10,403 research outputs found
Improved surgical technique for the establishment of a murine model of aortic transplantation.
Aortic allotransplantation is a reliable procedure to study the evolvement of chronic rejection in mice. The progressive nature of this process in mice is characterized by diffuse and concentric myointimal proliferation which is inevitably associated with variable degrees of luminal constriction. These vascular changes are comparable to those that are witnessed in organ allografts undergoing chronic rejection in humans, underscoring its utility as a model of choice for the study of the development of this lesion. Whilst improved surgical technique has resulted in markedly enhanced graft survival, the results are far from being acceptable. Realizing this limitation, we embarked on developing a modified technique for aortic transplantation which would allow for improved graft survival in mice. A bypass conduit was created by end-to-side anastomosis of a segment of the donor's thoracic aorta into the infrarenal portion of the recipient's abdominal aorta. Using this technique, the graft survival was >98% with evidence in allotransplanted aorta of morphological changes pathognomonic of chronic rejection. On the contrary, no histopathological anomalies were discerned in aortic grafts transplanted across syngeneic animals. This modified surgical approach ameliorates the unacceptably high graft loss associated with earlier techniques, further extending the utility of this model as a tool to study the molecular and cellular mechanisms rudiment to the evolvement of chronic rejection
Marked mitigation of transplant vascular sclerosis in FasL(gld) (CD95L) mutant recipients. I. The role of alloantibodies in the development of chronic rejection
Background. In the acute rejection of allografts, the interaction between Fas (CD95) and its ligand (FasL; CD95L) has been shown to be involved in mediating apoptotic cell death. The role, however, of these molecules in the pathogenesis of transplant vascular sclerosis is as yet undetermined. The present study was therefore designed to address this issue. Material. C3H/HEJ FasL(gld) (FasL-; H2(k)) spontaneously mutant mice were used either as donors or recipients of aortic allografts; wild-type C57BI/6 (B6; H2b) were used as corresponding recipients or donors (n=6/group), respectively. Controls included aortas transplanted across appropriate allogeneic and syngeneic strain combinations. For histopathological evaluations, the grafts were harvested at day 40 after transplantation, at which time, splenocytes and sera were also obtained for mixed leukocyte reaction and complement- mediated microcytotoxicity assays, respectively. Results. Similar to aortas obtained from allogeneic controls, allografts harvested from FasL-→B6 recipients had morphological evidence of chronic rejection characterized by circumferential intimal thickening with partial disruption of the elastic membranes. Correspondingly, heightened antidonor cellular reactivity was also witnessed in these recipients. On the contrary, B6 allografts harvested from the majority of C3H→FasL- recipients exhibited marked preservation of aortic morphology. Although these recipients had diminished antidonor cellular proliferation, the titers of alloantibodies were markedly elevated. Conclusion. The presence of FasL-expressing functional cytotoxic T cells is required for the pathogenesis of transplant vascular sclerosis. The significant reduction and/or absence of chronic rejection with the concomitant retention of antidonor humoral response in C3H FasL- recipients of B6 aortas prompt us to suggest that perhaps posttransplantation vasculopathy is initiated by cell-mediated cytotoxicity with its perpetuation facilitated by alloantibodies
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Service planning and delivery outcomes of home adaptations for ageing in the UK
In response to the impact of demographic change on the healthcare system, ‘ageing in place’ was introduced as a national policy to support elderly people living independently in their homes. Housing adaptation is essential for successful independent living and has been given increased political priority. However, adaptation policies and practice vary regionally, reflecting statutory limits, policy choices and local planning. This study investigated the current status of adaptation provision in different regions in the UK and assessed the effectiveness of local service planning and management. A mixed-methods sequential explanatory research strategy was employed. In the first quantitative phase, a questionnaire survey was carried out involving all 378 local authorities in England, Scotland and Wales. This was followed by a second qualitative phase involving individual interviews with five professionals and two clients and a focus group meeting with six key stakeholders. The study found that the current number of adaptations was relatively small compared with potential demands in most local areas, as was funding for adaptations. On the operational side, the adaptation process was fragmented, involving different service groups in many local authorities. There were disconnections between these groups, which often caused inefficiencies and poor effectiveness. Moving forward, local authorities need to have a clear vision of the overall need for adaptations and allocate sufficient resources. Practical guidelines are also needed for better integrated working and performance management
Older Clients' Pathway through the Adaptation System for Independent Living in the UK.
Housing adaptation is recognized as an effective intervention for successful independent living and has been given a greater political priority. However, the current adaptation implementation is fragmented and sometimes confusing. This study is aimed at examining blockages in the adaptation system in the United Kingdom (UK) and identifying practical ways to tackle them. It adopted a mixed-method sequential explanatory research strategy. A questionnaire survey was first conducted in all local authorities in England, Scotland and Wales. This was followed by individual interviews and a focus group with professionals and older clients. The study found that multiple organizations are involved during the delivery of housing adaptations; poor cooperation between them is a major barrier to a seamless service. The adaptation process involves five key stages; there are many inconsistencies and inequities in the process across local authorities. Significant delays are found at all stages, the average length of time taken to complete an adaptation is unacceptably long. There are also many inconsistencies and inequities across different local authorities. This study identified some common deficiencies, which cause inefficiencies and ineffectiveness in housing adaptation practices and makes some recommendations on specific actions that need to be taken at both national and local levels to address them
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