Current Issue : July - September Volume : 2019 Issue Number : 3 Articles : 5 Articles
The neutrophilic component in bronchiolitis obliterans syndrome (BOS, the main form of\nchronic lung rejection), plays a crucial role in the pathogenesis and maintenance of the disorder.\nHuman Neutrophil Elastase (HNE), a serine protease responsible of elastin degradation whose\naction is counteracted by alpha 1-antitrypsin (AAT), a serum inhibitor specific for this protease. This\nwork aimed to investigate the relationship between HNE and AAT in bronchoalveolar lavage fluid\n(BALf) from stable lung transplant recipients and BOS patients to understand whether the\nimbalance between proteases and inhibitors is relevant to the development of BOS. To reach this\ngoal a multidisciplinary procedure was applied which included: (i) the use of\nelectrophoresis/western blotting coupled with liquid chromatography-mass spectrometric analysis;\n(ii) the functional evaluation of the residual antiprotease activity, and (iii) a neutrophil count.\nThe results of these experiments demonstrated, for the first time, the presence of the complex\nbetween HNE and AAT in a number of BALf samples. The lack of this complex in a few specimens\nanalyzed was investigated in relation to a patientâ??s lung inflammation.\nThe neutrophil count and the determination of HNE and AAT activities allowed us to speculate that\nthe presence of the complex correlated with the level of lung inflammation....
Background. Individuals after solid organ transplant may develop secondary malignancies. In our clinical practice, we noted an\nincreasing number of individuals who developed colorectal cancers after solid organ transplantation.The primary aim of this study\nwas to describe the characteristics and outcomes of the patients who developed colorectal cancer after solid organ transplant.\nMaterials and Methods. Data was gathered andmerged fromseveral registries atMayo Clinic to identify all patients who received a\ndiagnosis of colon or rectal cancer and solid organ transplant. Continuous variables were summarized asmean (standard deviation)\nand median (range), while categorical variables were reported as frequency (percentage). Time to colorectal cancer after transplant\nand overall survival after cancer diagnosis were estimated using Kaplan-Meier method. Results. Initially, 115 colorectal cancer\npatients who also had a transplant were identified. The diagnosis of colorectal cancer was noted after solid organ transplant in\n63 patients.The mean age at transplant was 57 years. Majority had received a kidney transplant (44.4%) followed by liver (36.5%).\nThe median time to develop colorectal cancer was 59.3 months (range: 4.4-251.4 months). 15 (24.6%) were stage 4 at diagnosis\nand 13 (21.3%) had stage 3 colorectal cancer. Median overall survival was 30.8 months; 5-, 10- and 15-year survival were noted to\nbe 42.5%, 17.9%, and 7.5%, respectively. None of the stage 4 patients were alive at 5 years; 5-year survival rate for stage 1, 2, and 3\npatients was 77%, 50%, and 42%, respectively. Conclusions. Our study reports on one of the largest cohorts of patients of colorectal\ncancer that developed the cancer after solid organ transplant. Survival is extremely poor for advanced cases. However, long-term\nsurvivors are noted who developed the cancer at a relatively early stage. Colorectal screening recommendations may need to be\nrevised for patients after solid organ transplant....
Background and Objective. A common reconstruction procedure after a wide resection of bone tumors around the knee is\nendoprosthetic knee replacement. The aim of this study was to investigate the characteristics of bone injury of the patient after\nendoprosthetic knee replacement during walking. Methods. A subject-specific finite element model of the femur-prosthesis-tibia\ncomplex was established via CT scans. To obtain its physiologically realistic loading environments, the musculoskeletal inverse\ndynamic analysis was implemented. The extracted muscle forces and ground forces were then applied to the finite element\nmodel to investigate bone stress distribution at various stages of the gait cycle. Results. The maximum femur stress of each stage\nvaried from 33.14 MPa to 70.61 MPa in the gait cycle. The stress concentration position with a distance of 267.2mm to the tibial\nplateau showed a good agreement with the patient injury data. Conclusions. Overall results indicated the reasonability of the\nsimulation method to determine loading environments and injury characteristics which the patient experienced with knee\nendoprosthesis during walking....
Background: Selective plasma exchange (SePE) is a new simple plasma exchange (PE) modality that enables\nremoval of small and medium-sized molecules without removing larger substances such as coagulation factors.\nIn this study, we examined the efficacy of SePE for removal of isoagglutinins in pre-transplant desensitization for\nABO-incompatible (ABOi) kidney transplantation.\nMaterials and methods: A case series study was performed in 15 ABOi kidney transplant recipients (KTRs) who\nunderwent SePE alone (7 cases) and SePE in combination with double-filtration plasmapheresis or simple plasma\nexchange (8 cases). The target processed plasma volume (PV) was set at 2 PV, and 5% albumin solution was used\nas the substitution fluid in all SePE sessions. Changes in isoagglutinin titers (IgG and IgM) and serum IgG, IgM,\nand fibrinogen levels were examined. We also compared the decrease in isoagglutinin titers between SePE and\nconventional methods (PE and double-filtration plasmapheresis).\nResults: A total of 29 sessions of SePE were performed in the 15 KTRs. Isoagglutinin titers were controlled to greater than equal to 1:16 in\nall patients except for 2 with high isoagglutinin titers, and there were no cases of antibody-mediated rejection. SePE\nled to a median twofold decrease in isoagglutinin titers (IgG and IgM), with median IgG, IgM, and fibrinogen removal\nrates of 64.2, 11.7, and 25.5%, respectively. Side effects occurred in only 4 of the 29 sessions. Neither titer decreased\nafter SePE in 30% of the sessions. However, the reductions in isoagglutinin titers in patients undergoing SePE were\nsignificantly less than those in patients treated with conventional methods.\nConclusion: Because SePE is less efficient in removing isoagglutinins compared to conventional methods, the use of\nSePE alone should be limited to patients with low isoagglutinin titers, and SePE in combination with conventional\nmethods should be used for patients with high isoagglutinin titers. SePE may be a useful treatment option, if applied\nin appropriate cases, due to its lower cost (about half the price of PE using fresh frozen plasma in Japan) and fewer\nside effects. However, care is required because about 25% of fibrinogen is removed during SePE....
Replacement surgery of hip joint consists of the substitution of the joint with an implant\nable to recreate the articulation functionality. This article aims to review the current state of the art\nof the biomaterials used for hip implants. Hip implants can be realized with different combination\nof materials, such as metals, ceramics and polymers. In this review, we analyze, from international\nliterature, the specific characteristics required for biomaterials used in hip joint arthroplasty, i.e.,\nbeing biocompatible, resisting heavy stress, opposing low frictional forces to sliding and having a\nlow wear rate. A commentary on the evolution and actual existing hip prostheses is proposed. We\nanalyzed the scientific literature, collecting information on the material behavior and the\nhuman-body response to it. Particular attention has been given to the tribological behavior of the\nbiomaterials, as friction and wear have been key aspects to improve as hip implants evolve. After\nmore than 50 years of evolution, in term of designs and materials, the actual wear rate of the most\ncommon implants is low, allowing us to sensibly reduce the risk related to the widespread debris\ndistribution in the human body....
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