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The term "accommodation" was invoked to describe endothelial cell resistance to antibody-mediated rejection after ABO-incompatible kidney or experimental xenograft transplantation. Currently, there is much interest in how to achieve successful human leukocyte antigen (HLA)-incompatible allograft transplantation in HLA-sensitized patients and how to treat antibody-mediated rejection after ABO-compatible HLA-incompatible allotransplantation. The term "accommodation" is often used interchangeably to describe patients who have donor-specific ABO or HLA alloantibodies in the absence of damage to their allograft. Here, we suggest that there are important differences between the immune responses to protein versus carbohydrate antigens and that graft HLA molecules may respond differently to antibodies (and antibody isotypes) than ABO antigens. Neither the mechanisms nor a phenotype of accommodation have been defined fully. Further research is needed to define mechanisms of both resistance and susceptibility to antibody-mediated injury and to predict under which circumstances allograft accommodation may occur. 相似文献
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Philippe A. Halban Kenneth S. Polonsky Donald W. Bowden Meredith A. Hawkins Charlotte Ling Kieren J. Mather Alvin C. Powers Christopher J. Rhodes Lori Sussel Gordon C. Weir 《Diabetes care》2014,37(6):1751-1758
OBJECTIVE
This article examines the foundation of β-cell failure in type 2 diabetes (T2D) and suggests areas for future research on the underlying mechanisms that may lead to improved prevention and treatment.RESEARCH DESIGN AND METHODS
A group of experts participated in a conference on 14–16 October 2013 cosponsored by the Endocrine Society and the American Diabetes Association. A writing group prepared this summary and recommendations.RESULTS
The writing group based this article on conference presentations, discussion, and debate. Topics covered include genetic predisposition, foundations of β-cell failure, natural history of β-cell failure, and impact of therapeutic interventions.CONCLUSIONS
β-Cell failure is central to the development and progression of T2D. It antedates and predicts diabetes onset and progression, is in part genetically determined, and often can be identified with accuracy even though current tests are cumbersome and not well standardized. Multiple pathways underlie decreased β-cell function and mass, some of which may be shared and may also be a consequence of processes that initially caused dysfunction. Goals for future research include to 1) impact the natural history of β-cell failure; 2) identify and characterize genetic loci for T2D; 3) target β-cell signaling, metabolic, and genetic pathways to improve function/mass; 4) develop alternative sources of β-cells for cell-based therapy; 5) focus on metabolic environment to provide indirect benefit to β-cells; 6) improve understanding of the physiology of responses to bypass surgery; and 7) identify circulating factors and neuronal circuits underlying the axis of communication between the brain and β-cells. 相似文献998.
Srikar Adhikari Albert Fiorello Lori Stolz Travis Jones Richard Amini Austin Gross Kathleen O'Brien Jarrod Mosier Michael Blaivas 《The American journal of emergency medicine》2014
Objectives
To determine the ability of emergency physicians to detect complex abnormalities on point-of-care (POC) echocardiograms.Methods
Single-blinded, nonrandomized, cross-sectional study. Twenty-five different emergency medicine clinical scenarios (video clips and digital images) covering a variety of echocardiographic abnormalities were presented to a group of emergency physician sonologists. The echocardiographic abnormalities included right ventricular dysfunction, left ventricular systolic dysfunction, diastolic dysfunction, regional wall motion abnormalities, Doppler abnormalities of pericardial tamponade physiology, left ventricular hypertrophy, hypertrophic cardiomyopathy, and aortic abnormalities. All emergency physician sonologists were blinded to the study hypothesis. They reviewed echocardiography video clips and images individually, and their interpretations were compared with the criterion standard (expert echocardiographer interpretations).Results
A total of 200 echocardiography studies (video clips and images) were independently reviewed by 8 emergency physician sonologists with varying POC echocardiography experiences. Emergency physicians accurately identified left ventricular systolic dysfunction 94% of the time, diastolic dysfunction (100%), and right ventricular dysfunction 80% of the time. Regional wall motion abnormalities were detected only 50% of the time. Doppler echocardiographic abnormalities of pericardial tamponade physiology were accurately identified 57% of the time. Emergency physicians who performed more than 250 POC echocardiograms were found to be more accurate in identifying complex echocardiographic abnormalities.Conclusions
Our study results suggest that with increased experience, emergency physicians can accurately identify most of complex echocardiographic abnormalities. 相似文献999.
Josiane Bourré‐Tessier Christine A. Peschken Sasha Bernatsky Lawrence Joseph Ann E. Clarke Carol Hitchon C. Douglas Smith Michel Zummer Janet Pope Lori Tucker Marie Hudson John Esdaile Earl Silverman Gaelle Chédeville Adam M. Huber Patrick Belisle Christian A. Pineau 《Arthritis care & research》2013,65(8):1275-1280
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Mark Daniels Stephanie N. DuBose David M. Maahs Roy W. Beck Larry A. Fox Rose Gubitosi-Klug Lori M. Laffel Kellee M. Miller Heather Speer William V. Tamborlane Michael J. Tansey for the TD Exchange Clinic Network 《Diabetes care》2013,36(9):2639-2645