Effects on human heart valve immunogenicity in vitro by high concentration cryoprotectant treatment

It has been shown previously that cryopreservation, using an ice‐free cryopreservation method with the cryoprotectant formulation VS83, beneficially modulated immune reactions in vivo and in vitro when compared with conventionally frozen tissues. In this study, we assessed the impact of a VS83 post‐treatment of previously conventionally frozen human tissue on responses of human immune cells in vitro. Tissue punches of treated and non‐treated (control) aortic heart valve tissue (leaflets and associated aortic root) were co‐cultured for 7 days with peripheral blood mononuclear cells or enriched CD14⁺ monocytes. Effects on cellular activation markers, cytokine secretion and immune cell proliferation were analysed by flow cytometry. Flow cytometry studies showed that VS83 treatment of aortic root tissue promoted activation and differentiation of CD14⁺ monocytes, inducing both up‐regulation of CD16 and down‐regulation of CD14. Significantly enhanced expression levels for the C‐C chemokine receptor (CCR)7 and the human leukocyte antigen (HLA)‐DR on monocytes co‐cultured with VS83‐treated aortic root tissue were measured, while the interleukin (IL)‐6 and monocyte chemoattractant protein (MCP)‐1 release was suppressed. However, the levels of interferon (IFN)γ and tumour necrosis factor (TNF)α remained undetectable, indicating that complete activation into pro‐inflammatory macrophages did not occur. Similar, but non‐significant, changes occurred with VS83‐treated leaflets. Additionally, in co‐cultures with T cells, proliferation and cytokine secretion responses were minimal. In conclusion, post‐treatment of conventionally cryopreserved human heart valve tissue with the VS83 formulation induces changes in the activation and differentiation characteristics of human monocytes, and thereby may influence long‐term performance following implantation. Copyright © 2017 John Wiley & Sons, Ltd.     

Global epidemiology of viral hepatitis and national needs for complete control

Introduction. The World Health Organization recognizes that viral hepatitis is not only a massive public health issue but also a huge opportunity to improve quality of life and equity at a global level. Viral hepatitis causes about 1.5 million deaths each year and significantly affects the quality of life of hundreds of millions of people. To date, frail individuals in high-income countries and people living in low-income settings are paying the heaviest tool.

Areas covered. Here we present a broad discussion on current knowledge and topical issues about the hepatitis pandemic. The report includes a structured overview of global epidemiology, including the definition of specific local epidemic profiles for each hepatitis agents (HAV, HBV, HCV, and HEV), and a perspective about the critical actions needed for achieving a complete control.

Expert commentary. The control of viral hepatitis is currently, ethically urgent and even economically convenient. There is a wide consensus that viral hepatitis can be controlled through comprehensive intervention tailored on local needs addressing the issue of viral hepatitis as a unique public health issue. These strategies should include: (1) primary prevention (including vaccination and improved infection control), (2) improving diagnosis rate, and (3) management of existing cases of infections.     

A National Study of Australian Nurse Practitioners’ Organizational Practice Environment

The nurse practitioner (NP) workforce in Australia plays a vital role in helping the country meet the current demand for health care. Data from Australian NPs using the Nurse Practitioner Primary Care Organizational Climate Questionnaire demonstrated that one-seventh of the overall Australian NP population completed the study. The response was overwhelmingly positive in the area of practice; 71.6% of NPs had no restriction on their practice and felt valued by their organization. The results of this study enable a benchmark for ongoing national evaluations in addition to international comparative data.     

Use of speckle tracking in the evaluation of late subclinical myocardial damage in survivors of childhood acute leukaemia

Heart disease is the leading cause of non-cancer death in childhood cancer survivors. to determine the prevalence of subclinical cardiac dysfunction using speckle tracking and compare its results with those obtained by classical methods of assessing left ventricular function and its relationship with different factors to identify the population at higher risk. Echocardiographic assessment of left ventricular function included ejection fraction, tissue Doppler, longitudinal/circumferential strains and biochemical parameters (troponin-T and Pro-BNP) in a cohort of 57 survivors of childhood acute leukaemia with at least 10 years since diagnosis. Ventricular dysfunction was found in 5.2% of patients in M-mode (ejection fraction—EF?<?53% with a reduction in the EF?≥?10%) and in 7% of patients with Simpson’s method, compared with 21.05 and 8.8% with suboptimal global longitudinal strain (GLS) and global circumferential strain, respectively. The GLS alteration was significantly correlated with lower values of left ventricular systolic function and was associated with high tumour risk (odds ratio [OR] 13.8), cumulative doses of anthracyclines?≥?250 mg/m² (OR 7.6) and radiotherapy (OR 7.19). Biomarkers were not useful for the diagnosis of subclinical cardiomyopathy. Good reproducibility was obtained, with an intraobserver correlation of 93.6% and an interobserver correlation of 89.2% in the GLS. The alteration of the GLS was more prevalent than the alteration in the EF and was associated with the treatment received and high tumour risk. strain imaging seems to be a powerful tool to identify an increased number of survivor with an early myocardial injury.