Takayasu arteritis: burnt out or not?

We report a case of a 57‐year‐old woman with Takayasu arteritis. She had a long history of poorly controlled hypertension and now suffers from severe ischemic cardiomyopathy and lower limb claudication. She did not receive immunosuppressive treatment as there were no signs of inflammation clinically or biochemically. Inspite of the latter, her symptoms have progressed. This case highlights the importance of improved modes of detecting inflammation as well as the need for strict management of vascular risk factors to control atherosclerosis, which has an increased incidence in patients with Takayasu arteritis.     

Identification of a surrogate TSL-1 antigen of Trichinella spiralis from a phage library of random peptides

We sought to find a peptide analogue of an important antigen (TSL-1) of Trichinella spiralis which is recognized by the 7C2C5 antibody. A phage library which displays a short (15-mer) randomly-generated peptide at the filament of the minor coat protein of the virion was used for selection by the 7C2C5 antibody. A peptide thus identified, ICDASGLGCWCWSLSP, was found to be a true surrogate since its binding to the antibody could be blocked by the native antigen and, conversely, an antiserum made to the peptide could recognize the native antigen. In addition, the peptide appeared to detect T. spiralis -infected pigs although it was less discriminatory than the native antigen.     

Apsoriatic psoriatic arthritis

Numerous features distinguish psoriatic arthritis (PsA) from other arthropathies, including the presence of psoriasis, distal interphalangeal (DIP) joint involvement, nail dystrophy, enthesitis, dactylitis and spinal involvement. Two decades ago, the presence of psoriasis was mandatory in the diagnosis of PsA. Up to 15% of patients had joint disease preceding psoriasis. In this group of patients, it may have been years after the onset of arthritis before the definitive diagnosis of PsA could be made. With advancements in treatment modalities, an accurate and proper diagnosis is relevant to the management of PsA. In their case report appearing in this issue, Taniguchi and Kamatani present a case with classical PsA without skin and nail lesions for 21 years. It may not be that unusual to encounter this in clinical practice, but we think it an opportune time to review the classification criteria and illustrate how the diagnosis of PsA can be made earlier.     

Treatment of severe exacerbation of chronic obstructive pulmonary disease with mask-applied continuous positive airway pressure

Abstract The efficacy of mask-applied continuous positive airway pressure (CPAP) in the treatment of patients with acute severe exacerbations of chronic obstructive pulmonary disease (COPD) was examined. Ten patients with severe exacerbation of COPD who had deteriorated during conventional therapy were treated with face-mask delivered CPAP (+5 cmH₂ O; Downs Vital signs Inc., New Jersey, USA) instead of tracheal intubation and mechanical ventilation. The patients that were selected required mental alertness, intact upper airway reflexes, the clinical signs of dynamic hyperinflation and a positive end-expiratory pressure auto-(PEEP) manifested as expiratory wheeze and grunting. Nine out of 10 patients responded promptly to mask-CPAP with less distress, better oxygenation, lower respiratory and pulse rates. There was no significant change in arterial carbon dioxide tension with mask-CPAP treatment. One patient deteriorated on mask-CPAP and required intubation and mechanical ventilation. Three patients died (none of these patients died during the acute period of exacerbation). It was concluded that Mask-CPAP may be an alternative to mechanical ventilation in the treatment of selected patients with severe hypercapnic exacerbations of COPD.     

Interleukin‐2 receptor antibody does not reduce rejection risk in low immunological risk or tacrolimus‐treated intermediate immunological risk renal transplant recipients

Aim: The use of interleukin‐2 receptor antibody (IL‐2Ra) induction has been associated with reduced rejection rates in renal transplant recipients. However, the effect of IL‐2Ra induction on graft and patient outcomes in renal transplant recipients with differing immunological risk remains unclear. Methods: Using Australia and New Zealand Dialysis and Transplant Registry, renal transplant recipients in Australia between 1995 and 2005 were included. Recipients were stratified into low immunological risk (primary grafts with ≤2 human leucocyte antigen (HLA)‐mismatches and panel‐reactive antibody (PRA) < 10%) or intermediate immunological risk (subsequent grafts or >2 HLA‐mismatches or PRA > 25%) recipients. Recipients receiving T‐cell depletive induction therapy or steroid and/or calcineurin‐free inhibitor regimens were excluded. Outcomes analysed included the presence of rejection at 6 months, estimated glomerular filtration rate at 1 and 5 years, graft and patient survival. Results: 218 of 1220 (18%) low‐risk and 883 of 3204 (28%) intermediate‐risk recipients received IL‐2Ra. In intermediate‐risk recipients, IL‐2Ra induction was associated with a 26% reduction in the incidence of acute rejection; but this benefit was restricted only to recipients initiated on cyclosporine‐based immunosuppressive regimens. In contrast, the use of IL‐2Ra in low‐risk recipients was not associated with reduced rejection risk. There was no association between IL‐2Ra induction and other graft or patient outcomes in both low‐ and intermediate‐risk recipients. Conclusion: This registry analysis suggests that IL‐2Ra induction may be associated with a reduction in rejection risk in cyclosporine‐treated intermediate immunological risk recipients, but not in low‐risk renal transplant recipients.     

Comparable transplant outcomes between local and shipped deceased-donor kidneys in Australia: Analysis of Australia and New Zealand Dialysis and Transplant Registry 1992–2007

Aim:   Allocation of deceased-donor kidneys in Australia often involves the shipping of well-matched renal allografts across states. However, the impact of shipping on graft outcomes remains unclear. In this study, the effect of shipping of well-matched (0–2 human leucocyte antigen (HLA) mismatches) and poorer-matched (3–6 HLA mismatches) deceased-donor kidneys on transplant outcomes in Australia were examined.
Methods:   Using data from Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), graft and patient outcomes were compared between shipped and locally transplanted allografts in Australia between 1992 and 2007 stratified by the number of HLA mismatches.
Results:   Recipients receiving shipped renal allografts were more likely to be highly sensitized with previous grafts and/or higher panel reactive antibodies levels with significantly longer graft ischaemic time compared to local allografts. Regardless of the HLA mismatches, the risk of delayed graft function, acute rejection, 12 month serum creatinine, graft failure and patient survival was similar between shipped and locally transplanted renal allografts.
Conclusion:   Recipients of shipped renal allografts with 0–2 and 3–6 HLA mismatches have similar transplant outcomes to locally transplanted allografts.     

Total Particulate Matter and Wound Healing: An in vivo Study with Histological Insights

Objectives Wound healing in the skin is a multifarious orchestration of cellular processes and cigarette smoking may be a cause for delayed wound healing. The aim of this study was to investigate the plausible association between exposures of cigarette total particulate matter （TPM） and wound healing. Methods An in vivo wound healing model of mice was established for determination of assorted events of wound healing, dermal matrix regeneration, re-epithelialization, and neovascularization. A total of 72 adult mice, separated in eight groups, were exposed to TPM for 12 days. Results A highly considerable diminution in wound closure （P〈0.001） was pragmatic among all TPM-treated mice from day 6 to day 8 post-wounding. Histological investigations unveiled a noteworthy impede in the outcome of re-epithelialization, dermal matrix regeneration and maturation of collagen bundles among all TPM-exposed wounds. Delayed commencement of neovascularization was pragmatic among all TPM-treated mice, on day 12 post wounding. Abbot curve, angular spectrum, and other different parameters of 3D surface behavior of wounds revealed a very highly significant reduction （P〈0.001） in angiogenesis on days 6 and 8 post-wounding, which points that application of TPM instigates extensive delay in trigging the progression of angiogenesis, resulting in delayed onset of wound healing. Conclusion Our annotations validate the damaging effects of TPM on wound healing and excessive use of TPM may lead to the production of chronic wounds and oral ulcers.     

Clinical Significance of Early Recurrences of Atrial Tachycardia After Atrial Fibrillation Ablation

Early Recurrence After AF Ablation. Background: Atrial tachycardia (AT) commonly recurs within 3 months after radiofrequency catheter ablation for atrial fibrillation (AF). However, it remains unclear whether early recurrence of atrial tachycardia (ERAT) predicts late recurrence of AF or AT. Methods: Of 352 consecutive patients who underwent circumferential pulmonary vein isolation with or without linear ablation(s) for AF, 56 patients (15.9%) with ERAT were identified by retrospective analysis. ERAT was defined as early relapse of AT within a 3‐month blanking period after ablation. Results: During 21.7 ± 12.5 months, the rate of late recurrence was higher in patients with ERAT (41.1%) compared with those without ERAT (11.8%, P < 0.001). In a multivariable model, positive inducibility of AF or AT immediately after ablation (65.2% vs 36.4%, P = 0.046; odd ratio, 3.9; 95% confidence interval, 1.0–14.6) and the number of patients who underwent cavotricuspid isthmus (CTI) ablation (73.9% vs 42.4%, P = 0.042; odd ratio, 4.5; 95% confidence interval, 1.1–19.5) were significantly related to late recurrence in the ERAT group. The duration of ablation (174.3 ± 62.3 vs 114.7 ± 39.5 minutes, P = 0.046) and the procedure time (329.3 ± 83.4 vs 279.2 ± 79.7 minutes, P = 0.027) were significantly longer in patients with late recurrence than in those without late recurrence following ERAT. Conclusions: The late recurrence rate is higher in the patients with ERAT compared with those without ERAT following AF ablation, and is more often noted in the patients who underwent CTI ablation and had a prolonged procedure time. Furthermore, inducibility of AF or AT immediately after ablation independently predicts late recurrence in patients with ERAT. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1331‐1337, December 2010)