New rules of ABO-compatibility in kidney transplantation.

ABO compatibility rules in kidney transplantation have been deeply modified with the possibility of ABO-incompatible transplantation. The recipient has to be prepared in the days preceding surgery with an objective of ABO antibody titers of 1/8 or less. This is obtained through a procedure including antibody removal, rituximab and IV immunoglobulins alone or in association according to the initial titer. All ABO combinations are possible. Due to the preparation of the recipient, living related transplantation has been first carried out but ABO-incompatible transplantation from a deceased donor is becoming common practice in some countries (A2 or A2B donor to a B recipient). Lower uncensored graft survival has been reported by some studies but not when ABO-incompatible kidney transplantations were compared with matched ABO-compatible ones. The infectious risk in the perioperative period, consequence of higher immunosuppression, raises concern. The interlaboratory variability in hemagglutination anti-A/B assays remains an important question among cohort studies which leads to development of new tests. ABO-incompatible transplantation is associated with a rare process, accommodation, that is well known in xenotransplantation and according to which, the transplant is protected against the consequences of ABO antibody binding. In human kidney ABO-incompatible transplantation, few studies are available but suggest that this protection against the post-transplant antibody rebound might be mediated by the expression of anti-complement molecules by endothelial cells.

Pronase treatment improves flow cytometry crossmatching results.

Flow cytometry crossmatching (FC-XM) is the most sensitive cell-based method for detecting donor-specific antibodies in clinical organ transplantation. Unfortunately, background FC-XM reactivity is elevated in assays with B lymphocytes-partly because of nonspecific immunoglobulin binding by Fc receptors and B-cell surface immunoglobulins. To reduce the background reactivity in a B-cell FC-XM assay, we treated lymphocytes with pronase (1 mg/mL for 30 minutes). This treatment drastically reduced the presence of kappa light chains and Fc receptors (CD32b), while the concomitant decrease in CD19, CD20 and major histocompatibility complex (MHC) I and II expression on B-cells was acceptable. Higher pronase concentrations (>2 mg/mL) started to significantly affect CD19, CD20, MHC-I and -II expression on B-cells. In subsequent prospective experiments (on 42 donor cells tested with 102 sera), we found that pronase treatment was associated with a relative increase of the sensitivity and specificity in our B-cell FC-XM assay.

Evaluation of two matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) systems for the identification of Candida species.

Candida spp. are responsible for severe infections in immunocompromised patients and those undergoing invasive procedures. The accurate identification of Candida species is important because emerging species can be associated with various antifungal susceptibility spectra. Conventional methods have been developed to identify the most common pathogens, but have often failed to identify uncommon species. Several studies have reported the efficiency of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for the identification of clinically relevant Candida species. In this study, we evaluated two commercially available MALDI-TOF systems, Andromas™ and Bruker Biotyper™, for Candida identification in routine diagnosis. For this purpose, we investigated 1383 Candida isolates prospectively collected in eight hospital laboratories during routine practice. MALDI-TOF MS results were compared with those obtained using conventional phenotypic methods. Analysis of rDNA gene sequences with internal transcribed regions or D1-D2 regions is considered the reference standard for identification. Both MALDI-TOF MS systems could accurately identify 98.3% of the isolates at the species level (1359/1383 for Andromas™; 1360/1383 for Bruker Biotyper™) vs. 96.5% for conventional techniques. Furthermore, whereas conventional methods failed to identify rare or emerging species, these were correctly identified by MALDI-TOF MS. Both MALDI-TOF MS systems are accurate and cost-effective alternatives to conventional methods for mycological identification of clinically relevant Candida species and should improve the diagnosis of fungal infections as well as patient management.

Microwave engineering of plasma-assisted CVD reactors for diamond deposition.

The unique properties of CVD diamond make it a compelling choice for high power electronics. In order to achieve industrial use of CVD diamond, one must simultaneously obtain an excellent control of the film purity, very low defect content and a sufficiently rapid growth rate. Currently, only microwave plasma-assisted chemical vapour deposition (MPACVD) processes making use of resonant cavity systems provide enough atomic hydrogen to satisfy these requirements. We show in this paper that the use of high microwave power density (MWPD) plasmas is necessary to promote atomic hydrogen concentrations that are high enough to ensure the deposition of high purity diamond films at large growth rates. Moreover, the deposition of homogeneous films on large surfaces calls for the production of plasma with appropriate shapes and large volumes. The production of such plasmas needs generating a fairly high electric field over extended regions and requires a careful design of the MW coupling system, especially the cavity. As far as MW coupling efficiency is concerned, the presence of a plasma load represents a mismatching perturbation to the cavity. This perturbation is especially important at high MWPD where the reflected fraction of the input power may be quite high. This mismatch can lead to a pronounced heating of the reactor walls. It must therefore be taken into account from the very beginning of the reactor design. This requires the implementation of plasma modelling tools coupled to detailed electromagnetic simulations. This is discussed in section 3. We also briefly discuss the operating principles of the main commercial plasma reactors before introducing the reactor design methodology we have developed. Modelling results for a new generation of reactors developed at LIMHP, working at very high power density, will be presented. Lastly, we show that scaling up this type of reactor to lower frequencies (915 MHz) can result in high density plasmas allowing for fast and homogeneous diamond deposition on up to 160 mm diameter surfaces.

Polarization properties of thin films of diamond.

Thin films transparent to optical radiation offer polarization properties that are enhanced when the thickness of the film is an odd multiple of the quarter-wavelength. The transmission and reflection properties of a 1.16-µm-thick film of diamond realized by plasma-assisted chemical vapor deposition have been studied at 10.6 µm. A compact polarizer built with four films at a Brewster angle revealed an extinction ratio of better than 1:1000 of the S polarization. The interest in optics in which parasitic-reflected or transmitted beams do not exist is pointed out. The high damage threshold of diamonds opens the possibility of controlling the polarization characteristics of high-power lasers used, for example, for soldering and cutting applications.

[Treatment of early menopause. A report of 2 cases]. / Traitement de la ménopause précoce. A propos de deux observations.

Veralipride was given to two patients with early menopause ascertained by hormonal investigations. In both women (aged 33 and 30 years), an estradiol-progestogen combination given for hot flushes, disorders of character, and depression, had been unsuccessful. Symptoms resolved under therapy with veralipride alone or associated with the previous treatment. In one patient, symptoms recurred after veralipride was discontinued and resolved again once the drug was resumed.