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91.
Charles F. McTiernan Penelope Morel Leslie T. Cooper Navin Rajagopalan Vinay Thohan Mark Zucker John Boehmer Biykem Bozkurt Paul Mather John Thornton Jalal K. Ghali Karen Hanley-Yanez James Fett Indrani Halder Dennis M. McNamara 《Journal of cardiac failure》2018,24(1):33-42
Objective
The aim of this work was to evaluate the hypothesis that the distribution of circulating immune cell subsets, or their activation state, is significantly different between peripartum cardiomyopathy (PPCM) and healthy postpartum (HP) women.Background
PPCM is a major cause of maternal morbidity and mortality, and an immune-mediated etiology has been hypothesized. Cellular immunity, altered in pregnancy and the peripartum period, has been proposed to play a role in PPCM pathogenesis.Methods
The Investigation of Pregnancy-Associated Cardiomyopathy (IPAC) study enrolled 100 women presenting with a left ventricular ejection fraction of <0.45 within 2 months of delivery. Peripheral T-cell subsets, natural killer (NK) cells, and cellular activation markers were assessed by flow cytometry in PPCM women early (<6 wk), 2 months, and 6 months postpartum and compared with those of HP women and women with non–pregnancy-associated recent-onset cardiomyopathy (ROCM).Results
Entry NK cell levels (CD3–CD56+CD16+; reported as % of CD3– cells) were significantly (P?<?.0003) reduced in PPCM (6.6?±?4.9% of CD3– cells) compared to HP (11.9?±?5%). Of T-cell subtypes, CD3+CD4–CD8–CD38+ cells differed significantly (P?<?.004) between PPCM (24.5?±?12.5% of CD3+CD4–CD8– cells) and HP (12.5?±?6.4%). PPCM patients demonstrated a rapid recovery of NK and CD3+CD4–CD8–CD38+ cell levels. However, black women had a delayed recovery of NK cells. A similar reduction of NK cells was observed in women with ROCM.Conclusions
Compared with HP control women, early postpartum PPCM women show significantly reduced NK cells, and higher CD3+CD4–CD8–CD38+ cells, which both normalize over time postpartum. The mechanistic role of NK cells and “double negative” (CD4–CD8–) T regulatory cells in PPCM requires further investigation. 相似文献92.
Karandikar NJ Kroft SH Yegappan S Rogers BB Aquino VM Lee KM Kumar V Guenaga FJ Jaffe ES Douek DC McKenna RW 《Blood》2004,104(7):2007-2009
Familial hemophagocytic lymphohistiocytosis (FHL) is an inherited, fatal disorder of infancy. We report here a 17-day-old female infant who presented with high fever, hepatosplenomegaly, hypertriglyceridemia, hypofibrinogenemia, thrombocytopenia, and liver failure. Leukocytosis was detected with circulating "atypical" lymphoid cells. Flow cytometric studies revealed expanded subpopulations of CD8+ T cells with unusual immunophenotypic features, including a subset that lacked CD5 expression. A liver biopsy showed hemophagocytic lymphohistiocytosis with exuberant infiltrates of CD8+ T cells that lacked perforin. Mutational studies revealed a 666C-->A (H222Q) missense mutation in the perforin gene. T-cell receptor studies on flow-sorted T-cell subpopulations revealed no evidence of monoclonality. Analysis of T-cell receptor excision circle levels indicated long proliferative history in the aberrant CD8+ T-cell subsets. This case provides an instructive example of uncontrolled reactive proliferation of CD8+ T cells in FHL, resulting in atypical morphology and unusual immunophenotypic features that might suggest malignancy in other clinical settings. 相似文献
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Catherine Atkin Vinay Reddy-Kolanu Mark T. Drayson Elizabeth Sapey Alex G. Richter 《British journal of haematology》2020,189(6):1127-1135
Monoclonal gammopathy of undetermined significance (MGUS) affects 3·2% of adults aged >50 years. MGUS carries a life-long risk of progression to multiple myeloma and causes complications including infection and renal impairment; common causes of hospital admission. This study aimed to assess MGUS prevalence in emergency medical hospital admissions. Patients were recruited from unselected emergency medical admissions in a hospital in the United Kingdom. Serum protein electrophoresis was performed, with immunofixation of abnormal results. Reason for admission and routine test results were recorded. After education about MGUS and myeloma, patients chose whether they wished to be informed of new diagnoses. A total of 660 patients were tested and 35 had a paraprotein suggestive of MGUS. The overall rate of MGUS was 5·3%. MGUS prevalence in those aged >50 years was 6·94%, higher than the previously published rate of 3·2% (P < 0·0005). There were higher rates in those with chronic kidney disease (13·75% vs. 4·14%, P = 0·002), heart failure (14% vs. 4·59%, P = 0·012), anaemia (8·96% vs. 3·41%, P = 0·003) or leucocytosis (9·33% vs. 3·04%, P = 0·002). In all, 96% of patients wished to be informed of their screening results. The prevalence of MGUS in emergency hospital admissions is higher than expected based on previous population-based rates. This may suggest a selected population for screening. 相似文献
96.
Neeraj Chaudhary Vinay Kumaran Vibha Varma Sorabh Kapoor Naimish Mehta Samiran Nundy 《The Indian journal of surgery》2014,76(5):382-391
Recurrence after curative resection of gastrointestinal (GI) cancers is common. Early detection of resectable recurrences may result in a curative resection. In un-resectable recurrences, early detection may improve the quality of life by palliation or with the use of newer chemotherapeutic drugs. The guidelines regarding follow-up of patients after curative resection of GI cancers are from the West which is very different from the Indian population in terms of a disease pattern and social milieu. The guidelines which are commonly used are also not strictly followed. We have proposed in this article the protocols which we follow at our centre after curative resection of GI cancer and how these are different from the guidelines proposed by the West. 相似文献
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Wei-Chih Liao Phonthep Angsuwatcharakon Hiroyuki Isayama Vinay Dhir Benedict Devereaux Christopher J.L. Khor Ryan Ponnudurai Sundeep Lakhtakia Dong-Ki Lee Thawee Ratanachu-ek Ichiro Yasuda Frederick T. Dy Shiaw-Hooi Ho Dadang Makmun Huei-Lung Liang Peter V. Draganov Rungsun Rerknimitr Hsiu-Po Wang 《Gastrointestinal endoscopy》2017,85(2):295-304
100.
Eric G. Campbell Vinay Kini Julie Ressalam Bridget S. Mosley Dragana Bolcic-Jankovic Hillary D. Lum Elizabeth R. Kessler Matthew DeCamp 《Journal of general internal medicine》2022,37(13):3310
BackgroundApproximately 20% of the US population live in states where MAiD is a legal, though highly contentious, practice. Little generalizable data exists on the experiences of MAiD providers who comprise a small, and intentionally hidden, population.ObjectiveTo examine the nature, extent, and consequences of physicians’ participation in MAiD.DesignAn anonymous, multi-wave, mailed survey (RR= 55%).ParticipantsAn enriched sample (n=583) of Colorado physicians caring for potential MAiD patients.Main MeasuresPhysician willingness, preparedness, and participation in a continuum of MAiD activities. Other outcomes include the effects of providing MAiD and the barriers physicians face related to MAiD.Key ResultsOverall, 81.1% of respondents were willing to discuss MAiD with a patient, 88.3% to refer for MAiD, 46.3% to be a consultant, and 28.1% to be an attending. Fewer felt prepared to discuss MAiD (54.4%), provide a MAiD referral (62.8%), be a consultant (30.7%), or be an attending (18.0%). More than half of respondents (52.3%) had discussed MAiD with a patient, 27.3% provided a MAiD referral, 12.8% had been a MAiD consultant, and 8.5% had been a MAiD attending. Among MAiD consultants and attendings, 75% reported that their most recent MAiD case was emotionally fulfilling and professionally rewarding, though 75% also reported that it was time consuming and 46.9% reported that it was ethically challenging. Common barriers to physician participation in MAiD include lack of knowledge about MAiD (46.8%), the emotional (45.6%) and time (41.7%) investments, and ethical concerns (41.7%).ConclusionsMany physicians in our sample are both willing and prepared to discuss MAiD with patients and to provide MAiD referrals. Fewer are prepared and willing to serve as an attending or consultant and fewer have provided these services. MAID consultants and attendings largely report the experience to be emotionally fulfilling and professionally rewarding, but all respondents reported multiple barriers to participation.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07300-8.KEY WORDS: physician assisted death, physician assisted suicide, medical aid in the dying 相似文献