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

Evidence-based guidelines on the use of opioids in chronic non-cancer pain--a consensus statement by the Pain Association of Singapore Task Force

Item does not contain fulltextINTRODUCTION: While opioids are effective in carefully selected patients with chronic non-cancer pain (CNCP), they are associated with potential risks. Therefore, treatment recommendations for the safe and effective use of opioids in this patient population are needed. MATERIALS AND METHODS: A multidisciplinary expert panel was convened by the Pain Association of Singapore to develop practical evidence-based recommendations on the use of opioids in the management of CNCP in the local population. This article discusses specific recommendations for various common CNCP conditions. RESULTS: Available data demonstrate weak evidence for the long-term use of opioids. There is moderate evidence for the short-term benefit of opioids in certain CNCP conditions. Patients should be carefully screened and assessed prior to starting opioids. An opioid treatment agreement must be established, and urine drug testing may form part of this agreement. A trial duration of up to 2 months is necessary to determine efficacy, not only in terms of pain relief, but also to document improvement in function and quality of life. Regular reviews are essential with appropriate dose adjustments, if necessary, and routine assessment of analgesic efficacy, aberrant behaviour and adverse effects. The reasons for discontinuation of opioid therapy include side effects, lack of efficacy and aberrant drug behaviour. CONCLUSION: Due to insufficient evidence, the task force does not recommend the use of opioids as first-line treatment for various CNCP. They can be used as secondor third-line treatment, preferably as part of a multimodal approach. Additional studies conducted over extended periods are required

Ecological restoration in the slipstream of agricultural policy in the old and new world

The restoration of ecosystems to stop biodiversity losses in agricultural landscapes has high priority in many regions of the world. It does not take place in a vacuum but is nested in a socio-historical and agro-political context. Austria and Western Australia (WA) are examples of old and newly impacted agricultural environments, and these are used to examine two contrasting agro-political and agro-economic frameworks within which ecological restoration currently operates. WA is characterised by ancient, nutrient-impoverished, and degraded agricultural landscapes that have been under cultivation for some 100 years and support a low density rural population. In Austria agriculture has been practised for some 7000 years and the European Union (EU) and its extensive funding system largely determine agro-political policies. The paper concludes that: (1) differences in agro-political priorities have resulted in diverging agro-economic systems where producers are heavily subsidised (EU) or largely unsubsidised (WA); (2) diverging agro-political priorities result from differences in terms of land degradation; demographic characteristics, and duration of respective agriculture; (3) WA failed to develop a financial strategy aimed at ecological restoration for biodiversity conservation while Austria benefits from a EU-driven subsidy system to maintain biodiversity conservation; (4) the Landcare movement plays a significant role in the restoration of biodiversity in WA, but is largely absent in the EU; (5) different environmental and social histories demand different approaches to improve the economic frameworks within which ecological restoration is conducted in each region