Background and objectives An environmental trigger has been proposed as an inciting factor in the development of anti-GBM disease. This multicenter, observational study sought to define the national incidence of anti-GBM disease during an 11-year period (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) in Ireland, investigate clustering of cases in time and space, and assess the effect of spatial variability in incidence on outcome.Design, setting, participants, & measurements We ascertained cases by screening immunology laboratories for instances of positivity for anti-GBM antibody and the national renal histopathology registry for biopsy-proven cases. The population at risk was defined from national census data. We used a variable-window scan statistic to detect temporal clustering. A Bayesian spatial model was used to calculate standardized incidence ratios (SIRs) for each of the 26 counties.Results Seventy-nine cases were included. National incidence was 1.64 (95% confidence interval [95% CI], 0.82 to 3.35) per million population per year. A temporal cluster (n=10) was identified during a 3-month period; six cases were resident in four rural counties in the southeast. Spatial analysis revealed wide regional variation in SIRs and a cluster (n=7) in the northwest (SIR, 1.71; 95% CI, 1.02 to 3.06). There were 29 deaths and 57 cases of ESRD during a mean follow-up of 2.9 years. Greater distance from diagnosis site to treating center, stratified by median distance traveled, did not significantly affect patient (hazard ratio, 1.80; 95% CI, 0.87 to 3.77) or renal (hazard ratio, 0.76; 95% CI, 0.40 to 1.13) survival.Conclusions To our knowledge, this is the first study to report national incidence rates of anti-GBM disease and formally investigate patterns of incidence. Clustering of cases in time and space supports the hypothesis of an environmental trigger for disease onset. The substantial variability in regional incidence highlights the need for comprehensive country-wide studies to improve our understanding of the etiology of anti-GBM disease.

This study suggests that local C1-Inh degradation by plasmin may be a central and critical event in the loss of protease inhibition during inflammation. These findings have important implications for our understanding of pathogenic mechanisms in inflammation and for the development of more effectively targeted therapeutic regimes. These findings may also explain the efficacy of anti-plasmin agents in the treatment of C1-Inh deficiency states, as they may diminish plasmin-mediated C1-Inh degradation.

Tritium-labeled T-2 toxin [4~,15-diacetoxy,8a-(3-methylbutyryloxy)-3a-hydroxy-12,13-epoxytrichothec-g-ene] was synthesized using a two-step process. First, the C-3 hydroxyl was oxidized to a ketone using either chromium trioxide-pyridine or dimethyl sulfide-N-chlorosuccinimide complex. In step two, the ketone was reduced with either tritiated sodium cyanoborohydride or tritiated sodium borohydride to a mixture of epimers which were separable by thin-layer chromatography. The a epimer (naturally occurring T-2 toxin) was formed predominantly, i.e., a to ratio was 4 to 1. Final reduction with tritiated sodium borohydride yielded [3-3H]T-2 toxin in 23% yield with a specific activity of 790 mCi/mmol. The labeled product, when equilibrated with 0.01 N HC1, did not lose the tritium, indicating that no labile tritium was incorporated into T-2 toxin. Further, the oxidation of [3-3H]T-2 toxin resulted in total loss of activity in the corresponding ketone.The metabolites of species of Fusarium are commonly found in foodstuff and are prominent because of their association with cases of mycotoxicoses of humans and animals. One such metabolite, T-2 toxin (1) [4&15-diacetoxy,8a-( 3-methylbutyryloxy)-3a-hydroxy-12,13-epoxytrichothec-g-ene] has been implicated as a mycotoxin responsible for the hemorrhagic syndrome and death of dairy cattle (Hsu et al., 1972). T-2 toxin causes an extreme dermal necrosis in most animals and is also one of the most

Background: Caregiver burden (CB) is a consequence of providing care to people with spinal cord injury (SCI). However, there is a lack of clarity about the influence of secondary conditions of care recipients on family caregivers. Secondary conditions refer to the physical and psychological complications that can occur after SCI and lead to increased hospitalization and reduced functionality, quality of life, and social participation. Objective: To assess the impact of physical and psychological secondary conditions of people with SCI on the perceived burden of family caregivers. Methods: A multicenter, cross-sectional study of 56 dyads of family caregivers and individuals with SCI in two urban spinal units in Italy and Ireland. Care recipients completed a toolset consisting of demographic information and assessments of functional, physical, and psychological health. Caregivers completed a multidimensional measure of CB. Bivariate data analysis was used. Results: No significant differences between centers were identified. CB was found to be related to physical secondary conditions and functional independence but not to mental health of care recipients. Bladder dysfunction and urinary tract infections influenced all dimensions of CB, whereas pressure injuries influenced only the time-dependent dimension. Level and completeness of injury and duration of caregiving increased CB. Conclusion: Findings indicate the value of a reduction in secondary conditions not just for individuals with SCI but also for their family caregivers. To reduce the individual and family burden of secondary conditions, a two-pronged, multidimensional approach, focusing on self-management for care recipients and psychoeducational support for caregivers, is required.

Urinary incontinence is linked to pelvic floor dysfunction; the delicate balance between bones, muscles, tendons, and nerves is fundamental for continence and can be altered for numerous reasons, also linked to anatomical areas other than the pelvis. The assessment of the patient is at the basis of treatment choices; the literature reports the need to assess the patient's postural, respiratory, muscular and neurological components. To date, however, there are no studies that provide the nurse with a compendium of evidence in the form of a practical guide to assessment. To present literature evidence regarding the assessment of patients with urinary incontinence, undergoing pelvic conservative rehabilitation and to discuss the practical implications. This evaluation refers to the first contact with the patient and aims to understand how to set up the rehabilitation pathway and whether specific investigations or consultations are needed before starting rehabilitation. Narrative reviews of the literature on the PubMed, CINAHL, Cochrane Library, EMBASE, Scopus, Web of Science, PEDro database. We included studies published in the last 10 years, with no design restrictions, on the topic of assessment criteria for patients with urinary incontinence undergoing pelvic floor conservation rehabilitation, with regard to the role of the nurse. Thirty‐two references were retrieved including two systematic reviews. Assessment should focus on physical activity, bowel habits, spine and posture, nutrition and food habits, breathing and clinical history. Physical examination is aimed at (1) collecting data for establishing the correct rehabilitation programme and (2) excluding the need for evaluation/intervention by other healthcare professionals. Nurses play a key role in pelvic rehabilitation teams. Assessment and decision making about rehabilitation methods are complex tasks which require specialistic education. This paper summarizes the key points of both areas. Conservative rehabilitation of urinary incontinence requires a complex assessment in order to correctly set up the rehabilitation pathway. Aspects to be assessed include muscular, postural, respiratory, neurological and medical history. There are no works in the literature offering a compendium of the information to be considered. A complete overview of the evaluation phases and their characteristics including a practical description of the nursing assessment of the patient undergoing pelvic rehabilitation for urinary incontinence.