Kawasaki Disease - A Review of Treatment and Outcomes in an Irish Paediatric Cohort 2010-14.

Diagnosis of Kawasaki Disease (KD) can be challenging due to lack of a diagnostic test, and some children present with 'incomplete' KD when not all diagnostic criteria are met. Treatment with intravenous immunoglobulin (IVIG) and aspirin reduces the risk of coronary artery complications. There is sub-group of patients who are resistant to IVIG/aspirin therapy and are at increased risk of complications. Recent evidence suggests that additional treatment of this high-risk group with corticosteroids is beneficial in reducing this risk. We examine the treatment and coronary artery outcomes, by retrospective review of medical records, of a cohort of 32 paediatric patients with KD admitted to a single Irish tertiary centre from January 2010-December 2014. Twenty-eight percent of patients (9/32) had an incomplete diagnosis of KD; these patients received IVIG later compared to those with a complete KD diagnosis. 15/32 (47%) had abnormal echocardiogram findings in the acute phase, 8/32 (25%) had echocardiogram abnormalities at 6-week follow-up, and 4/32 (12.5%) had persisting abnormalities. This study highlights the potential for adverse outcome in KD, the difficulty in diagnosis in 'incomplete' cases, and the need to identify children at higher risk for adverse outcome where adjunctive therapies would be most beneficial.

Thymopoiesis following HSCT; a retrospective review comparing interventions for aGVHD in a pediatric cohort.

Acute graft-versus-host disease (aGVHD) complicates allogeneic hematopoietic stem cell transplantation (HSCT), and is treated with topical and/or systemic corticosteroids. Systemic corticosteroids and aGVHD damage thymic tissue. We compared thymopoietic effect of topical steroid therapy, corticosteroids and extracorporeal photopheresis (ECP) in 102 pediatric allogeneic HSCT patients. We categorized patients into 4 groups: - no aGVHD, aGVHD treated with topical or systemic steroid, or ECP. Naïve CD4+CD45RA+CD27+ T-lymphocyte values at 3, 6, 9, 12months post-HSCT were recorded: for ECP patients, values were recorded at 3, 6, 9, 12months during ECP. Differences were compared using the Kruskal-Wallis test. 41 patients had no aGVHD, 23 had aGVHD treated topically or systemically (25), 13 received ECP. Rate of thymopoiesis was significantly different between all groups at all time-points post-transplant (p=0.002, p<0.001, p<0.001, p=0.001 respectively). Even mild aGVHD impairs thymopoiesis. Worst recovery was in ECP patients. Earlier institution of ECP may speed thymic recovery.

Ubiquinone and urease distribution in Taphrina and Symbiotaphrina.

Identifications of ubiquinone isoprenologues are presented for isolates identified with six species of Taphrina and for isolates of the two species of Symbiotaphrina. All had Q-10 as the major ubiquinone system. The inclusion of T. populina and S. buchneri, the respective type species, establishes this as the value for these genera. Both species of Symbiotaphrina were urease positive even though, according to the literature, they are unable to utilize urea as a sole nitrogen source. The urease results for the Taphrina isolates were mixed.

Significance of photosynthetic and respiratory exchanges in the carbon economy of the developing pea fruit.

The nutritional economy of the developing fruit of Pisum sativum L. (cv. Greenfeast) was studied in terms of intake of translocate, incorporation of C and N into dry matter, transpiration, and CO(2) exchanges of the fruit with its external and internal atmospheres. The environmental conditions were 12-hr days (22 C, 850 mueinsteins m(-2) sec(-1) at fruit level); 12-hr nights of 15 C.Between 6 and 30 days after anthesis, pod photosynthesis resulted in small gains of CO(2) from the external atmosphere, and assimilated most of the CO(2) respired by the fruit during the day. From then until maturity (40 days) the fruit lost CO(2) during the day. Night losses of CO(2) increased with fruit age.The gas cavity of the fruit contained 0.15 to 1.5% (v/v) CO(2). Lower levels were maintained in the day than at night. CO(2) levels were influenced by fruit age, radiant flux, and temperature. Labeled CO(2) injected into the gas cavity was fixed by the pod but not by seeds in the light, and by neither pod nor seeds in darkness. Dark-to-light or light-to-dark transfer of a fruit promoted rapid changes in CO(2) and O(2) levels of the gas space, consistent with a shift in the assimilation-respiration balance of the pod.The fruit transpired 27.6 cm(3) H(2)O per gram dry matter accumulated. Daytime ventilation was greatest 12 to 15 days after anthesis and declined as pod photosynthesis became increasingly involved in the retrieval of CO(2) respired by pod and seeds. Most, 69% by weight, of the translocate from the parent plant was converted to dry matter of seeds; nearly half, 45%, to useful seed reserves (sugar plus starch-protein-oil, 45:20:1). Illumination resulted in a fruit requiring 16% less translocate than if laying down an equal amount of dry matter in darkness.

Histology and histochemistry of the cotyledons of pisum arvense L. during germination.

The mature cotyledon of Pisum arvense L. comprises several distinct tissue regions; these are the epidermis, hypodermis, storage parenchyma and procambium. The storage parenchyma includes two zones: an outer abaxial zone and an inner adaxial zone. The cells of both zones contain abundant starch grains and protein bodies. Scattered through the storage tissue but increasing in frequency towards the periphery are certain cells which differ to a slight extent from the majority of the parenchyma cells. They have a more opaque, granular cytoplasm and a higher level of cytoplasmic RNA. the cotyledon has a complex, reticulate vascular system. Differentiation of the conducting elements from the procambium appears to begin about 12 hours and to be completed 48 hours after the commencement of imbibition. Differentiation of phloem preceeds that of xylem. The relationship between the timing of vascular differentiation and various physiological events in the cotyledon is discussed.Mobilization of the reserves in the storage parenchyma is initiated at the periphery of the cotyledon and proceeds inwards. There appears to be a correlation between the breakdown of the reserves and changes in DNA and RNA content of the cells.

The localization of enzymes in the cotyledons of Pisum arvense L. during germination.

Enzyme activity is not uniformly distributed through the cotyledon of Pisum arvense. Initially the peripheral region, certain scattered cells of the storage tissue and the procambium show a high level of activity of succinic dehydrogenase, cytochrome oxidase, acid phosphatase and esterase. Activity of acid phosphatase declines sharply after the first day of germination; activity of the other enzymes declines after about three days. In the storage tissue, where activity is lower initially, it declines after about five days and is correlated with the disappearance of the reserves. The pattern of alkaline phosphatase activity is similar except that activity is lower in the procambium but increases in the sieve-elements during differentiation of the phloem. 5-nucleotidase and glucose-6-phosphatase activity is low throughout the cotyledon but it also increases to a significant level in the sieve-elements. Activity of starch synthesizing enzymes is high in the parenchymatous bundle sheath, where they may be involved in the pathway from lipids to soluble carbohydrates.