Acute cellular and antibody-mediated rejection of the pancreas allograft: incidence, risk factors and outcomes.

Antibody-mediated rejection (AMR) after pancreas transplantation is a recently identified entity. We describe the incidence of, risk factors for, and outcomes after AMR, and the correlation of C4d immunostaining and donor-specific antibody (DSA) in the diagnosis of AMR. We retrospectively analyzed 162 pancreas transplants in 159 patients who underwent 94 pancreas allograft biopsies between 2006 and 2009. Univariate and multivariate analyses were performed to evaluate risk factors for pancreas graft AMR. One-year rejection rates and survival after rejection were calculated by Kaplan-Meier methods. AMR occurred in 10% of patients by 1-year posttransplant. Multivariate risk factors identified for AMR include nonprimary simultaneous pancreas-kidney (SPK) transplant, primary solitary pancreas (PAN) transplant and race mismatch. After pancreas rejection, patient survival was 100% but 20% (8 of 41) of pancreas grafts failed within 1 year. Graft survival after acute cellular rejection (ACR), AMR and mixed rejection was similar. Of biopsies that stained >5% C4d, 80% were associated with increased Class I DSA. In summary, AMR occurs at a measurable rate after pancreas transplantation, and the diagnosis should be actively sought using C4d staining and DSA levels in patients with graft dysfunction, especially after nonprimary SPK and primary PAN transplantation.

The effect of parental traumatic brain injury on parenting and child behavior.

OBJECTIVES: To examine (1) the parenting skills of individuals with traumatic brain injury (TBI) and their spouses, (2) the effects of parental TBI on children, and (3) the effects of parental TBI on levels of depression for all family members. DESIGN: Independent two-tailed t tests and Pearson chi-square analyses were utilized to compare parents with TBI versus parents without TBI, spouses of parents with TBI versus spouses of parents without TBI, and children of parents with TBI versus children of parents without TBI. SETTING: Urban, suburban, and rural New York State. PARTICIPANTS: 32 families participated in the study; in 16 families one parent had a TBI and in the remaining 16 families, no parent had a TBI. Eighteen children from families with parental TBI and 26 children from families without TBI were interviewed. On average, parents with TBI were 9 years post-onset of injury at the time of interview. MAIN OUTCOME MEASURES: The parents' battery explored parents' perspectives of their own parenting skills (Parent Behavior Form, Parent Practices Questionnaire, Parenting Dimensions Inventory), their mood (Beck Depression Inventory), and the behaviors of their children (Children's Problem Checklist, Behavior Rating Profile). The child's battery tapped the children's perspective of their own behaviors (Behavior Rating Profile), their mood (Children's Depression Inventory), and the parental abilities of both parents (Parent Behavior Form, Parent Practices Questionnaire). RESULTS: Although parents with TBI and their spouses were similar to their comparison group in many parenting skills, parents with TBI reported less goal setting, less encouragement of skill development, less emphasis on obedience to rules and orderliness, less promotion of work values, less nurturing, and lower levels of active involvement with their children. Spouses of individuals with TBI, compared to their counterparts, reported less feelings of warmth, love, and acceptance toward their children. Children from families in which a parent had a TBI perceived both parents as more lax in their discipline, with the parent without TBI perceived as less actively involved in parenting roles. No differences in the frequency of behavioral problems were found between children of parents with TBI and children of parents without TBI. Parents with TBI and their children experienced more symptoms of depression relative to their respective comparison groups. CONCLUSION: Parental TBI has select consequences for all family members: individuals with TBI, their spouses, and their children. Prospective clinical evaluations of family members and proactive interventions to maximize family adjustment and minimize affective distress are indicated.

Separation anxiety in infants.

The following observation study examines separation anxiety in infants; comparing literature and a specific case study. An eight month old infant, and her mother are the basis of this study. Developmental levels, according to Piaget and Erickson are discussed. Various past and present child development ideas are used to compare the findings. It is revealed that separation anxiety, supported by the research, as well as the study, is a necessary, and healthy adaptation children make to develop emotionally.

Carotid arterial bifurcation advancement.

Acute postoperative thrombosis and late restenosis are well known complications of carotid endarterectomy. Vein or synthetic patches are imperfect solutions leading to occasional infections, false aneurysms and possible rupture. A new technique is described that patches the internal carotid artery with the external carotid artery after complete endarterectomy of both vessels. Twenty-five of these procedures were performed upon 22 symptomatic patients with no early or late morbidity or mortality. Theoretic advantages include wide patching of the internal carotid artery above the endarterectomy end point where narrowing is most dangerous, full endarterectomy of the external carotid artery and double tacking of the endarterectomy end points to deter circumferential intimal flaps.