Simultaneous pancreas and kidney transplantation as the standard surgical treatment for diabetes mellitus patients with end-stage renal disease.

OBJECTIVES: To review the outcome following simultaneous pancreas and kidney transplantation in patients with type 1 diabetes mellitus and end-stage renal disease, as well as those with type 2 diabetes mellitus, and to discuss the applicability of this treatment in this locality. METHODS: A systematic literature review was performed by searching the PubMed and Elsevier databases. The search terms used were "simultaneous pancreas and kidney transplantation", "diabetes", "pancreas transplant" and "SPK". Original and major review articles related to simultaneous pancreas and kidney transplantation were reviewed. Papers published in English after 1985 were included. Clinical outcomes following transplantation were extracted for comparison between different treatment methods. Outcomes of simultaneous pancreas and kidney transplant and other transplantation methods were identified and categorised into patient survival, graft survival, diabetic complications, and quality of life. Patient survivals and graft survivals were also compared. RESULTS: Currently available clinical evidence shows good outcomes for type 1 diabetes mellitus in terms of patient survival, graft survival, diabetic complications, and quality of life. For type 2 diabetes mellitus, the efficacy and application of the procedure remain controversial but the outcomes are possibly comparable with those in type 1 diabetes mellitus. CONCLUSIONS: Simultaneous pancreas and kidney transplantation is a technically demanding procedure that is associated with significant complications, and it should be regarded as a 'last resort' treatment in patients whose diabetic complications have become life-threatening or severely burdensome despite best efforts in maintaining good diabetic control through lifestyle modifications and medications.

The feasibility of repositioning ability as a tool for ergonomic evaluation: effects of chair back inclination and fatigue on head repositioning.

Poor posture has been suggested as one of the main factors contributing to the high prevalence of neck pain in video display unit (VDU) users, but no clear association between pain and any particular resting neck posture has been found. Postural awareness of the neck, as indicated by the repositioning accuracy, may therefore be an appropriate measure and potentially useful assessment tool. The objective of this study is to examine whether posture and fatigue affect the head repositioning ability in typical VDU usage. A group of 20 healthy participants reproduced a normal comfortable posture for forward, upright and backward chair back inclinations in random order both before and after fatigue of the upper trapezius muscles. Ten repetitions of the posture were recorded for 2 s each, and the angular and translational deviations from the original head position were measured with regard to the external environment (head in space repositioning) and with regard to the trunk (head on trunk repositioning). Analysis by repeated measures ANOVA showed significant effects and interactions of fatigue and chair back inclination on the repositioning errors in the sagittal plane, which typically showed systematic trends towards certain postures rather than random errors around a mean position. While further work is required to examine the ergonomic impact of impaired repositioning ability, head repositioning is sensitive to ergonomic factors such as seating configuration and fatigue, and may therefore be a useful tool for evaluation of static working postures.

Development and evaluation of an ultrasonic ground water seepage meter.

Submarine ground water discharge can influence significantly the near-shore transport and flux of chemicals into the oceans. Quantification of the sources and rates of such discharge requires a ground water seepage meter that provides continuous measurements at high resolution over an extended period of time. An ultrasonic flowmeter has been adapted for such measurements in the submarine environment. Connected to a steel collection funnel, the meter houses two piezoelectric transducers mounted at opposite ends of a cylindrical flow tube. By monitoring the perturbations of fluid flow on the propagation of sound waves inside the flow tube, the ultrasonic meter can measure both forward and reverse fluid flows in real time. Laboratory and field calibrations show that the ultrasonic meter can resolve ground water discharges on the order of 0.1 microm/sec, and it is sufficiently robust for deployment in the field for several days. Data from West Neck Bay, Shelter Island, New York, elucidate the temporal and spatial heterogeneity of submarine ground water discharge and its interplay with tidal loading. A negative correlation between the discharge and tidal elevation was generally observed. A methodology was also developed whereby data for the sound velocity as a function of temperature can be used to infer the salinity and source of the submarine discharge. Independent measurements of electrical conductance were performed to validate this methodology.

Oxygen demand, nitrogen and copper removal by free-water-surface and subsurface-flow constructed wetlands under tropical conditions.

This study was conducted to: (1) assess the role of wetland vegetation in the removal of oxygen demand and nitrogen under tropical conditions, (2) estimate the uptake of nitrogen and copper by wetland plants and (3) investigate the speciation of Cu in wetland media among four operationally defined host fractions, namely exchangeable, carbonate, reducible and organically bound. Four laboratory-scale wetland units, two free-water-surface (FWS) and two subsurface-flow (SF) with one of each planted with cattails (Typha augustifolia), were fed with primary-treated sewage and operated at nominal retention times of 0.6-7 days. The influent and effluent BOD/COD and nitrogen concentrations were monitored to assess the performance of the wetland units for various mass loading rates. At the end of the study, all cattail plants were harvested and analyzed for total Kjeldahl nitrogen (TKN). Four other wetland units, which were identical to the first four, were fed with domestic wastewater spiked with copper in increasing concentrations. Copper speciation patterns in the sand layer were determined at the end of the study. The results showed that wetland vegetation did not play an important role in oxygen demand removal but were capable of removing about 22% and 26% of the nitrogen input in the FWS and SF wetland units, respectively. Mass balance analysis indicated that less than 1% of copper introduced was taken up by the cattails. Copper speciation patterns in the sand media showed that the exchangeable fraction contributed 30-57% and 63-80% of the nonresidual copper in the planted and unplanted FWS wetlands, respectively. For SF units, the percentages were 52-62% and 59-67%, respectively. This indicates that large amount of copper in the media were potentially remobilizable.

Imaging the pore structure of geomaterials.

Laser scanning confocal microscopy can be used to image the pore structure of geologic materials in three dimensions at a resolution of 200 nanometers. The technique involves impregnation of the void space with an epoxy doped with a fluorochrome whose fluorescent wavelength matches the excitation wavelength. Optical sections with a thickness of less than 1 micrometer can be sliced from thick polished sections and combined to produce three-dimensional reconstructions. Application of the technique to rocks with porosities from 1 to 20 percent reveals the geometric complexity of the pore space. The technique can also be applied to other brittle solids such as ceramics.

N-(2-cyanoethyl)tranylcypromine, a potential prodrug of tranylcypromine: its disposition and interaction with catecholamine neurotransmitters in brain.

The disposition of the N-cyanoethyl analogue of tranylcypromine (TCP) and the TCP formed from it have been studied in the rat brain following intraperitoneal (ip) administration (0.1 mmol/kg) and the resultant data compared with those obtained following an equimolar dose of TCP. Brain concentrations of the neurotransmitter amines dopamine (DA) and noradrenaline (NA) have also been determined, as well as the percentage inhibition of monoamine oxidase (MAO) types A and B. Our results indicate that the N-cyanoethyl analogue may be a useful prodrug of TCP, providing lower but more sustained concentrations of TCP in brain. Brain levels of DA were increased in a similar pattern after CE-TCP or TCP. Brain levels of NA were decreased by TCP at most time intervals, while CE-TCP produced a much less pronounced effect. Both CE-TCP and TCP inhibited MAO-A and MAO-B, with maximum inhibition occurring 60 min after CE-TCP dosing and 30 min after dosing with TCP, times at which brain concentrations of CE-TCP and TCP were at the maximum.

Parallelism between ethanol and imidazole interactions with horse liver alcohol dehydrogenase.

The rate effects of imidazole on the EE isoenzyme of horse liver alcohol dehydrogenase have been analysed in terms of the elucidated kinetic mechanism of the enzyme. These imidazole effects on both directions of the reaction within nonexcess as well as excess ranges of substrate concentrations pointed to the competition between imidazole and ethanol for binding to the same three enzyme species in the kinetic mechanism, namely the free enzyme, the enzyme-NAD+ complex, and the enzyme-NADH complex. Moreover, both imidazole and ethanol brought about an enhancement in the rate of dissociation of NAD+ from its binding site on the enzyme.

A new fiberintestinoscope type FIS-T1 patterned after intestinal biopsy tube.

A new type of fiberintestinoscope (FIS-T1) patterned after an intestinal biopsy tube was developed for observing the small intestine beyond the ligament of Treitz. The flexible part of the new FIS has been made as pliable as the Cantor tube or the Miller-Abbott tube so that the tip of the new FIS is carried on into the small intestine by peristaltic activity along its natural configuration. A balloon attached near the tip of the new FIS acted as a bolus, enabling peristaltic activity to carry the fiberscope to the distal portion. In order to facilitate the passage of the fiberscope, it was also advisable to keep changing the posture and position of the body with a minimum of fluoroscopic exposure. Inflation of the balloon as well as air feeding through the air channel of the fiberscope made possible satisfactory observation. In a patient suffering from protein-losing gastroenteropathy, multiple white spots on the diffuse rough surface of the mucosa were visualized by using the new FIS. Histological finding of the biopsy specimen taken from near the ligament of Treitz by using the fiberduodenoscope showed dilated lymph vessels in the villi.