Antibody depletion for the treatment of crossmatch‐positive pediatric heart transplant recipients

Sensitization to HLA is a risk factor for adverse outcomes after heart transplantation. Requiring a negative prospective CM results in longer waiting times and increased waitlist mortality. We report outcomes in a cohort of sensitized children who underwent transplant despite a positive CDC CM+ using a protocol of antibody depletion at time of transplant, followed by serial IVIG administration. All patients <21 yrs old who underwent heart transplantation at Boston Children's Hospital from 1/1998 to 1/2011 were included. We compared freedom from allograft loss, allograft rejection, and serious infection between CM+ and CM? recipients. Of 134 patients in the cohort, 33 (25%) were sensitized prior to transplantation and 12 (9%) received a CM+ heart transplant. Serious infection in the first post‐transplant year was more prevalent in the CM+ patients compared with CM? patients (50% vs. 16%; p = 0.005), as was HD‐AMR (50% vs. 2%; p < 0.001). There was no difference in freedom from allograft loss or any rejection. At our center, children transplanted despite a positive CM had acceptable allograft survival and risk of any rejection, but a higher risk of HD‐AMR and serious infection.     

Effect of metformin on the clinical and metabolic assessment of women with polycystic ovary syndrome

A longitudinal prospective study was conducted in 21 women with polycistic ovary syndrome (PCOS), aged 27.20?±?5.02 years and treated with metformin (1500?mg/day) for 8 weeks. The patients were assessed for spontaneous menstruation, weight, body mass index (BMI), waist circumference, waist/hip ratio (WHR), glucose and insulin concentrations under fasting conditions and after a 75-g glucose tolerance test, lipid profile, testosterone, androstenedione, dehydroepiandrosterone sulfate, sex-hormone binding globulin (SHBG), and insulin-like growth factor (IGF)-I. Spontaneous menstruation was observed in 81% of the women treated with metformin, with no changes in weight or BMI. Waist measurement and the WHR were reduced. The quantitative insulin sensitivity check index (QUICKI) improved from 0.33?±?0.03 to 0.35?±?0.04 (p?<?0.005), and serum total cholesterol and low-density lipoprotein-cholesterol were reduced, while high-density lipoprotein-cholesterol was increased. Serum testosterone concentrations were also reduced. There were no differences in serum triglycerides, SHBG or IGF-I. The occurrence of spontaneous menstruation and changes in the pattern of body fat distribution, the reduction in serum testosterone concentrations, the improvement in lipid profile and the reduction of insulinemia with the use of metformin permit us to conclude that treatment with this drug is of benefit to women with PCOS.     

Study of time reversibility/irreversibility of cardiovascular data: theoretical results and application to laser Doppler flowmetry and heart rate variability signals

Time irreversibility can be qualitatively defined as the degree of a signal for temporal asymmetry. Recently, a time irreversibility characterization method based on entropies of positive and negative increments has been proposed for experimental signals and applied to heart rate variability (HRV) data (central cardiovascular system (CVS)). The results led to interesting information as a time asymmetry index was found different for young subjects and elderly people or heart disease patients. Nevertheless, similar analyses have not yet been conducted on laser Doppler flowmetry (LDF) signals (peripheral CVS). We first propose to further investigate the above-mentioned characterization method. Then, LDF signals, LDF signals reduced to samples acquired during ECG R peaks (LDF_R(ECG) signals) and HRV recorded simultaneously in healthy subjects are processed. Entropies of positive and negative increments for LDF signals show a nonmonotonic pattern: oscillations--more or less pronounced, depending on subjects--are found with a period matching the one of cardiac activity. However, such oscillations are not found with LDF_R(ECG) nor with HRV. Moreover, the asymmetry index for LDF is markedly different from the ones of LDF_R(ECG) and HRV. The cardiac activity may therefore play a dominant role in the time irreversibility properties of LDF signals.     

Arthroscopic biceps tenodesis using the percutaneous intra-articular transtendon technique

Traditional management of end-stage pain and degeneration of the proximal biceps tendon has included open tenodesis of the biceps tendon. Several methods have been described. More recently, however, arthroscopic techniques have been developed. This article introduces a novel method of arthroscopic biceps tenodesis that does not require any specialized hardware.