Aplastic anemia and concomitant autoimmune diseases

The association of aplastic anemia (AA) with other autoimmune diseases (AID) has been described but so far not systematically evaluated. We assessed the incidence and the outcome of concomitant AID in a retrospective, single-center study of 243 patients with severe AA treated between 1974 and 2006 with either immunosuppression (186) or hematopoietic stem cell transplantation (57) and a median follow-up time of 9.3years (0-33). Clinically manifest AID were observed in 24 out of 243 (10 ± 3.7%) patients. Age at diagnosis of AA was significantly younger in patients without AID compared to patients with AID (median, 20 versus 52years; P < 0.001). In 12 patients where the diagnosis of AID was done before AA therapy, response to antithymocyte globulin was good for AA (ten out of 12) but not for AID (2 out of 12). In 13 patients in which AID occurred after first-line therapy, the median time to the AID was 7years (range 3months-27.5years

Personalized therapy for mycophenolate:Consensus report by the international association of therapeutic drug monitoring and clinical toxicology

When mycophenolic acid (MPA) was originally marketed for immunosuppressive therapy, fixed doses were recommended by the manufacturer. Awareness of the potential for a more personalized dosing has led to development of methods to estimate MPA area under the curve based on the measurement of drug concentrations in only a few samples. This approach is feasible in the clinical routine and has proven successful in terms of correlation with outcome. However, the search for superior correlates has continued, and numerous studies in search of biomarkers that could better predict the perfect dosage for the individual patient have been published. As it was considered timely for an updated and comprehensive presentation of consensus on the status for personalized treatment with MPA, this report was prepared following an initiative from members of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). Topics included are the criteria for analytics, methods to estimate exposure including pharmacometrics, the potential influence of pharmacogenetics, development of biomarkers, and the practical aspects of implementation of target concentration intervention. For selected topics with sufficient evidence, such as the application of limited sampling strategies for MPA area under the curve, graded recommendations on target ranges are presented. To provide a comprehensive review, this report also includes updates on the status of potential biomarkers including those which may be promising but with a low level of evidence. In view of the fact that there are very few new immunosuppressive drugs under development for the transplant field, it is likely that MPA will continue to be prescribed on a large scale in the upcoming years. Discontinuation of therapy due to adverse effects is relatively common, increasing the risk for late rejections, which may contribute to graft loss. Therefore, the continued search for innovative methods to better personalize MPA dosage is warranted.</p

Rubber mat placement in a farrowing and lactation facility: tips and techniques

Sow lameness may result in severe economic consequences to the producer, as lameness has been associated with increases in involuntary culling, poor reproductive performance, and suboptimal sow longevity. Lameness prevalence and severity are impacted by facility design, with a particular focus on hard concrete surfaces. Use of rubber mats has been previously investigated for its ability to increase sow comfort, prevent lameness development, and mitigate lameness severity. However, limited recommendations or guidelines are available to producers and veterinarians to successfully implement on-farm mat use. This production tool provides guidelines and techniques for selecting, installing, and maintaining rubber mats in farrowing stalls for multiparous sows.This is an article from Campler, Magnus, Monique Pairis-Garcia, Kenneth J. Stalder, and Anna K. Johnson. "Rubber mat placement in a farrowing and lactation facility: tips and techniques." Journal of Swine Health and Production 24, no. 3 (2016): 142-146. Posted with permission.</p

Rubber mat placement in a farrowing and lactation facility: tips and techniques

Sow lameness may result in severe economic consequences to the producer, as lameness has been associated with increases in involuntary culling, poor reproductive performance, and suboptimal sow longevity. Lameness prevalence and severity are impacted by facility design, with a particular focus on hard concrete surfaces. Use of rubber mats has been previously investigated for its ability to increase sow comfort, prevent lameness development, and mitigate lameness severity. However, limited recommendations or guidelines are available to producers and veterinarians to successfully implement on-farm mat use. This production tool provides guidelines and techniques for selecting, installing, and maintaining rubber mats in farrowing stalls for multiparous sows

Venovenous extracorporeal membrane oxygenation to treat hypercapnia in a morbidly obese patient

Morbid obesity plays an increasingly important role in healthcare. Patients who are severely obese often suffer from a range of medical problems. One problem is obesity-related hypoventilation syndrome with its resulting hypercapnia. We report a case of a 33-year-old female patient who was in an extraordinarily bad medical state, with severe hypercapnia (pCO2 15.1 kPa), sepsis, acute anuric kidney failure and resulting acidosis (pH 6.96). Her body mass index was 84 kg/m2. Her chances of survival were considered very low after failed attempts at noninvasive ventilation. Based on prior research, we refrained from intubation and chose venovenous extracorporeal membrane oxygenation to treat the hypercapnia. In the entire medical literature, we are not aware of a similarly extraordinary case of obesity-related hypoventilation syndrome that could finally be treated successfully. The idea behind this case report is to consider venovenous extracorporeal membrane oxygenation as an alternative to intubation in this patient collective

Aplastic anemia and concomitant autoimmune diseases

The association of aplastic anemia (AA) with other autoimmune diseases (AID) has been described but so far not systematically evaluated. We assessed the incidence and the outcome of concomitant AID in a retrospective, single-center study of 243 patients with severe AA treated between 1974 and 2006 with either immunosuppression (186) or hematopoietic stem cell transplantation (57) and a median follow-up time of 9.3 years (0-33). Clinically manifest AID were observed in 24 out of 243 (10 +/- 3.7%) patients. Age at diagnosis of AA was significantly younger in patients without AID compared to patients with AID (median, 20 versus 52 years; P > 0.001). In 12 patients where the diagnosis of AID was done before AA therapy, response to antithymocyte globulin was good for AA (ten out of 12) but not for AID (2 out of 12). In 13 patients in which AID occurred after first-line therapy, the median time to the AID was 7 years (range 3 months-27.5 years)

Medien – Wissen – Bildung: Kulturen und Ethiken des Teilens

Dass das Teilen in der Gesellschaft der Gegenwart einmal eine so große Rolle spielen würde, hätte bis vor kurzem wohl kaum jemand vorausgesagt. Eine globale Protestbewegung brachte ein tiefes Bedürfnis zum Ausdruck, alternative Wege einzuschlagen, die auf anderen Werten beruhten als jene, die allem Anschein nach zur Finanzkrise geführt hatten. Gleichzeitig sind hoch entwickelte Informations- und Kommunikationstechnologien, die das Teilen erleichtern, nicht nur beinahe überall verfügbar; sie stehen auch im Zentrum des Interesses zahlreicher Menschen, die viel Zeit und Einsatz aufbringen, um mit diesen Technologien zu experimentieren und sie in die Abläufe ihres Alltagslebens eingliedern. Eine ganze Generation von medienkompetenten, radikal globalisierten Menschen wächst mit der täglichen und persönlichen Erfahrung auf, dass das Teilen von (digitalen) Gütern ein unverzichtbares Element im Aufbau gemeinschaftlicher Beziehungen verschiedenster Art ist. Heute stehen diese Erfahrungen im krassen Widerspruch zu anderen gesellschaftlichen Erfahrungen, bei denen Wettbewerb und individuelles Besitzstreben vorherrschen. Dieser Band will einen Beitrag zur kollektiven Arbeit leisten, das Teilen in der Gesellschaft neu zu denken

Medien – Wissen – Bildung: Kulturen und Ethiken des Teilens

Dass das Teilen in der Gesellschaft der Gegenwart einmal eine so große Rolle spielen würde, hätte bis vor kurzem wohl kaum jemand vorausgesagt. Eine globale Protestbewegung brachte ein tiefes Bedürfnis zum Ausdruck, alternative Wege einzuschlagen, die auf anderen Werten beruhten als jene, die allem Anschein nach zur Finanzkrise geführt hatten. Gleichzeitig sind hoch entwickelte Informations- und Kommunikationstechnologien, die das Teilen erleichtern, nicht nur beinahe überall verfügbar; sie stehen auch im Zentrum des Interesses zahlreicher Menschen, die viel Zeit und Einsatz aufbringen, um mit diesen Technologien zu experimentieren und sie in die Abläufe ihres Alltagslebens eingliedern. Eine ganze Generation von medienkompetenten, radikal globalisierten Menschen wächst mit der täglichen und persönlichen Erfahrung auf, dass das Teilen von (digitalen) Gütern ein unverzichtbares Element im Aufbau gemeinschaftlicher Beziehungen verschiedenster Art ist. Heute stehen diese Erfahrungen im krassen Widerspruch zu anderen gesellschaftlichen Erfahrungen, bei denen Wettbewerb und individuelles Besitzstreben vorherrschen. Dieser Band will einen Beitrag zur kollektiven Arbeit leisten, das Teilen in der Gesellschaft neu zu denken