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.

Retinal Morpho-Functional Changes Following 0.19 mg Fluocinolone Acetonide Intravitreal Implant for Chronic Diabetic Macular Edema.

PURPOSE: To evaluate morpho-functional outcomes of the intravitreal fluocinolone acetonide (FAc) implant. METHODS: Retrospective, observational, single-center study. Primary endpoint was the mean change in central macular thickness (CMT) from baseline to month 1-3. Secondary endpoints included mean CMT change from baseline to month 4-8 and 9-14 and mean best corrected visual acuity (BCVA), photopic negative response (PhNR) and b-wave of flash full-field electroretinogram (ERG) changes from baseline to month 1-3, 4-8, and 9-14. RESULTS: Fourteen patients (18 eyes) were included. Mean (standard deviation) CMT decreased from 473 (196) µm at baseline to 371 (163) µm at month 1-3 (mean difference - 102.3 ± 98.35 µm, 95% CI ± 46.4 µm; p < 0.0001) and this decrease tended to endure up to month 9-14. BCVA did not change significantly. There was an improvement in mean PhNR amplitude from 2.76 (1.65) µV at baseline to 3.73 (2.32) µV at month 1-3 (mean difference 0.91 (1.14) µV, 95% CI ± 0.54 µV, p = 0.003); b-wave amplitude improved from 8.83 (4.52) µV at baseline versus 10.05 (5.04) µV at month 1-3 (mean difference 1.22 (2.23) µV, 95% CI ± 1.08 µV, p = 0.0384). These ERG positive changes tended to endure up to month 9-14, although they did not reach statistical significance after month 3. CONCLUSIONS: Intravitreal FAc implant significantly improved anatomic as well as functional outcomes related to middle and inner retinal layers, known to be altered in diabetic retinopathy. Our findings support the hypothesis that intravitreal FAc implant may exert a protective effect in diabetic retinas with diabetic macular edema.

Detecting changes following the provision of assistive devices: utility of the WHO-DAS II.

The World Health Organization Disability Assessment Schedule II (WHO-DAS II) is a non-disease-specific International Classification of Functioning, Disability, and Health-based disability assessment instrument developed to measure activity limitations and restrictions to participation. The aim of this pilot study is to evaluate WHO-DAS II responsiveness in detecting short-time changes following the provision of an Assistive Technology,which is important to define its utility in performing daily activities. Adult inpatients with a diagnosis of Disease of the Nervous System (included in Chapter VI of the ICD-10),who were prescribed an Assistive Technology to be used in the household settings, were enrolled. The WHO-DAS II was administered in individual interview at baseline and at a 2 months follow-up: in this period patients were transitioning from the hospital to home. Changes in disability profiles were detected by calculating the effect size (ES) for each WHO-DAS II domain. Ten patients with different neurological diseases were enrolled. Few longitudinal changes in disability level are reported: mild improvement is observed in the household activities (ES0.28), whereas mild worsening is reported in self-care and participation in society domains (ES ­ 0.27 and ­ 0.26,respectively). Our study shows that the WHO-DAS II is responsive in detecting domain-specific changes over a short-term period and provides preliminary encouraging evidence for the utility of its utilization in clinical settings.However, changes in setting between baseline and follow up could have an impact on the findings and interpretation of this study.

The White Book on Disability in Italy: an ICF-based Italian survey.

PURPOSE: To describe the functioning and disability profiles of Italian person with disability (PwD) getting invalidity pension. METHODS: Adult subjects were selected within the registries of local health agencies that provide invalidity certificates. The International Classification of Functioning Disability and Health (ICF) checklist was administered by trained interviewers. Count-based indexes were calculated for each ICF chapter and domain. Descriptive analysis and paired-sample t-test for evaluating differences between capacity and performance indexes in Activities and Participation (A&P) were employed. RESULTS: A total of 742 persons were enrolled. Mean age among children and youth (N = 106) was 8.6 years, and among adults (N = 636) was 47.6 years. Most common health conditions are neurological diseases (30.2%), tumors (18.1%) and mental disorders (13.5%). Body Functions and Structures impairments are consistent with sample compositions. In A&P, capacity indexes are higher than performance ones, and facilitators are essentially reported among Environmental Factors (EF). CONCLUSIONS: ICF-based tools are adequate to capture difficulties in different A&P areas, and to estimate EF's effect. In our study, the widest difficulties and the widest impact of EF are reported in areas describing activities of daily living, while areas describing communication, employment and leisure time activities are less problematic but, at the same time, less influenced by EF.

Role of disability-case manager for chronic diseases: using the ICF as a practical background.

PURPOSE: To report on the case manager's activity in a hospital setting as a supporting professional for families that need to deal with different services and professionals to get answers on their health and psychosocial needs. METHOD: A qualitative analysis and interpretation based on the case manager observations and ICF checklist evaluation with medical and rehabilitation professionals were employed. RESULTS: The case study presented aimed to show one of the most typical interventions of the case manager: the creation of a network around a person with complex and multifaceted needs, where this network does not exist. Case manager bridged the gap between health and social services, specifically organising home-based rehabilitation and helping to find appropriate assistive devices. CONCLUSIONS: This case study showed that the case manager's role is fundamental to support patients and their families in relating to the different services and professionals they need, and illustrated one of the most typical interventions of the case manager: the creation of a network around a person with complex and multifaceted needs, where this network does not exist.

ICF in neurology: functioning and disability in patients with migraine, myasthenia gravis and Parkinson's disease.

PURPOSE: To report and compare functional features of patients with migraine, myasthenia gravis (MG) and Parkinson's disease (PD) with the International Classification of Functioning, Disability and Health (ICF). METHOD: Adult patients with migraine, MG and PD were enrolled and the ICF checklist administered. Count-based indexes were calculated for each ICF chapter and domain. Indexes were compared across conditions by means of ANOVA; relationships between ICF domains were evaluated using Spearman's correlation; group based on disability status were defined through cluster analysis and compared with disease groups using chi(2) test. Finally, most prevalent ICF categories were identified. RESULTS: A total of 300 patients were enrolled and specific differences in BF, BS, A&P and EF indexes are reported. Spearman's correlations reported moderate relationships between BF and A&P indexes, whereas the correlation between A&P and EF is lower. Cluster analysis and chi(2) test show that patients with Migraine and MG are more likely to report moderate and low disability, whereas patients with PD are more likely to report moderate or severe disability. A total of 60 ICF relevant categories, mostly from A&P, were identified. CONCLUSIONS: Our study provided a description of functioning and disability domains in migraine, MG and PD and enabled to report the impact of EF in determining the actual disability experience.