Made available in DSpace on 2014-12-17T15:30:54Z (GMT). No. of bitstreams: 1 PedroHASL_Dissret.pdf: 4618668 bytes, checksum: 5bca73a0220258bdbd17a75573adb995 (MD5) Previous issue date: 2009-08-31 / Oral and facial bone defects can undertake appearance, psychosocial well-being and stomathognatic function of its patients. Over the yerars several strategies for bone defect regeneration have arised to treat these pathologies, among them the use of frozen and irradiated bone allograft. Manipulation of bone grafts it s not determined yet, and several osteotomy alternatives can be observed. The present work evaluated with a microscope the bone fragments obtained from different osteotomy methods and irrigation on rings and blocks allografts irradiated and frozen at 80? negative in a rabbit model. The study is experimental in vitro and it sample was an adult male New Zealand rabbit. The animal was sacrificed to obtain long bones, that were submitted to freezing at 80? negative and irradiated with Cobalt- 60. Then the long bones were sectioned into 24 bone pieces, divided into 4 groups: G1 (n=06) osteotomy was performed with bur No. 6 forming rings with 5 mm thickness with high-speed handpiece with manual irrigation; G2 (n=06) osteotomy was performed with bur No. 6 forming rings with 5 mm thick with surgical motor with a manual irrigation rotation 1500 rpm; GA (n=06), osteotomy with trephine using manual irrigation with saline; and GB (n=06), osteotomy with trephine using saline from peristaltic pumps of surgical motor. Five bone pieces of each group were prepared for analysis on light microscopy (LM) and one on electronic scan electronic microscopy (SEM). On the SEM analysis edges surface, presence of microcracks and Smear Layer were evaluated. Analyzing osteotomy technics on SEM was observed: increased presence of microcracks cutting with high speed; increased presence of areas covered by Smear Layer when cutting with motor implant. The irrigation analysis with SEM was observed: that the presence of microcracks does not depend on the type of irrigation; on manual irrigation, there was greater discrepancy between the cutting lines. The descriptive analysis of the osteotomy and irrigation process on LM showed: histological analysis showing the bony margins with clear tissue changed layer, composed of blackened tissue of charred appearance near to the cortical bone; on the edges of the bony part, bone fragments that were displaced during the bone cut and bone irregularities were observed. After analysis of results we can conclude: that there was greater regularity of the bone cut using high-speed handpiece than using motor implant; the cut with trephine using saline irrigated from peristaltic pumps of surgical motor showed greater homogeneity when compared with manual irrigation; charred tissue was found in all obtained bone samples, whit no significant statistically difference on the proportion of carbonization of the two analysed technics / Os defeitos ?sseos bucais e faciais comprometem a apar?ncia, o bem estar psicossocial e a fun??o estomatogn?tica dos seus portadores. Diante da necessidade de tratamento dessas patologias, surgiram, com o decorrer do tempo, diversas estrat?gias para a regenera??o de defeitos ?sseos, dentre elas o uso de aloenxerto ?sseo congelado e irradiado. A manipula??o dos enxertos ?sseos ainda n?o est? determinada, podendo-se observar v?rias alternativas de osteotomia. Este trabalho avaliou microscopicamente os fragmentos ?sseos obtidos por diferentes m?todos de osteotomia e de irriga??o sobre an?is e blocos de aloenxertos irradiados e congelados a 80?C negativos de coelho. O estudo ? do tipo Experimental in vitro e teve como amostra 01 coelho, adulto, da ra?a New Zealand. O animal foi sacrificado para obten??o de ossos longos, os quais foram congelados a 80? negativos e irradiados com Cobalto-60. Em seguida, os ossos foram seccionados em 24 pe?as ?sseas, divididos em quatros grupos: G1 (n=06) foi realizado a osteotomia com broca esf?rica n? 6 formando an?is com 5 mm de espessura com caneta de alta rota??o com irriga??o manual; G2 (n=06) foi realizado a osteotomia com broca esf?rica n? 6 formando an?is com 5 mm de espessura com motor cir?rgico com irriga??o manual a uma rota??o de 1500 rpm; GA (n=06), osteotomia com trefina usando irriga??o manual com soro fisiol?gico; e GB (n=06), osteotomia com trefina usando soro fisiol?gico proveniente de bombas perist?lticas do motor cir?rgico. De cada grupo, cinco pe?as ?sseas foram destinadas ? an?lise em Microscopia de Luz (ML) e uma analisada por Microscopia Eletr?nica de Varredura (MEV). A an?lise por ML levou em considera??o a presen?a de tecido carbonizado. Na an?lise por MEV levou em considera??o: superf?cie das bordas; presen?a de microfissuras e Smear Layer. Ao analisar a t?cnica de osteotomia utilizando MEV observa-se: maior presen?a de microfissuras ao corte com alta rota??o; maior presen?a de ?reas cobertas por uma camada de smear layer em cortes com motor de implante. Na analise da irriga??o com MEV observou-se que: a presen?a de microfissuras n?o depende do tipo de irriga??o; na irriga??o manual, verificou-se uma discrep?ncia maior entre as linhas de corte. Ao avaliar descritivamente o processo de osteotomia e irriga??o na ML, verificou-se que: na an?lise histol?gica as margens ?sseas apresentavam uma evidente camada alterada de tecido, composta por um tecido enegrecido de aspecto carbonizado, pr?ximo ao osso cortical; nas margens da pe?a ?ssea foram observados fragmentos ?sseos deslocados durante o corte ?sseo e irregularidades ?sseas. Ap?s an?lise dos resultados, pode-se concluir que: houve maior regularidade do corte ?sseo utilizando caneta de alta rota??o do que motor de implante; o corte com trefina usando irriga??o com bombas perist?lticas do motor de implante se mostrou mais homog?nea quando comparada ? t?cnica com irriga??o manual; tecido carbonizado foi encontrado em todos os esp?cimes ?sseos obtidos, sem diferen?a estatisticamente significativa na propor??o de carboniza??o nas duas t?cnicas de irriga??o estudadas

The Mucopolysaccharide (MPS) diseases are a group of lysosomal storage disorders, caused by a lack of the enzymes required for catabolism of glycosaminoglycans (GAGs), leading to severe neurological decline, skeletal deformities, organomegaly, cardiac and respiratory compromise, and premature death. The severe form of MPS I, Hurler syndrome, can be successfully treated using haematopoietic stem cell transplantation (HSCT), but the risks associated with myeloablation and immune suppression limit the broader application of HSCT to attenuated diseases. Successful engraftment in MPS I has been difficult to achieve, and requires fully myeloablative conditioning, whilst reduced intensity conditioning is a risk factor for graft rejection. Non-myeloablative conditioning generating reliable graft acceptance and high donor chimerism could increase safety and applicability of HSCT in genetic disease, therefore the aim of this research was to identify such a regimen in a clinically relevant mouse model of HSCT.Conditioning regimens developed in existing mouse models of HSCT have had limited clinical success, and often require clinically unachievable high cell doses or less stringent strain combinations to overcome allogeneic transplant rejection. To improve clinical relevance we used CBA donors and C57BL/6 recipients, which require full myeloablation with busulfan and immune suppression using non-depleting anti-CD4 and anti-CD8 monoclonal antibodies for engraftment of low cell doses across a major histocompatibility complex barrier. In syngeneic transplant donor chimerism was improved by generating a greater ratio of donor:recipient haematopoietic cells in the bone marrow initially, therefore we tested granulocyte colony stimulating factor (G-CSF), high cell dose and stem cell niche disruption and compared this to anti-CD40L costimulatory blockade in allogeneic transplant performed with a reduced dose of busulfan that was insufficient for graft acceptance. Despite improvements in initial engraftment with some of these treatments, only combined signal 1 and 2 T cell blockade were effective in reducing the dose of busulfan required for long-term graft acceptance. Early detection of MPS is important in treatment success; good disease biomarkers are vital, and biomarkers suitable for monitoring treatment outcome in MPS are lacking. We evaluated serum heparin cofactor II-thrombin (HCII-T) complex for MPS. We determined optimal sample collection and storage conditions, assay limitations and developed measurement in dried blood spots. Dermatan sulphate has a greater effect on in vivo HCII-T complex formation than heparan sulphate, thus in the MPS mouse models HCII-T is a reliable biomarker for MPS I, but not MPS IIIA or IIIB. HCII-T is greatly elevated in MPS I, II and VI patients, who all store dermatan sulphate, but it is also elevated by a small but significant amount in MPS III patients, who store heparan sulphate. HCII-T was also measured longitudinally in MPS I, II and VI patients, compared to an existing clinical biomarker, and validated against clinical outcomes to show that it is a good biomarker of short-term treatment outcomes and responds rapidly to perturbations in treatment. Finally, we determined whether an engraftment defect was observed in the MPS I mouse model, and show that this is present following both syngeneic and allogeneic HSCT. The effect of enzyme replacement therapy (ERT) and anti-inflammatory treatment prior to allogeneic HSCT was investigated, and initial results suggest that ERT, but not ibuprofen, may improve HSCT outcome. Overall, a clinically relevant mouse model of allogeneic HSCT has been developed and used to determine a non-myeloablative conditioning regimen that generates high levels of donor chimerism with a minimal dose of busulfan and blockade of both signal 1 and 2 of T cell activation. The conditions required to observe an engraftment defect in MPS I mice have also been defined, and preliminary studies have suggested that ERT, but not anti-inflammatory treatment, may overcome the engraftment defect in MPS I. Alongside this work, the HCII-T biomarker has been evaluated in MPS mouse models and patients, determining that it correlates well with short-term treatment outcomes. The techniques and models developed here will provide an excellent basis for further work in developing non-myeloablative conditioning for bone marrow transplant in MPS I.

Aims: To explore the clinical significance of EBV infection in adult renal transplant recipients when detected in the late post-transplant period. Methods: (1) A prospective observational study recruiting 499 stable adult kidney transplant recipients with serial blood sampling for EBV DNAemia and assessment of clinical outcomes and associated factors. (2) A retrospective analysis of PTLD incidence, timing and outcomes in relation to EBV infection. Results: EBV DNAemia in stable kidney transplant recipients is common, found in 46% of recruited individuals screened over 1 year, with persistent DNAemia seen in 10%. DNAemia prevalence increased significantly with time from transplant (p<0.0001) from 16% within 1 year of transplant to 66% in those transplanted for 20-24 years. High baseline DNA levels predicted persistence of DNAemia. Time adjusted analyses showed significant association of DNAemia with EBV seronegative status and previous PTLD and low DNAemia rates with Mycophenolate Mofetil (MMF) use and lymphopenia. The mechanism did not appear to be directly linked to MMF induced B cell depletion. Chronic high viral load detection was significantly associated with time from transplant, EBV seronegative status at transplant, ciclosporin use and plasma detection of DNA. No significant differences in overall patient survival at 3 years, clinical symptoms or clinical findings such as anaemia, thrombocytopenia or rate of decline in renal function were seen between stable transplant recipients with and without EBV DNAemia. PTLD incidence also increases with time from transplant and was greatest during the 10th-14th post-transplant years. Disease was EBV positive in 68% cases. No statistically significant differences in overall patient survival, or overall disease complete response rates were seen in relation to recipient EBV serostatus or EBV status of PTLD histology. Conclusions: EBV DNAemia prevalence increases with time from transplant but was not associated with worse patient or graft survival or specific symptoms. PTLD incidence including EBV negative disease also increases with time from transplant but response rates and survival were not influenced by EBV serostatus or histological status.

No description available.

No description available.

Bakgrund: Njuren är det mest donerade organet i Sverige och så många som 445 stycken transplantationer av njurar utfördes 2021. Som sjuksköterska är det viktigt att öka förståelsen kring patientens upplevelse för att främja trygghet och ett gott välbefinnande. Sjuksköterskan har en viktig roll i omvårdnaden i form av information och stöd.  Syfte: Syftet med litteraturstudien var att belysa patienters upplevelser av att vänta på en njurtransplantation. Metod: Det utfördes en litteraturöversikten med en kvalitativ ansats. Med den här metoden identifierades problemområdet som sammanställdes och sammanfattades med hjälp av redan tillgänglig forskning och kunskap för att fastställa kunskapsläget inom området.  Resultat: Det redovisades fem teman utifrån tio kvalitativa vetenskapliga artiklar som beskriver patientens upplevelse i väntan av en njurtransplantation. De fem teman som identifierades var: Att vara inskriven på väntelistan, en väntan utan tydligt slut, livet på paus, lycka och död samt önskan om stöd.  Slutsats: En njurtransplantation var nyckeln till ett nytt liv för människor som levde med en sviktande njure och behandlas med dialys. Många av patienterna som var med på väntelistan hade tappat hoppet och behövde mer information och stöd från vårdpersonalen för att hitta strategier och återfå hoppet för en fungerande vardag. / Background: The kidney is the most donated organ in Sweden and as many as 445 kidney transplants were performed in 2021. As a nurse it's important to improve the understanding of the patient's experience in order to promote security and a good sense of well-being. The nurse has an important role in nursing regarding information and support. Aim: The purpose of this literature study was to shed light on the patient's experience of waiting for a kidney transplant. Method: A literature review was carried out with a qualitative approach. This method identified the problem area, which compiled and summarized already available research and knowledge in order to determine the state of knowledge in the field. Results: Five themes were reported on ten qualitative articles that describe the patient's experience while waiting for a kidney transplant. The five themes were: To be on the waiting list, A wait without a clear ending, Life on pause, Happiness and death and The wish for support.  Conclusion: A kidney transplant was the key to a new life for people living with kidney failure and being treated with dialysis. Many of the patients who were on the waiting list had lost hope and needed more information and support from the healthcare staff to find strategies. Strategies were needed to regain hope and to have a functioning everyday life.

The objective of this dissertation is to first identify if there are any academic research gaps in our understanding of the medical supply chain and secondly to understand the role and impact of logistics on the human organ transplant process. The first essay identifies the current status of medical supply chain literature and provides future direction for improving the medical supply chain. This was accomplished by preforming a systematic literature review and a bibliometric analysis from 2,160 publications was conducted. The second essay explores how logistical aspects impact transplant logistics performance and the quality of life for the transplant recipient. Survey data was collected from medical professionals and analyzed using structural equation modeling. The third essay identifies the factors are influencing the number of donor kidneys discarded each year. A retrospective analysis of all deceased donor kidneys procured in hospitals in UNOS region 4 (Texas and Oklahoma) from January 1, 2001, to June 28, 2021, was conducted. Data was analyzed using multinomial logit regression and panel data analysis. As a result, we identified several medical and logistics factors that have influenced the number of donor kidneys discarded in the United States.

Lung transplantation is a treatment for patients with end stage lung disease; they will not survive without such surgery. A caregiver is essential for a patient to become eligible for a lung transplant and the caregiver plays an essential role in the transplant recipient’s care both before and after transplant surgery. Most caregiver research has been conducted on caregivers of persons with Alzheimer’s disease, dementia or on elderly patients, however, it is important to examine caregivers’ experiences caring for other patient groups with disabling conditions. Caregivers of transplant recipients are one such group. The purpose of this qualitative study, using a hermeneutic phenomenological approach, was to examine the lived experiences of caregivers of lung transplant recipients pre- and post-lung transplantation. The study used semi- structured, face to face, tape recorded in- depth interviews to document the experiences of a purposive sampling of 20 caregivers of lung transplant recipients. Interviews (English, Spanish) were transcribed verbatim and analyzed for emerging themes. The resulting 4 themes and 12 sub themes were: 1) Establishing the diagnosis; 2) Caregivers roles; 3) Caregivers psychological and psychosocial Issues; and 4) Support. The 12 sub themes were:1) Caregivers reaction to transplant option; 2) Caregivers’ lack of basic knowledge as related to lung transplant 3) Disease progression: Reality of unanticipated changes/fear of death; 4) Pre- transplant experiences; 5) Hospital course; 6) Home care; 7) Lifestyle changes and Social activities;8) Physical health and Emotional health ; 9) Financial and Employment issues;10) Family/Friends;11) Professional support; 12) Support groups. Study results demonstrated caregivers’ lack of knowledge about transplantation, dramatic changes in caregivers ‘family life, social activities, employment, and often financial status. Results also demonstrated a need for health care providers and policy makers to recognize caregivers’ stressful life changes and implement informational, psychological and emotional interventions and policies to assist these caregivers during their stressful and tedious experiences.

BACKGROUND:Nephropathic cystinosis is an autosomal recessive disease resulting from intracellular accumulation of cystine leading to multiple organ failure.CASE REPORT:We describe the clinical course of a patient managed from the age of six until his death at the age of 33 years. He underwent multiple surgery, including two renal transplants, developed transplant renal artery stenosis that was managed medically, and progressive heart failure at the age of 33 years. His death from a ruptured pseudoaneurysm associated with a restrictive cardiomyopathy is noteworthy. A limited cardiac autopsy revealed the presence of cystine crystals in interstitial cardiac histiocytes and one myocardial cell, along with 1000-fold higher tissue cystine content of the left ventricular myocardium compared to patients without cystinosis, suggesting the possibility of direct cystine mediated metabolic injury.

Background: Since constrictive pericarditis is most often idiopathic and the pathophysiology remains largely unknown, both the diagnosis and the treatment can be challenging. However, by definition, inflammatory processes are central to this disease process. Amniotic membrane patches have been shown to possess anti-inflammatory properties and are believed to be immune privileged. Due to these properties, amniotic membrane patches were applied intraoperatively in a complicated patient presenting with constrictive pericarditis. Case presentation: A patient with a history of multiple cardiac surgeries presented with marked fatigue, worsening dyspnea and sinus tachycardia. He was found to have constrictive physiology during cardiac catheterization, with cardiac MRI demonstrating hepatic vein dilatation, atrial enlargement and ventricular narrowing. After amniotic membrane patch treatment and pericardiectomy, post-operative cardiac MRI failed to demonstrate any appreciable pericardial effusion or inflammation, with no increased T2 signal that would suggest edema. Conclusions: Given the positive results seen in this complex patient, we suggest continued research into the beneficial properties of amniotic membrane patches in cardiac surgery.