Simultaneous administration of adjuvant donor bone marrow in pancreas transplant recipients

Objective: The effect of donor bone marrow was evaluated for its potentially favorable effect in the authors' simultaneous pancreas/kidney transplant program. Methods: From July 1994 to January 1999, 177 pancreas transplants were performed, 151 of which were simultaneous pancreas/kidney transplants. All patients received tacrolimus, mycophenolate mofetil, and steroids for immunosuppression (azathioprine was used in the first year of the program). Fifty-three simultaneous pancreas/kidney transplant recipients received perioperative unmodified donor bone marrow, 3 to 6 x 108 cells/kg. Results: Overall actuarial survival rates at 1 and 3 years were 98% and 95% (patient), 95% and 87% (kidney), and 86% and 80% (pancreas), respectively. In the adjuvant bone marrow group, 1- and 3-year survival rates were 96% and 91% (patient), 95% and 87% (kidney), and 83% and 83% (pancreas), respectively. For 98 recipients who did not receive bone marrow, survival rates at 1 and 3 years were 100% and 98% (patient), 96% and 86% (kidney), and 87% and 79% (pancreas), respectively. No pancreas allografts were lost after 3 months in bone marrow recipients, and seven in the non-bone marrow recipients were lost to rejection at 0.7, 6.7, 8.8, 14.6, 24.1, 24.3, and 25.5 months. Twenty-two percent of bone marrow patients were steroid-free at 1 year, 45% at 2 years, and 67% at 3 years. Nineteen percent of the non-bone marrow recipients were steroid-free at 1 year, 38% at 2 years, and 45% (p = 0.02) at 3 years. The mean acute cellular rejection rate was 0.94 ± 1.1 in the bone marrow group and 1.57 ± 1.3 (p = 0.003) in the non-bone marrow group (includes borderline rejection and multiple rejections). The level of donor cell chimerism in the peripheral blood of bone marrow patients was at least two logs higher than in controls. Conclusion: In this series, which represents the largest experience with adjuvant bone marrow infusion in pancreas recipients, there was a higher steroid withdrawal rate (p = 0.02), fewer rejection episodes, and no pancreas graft loss after 3 months in bone marrow recipients compared with contemporaneous controls. All pancreas allografts lost to chronic rejection (n = 6) were in the non-bone marrow group. Donor bone marrow administered around the time of surgery may have a protective effect in pancreas transplantation

Platinum(II), palladium(II), nickel(II), and gold(I) complexes of the “electrospray-friendly” thiolate ligands 4-SC₅H₄N- and 4-SC₆H₄OMe-

The series of platinum(II), palladium(II), and nickel(II) complexes [ML₂(dppe)] [M = Ni, Pd, Pt; L = 4-SC₅H₄N or 4-SC₆H₄OMe; dppe = Ph₂PCH₂CH₂PPh₂] containing pyridine-4-thiolate or 4-methoxybenzenethiolate ligands, together with the corresponding gold(I) complexes [AuL(PPh3)], were prepared and their electrospray ionization mass spectrometric behavior compared with that of the thiophenolate complexes [M(SPh)₂(dppe)] (M = Ni, Pd, Pt) and [Au(SPh)(PPh₃)]. While the pyridine-4-thiolate complexes yielded protonated ions of the type [M + H]+ and [M + 2H]²+ ions in the Ni, Pd, and Pt complexes, an [M + H]+ ion was only observed for the platinum derivative of 4-methoxybenzenethiolate. Other ions, which dominated the spectra of the thiophenolate complexes, were formed by thiolate loss and aggregate formation. The X-ray crystal structure of [Pt(SC₆H₄OMe-4)₂(dppe)] is also reported

Evaluasi Kerasionalan Pengobatan pada Pasien Diabetes Melitus Tipe 2 di Instalasi Rawat Inap RSU YARSI Pontianak

Diabetes melitus (DM) merupakan penyakit kronik yang ditandai dengan tingginya kadar gula dalam darah (hiperglikemia). DM saat ini termasuk ke dalam lima besar penyebab kematian dan jumlah penderitanya di dunia masih sangat tinggi. Penelitian ini bertujuan untuk mengevaluasi kerasionalan pengobatan pada pasien DM tipe 2 rawat inap di RSU Yarsi Pontianak. Peneliti melakukan pengambilan data melalui rekam medis pasien periode Juli-Desember 2014 dengan desain cross-sectional. Teknik pengambilan data berupa quota sampling, didapatkan 32 sampel yang sesuai dengan kriteria inklusi penelitian. Adapun parameter evaluasi meliputi tepat indikasi, tepat obat, tepat dosis, tepat pasien dan interaksi obat. Pada hasil penyajian data secara deskriptif, penilaian ketepatan berdasarkan pemberian obat antidiabetes pada pasien terdapat tepat indikasi sebesar 87,5%, tepat obat sebesar 15,62%, tepat dosis sebesar 100%, tepat pasien sebesar 87,5% dan tidak adanya interaksi obat sebesar 84,37%. Dari hasil penelitian dapat disimpulkan bahwa dari total 32 sampel yang memenuhi kelima parameter evaluasi berjumlah 3 sampel

Geological Report of Summer Field Trip 1928

The object of this trip and report was to familiarize the students of the Montana State School of Mines with methods of taking and mapping surface and undergound geology. All surface geology was mapped by means of plane table and alidade, and undergound work by means of Brunton compass and taps. The senior class of the Montana State School of MInes under the supervision of Dr. E.S. Perry performed the work, which covered an area in Madison County including South Boulder Creek, near Jefferson Island, the Silver Star Mining District, and the Alameda Mine, near Virginia City

Genome-wide Analysis Using ChIP-seq Reveals Novel Downstream Targets of Stat3

poster abstractMany cells are involved in the orchestra that is bone homeostasis--particularly osteoclasts and osteoblasts who mediate remodeling of bones. This creates a balance that must be kept in check, otherwise pathologies arise. The JAK-Stat signaling pathway is crucial to maintaining this balance. It has long been known that the transcription factor Stat3 has more profound effects on bone homeostasis than other members of the Stat family of proteins. Recently, a genetic condition called Job’s Syndrome has been specifically linked to point mutations in the STAT3 gene. These patients present with severe bone abnormalities including prominent foreheads, broad nasal bridges, and abnormal eye spacing. Therefore, our lab has extensively studied conditional knockouts of Stat3 in all three types of bones cells in mice and observed severe deficiencies in numerous parameters of normal bone phenotypes. Stat3 seems to play a principal role in the signaling that takes place upon mechanical loading of bone tissues and calling cells into action where they are needed. Furthermore, STAT3 has been found to be up-regulated in the early-response gene cluster following mechanical loading. Our current approach to studying Stat3’s effects on bone include employing available ChIP-seq data in order to elucidate the genome-wide binding patterns of Stat3. From the peak distribution, we can begin to uncover novel downstream effectors of Stat3 signaling that are responsible for the observed phenotypes in our mouse knockout model. A preliminary look at the ChIP-seq data reveals Wnt and Nrf2 signaling to be under the control of Stat3. In our further research we endeavor to experimentally confirm the ChIP-seq data for Stat3 with RNA-seq experiments in the hopes of finding potential therapeutic targets for bone pathologies

Langevin Trajectories between Fixed Concentrations

We consider the trajectories of particles diffusing between two infinite baths of fixed concentrations connected by a channel, e.g. a protein channel of a biological membrane. The steady state influx and efflux of Langevin trajectories at the boundaries of a finite volume containing the channel and parts of the two baths is replicated by termination of outgoing trajectories and injection according to a residual phase space density. We present a simulation scheme that maintains averaged fixed concentrations without creating spurious boundary layers, consistent with the assumed physics

Results of pancreas transplantation after steroid withdrawal under tacrolimus immunosuppression

Purpose. The results of steroid withdrawal in pancreas transplant recipients under tacrolimus immunosuppression were analyzed. Methods. From July 4, 1994 until April 30, 1998, 147 pancreas transplantations were performed in 141 patients, including 126 simultaneous pancreas-kidney transplantations, 13 pancreas after kidney transplantation, and 8 pancreas transplantations alone. Baseline immunosuppression consisted of tacrolimus and steroids without antilymphocyte induction. Twenty-three patients were excluded from analysis because of early graft loss in 17 cases, retransplantation in 5 cases, and simultaneous pancreas-kidney transplantation after heart transplantation in 1 patient. Results. With a mean follow-up of 2.8±1.1 years (range 1.0 to 4.8 years), complete steroid withdrawal was achieved in 58 (47%) patients with a mean time to steroid withdrawal of 15.2±8 months (range 4 to 40 months after transplantation). Of the entire cohort of 141 patients, overall 1-, 2-, and 4-year patient survival rates were 98%, 95.5%, and 86%, respectively. Overall 1-, 2-, and 4- year graft survival rates were 83%, 80%, and 71% (pancreas) and 95%, 91%, and 84% (kidney), respectively. Of the 124 patients analyzed for steroid withdrawal, 1-, 2-, and 4-year patient survival rates were 98%, 97%, and 92%, respectively. Overall 1-, 2-, and 4-year graft survival rates were 98%, 91.5%, 83% (pancreas) and 97%, 95%, and 91% (kidney). Patient, pancreas, and kidney survival rates at 1 year were 100%, 100%, and 98% (off steroids) versus 97%, 91%, and 96% (on steroids, all NS) and at 4 years were 100%, 94%, and 95% (off steroids) versus 78%, 68%, and 85% (on steroids, P=0.01, 0.002, and NS, respectively). The cumulative risk of rejection at the time of follow-up was 76% for patients on steroids versus 74% for patients off steroids (P=NS). Seven patients originally tapered off steroids were treated for subsequent rejection episodes, which were all steroid sensitive, and two of these seven patients are currently off steroids. Thirteen patients received antilymphocyte therapy for steroid-resistant rejection, five of whom are now off steroids. Tacrolimus trough levels were 9.3±2.4 ng/ml (off steroids) and 9.7±4.3 (on steroids, P=NS). Mean fasting glucose levels were 98±34 mg/dl (off steroids) and 110±41 mg/dl (on steroids, P=NS). Mean glycosylated hemoglobin levels were 5.2±0.9% (off steroids) and 6.2±2.1% (on steroids, P=0.02), and mean serum creatinine levels were 1.4±0.8 mg/dl (off steroids) and 1.7±1.0 mg/dl (on steroids, P=0.02). Conclusion. These data show for the first time that steroid withdrawal can be safely accomplished in pancreas transplant recipients maintained on tacrolimus-based immunosuppression. Steroid withdrawal is associated with excellent patient and graft survival with no increase in the cumulative risk of rejection

Ordinal Logistic Regression with an Application to Health Service Quality in Raden Mattaher Jambi Hospital

Health care is a treatment received by the community provided by health workers. The quality of health services will provide satisfaction to health services. Service actions that affect the value of satisfaction are availability and completeness of facilities, physical evidence of administration, reliability of officers, responsiveness of officers, guarantees received by patients and families of patients, and empathy felt by patients. This level of satisfaction assessment is in the form of an ordinal scale that is not satisfied, less satisfied, satisfied and very satisfied. The analysis used to determine the level of satisfaction is by ordinal logistic regression analysis. The sample used in this study is the patient or family of patients at Raden Mattaher Hospital. The stages of data analysis used are the validity and reliability test, parameter estimation, model feasibility test, parameter significance test and the best model selection. The results of the analysis obtained the best models  and  with factors that influence the level of quality of health services at Raden Mattaher Hospital, namely physical evidence, availability and completeness of facilities and responsiveness