Purpose The purpose of this study was to evaluate the benefits of computer navigation on tunnel placement during anterior cruciate ligament reconstruction. Methods A prospective, randomized, ...controlled study comparing computer navigation with manual operation was performed between December 2003 and April 2004. We assigned 20 patients to the computer navigation group and 20 patients to the manual navigation group. Surgery was performed by use of a patellar tendon autograft with press-fit fixation. A lateral radiograph of the knee at maximum extension was used to determine the exact position of the tibial tunnel at 4 days postoperatively. Outcomes were evaluated with International Knee Documentation Committee 2000, Tegner, and Lysholm scoring. There was an additional magnetic resonance imaging (MRI) evaluation of tunnel placement and graft quality at the most recent follow-up, approximately 24 months after surgery. Results The postoperative radiographs and 2-year postoperative MRI scans showed no differences between groups for tibial or femoral tunnel placement. In both groups the mean tibial tunnel placement was 46% of the maximal diameter of the tibia. There were no significant differences between groups for objective and subjective outcomes scoring. Although some qualitative differences existed between groups with respect to MRI graft appearance at 2 years, this had no correlation with overall results. Conclusions No significant differences were found between computer-assisted and manually navigated anterior cruciate ligament reconstruction with regard to tunnel placement and clinical results at a mean of 2 years postoperatively. Level of Evidence Level I, randomized, single-blinded, controlled trial.
Kidney transplantation is the best treatment for end-stage renal disease since it offers the greatest survival benefit compared to dialysis. The gap between the number of renal transplants performed ...and the number of patients awaiting renal transplants leads to a steadily increasing pressure on the scientific community. Kidney preimplantation biopsy is used as a component of the evaluation of organ quality before acceptance for transplantation. However, the reliability and predictive value of biopsy data are controversial. Most of the previously proposed predictive models were not associated with graft survival, but what has to be reaffirmed is that histologic examination of kidney tissue can provide an objective window on the state of the organ that cannot be deduced from clinical records and renal functional studies. The balance of evidence indicates that reliable decisions about donor suitability must be made based on the overall picture. This work discusses recent trends that can reduce diagnostic timing and variability among players in the decision-making process that lead to kidney transplants, from the pathologist's perspective.
Abstract
Background
The ongoing coronavirus pandemic has major impacts on both patients and healthcare systems worldwide, thus creating new realities. Patients on maintenance dialysis listed for ...renal transplantation are a vulnerable subgroup with many comorbidities and recurring contacts with the healthcare system. Due to the COVID-19 pandemic transplant numbers have dropped considerably, further increasing waiting times in this high-risk population. On the other hand, knowledge of the severity of SARS-CoV-2 infection in immunocompromised patients, development and persistence of neutralising antibodies in such patients is just emerging. It is unclear how best to address the dilemma of postponing the life-saving transplantation.
Case presentation
We present a case report of a successful kidney transplantation only 65 days after the recipient was hospitalized for treatment of COVID-19 pneumonia. In a follow up of 9 months, we observed no signs of recurrent disease and transplant function is excellent. Monitoring SARS-CoV-2 antibody response demonstrates stable IgG levels.
Conclusion
This reassuring case provides guidance to transplant centers how to proceed with kidney transplantation safely during the pandemic. Careful consideration of risks and benefits of the organ offer, full recovery from COVID-19 symptoms and the presence of a positive SARS-CoV-2 IgG antibody test, qualifies for kidney transplantation.
Mammalian target of rapamycin (mTOR) inhibitors are increasingly used as immunosuppressive agents in kidney transplantation. In the experimental setting it has been shown that mTOR inhibitors promote ...autophagy, but the concept that this might also occur in transplant patients has not been addressed.
This study was designed to investigate the association between mTOR inhibition and autophagy in renal transplants under routine clinical conditions.
Protocol transplant biopsies of patients receiving sirolimus were compared to biopsies of patients treated without mTOR inhibitor. Electron microscopy was used for quantitative stereological analysis of autophagosomal volume fractions. Ultrastructural analysis was focused on podocytes to avoid cell type bias. Autophagy-related gene products were profiled by QPCR from laser assisted microdissected glomeruli and by immunohistochemistry for semiquantitative evaluation.
By electron microscopy, we observed a significant > 50% increase in podocytic autophagosomal volume fractions in patients treated with sirolimus. Evaluation of biopsy material from the same patients using transcriptional profiling of laser capture microdissected glomeruli revealed no differences in autophagy-related gene expressions. Immunohistochemical evaluation of autophagic degradation product p62 was also unaltered whereas a significant increase was observed in podocytic LC3 positivity in biopsies of sirolimus treated patients.
These results indicate an association of sirolimus treatment and autophagosome formation in transplant patients. However, they might reflect autophagosomal buildup rather than increased autophagic flux. Further research is needed to investigate the potential functional consequences in short- and long-term outcome of patients treated with mTOR inhibitors.
Highlights • We assess the use of real-time PCR in feces for diagnosing CMV intestinal disease. • Qualitative fecal CMV PCR results are specific, making quantification dispensable. • Fecal PCR has a ...good specificity but low sensitivity for diagnosing CMV colitis. • CMV DNA detection in feces is associated with high CMV levels in gut biopsies.
Transplant failure requires the consideration of numerous potential causes including rejection, acute tubular necrosis, infection, and recurrence of the original kidney disease. Kidney biopsy is ...generally required to approach these differential diagnoses. However, the histopathological findings on their own do not always lead to a definite diagnosis. Consequently, it is crucial to integrate them with clinical findings and patient history when discussing histopathological patterns of injury. The histopathologic finding of a membranoproliferative glomerulonephritis (MPGN) is one of the most challenging constellations since it does not refer to a specific disease entity but rather reflects a pattern of injury that is the result of many different causes. Whilst MPGN is occasionally classified as immune complex mediated, careful evaluation usually reveals an underlying disorder such as chronic infection, plasma cell dyscrasia, complement disorders, and autoimmune disease.
We describe the case of a 43-year-old woman who was referred to us because of a slowly rising serum creatinine 4 years after kidney transplantation. As in the native kidney, the biopsy revealed an MPGN pattern of injury. The cause of this finding had not been established prior to transplantation leading to a classification as idiopathic MPGN in the past. Further workup at the time of presentation and allograft failure revealed chronic infection of a ventriculoatrial shunt as the most probable cause.
This case underlines the fact that MPGN is not a disease but a histopathological description. Consequently, the causative disorder needs to be identified to avoid kidney failure and recurrence after transplantation.
Social Law 4.0 Becker, Ulrich; Chesalina, Olga
2021
eBook
Odprti dostop
Digitalisation and the changing world of work are calling into question the standard employment model as a basis for social security systems. Whilst a growing number of publications deal with the ...consequences for industrial relations and labour law, social law is still being left out of most research projects on digital work. This book aims at widening the perspective. It concentrates on the two most important questions in the context of social protection in a digitalised world, namely access to social protection systems and their future financing, putting emphasis on platform work. It gives an overview of different national approaches to these questions, it analyses the respective solutions in a comparative manner, and it puts them into a transnational context. By bringing together case studies from Belgium, Italy, the United Kingdom, the Netherlands, Denmark, Sweden, Spain, France and Estonia and addressing the specific reform challenges for EU standard setting, EU coordination and the relation to tax law, the book provides new insights on what a “Social Law 4.0” should look like. Digitalisierung und die damit einhergehenden Veränderungen der Arbeitswelt stellen das Standardmodell der Beschäftigung als Basis von sozialen Sicherungssystemen zunehmend in Frage. Während sich eine wachsende Zahl an Veröffentlichungen mit deren Folgen für das Arbeitsrecht beschäftigen, bleibt bis heute das Sozialrecht weitgehend ausgeblendet. Das Buch schafft Abhilfe. Es beschäftigt sich mit den wichtigsten Herausforderungen für den sozialen Schutz durch Digitalisierung, dem Zugang zu Sicherungssystemen und deren Finanzierung am Beispiel der Plattformarbeit. Es gibt einen Überblick über nationale Lösungsansätze, analysiert dies in vergleichender Perspektive und stellt sie in einen transnationalen Kontext. Das Buch vereint Fallstudien aus Belgien, Italien, dem Vereinigten Königreich, den Niederlanden, Dänemark, Schweden, Spanien, Frankreich und Estland und behandelt die Herausforderungen, die Reformen für eine Standardsetzung auf EU-Ebene, für die Koordinierung innerhalb der EU und für ihr Verhältnis zum Steuerrecht ausgesetzt sind. Es vermittelt damit neue Einsichten, wie ein „Sozialrecht 4.0“ aussehen sollte.
The prevalence of end stage renal disease of unknown etiology in adult patients is globally high and accounts for almost 20% of all dialysis patients. Recent studies have suggested that the ...percentage of adult patients with a causal genetic variant has been underestimated so far. Despite severe prognostic and therapeutic implications, awareness about prevalence and manifestations of genetic kidney diseases in adult renal patients is still limited.
We recruited 58 individuals from 39 families at our transplantation center, fulfilling at least one of the following criteria: 1) unclear etiology of kidney disease 2) clinically suspected genetic kidney disease 3) positive family history for nephropathies. The cohort consisted of patients waitlisted for kidney transplantation and patients in the follow-up after transplantation. Detailed documentation of family history and phenotype was obtained before initiating gene panel sequencing of 479 nephropathy-associated genes.
With this study design, a molecular genetic diagnosis was established in one third of all patients. Mutations in the collagen COL4A-genes, and mutations in MUC1 and UMOD were the most frequent among all detected causal variants. Overall, rare genetic variants were detected in more than half of all cases.
The combination of detailed phenotyping prior to NGS diagnostics was highly efficient. Elucidating the underlying genetic causes in a cohort of adult renal patients has considerable clinical impact on medical management.
Endothelial Progenitor Cells have been shown as effective tool in experimental AKI. Several pharmacological strategies for improving EPC-mediated AKI protection were identified in recent years. Aim ...of the current study was to analyze consequences of constitutive Atg5 activation in murine EPCs, utilized for AKI therapy.
Ischemic AKI was induced in male C57/Bl6N mice. Cultured murine EPCs were systemically injected post-ischemia, either natively or after Atg5 transfection (Adenovirus-based approach). Mice were analyzed 48 h and 6 weeks later.
Both, native and transfected EPCs (EPCs
) improved persisting kidney dysfunction at week 6, such effects were more pronounced after injecting EPCs
. While matrix deposition and mesenchymal transdifferentiation of endothelial cells remained unaffected by cell therapy, EPCs, particularly EPCs
completely prevented the post-ischemic loss of peritubular capillaries. The cells finally augmented the augophagocytic flux in endothelial cells.
Constitutive Atg5 activation augments AKI-protective effects of murine EPCs. The exact clinical consequences need to be determined.
Die Verordnung von Medikamenten außerhalb ihrer arzneimittelrechtlichen Zulassung (Off-Label-Use) ist fester Bestandteil des medizinischen Alltags in Deutschland. Ziel des Tagungsbandes ist es, ...basierend auf einer einleitenden Darstellung der medizinischen Grundproblematik, die mit dem Off-Label-Use verbundenen sozial- und haftungsrechtlichen Probleme aufzuzeigen und zu diskutieren. Der Band beginnt mit einer Darstellung des Off-Label-Use aus ärztlicher Sicht im Bereich der Onkologie und geht dann im nächsten Beitrag auf zwei ausgewählte Aspekte des Off-Label-Use in den USA ein. Es folgt eine eingehende Aufarbeitung der Rechtsprechung des Bundessozialgerichts (BSG) und deren Entwicklung. Anschließend werden die durch das BSG aufgestellten Kriterien aus Sicht der Rechtsanwendung kritisch untersucht und deren Praktikabilität im alltäglichen Umgang mit Patienten hinterfragt. Nach einem Statement zum Off-Label-Use aus Sicht der Pharmaindustrie schließt der Band mit einem Beitrag zu den zivil-, sozial- und strafrechtlichen Haftungsrisiken, denen sich ein Arzt, der den Off-Label-Use eines Arzneimittels verordnet, ausgesetzt sieht.
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