes. Dorsoventral asymmetry of Antirrhinum leaves requires activity of the Phantastica gene and other factors acting redundantly with it. We describe the effects of a mutation in the Handlebars gene, identified as an enhancer of the phantastica mutant phenotype. Genetic analysis suggests that Handlebars functions redundantly with Phantastica to promote dorsal fate in lateral organs and to maintain activity of stem cells within shoot apical meristems. Handlebars appears dispensable in vegetative development but is needed for asymmetry of petals along the dorsoventral axis of the flower as a whole. This suggests that common mechanisms may control dorsoventral asymmetry in lateral organ primordia and in floral meristems.

Control of a genetic regulatory network by a selector gene

The formation of many complex structures is controlled by a special class of transcription factors encoded by selector genes. It is shown that SCALLOPED, the DNA binding component of the selector protein complex for the Drosophila wing field, binds to and directly regulates the cis-regulatory elements of many individual target genes within the genetic regulatory network controlling wing development. Furthermore, combinations of binding sites for SCALLOPED and transcriptional effectors of signaling pathways are necessary and sufficient to specify wing-specific responses to different signaling pathways. The obligate integration of selector and signaling protein inputs on cis-regulatory DNA may be a general mechanism by which selector proteins control extensive genetic regulatory networks during development.