Donor-specific HLA antibodies and graft function in children after renal transplantation

Background  

The presence of circulating donor-specific human leukocyte antigen antibodies (HLA-DSA) has been associated with chronic antibody-mediated rejection, leading to progressive graft dysfunction and poor graft survival. The aim of this study was to investigate the incidence and significance of HLA-DSA in paediatric renal transplantation (RTx) patients.     

A new semi-defined medium for Trypanosoma brucei sspp.

A new, easy to prepare semi-defined medium for the cultivation of trypanosomes of the T. brucei complex is introduced. Containing the two commercially available media MEM (Minimum Essential Medium) and Medium 199 TC45 as well as 10% inactivated foetal calf serum (fcs), the medium supports optimum growth and direct adaptation of bloodstream forms. Growth characteristics, glucose uptake, amino acid utilization and the ultrastructure of trypanosomes grown in this medium are described briefly.     

Outcome of pregnancy in women with congenital shunt lesions

OBJECTIVE: To evaluate the outcome of pregnancy in women with congenital shunt lesions. SETTING: Retrospective study in a tertiary care centre. METHODS: Pregnancy history was obtained by a standardised questionnaire and medical records were reviewed. PATIENTS: 175 women were identified, at a mean (SD) age of 42 (14) years. Pregnancies occurred in 126 women: 50 with an atrial septal defect, 22 with a ventricular septal defect, 22 with an atrioventricular septal defect, 19 with tetralogy of Fallot, and 13 with other complex shunt lesions. RESULTS: 309 pregnancies were reported by 126 woman (2.5 (1.6) pregnancies per woman). The shortening fraction of the systemic ventricle was 40 (8)%, and 98% were in New York Heart Association class I-II at last follow up. Spontaneous abortions occurred in 17% of pregnancies (abortion rate, 0.4 (0.9) per woman). Gestational age of the 241 newborn infants was 8.8 (0.8) months. There were no maternal deaths related to pregnancy. Pre-eclampsia and embolic events were observed in 1.3% and 0.6%, respectively of all pregnancies. Women with complex shunt lesions more often underwent caesarean section (70% v 15-30%, p = 0.005) and gave birth to smaller babies for equivalent gestation (2577 (671) g v 3016 (572) to 3207 (610) g, p < 0.05). The recurrence risk of congenital heart disease was 2.5%. CONCLUSIONS: The outcome of pregnancy is favourable in women with congenital shunt lesions if their functional class and their systolic ventricular function are good. Such patients can be reassured.     

Echocardiographic findings in former professional cyclists after long-term deconditioning of more than 30 years.

BACKGROUND: In professional cyclists, typical changes include reversible dilatation of atria and left ventricle (LV), LV hypertrophy but normal diastolic function. Data on long-term outcome are limited. METHODS: Of all 134 former Swiss professional cyclists (PC) participating >or=1x in the professional bicycle race Tour de Suisse from 1955 to 1975, 62 (42%) were recruited for a prospective case control study. The PC and a control group of 62 golfers (matched for age, gender, hypertension, present physical activity) were screened [clinical examination, history, echocardiography, measurement of proBNP (normal <227 pg/mL)]. RESULTS: The interval since the last bicycle race as PC was 38 (15-49) years. Average age at exam was equal in controls and PC (66+/-6 vs 66+/-7 years; P = 0.73). Percentage of participants undergoing >4 h of endurance training per week was identical (P = 0.72). Total kilometers (km) on the bicycle were higher in PCs with 311,000 (60,000-975,000) than in controls (2500 [0-120,000]; P < 0.0001). PC had larger atrial volume indices (P = 0.002) and tended to have higher LV muscle mass indices (P = 0.07). Multiple regression analysis identified the total number of bicycle km as an independent factor for LV muscle mass. For left atrial size, heart rate at rest, age, years since the last bicycle race and the current hours of endurance training were identified as independent predictors. Long axis function of both ventricles (systolic velocities of mitral and tricuspid annulus) was decreased in PC (P 相似文献   

Ebstein's anomaly in adults: Doppler-echocardiographic evaluation

A systematic approach and segmental analysis are required for comprehensive assessment including both morphologic and functional abnormalities associated with Ebstein's anomaly. The essence of the disease is an apical displacement of both the septal and the posterior tricuspid leaflets, exceeding 20 mm or 8 mm/m2 in adults. As a consequence, the right heart consists of three components including the true right atrium, the functional right ventricle (RV) and an intervening zone that is anatomically ventricular but functionally right atrial (atrialized RV). The thin wall of the atrialized RV may result in an aneurysm between the anatomic tricuspid annulus and the apically displaced posterior leaflet. The annular attachment of the anterior leaflet is normal, which may be dysplastic and adherent to the RV wall. Tricuspid regurgitation is usually moderate to severe. Size, shape and function of the functional RV must be described. The paradoxical motion of the interventricular septum causes alterations in left ventricular geometry and function. An interatrial communication is frequently present. Echocardiography is the method of choice to diagnose Ebstein's anomaly on its own or in association with other heart defects.     

Left ventricular flow from apex to base during systole and isovolumic relaxation in a patient with hypertrophic cardiomyopathy and midventricular obstruction.

The occurrence of a left ventricular anterograde flow velocity (maximal: 3.9 m.s-1) is demonstrated in a 32-year-old patient with hypertrophic cardiomyopathy and midventricular obstruction, beginning at early systole and persisting throughout the isovolumic relaxation. Cardiac catheterization with simultaneous dual high fidelity pressure measurements in the apical and basal chambers confirmed the presence of the Doppler maximal instantaneous pressure gradient of 60 mmHg. Contrast left ventricular angiography excluded apical dyskinesia. In the two intracavity compartments, isovolumic relaxation time and the time constant of pressure decay (tau) were abnormal whereby tau was more delayed in the apical than in the basal portion. The presence of an apical high pressure zone during systole with impeded and delayed emptying through the midventricular obstacle and the late onset and prolongation of relaxation are thought to be the cause of the intraventricular flow from apex to base lasting from early systole throughout isovolumic relaxation.