History of clinical transplantation

How transplantation came to be a clinical discipline can be pieced together by perusing two volumes of reminiscences collected by Paul I. Terasaki in 1991-1992 from many of the persons who were directly involved. One volume was devoted to the discovery of the major histocompatibility complex (MHC), with particular reference to the human leukocyte antigens (HLAs) that are widely used today for tissue matching.1 The other focused on milestones in the development of clinical transplantation.2 All the contributions described in both volumes can be traced back in one way or other to the demonstration in the mid-1940s by Peter Brian Medawar that the rejection of allografts is an immunological phenomenon.3,4 © 2008 Springer New York

The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). INTERPRETATION: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden

Factors Associated with Outcome in Foals with Neonatal Isoerythrolysis (72 Cases, 1988-2003)

Background: Neonatal foals with isoerythrolysis (NI) often die, but the risk factors for death have not been identified. Objectives: To identify factors associated with outcome in foals with NI and to identify factors associated with death from liver failure or kernicterus in the same population. Animals: Seventy-two foals with NI examined at referral institutions. Methods: Retrospective case series. Information on signalment, clinical examination findings, laboratory testing, treatment, complications, outcome, and necropsy results were obtained. Results: The overall survival rate was 75% (54 of 72). Liver failure (n = 7), kernicterus (n = 6), and complications related to bacterial sepsis (n = 3) were the 3 most common reasons for death or euthanasia. The number of transfusions with blood products was the factor most strongly associated with nonsurvival in a multivariate logistic regression model. The odds of liver failure developing in foals receiving a total volume of blood products ≥ 4.0 L were 19.5 (95% confidence intervals [CI]: 2.13–178) times higher than that of foals receiving a lower volume (P= .009). The odds of kernicterus developing in foals with a total bilirubin ≥ 27.0 mg/dL were 17.0 (95% CI: 1.77–165) times higher than that of foals with a lower total bilirubin (P= .014). Conclusions and Clinical Importance: Development of liver failure, kernicterus, and complications related to bacterial sepsis are the most common causes of death in foals with NI. Foals administered a large volume of blood products are at greater risk for developing liver failure

Admission clinicopathological data, length of stay, cost and mortality in an equine NICU

Veterinary internists need to prognosticate patients quickly and accurately in a neonatal intensive care unit (NICU). This may depend on laboratory data collected on admission, the cost of hospitalisation, length of stay (LOS) and mortality rate experienced in the NICU. Therefore, we conducted a retrospective study of 62 equine neonates admitted to a NICU of a private equine referral hospital to determine the prognostic value of venous clinicopathological data collected on admission before therapy, the cost of hospitalisation, LOS and mortality rate. The WBC count, total C02 (TC02) and alkaline phosphatase (ALP) were significantly higher (F :;; 0.05) and anion gap lower in survivors compared with nonsurvivors. A logistic regression model that included WBC count, hematocrit, albumin/globulin ratio, ALP, TC02, potassium, sodium and lactate, was able to correctly predict mortality in 84 % of cases. Only anion gap proved to be all independent predictor of neonatal mortality in this study, In the study population, the overall mortality rate was 34 % with greatest mortality rates reported in the first 48 hours and again on day 6 of hospitalisation. Amongst the various clinical diagnoses, mortality was highest in foals after forced extraction during correction of dystocia. Median cost per day was higher for nonsurvivors while total cost was higher in survivors

Admission clinicopathological data, length of stay, cost and mortality in an equine neonatal intensive care unit

Veterinary internists need to prognosticate patients quickly and accurately in a neonatal intensive care unit (NICU). This may depend on laboratory data collected on admission, the cost of hospitalisation, length of stay (LOS) and mortality rate experienced in the NICU. Therefore,we conducted a retrospective study of 62 equine neonates admitted to aNICU of a private equine referral hospital to determine the prognostic value of venous clinicopathological data collected on admission before therapy, the cost of hospitalisation, LOS and mortality rate

Admission clinicopathological data, length of stay, cost and mortality in an equine neonatal intensive care unit

Veterinary internists need to prognosticate patients quickly and accurately in a neonatal intensive care unit (NICU). This may depend on laboratory data collected on admission, the cost of hospitalisation, length of stay (LOS) and mortality rate experienced in the NICU. Therefore,we conducted a retrospective study of 62 equine neonates admitted to aNICU of a private equine referral hospital to determine the prognostic value of venous clinicopathological data collected on admission before therapy, the cost of hospitalisation, LOS and mortality rate

Resposta clínica e metabólica de potros neonatos em relação aos achados histopatológicos da placenta na égua

Avaliaram-se as respostas clínica e metabólica de potros neonatos em relação aos achados histopatológicos da placenta na égua. Foram avaliados dois grupos de éguas da raça Puro Sangue Inglês - um grupo-problema (n=25) e um grupo-controle (n=25), de acordo com os achados da placenta. O exame dos potros constou de avaliação clínica geral, hematologia e bioquímica sérica. O exame histopatológico da placenta apresentou resultado compatível com a apresentação clínica do potro, sendo que a presença de lesões inflamatórias resultou na produção de potros debilitados. A presença de lesões degenerativas não comprometeu o estado clínico do neonato, mas pode ser responsável pela manifestação de distúrbios subclínicos, evidenciados pelo aumento das taxas de AST e GGT. A ureia pareceu ser um indicador de dano renal decorrente de insuficiência placentária em potros neonatos