Hypothermic Machine Perfusion in Kidney Transplantation: Back to the Future?

Static cold storage is currently the most used method of organ preservation worldwide. However, cutting edge technology and dramatic changes in the donor pattern have lately renewed the interest toward hypothermic machine perfusion. Marginal and cardiac death donors show higher rates of primary non function and delayed graft function compared to standard criteria donors. In this setting, machine perfusion may offer several theoretical advantages such as improved organ preservation, continuous graft evaluation, and ex-vivo conditioning of the graft before implantation. These topics have been recently reassessed by several studies. In particular, perfusion characteristics (renal resistance) and perfusate biomarker concentrations (lactate dehydrogenase, aspartate aminotransferase, heart-type fatty acid binding protein, and IL-18) during machine preservation, proved to be reliable tools to rule out graft viability and predict outcomes after transplantation. Treatment strategies acting on tissue repair, cell metabolism, and allorecognition pathway are also under investigation with promising results. Machine perfusion has finally shown its real potential however, stronger evidences and updated cost-effectiveness analysis are needed to fully support its role for the next future

Impact assessment of design guidelines in the conceptual development of aircraft product architectures

The optimization of the assembly phase, in complex products, is a challenging phase and it need to be handled in the early phase of product development (i.e., conceptual design). Several methods have been developed to assess the assemblability of product at the conceptual design phase, however, the most critical aspect concerns the possibility to derive design guidelines starting from the results of assemblability analysis. In this context, the present work aims at defining a methodology able to retrieve design for assembly and installation guidelines starting from the analysis of a given product architecture at the conceptual design phase (loop-back of the design for assembly method). The developed method makes use of matrices and vectors to provide a list of design actions that affect the product assemblability including a ranking of their impacts on the final design. The methodology was used to retrieve and select design guidelines in the context of aircraft manufacturing. The case study (cabin equipping of commercial aircraft) provides interesting results in the identification and implementation of design guidelines to improve the aircraft architecture at the conceptual level

Adipose-derived stem/stromal cells in kidney transplantation: Status quo and future perspectives

Kidney transplantation (KT) is the gold standard treatment of end-stage renal disease. Despite progressive advances in organ preservation, surgical technique, intensive care, and immunosuppression, long-term allograft survival has not significantly improved. Among the many peri-operative complications that can jeopardize transplant outcomes, ischemia-reperfusion injury (IRI) deserves special consideration as it is associated with delayed graft function, acute rejection, and premature transplant loss. Over the years, several strategies have been proposed to mitigate the impact of IRI and favor tolerance, with rather disappointing results. There is mounting evidence that adipose stem/stromal cells (ASCs) possess specific characteristics that could help prevent, reduce, or reverse IRI. Immunomodulating and tolerogenic properties have also been suggested, thus leading to the development of ASC-based prophylactic and therapeutic strategies in pre-clinical and clinical models of renal IRI and allograft rejection. ASCs are copious, easy to harvest, and readily expandable in culture. Furthermore, ASCs can secrete extracellular vesicles (EV) which may act as powerful mediators of tissue repair and tolerance. In the present review, we discuss the current knowledge on the mechanisms of action and therapeutic opportunities offered by ASCs and ASC-derived EVs in the KT setting. Most relevant pre-clinical and clinical studies as well as actual limitations and future perspective are highlighted

Wildlife veterinarians rabies vaccination in Chile: a survey

Indexación: Web of Science; Scielo.Introduction: Rabies is a lethal but preventable disease. Knowing the extent of immunization coverage among at risk populations, may help to guide immunization efforts, as well as increase the effectiveness of rabies control and prevention programs. Aim: To determine the proportion of wildlife veterinarians in Chile, as part of a group at risk of rabies transmission. Methods: An electronic survey was sent to wildlife veterinarians in Chile. Results: We found that veterinarians in Chile work mainly with carnivores and deer compared to other mammals (p < 0.001), rarely works with bats (p = 0.6572). Most of the participants had been bitten by domestic animals, while a lesser proportion (29%) by wild animals. Most of the participants never received rabies vaccination (53%), while within the group that had started a rabies vaccination scheme, a substantial proportion (39%) did not complete it. Discussion and conclusion: Identify the vaccination status of risk groups is important for infectious disease control and prevention programs, as this information helps to identify priority groups during outbreaks or vaccine scarcity. Wildlife veterinarians in Chile are at risk of rabies transmission and should be included in rabies prevention programs, especially considering their vulnerability and lack of biosafety practices. Increasing education in rabies epidemiology and prevention is urgently needed in veterinary faculties in Chile.Introducción: La rabia es una enfermedad infecciosa mortal pero prevenible. Establecer si existe una adecuada inmunización pre-exposición contra la rabia en un grupo de riesgo, puede ayudar a enfocar los esfuerzos de inmunización para hacer efectivos los programas de control y prevención de la enfermedad. Objetivo: Determinar mediante una encuesta la proporción de veterinarios de fauna silvestre como grupo de riesgo que han recibido inmunización contra la rabia. Métodos: Se realizó una encuesta electrónica a veterinarios de fauna de vida silvestre de Chile. Resultados: Los veterinarios encuestados tienden a trabajar con carnívoros y ciervos en comparación con otros mamíferos (p < 0,001), rara vez con murciélagos (p = 0,6572). La mayoría de los encuestados había sido mordido por animales domésticos y una proporción menor (29%) por animales silvestres. La mayoría nunca había sido vacunado contra la rabia (53%), mientras que del grupo que sí había recibido vacunación anti-rábica, una importante proporción (39%) no completó el esquema de vacunación. Sorprendentemente, este grupo de profesionales rara vez trabaja con murciélagos (p = 0,6572), lo que puede reducir su exposición a linajes de rabia transmitida por murciélagos. Discusión y Conclusión: Identificar el estado de inmunización contra la rabia en grupos de riesgo es una información importante para evaluar los programas de prevención y control de enfermedades infecciosas y podría ayudar a identificar grupos prioritarios en situaciones de brote o escasez de vacuna. Los veterinarios de fauna de vida silvestre en Chile constituyen un grupo vulnerable: no mantienen prácticas de bioseguridad necesarias y tienen riesgo de adquirir la encefalitis rábica por lo que deberían ser considerados en los programas de prevención pre-exposición de la enfermedad. La educación sobre la epidemiología y prevención de la rabia es urgente en las facultades de medicina veterinaria en Chile.http://ref.scielo.org/c5d5b

Conceptual design for assembly in aerospace industry: Sensitivity analysis of mathematical framework and design parameters

One of the most challenging activity in the engineering design process is the definition of a framework (model and parameters) for the characterization of specific processes such as installation and assembly. Aircraft system architectures are complex structures used to understand relation among elements (modules) inside an aircraft and its evaluation is one of the first activity since the conceptual design. The assessment of aircraft architectures, from the assembly perspective, requires parameter identification as well as the definition of the overall analysis framework (i.e., mathematical models, equations). The paper aims at the analysis of a mathematical framework (structure, equations and parameters) developed to assess the fit for assembly performances of aircraft system architectures by the mean of sensitivity analysis (One-Factor-At-Time method). The sensitivity analysis was performed on a complex engineering framework, i.e. the Conceptual Design for Assembly (CDfA) methodology, which is characterized by level, domains and attributes (parameters). A commercial aircraft cabin system was used as a case study to understand the use of different mathematical operators as well as the way to cluster attributes

Treatment options for localised renal cell carcinoma of the transplanted kidney

Currently, there is no consensus among the transplant community about the treatment of renal cell carcinoma (RCC) of the transplanted kidney. Until recently, graftectomy was universally considered the golden standard, regardless of the characteristics of the neoplasm. Due to the encouraging results observed in native kidneys, conservative options such as nephron-sparing surgery (NSS) (enucleation and partial nephrectomy) and ablative therapy (radiofrequency ablation, cryoablation, microwave ablation, high-intensity focused ultrasound, and irreversible electroporation) have been progressively used in carefully selected recipients with early-stage allograft RCC. Available reports show excellent patient survival, optimal oncological outcome, and preserved renal function with acceptable complication rates. Nevertheless, the rarity and the heterogeneity of the disease, the number of options available, and the lack of long-term follow-up data do not allow to adequately define treatment-specific advantages and limitations. The role of active surveillance and immunosuppression management remain also debated. In order to offer a better insight into this difficult topic and to help clinicians choose the best therapy for their patients, we performed and extensive review of the literature. We focused on epidemiology, clinical presentation, diagnostic work up, staging strategies, tumour characteristics, treatment modalities, and follow-up protocols. Our research confirms that both NSS and focal ablation represent a valuable alternative to graftectomy for kidney transplant recipients with American Joint Committee on Cancer stage T1aN0M0 RCC. Data on T1bN0M0 lesions are scarce but suggest extra caution. Properly designed multi-centre prospective clinical trials are warranted

“Salus Populi Suprema Lex”: Considerations on the Initial Response of the United Kingdom to the SARS-CoV-2 Pandemic

In several countries worldwide, the initial response to coronavirus disease 2019 (COVID-19) has been heavily criticized by general public, media, and healthcare professionals, as well as being an acrimonious topic in the political debate. The present article elaborates on some aspects of the United Kingdom (UK) primary reaction to SARS-CoV-2 pandemic; specifically, from February to July 2020. The fact that the UK showed the highest mortality rate in Western Europe following the first wave of COVID-19 certainly has many contributing causes; each deserves an accurate analysis. We focused on three specific points that have been insofar not fully discussed in the UK and not very well known outside the British border: clinical governance, access to hospital care or intensive care unit, and implementation of non-pharmaceutical interventions. The considerations herein presented on these fundamental matters will likely contribute to a wider and positive discussion on public health, in the context of an unprecedented crisis

A stochastic approach to LCA of internal insulation solutions for historic buildings

Internal insulation is a typical renovation solution in historic buildings with valuable facades. However, it entails moisture-related risks, which affect the durability and life-cycle environmental performance. In this context, the EU project RIBuild developed a risk assessment method for both hygrothermal and life-cycle performance of internal insulation, to support decision-making. This paper presents the stochastic Life Cycle Assessment method developed, which couples the LCA model to a Monte-Carlo simulation, providing results expressed by probability distributions. It is applied to five insulation solutions, considering different uncertain input parameters and building heating scenarios. In addition, the influence of data variability and quality on the result is analyzed, by using input data from two sources: distributions derived from a generic Life Cycle Inventory database and "deterministic" data from Environmental Product Declarations. The outcomes highlight remarkable differences between the two datasets that lead to substantial variations on the systems performance ranking at the production stage. Looking at the life-cycle impact, the general trend of the output distributions is quite similar among simulation groups and insulation systems. Hence, while a ranking of the solutions based on a "deterministic" approach provides misleading information, the stochastic approach provides more realistic results in the context of decision-making