The development of bronchiolitis obliterans syndrome (BOS) after lung transplantation is associated with viral infections. Natural killer (NK) cells are involved in the lysis of viral infected cells, ...and their activation is largely controlled by activating and inhibitory killer immunoglobulin-like receptors (KIRs). We hypothesized that KIR ligand incompatibility and recipients' individual KIRs could influence the development of BOS and the incidence of cytomegalovirus reactivation after lung transplantation.
The KIR gene contents were determined in 48 patients who received a lung transplant, and human leukocyte antigen (HLA)-Cw and HLA-Bw4 typing was performed on their respective donors.
BOS developed in 7 patients and cytomegalovirus reactivation occurred in 16. BOS developed in 5 of 19 patients homozygous for KIR haplotype A compared with 2 of 27 patients with KIR haplotype AB and B (homozygous; p = 0.03; log-rank test). In none of the patients with BOS was the activating KIR2DS5 gene detected, whereas it was present in 35% of patients without BOS (p = 0.04; log-rank test). No correlation was found between KIR gene content and cytomegalovirus reactivation.
Our results suggest that the lack of activating KIRs may play an important role in the development of BOS but not in the control of cytomegalovirus reactivation after lung transplantation.
Abstract Early and accurate diagnosis of intestinal ischemia is important in order to provide rapid and correct treatment and reduce morbidity and mortality rates. Clinical signs and symptoms are ...often unspecific. This systemic review sums up literature regarding human plasma biomarkers for acute mesenteric ischemia reported during the last ten years. Classic, general markers, including lactate, white cell count, base excess, show poor diagnostic accuracy for intestinal ischemia. Preliminary results for ischemia-modified albumin are promising, which is also true for the inflammatory marker procalcitonin. Best diagnostic accuracy is described for D-dimer, a-Glutathione S-transferase (a-GST) and Intestinal fatty acid binding protein (I-FABP), reflecting coagulation activity and mucosal damage respectively. Future studies should be directed at phase four questions (Do patients who undergo the diagnostic test fare better (in their ultimate health outcomes) than similar patients who do not?) for these markers and the identification of additional, novel plasma biomarkers signaling various types and stages of intestinal ischemia.
The aim of this study was to evaluate the association between flap harvest technique and occurrence of abdominal bulging.
A retrospective analysis of 159 patients undergoing DIEP flap breast ...reconstruction between 2014 and 2021 in the University Medical Center Utrecht was conducted. Outcomes measured were preoperative rectus diastasis, flap weight, laterality of flap harvest (unilateral or bilateral), timing of the harvest (immediate or delayed), number of perforators harvested (single or multiple), and location of the harvested perforator (medial, lateral, or both).
In 159 patients, 244 DIEP flaps were performed, 16 of these donor-sites (6.6%) developed a clinically evident abdominal bulge. When preoperative rectus abdominis diastasis was found (n = 97), postoperative bulging occurred significantly more often (
< 0.01). Patients in whom the medial perforator artery was harvested for reconstruction (n = 114) showed less abdominal bulging than patients in whom the lateral (n = 92) was harvested (
= 0.02). Using single versus multiple perforators for the DIEP flap, bilateral versus unilateral reconstruction or timing of the operation showed no significant difference in outcome of bulging (
= 1.00,
= 0.78,
= 0.59, respectively).
The incidence of bulging in our study cohort is comparable to the literature. Harvesting the medial perforator artery for the DIEP flap showed less abdominal bulging than using the lateral perforator artery in a DIEP flap breast reconstruction. Also, preoperative rectus diastasis was found to be an important risk factor for the occurrence of bulging.
Summary The identification of factors that can affect the efficacy of immunomodulatory drugs in relapsing-remitting multiple sclerosis (MS) is important. For the available interferon-beta products, ...neutralising antibodies (NAb) have been shown to affect treatment efficacy. In June, 2009, a panel of experts in MS and NAbs to interferon-beta therapy convened in Amsterdam, Netherlands, under the auspices of the Neutralizing Antibodies on Interferon beta in Multiple Sclerosis consortium, a European-based project of the 6th Framework Programme of the European Commission, to review and discuss data on NAbs and their practical consequences for the treatment of patients with MS on interferon beta. The panel believed that information about NAbs and other markers of biological activity of interferons (ie, myxovirus resistance protein A MxA) can be integrated with clinical and imaging indicators to guide individual treatment decisions. In cases of sustained high-titre NAb positivity and/or lack of MxA bioactivity, a switch to a non-interferon-beta therapy should be considered. In patients who are doing poorly clinically, therapy should be switched irrespective of NAb or MxA bioactivity.
The effect of antiretroviral therapy on both T-cell numbers and T-cell function in peripheral blood was studied. CD4+ and CD8+ T-cell numbers, T-cell reactivity to CD3 monoclonal antibodies (mAb), ...and viral RNA load date were obtained from patients treated for at least 28 weeks with either the HIV-1 protease inhibitor ritonavir, the nonnucleoside HIV-1 reverse transcriptase (RT) inhibitor nevirapine, or the nucleoside-analogue RT inhibitor zidovudine. Compared with both RT inhibitors, treatment with the protease inhibitor ritonavir resulted in the most significant and persistent elevation of CD4+ and CD8+ T-cell counts. However, in vitro T-cell functional improvement was of limited duration in the ritonavir-treated group and was inversely correlated with viral RNA load changes during the entire follow-up period. Thus, despite what can be assumed of responses during RT inhibitor therapy, quantitative responses on therapy did not necessarily correlate with qualitative immunologic responses, as can be seen during treatment with ritonavir. For optimal immune reconstitution, both numeric and functional immunologic improvements are essential. During antiretroviral therapy, measurement of in vitro improvement in immune function will be useful as a correlate for transient drug-induced alteration of immunodeficiency.
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