Play it, Jen

Every good movie has a piano player somewhere in the background--
sometimes seen, usually unseen.
Seldom really noticed.
The feeling, the very soul of a scene, is created by that person tinkering at the keys.
It has been said, "All the world's a stage."
Well then...Play it, Jen.

My Photo
Location: Over Yonder, Missouri

I'm a California Native transplanted to the Missouri Ozarks. I've learned how to chase cows in high heels and load hay faster than you can say "Coco Chanel." These are some of our pictures and stories of living in a land with breath-taking beauty and adventure around every bend.

Friday, July 28, 2006

Drug Mistakes Injure 1.5 Million in US Every Year

Drug Mistakes Injure 1.5 Million in US Every Year: "WASHINGTON (Reuters) Jul 20 - Medication errors hurt 1.5 million people every year in the United States and cost at least $3.5 billion, according to a report issued on Thursday.
If hospitals, clinics and other providers owned up to each and every mistake, it would help to keep track of and eventually reduce them, and systems such as electronic prescribing would also help, the Institute of Medicine report said.
'Medication errors are among the most common medical errors, harming at least 1.5 million people every year,' the Institute said in a statement.
Such mistakes kill at least 7,000 people a year, according to the Institute, an independent, non-profit organization that advises the federal government on health issues.
'The extra medical costs of treating drug-related injuries occurring in hospitals alone conservatively amount to $3.5 billion a year, and this estimate does not take into account lost wages and productivity or additional health care costs,' the institute added."

High Skin Cancer Risk in Transplant Recipients Calls for Heightened...

High Skin Cancer Risk in Transplant Recipients Calls for Heightened...: "NEW YORK (Reuters Health) Jul 17 - Recipients of solid organ transplants are at much higher risk for aggressive squamous cell carcinomas than the general population, and dermatologists want physicians, nurses, and patients to be aware of this risk so that suspicious lesions can be treated as early as possible.
'This is a very bad problem that's going to get worse as more patients undergo transplant surgery and survive,' Dr. Clark C. Otley told Reuters Health. 'But it has a potential solution that will require a multi-pronged approach, because all skin cancers go through a curable stage, and if they're removed in time, they won't be lethal.'
To raise awareness, Dr. Otley and other members of the AT-RISC (After Transplantation-Reduce Incidence of Skin Cancer) Alliance are presenting large symposia at the World Transplant Congress to be held in Boston, to educate transplant physicians, transplant coordinators, and nurses.
Dr. Otley is chair of the Division of Dermatologic Surgery at the Mayo Clinic in Rochester, Minnesota, and one of the founders of the ITSCC (International Transplant-Skin Cancer Collaborative.) The ITSCC is collaborating with the International Transplant Nurses Society (ITNS) and the Transplant Recipients International Organization (TRIO) to launch the AT-RISC Initiative.
The physician explained that transplant recipients are 65 times more likely to develop squamous cell carcinoma, involving not only the skin but also other epithelial tissue, such as the throat, vagina, and the cervix, as a result of the powerful immunosuppressant drugs taken to prevent graft rejection.
'The skin has a potent immune system, which, in addition to fighting off infection, also controls and prevents cancer,' he noted. 'Without that pr"

Tacrolimus Ointment Effective for Nickel-Induced Atopic Dermatitis

Tacrolimus Ointment Effective for Nickel-Induced Atopic Dermatitis: "July 28, 2006 � Tacrolimus 0.1% ointment suppresses signs and symptoms of allergic contact dermatitis among individuals who are sensitive to nickel and who continue to be exposed to this metal, a new study shows.
The investigators used nickel as a model of chronic allergic contact dermatitis. 'Theoretically, since the mechanism of action is the same,' tacrolimus ointment would be effective in allergic contact dermatitis induced by other compounds, Dr. Donald Belsito from the University of Missouri in Kansas City told Reuters Health.
Allergic contact dermatitis � characterized by inflammation, erythema, pruritus, and blistering � is one of the most common occupationally related conditions in the US, costing an estimated $1 billion annually due to lost work, reduced productivity, medical care and disability payments.
Nickel induces allergic reactions in roughly 5.8% of the US population, making it an appropriate model for studying allergic contact dermatitis.
In the July Journal of the American Academy of Dermatology, Dr. Belsito and colleagues from several other US institutions report the efficacy results for 91 patients and safety results for 97 patients who received tacrolimus 0.1% ointment of the treatment of nickel-induced allergic contact dermatitis.
The subjects, who were 17 years of age or older and had a history of patch test-confirmed nickel allergy, applied a thin layer of tacrolimus ointment to the upper inner aspect of one arm and an inactive control ointment to the other arm twice daily. The study subjects were then randomized to a nickel-containing patch or a vehicle ointment patch for 4 to 8 hours each day.
Tacrolimus ointment proved significantly more effective than vehicle control in ameliorating signs and symptoms of nickel-induced allergic contact dermatit"

Most Recent Warning Letters

Most Recent Warning Letters

Thursday, July 27, 2006

Moonlight serenade

Moonlight serenade
Originally uploaded by *Christian.

Tuesday, July 25, 2006


Originally uploaded by Yawp Barbarian.
We're under another power emergency here again today. Crazy hot weather. They're asking everyone to conserve energy, so I'm playing on my computer! ;) Why is it I'm asked to not run appliances or do any of MY daily work (laundry, dishes, etc.) yet I don't see them telling businesses to turn off their computers and things like that. Oh well, just another unimportant housewife moving along with the masses....

Under the lid

Originally uploaded by malota.

Victor Borge and Guest: Liszt - Hungarian Rhapsody No. 2

This is one of my all-time favorite performances. This man was so amazing!

Thursday, July 13, 2006

Crazy Surfing video Powerade Commercial


Originally uploaded by Ricardo Bevilaqua.


Immunosuppression in Pediatric Liver Transplantation
The optimal immunosuppression for liver transplantation recipients remains a topic of debate. Excellent results have been reported from a great number of centers utilizing various treatment regimens. The choice of 1 strategy over another is largely physician dependent. With good results obtainable using almost all drug combinations, it becomes important to minimize the toxic side effects related to chronic immunosuppressive drug use. This is even more important in the pediatric population, where undesirable side effects may lead to noncompliance in a population that requires relatively long graft survival.

CsA Microemulsion vs Tacrolimus (TAC) Therapy in Pediatric Liver Transplant Recipients
A multicenter, European trial compared the use of CsA microemulsion (Neoral) to TAC triple therapy in pediatric liver transplantation.[13] No differences in patient or graft survival between the groups were demonstrated. Acute rejection was documented in 45% of patients treated with TAC, compared with 60% of patients treated with Neoral. Furthermore, the incidence of corticosteroid-resistant rejection was lower in the TAC group. Use of Neoral was associated with a higher incidence of hirsutism and gingival hyperplasia, side effects that have been associated with patient noncompliance.

Daclizumab Induction Therapy In Pediatric Liver Transplant Recipients
Induction therapy with daclizumab, a nondepleting antibody, plus delayed institution of TAC therapy (at day 7) was evaluated in a pediatric population.[14] Patients also received corticosteroids and mycophenolate mofetil (MMF). Historical controls received standard TAC-based triple therapy started immediately posttransplantation. Daclizumab induction was associated with a significantly lower risk of acute rejection within the first 30 days posttransplantation, 15% vs 50%, respectively. Early renal function (at 7 days posttransplantation) was improved in the group that received daclizumab. However, 2-year patient and graft survival rates were not significantly different between groups. These findings indicate that this strategy is efficacious and may be beneficial in the child with underlying renal dysfunction at time of liver transplantation.

Long-term Follow-up in Pediatric Patients Treated With TAC-Based Immunosuppressive Therapy
Long-term follow-up (mean = 9 years) of chronic rejection in 166 pediatric liver recipients managed on TAC-based immunosuppression showed that 10-year actuarial patient and graft survival rates were 84% and 80%, respectively.[15]s Only 4 patients had biopsy-proven chronic rejection. Each of these patients had undergone reduction or withdrawal of immunosuppression as treatment for viral infection/PTLD, or were noncompliant. None of the remaining patients maintained on TAC-based immunosuppression had chronic rejection. By comparison, 20% of children on CsA-based maintenance immunosuppression developed chronic rejection. TAC rescue therapy was effective in 70% of these patients, with normalization of liver enzymes and improvement in liver histology. These findings suggest that TAC is an effective drug for long-term maintenance immunosuppression and prevention of chronic rejection in pediatric liver transplant recipients.
Data emerging on immunosuppressive therapies in pediatric patients generally parallel the findings in adult patients. A number of regimens have been found to be effective in preventing or treating rejection. Emphasis now is on reducing or eliminating side effects that either increase morbidity or contribute to noncompliance. Thus, the armamentarium available to the transplant physician is no longer restricted to corticosteroids, azathioprine, and a calcineurin inhibitor. Judicious use of T cell-depleting and nondepleting antibodies, sirolimus, and MMF have allowed reduction or complete withdrawal of some agents without increasing graft loss or complications. As experience is gained with the use of these drugs, regimens will be tailored individually to the patient based on the side effects encountered.

Pediatric Issues in Solid Organ Transplantation

Pediatric Issues in Solid Organ Transplantation

Current Studies

Current Studies

Ideas on Biliary Atresia

Biliary Atresia -- Mechanism and Outcome
Biliary atresia is the most common indication for liver transplantation in children, yet its cause is elusive. One theory implicates a virus-initiated process that culminates in autoimmune-mediated destruction of bile ducts. New insight has been provided by the rhesus rotavirus (RRV)-induced murine model of biliary atresia that resembles the human disease. In this model, immune-mediated inflammation of bile ducts progresses to biliary obstruction and death by 3 weeks of age.

During the plenary session at this year's AASLD meeting, Mack and colleagues[1] reported the results of a study to test the theory that autoreactive T cells are present in the RRV-model, and thus that transfer of these cells should elicit an autoimmune attack on the bile ducts of a recipient mouse. Liver lymphocytes from RRV-diseased animals were adoptively transferred into immunodeficient mice; this transfer resulted in marked cellular infiltration surrounding the bile ducts of all mice. The infiltrates were composed, in part, of the adoptively transferred CD3+ T cells. This periductular inflammation was not found in the control group and was organ-specific. The T cells migrated to bile duct epithelium in an antigen-specific fashion, suggesting autoreactive T-cell-mediated bile duct injury. Future studies are needed that include T-cell proliferation assays aimed at investigating bile duct epithelium as the target antigen.

Narayanaswamy and colleagues[2] characterized the nature of the inflammatory process in biliary atresia in 21 affected infants. They noted a persistent inflammatory process that involved both a nonpolarized T-helper cell (Th1 and Th2) response, as well as macrophages. The intensity of the inflammatory process correlated directly with outcome. A Th1 commitment also occurs in the murine model. The livers of mice with induced biliary atresia demonstrate increased numbers of T lymphocytes along with high-level expression of Th1-type cytokines (interleukin [IL]-2 and interferon [IFN]-alpha). By 2 weeks post infection, the disease is marked by elevated numbers of macrophages concurrent with high expression of the proinflammatory cytokine TNF-alpha. In mouse models of other inflammatory diseases, TNF- blockade results in rapid recovery or prevention of disease. In view of the similar increase in expression of TNF-alpha at time of diagnosis in infants with biliary atresia, Hendrickson and colleagues[3] hypothesized that elimination of a functional TNF pathway in RRV-infected mice would result in enhanced recovery. Although RRV-infected mice had elevated expression of TNF-alpha, depletion of this cytokine was not sufficient to affect the progression of bile duct inflammation and obstruction. In related murine studies, it has been noted that the absence of IFN-gamma improves cholestasis by decreasing the tropism of lymphocytes to bile ducts. On the basis of previous findings of high levels of expression of the Th1 cytokine IL-12 at the time of duct obstruction, Mohanty and colleagues[4] hypothesized that loss of IL-12 would prevent bile duct obstruction. They found that loss of functional IL-12 did not prevent bile duct obstruction, attenuated -- but did not abolish -- the Th1 response, and induced high expression of type-1 IFNs and infiltration of bile ducts by neutrophils.

Cumulatively, these studies strongly support a role for type-1 IFNs and neutrophils in the pathogenesis of biliary atresia. Additional elucidation of this process may enable specific immunomodulatory therapy for this condition.

Etiopathogenesis of Biliary Atresia

Etiopathogenesis of Biliary Atresia

Pandemic Influenza and Its Implications for Transplantation

Pandemic Influenza and Its Implications for Transplantation

Seven children doing well with laboratory-grown organs - News Room - Children's Hospital Boston

Seven children doing well with laboratory-grown organs - News Room - Children's Hospital Boston: "Three boys and four girls treated at Children's Hospital Boston are the first people in the world to receive laboratory-grown organs."

Tuesday, July 11, 2006

Star Wars

I love this one!


My nephew AJ is at it again. AJ is the one in dark pants. The girl is my niece, Leia.

Tuesday, July 04, 2006

Making A Splash