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Background The prevalence of obesity and obesity-related morbidity in end-stage renal disease patients is rising. Although it is established that obesity does not abrogate the transplant benefit with respect to lower long-term mortality and cardiovascular risk, it is associated with increased graft failure, delayed graft function, surgical complications, prolonged hospital stay, and costs. Objectives To examine the safety and efficacy of LSG (laparoscopic sleeve gastrectomy) in renal transplant candidates and evaluate transplant outcomes. Setting Single-center prospective nonrandomized trial Methods We here report on a prospective single-center trial establishing a 2-step approach for obese renal transplant candidates. Patients with end-stage renal disease and a BMI (body mass index) of 35 kg/m 2 or higher underwent laparoscopic sleeve gastrectomy. After reaching a BMI of<35 kg/m 2 , patients were waitlisted for kidney transplantation. Age, gender, body mass index (BMI), associated co-morbidities, cause of end-stage renal disease, surgical complications, and outcome after kidney transplantation (graft survival, incidence of delayed graft function, incidence of rejection, serum creatinine) were collected. Results LSG was performed in 8 renal transplant candidates with a mean BMI of 38.8 kg/m 2 each. BMI dropped to below 35 kg/m 2 within a median of 3 months. Percent excess body mass index loss (%EBMIL) was 62.7% at 1 year after LSG. Within 17 months (mean) after metabolic surgery, 7 patients underwent kidney transplantation. All transplants were successful with a serum creatinine of 1.9±.8 mg/dL at discharge and stable allograft function thereafter. Mean follow-up was 3.2±1.4 years; no patient was lost to follow-up. Conclusion LSG is safe and efficacious for treatment of obesity in renal transplant candidates. Rapid and sustained weight loss and subsequent waitlisting for kidney transplantation may reduce overall and in particular posttransplant patient morbidity. [ABSTRACT FROM AUTHOR]

Abstract: Optimal management of transplanted organs requires specific and sensitive biomarkers for immunologic graft monitoring and subsequently patient tailored treatment. Proteomic science has emerged as an attractive tool in clinical biomarker research generating massive amounts of proteomic-driven data. However, critical interpretation of these data requires basic knowledge of proteomic principles and technology. This review provides an overview of proteomic approaches along with their advantages and limitations. Furthermore, this article summarizes the current status of biomarker achievements in the different areas of solid organ transplantation and discusses the hurdles that have precluded routine clinical application of these promising markers so far. [Copyright &y& Elsevier]

Abstract: Mycoplasma pneumoniae is one of the most common known bacterial pathogens of the respiratory tract, especially in patients between 5 and 30 years of age. It may be encountered at a relatively high rate in the non-life-threatened fraction of Emergency Department (ED) patients presenting with upper respiratory symptoms or cough. Yet its hallmarks are very non-specific, including a great variety of presentations from mild pharyngitis to potentially life-threatening complications such as the Stevens-Johnson Syndrome. Here, we describe a typical case of pneumonia due to Mycoplasma pneumoniae in a young adult with mild pharyngitis as the leading symptom. Disease presentation, complications, diagnostic means, therapeutic options, and suspicious clinical settings are discussed to provide a review on the clinical aspects of the disease that are important in the ED setting. [Copyright &y& Elsevier]

Do epiphytes drop out above the treeline because of climatic reasons or due to lack of appropriate substrate? We set out to address this question by studying various key aspects of their biology at a natural treeline on a tropical mountain top in Panama: species composition of assemblages, host preferences, population structure and dynamics, individual growth and reproductive investment. Lack of relevant climate data caused us to monitor microclimatic conditions in tree crowns for 12 months. At our study site we found 15 epiphyte species, mostly ferns, although in terms of abundance orchids were highly dominant. Compared to lowland vegetation of similar stature, the epiphyte assemblages were less species-rich and abundances lower. Some species may only be present at this treeline because of continuous immigration from lower elevations (i.e. represent sink populations). Many species, however, were rather abundant with many reproductive individuals, arguably forming viable local populations. The results of a detailed demographic study with the orchid Pachyphyllum hispidulum over three years also support this notion, being comparable to studies from lowland habitats. Our descriptive study does not allow unambiguous conclusions on mechanisms, but our findings suggest that lack of suitable substrate (=trees) rather than climatic reasons are responsible for the disappearance of epiphytes immediately above the treeline. This notion needs rigorous verification by experimental physiological studies. [ABSTRACT FROM AUTHOR]

The use of East African freshwater wetlands for agriculture has increased in recent decades, raising concerns about potential impacts on wetlands and the long-term sustainability of such land use trends. WET-health is an indicator-based rapid wetland assessment approach developed in South Africa. It allows determining the conditions of wetlands in four assessment modules (hydrology, geomorphology, vegetation, and water quality) by observing the degree of deviation of a wetland from its anticipated natural reference state. We tested the transferability of the WET-health concept for East African inland valley swamps and floodplain wetlands based on 114 assessment units at four study sites. Due to large wetland areas and different environmental settings in East Africa, we modified the original approach using a random selection of assessment units and an assessment scheme based on disturbance types (Appendices A and B). Estimated WET-health impact scores were matched with biophysical and socioeconomic variables using a generalized linear mixed model. Land use included largely undisturbed wetland units occurring side by side with seasonally cropped or grazed units, and drained, permanently cultivated units. A strong differentiation of impact scores between the four assessment modules was apparent with highest scores for vegetation and lowest scores for geomorphology. Vegetation and water quality responded most sensitively to land use changes. The magnitude of wetland disturbance is predominantly determined by management factors such as land use intensity, soil tillage, drainage intensity, and the application of agrochemicals and influences vegetation attributes and the provision of ecosystem services. The proposed modification of WET-health enables users to assess large wetland areas during relatively short periods of time. While further studies will be required, WET-health appears to be a promising concept to be applied to wetlands in East Africa and possibly beyond. [ABSTRACT FROM AUTHOR]