Panel reactive HLA antibodies,soluble CD30 levels,and acute rejection six months following renal transplant

Domingues EMFL, Matuck T, Graciano ML, Souza E, Rioja S, Falci MC, Monteiro de Carvalho DB, Porto LC. Panel reactive HLA antibodies, soluble CD30 levels, and acute rejection six months following renal transplant.
Clin Transplant 2010: 24: 821–829. © 2009 John Wiley & Sons A/S. Abstract: Background: Specific anti‐human leukocyte antigen antibodies (HLA) in the post‐transplant period may be present with acute rejection episodes (ARE), and high soluble CD30 (sCD30) serum levels may be a risk factor for ARE and graft loss. Methods: HLA cross‐matching, panel reactive antibodies (PRA), and sCD30 levels were determined prior to transplantation in 72 patients. Soluble CD30 levels and PRA were re‐assessed at day 7, 14, 21, and 28, and monthly up to the sixth. Results: Twenty‐four subjects had a positive PRA and 17 experienced ARE. Nine of 17 ARE subjects demonstrated positive PRA and 16 had HLA mismatches. Positive PRA was more frequent in ARE subjects (p = 0.03). Eight subjects with ARE had donor‐specific antibodies (DSA) in serum samples pre‐transplantation, two subjects developed DSA. Three subjects without ARE had positive PRA only in post‐transplantation samples. Soluble CD30 levels were higher in pre‐transplant samples and ARE subjects than non‐ARE subjects (p = 0.03). Post‐transplant sCD30 levels were elevated in subjects who experienced rejection and were significantly higher at seven d (p = 0.0004) and six months (p = 0.03). Conclusions: Higher sCD30 levels following transplant were associated with ARE. Elevated sCD30 levels may represent a risk factor for acute rejection.     

Lenalidomide plus dexamethasone vs. lenalidomide plus melphalan and prednisone: a retrospective study in newly diagnosed elderly myeloma

Background: The goal of this retrospective study was to compare the efficacy and toxicity of lenalidomide–dexamethasone (len/dex) vs. melphalan–prednisone–lenalidomide (MPR) as upfront therapy for newly diagnosed elderly patients with myeloma. Methods: Data from 51 patients enrolled in an Italian phase I/II trial and treated with MPR were analyzed and compared with data from 38 patients, seen at the Mayo Clinic, treated with len/dex and enrolled in phase II/III trials. Results: On intention‐to‐treat analysis, time to progression (median: 24.7 vs. 27.5 months in MPR and len/dex groups, respectively, P = 0.903), progression‐free survival (median: 24.7 vs. 27.5 months in MPR and len/dex groups, respectively, P = 0.926), and overall survival (2‐yr overall survival: 86.2% in MPR vs. 89.1% in len/dex, P = 0.730) were not significantly different between the two groups. Results were confirmed when the analysis was restricted to MPR and len/dex matched pair mates. Hematologic grade 3–4 toxicities were more common with MPR (neutropenia: 66.7% vs. 21.1%, P < 0.001; thrombocytopenia: 31.4% vs. 2.6%, P < 0.001). Grade 3–4 gastrointestinal events (13.2% vs. 3.9%, P = 0.132), thrombotic events (13.2% vs. 5.9%, P = 0.279), and fatigue (10.5% vs. 3.9%, P = 0.395) were more common with len/dex. Conclusions: Results show that both MPR and len/dex are efficacious regimens for elderly patients with myeloma. Randomized trials are needed to confirm these results.     

Utilidad de los fármacos modificadores de enfermedad (FAME) en el tratamiento de las espondiloartropatías

Disease-modifying antirheumatic drugs (DMARDs), a heterogeneous group of drugs, are widely used in rheumatoid arthritis management. The scientific evidence on the management of spondyloarthropathy with DMARDs is limited and the results are inconclusive. In this article, we review the role of DMARDs in the management of axial involvement in spondyloarthropathies, emphasizing its paradigm, ankylosing spondylitis. We review the data published to date on the efficacy and tolerability of salazopyrin, mesalazine, methotrexate, and leflunomide, as well as those of other drugs used on specific occasions such as pamidronate and thalidomide. Data on the effects of this management on peripheral symptoms and organic disease-like uveitis are also included.     

Drug‐induced gingival enlargement: Biofilm control and surgical therapy with gallium–aluminum–arsenide (GaAlAs) diode laser—A 2‐year follow‐up

Drug‐induced gingival enlargement has been reported in patients treated with various types of anticonvulsant drugs, and is generally associated with the presence of plaque, gingival inflammation, and a genetic predisposition. Effective treatment includes daily oral hygiene and periodic professional prophylaxis. However, in some patients, surgical removal of the gingival tissue overgrowth becomes necessary. The patient in this case report was mentally impaired and had severe drug‐induced gingival enlargement. This report describes the initial protocol, the gingivectomy, and a 2‐year follow‐up. A diode laser was used as an effective and safe method to remove the patient's overgrown gingival tissue.     

Association of Retinol-Binding Protein-4 (RBP4) with Lipid Parameters in Obese Women

Background  

Although the adipokine retinol-binding protein-4 (RBP4) has been implicated in the development of obesity-related insulin resistance, its role in human obesity is still unclear. Our objectives were to find out the effect on RBP4 systemic levels of a weight loss induced by gastric bypass surgery and to analyze RBP4 relationships with insulin resistance, parameters of body composition, lipid metabolism, and inflammation.     

Factors influencing inpatient rehabilitation length of stay following revision hip replacements: a retrospective study

Background  

The annual incidence of revision hip replacements has increased in both Canada and United States, particularly in younger adults. Patients following revision hip replacements often require longer hospital length of stay (LOS) but little is known about predictors of inpatient rehabilitation LOS in this group of patients. The purpose of this study was to evaluate the socio-demographic, pre-surgery, surgery and post-surgery related factors that might influence rehabilitation LOS of inpatients following revision hip replacements.     

RhD variant caused by an in‐frame triplet duplication in the RHD gene

BACKGROUND: The RHD gene is highly polymorphic and a large number of D variants have already been detected. Several mechanisms are involved in the origin of D variants. In‐frame deletions, resulting in a single‐amino‐acid deletion, have been described associated with RhD and RhCE variants. No in‐frame duplications and/or insertions have been reported in the RH genes to date. STUDY DESIGN AND METHODS: Blood samples from a Brazilian blood donor and his sister were serologically tested with routine anti‐D reagents and anti‐D panels (ALBAclone advanced partial D typing kit, Alba Bioscience Limited; and D‐Screen, Diagast), followed by molecular biology techniques, RHD polymerase chain reaction with sequence‐specific priming and sequencing. RESULTS: Samples tested negative with routine immunoglobulin M (IgM) anti‐D reagents and positive with IgG anti‐D, which detect weak D cells. The pattern of results with anti‐D panels did not correspond to any described before. A 3‐bp in‐frame duplication within Exon 1 (c.75_77dupTCT), resulting in the duplication of leucine 26 (p.Leu26dup), was identified in the two samples. CONCLUSION: We report the first RhD variant associated with a 3‐bp in‐frame duplication in the RHD gene, predicted to be located within the RhD protein transmembrane domain that might be expected to result in a weak‐D–like phenotype, concordant with serologic findings.