Draft genome sequencing of Enterococcus avium strains isolated from bovine mastitis.

We performed whole-genome sequencing of four multidrug-resistant Enterococcus avium strains isolated from milk (4M1), feces (4F1 and 4F2), and farm soil (4S1) of mastitic dairy cows. The draft genomes of E. avium strains 4M1, 4F1, 4F2, and 4S1 were approximately 4.2 Mbp, with 39.1% GC content and 66.5× coverage.

Coir fiber as thermal insulator and its performance as reinforcing material in biocomposite production.

Coir is a lignocellulosic natural fiber derived from the coconut's husk, an abundantly found fruit or nut worldwide. This fiber has some unique characteristics, such as its resistance to seawater, microbial attack, high impact, etc. But its low thermal conductivity or high thermal insulating property makes it suitable for being used as insulators in civil engineering sites. On the other hand, the sustainability of a material depends heavily on its environmental impact of the material. For making sustainable materials like biocomposite, there are no options other than using polymers derived from natural renewable sources. Polylactic acid(PLA) is an example of those types of material. And these materials are often being reinforced by fibers like coir for various reasons including improving mechanical properties, reducing the cost of the material, and improving the material's sustainability. Many coir-reinforced sustainable biopolymer composites have already been produced in many pieces of research, which will be discussed in this paper, along with the chemical and physical structure of coir fiber. In addition, this paper will try to focus on the insulating properties of coir and coir-reinforced composites while will also compare some properties of the composites with some commonly used materials based on different parameters to show the suitability of using the coir fiber in heat-insulating applications and to produce sustainable biocomposite materials.

Correlation of Vascular Changes in Skin Tissue of Diabetic Patients with Glycosylated Hb and duration of Disease.

Skin is the largest organ and outer covering of human body. It plays a great role in our visible appearance. Humans are more conscious about skin disease because it has a cosmetic priority. The cases that fulfil the selection criteria will be enrolled as study samples with a view to see correlation with glycosylated Hb, vascular changes and duration of DM. This cross-sectional study was performed in the Department of Skin and VD and the Department of Pathology of BIRDEM, Dhaka, Bangladesh from March 2017 to February 2019. Study population was all diabetic patients with skin diseases attending dermatology department of BIRDEM hospital. Among them 90 patients were selected who will do skin biopsy with diabetes mellitus. Skin biopsy tissue and blood sample were taken as materials to determine the type of skin lesion in patients with satisfactory and unsatisfactory glycaemic control; the relationship of diabetic skin lesions with duration of diabetes; and assessing the cutaneous or dermal capillary vascular changes was in Diabetes Mellitus and its correlation with HbA1c level and duration of Diabetes Mellitus. Among 90 cases age ranged from 31 to 85 years with mean age of the patients 55.06 ± 12.10 years. Maximum patients were in age group 41-50 years (32.2%). Skin disorders in Diabetes mellitus are more common in female in this study. Almost three fourth of the patients glycemic status was unsatisfactory. Satisfactory glycemic patients were 17 cases (18.9%) and unsatisfactory glycemic patients were 73 cases (81.1%). Mean HbA1c shows unsatisfactory glycemic status among 90 cases in this study. Mean HbA1c is more unsatisfactory in female patients in this study. Most common group of lesion was 37.7 % belong to miscellaneous group followed by skin diseases with strong to weak association with DM. There were no significant differences in different types of skin lesions between satisfactory and unsatisfactory blood glucose patients. Majority of the cases (37.8%) occurred after 10 years of diagnosis of DM. Mean duration of DM was highest among the patients with skin reaction to diabetic treatment (10.04±6.19). There is marked variation in thickness of dermal capillary basement membrane with duration of diabetes. There was a significant inverse correlation between perivascular infiltration and capillary basement membrane thickness.

Evaluation of the impact of cotton sheath linear density of core spun yarn on the performance of denim fabrics.

In the textile sector, denim is one of the most iconic woven fabrics. The quality of denim fabric is influenced by several factors. For example, changes in the linear density of yarn might alter the projected fabric qualities, allowing it to fit current fashion market demands, which is the ultimate target of a textile product. The present investigation was designed to evaluate the impact of cotton sheath linear densities of core spun yarn (cotton/spandex) on performance properties like stretchability, tensile and tearing strength, weight, dimensional stability, pilling, and abrasion resistance of denim fabrics. Acquired results revealed that with the upsurge in the linear density of cotton sheath, several properties of the fabric, such as elongation and recovery percentage, tensile and tearing strength in the weft direction were improved because of the utilization of the variable linear density of sheath yarn in the same direction. Width-wise shrinkage and fabric weight were also decreased substantially. It was also found that increasing the sheath count enhances the denim fabric's overall resistance to pilling.

Genicular nerve radiofrequency ablation for pain control following anterior cruciate ligament reconstruction - A case report.

Adequate postoperative pain control is an essential factor for the success of rehabilitation programs after anterior cruciate ligament reconstruction (ACLR). The genicular nerve radiofrequency ablation (GNRF) is a recently developed method.This study aimed to evaluate the use of GNRF in patients who underwent ACLR.We performed GNRF guided by ultrasonography for patients who underwent ACLR with aggravated pain. GNRF was performed following ACLR a day after surgery. The pain was evaluated using the Visual Analogue Scale (VAS), and the Euroqol-5 Dimension (EQ-5D) measured the quality of life on the day of one, three, and seven after surgery. Results: In this study, two patients participated. In the postoperative days first, third, and seventh, the mean VAS was decreased after providing the intervention (from 8 to 5, 2, and 1, respectively). The mean EQ5D improved from 0.48 to 0.52, 0.56, 0.66, respectively.We concluded that GNRF is an adequate and safe procedure for managing postoperative pain after ACLR. It may enhance the postoperative rehabilitation program.

The absorption of water from humid air by grass embryos during germination.

Grass embryos possess structures that do not occur in any other flowering plants. Due to the specific embryo structure and position, grass embryo surfaces may be exposed to surrounding air under partial caryopsis-soil contact conditions, but whether caryopses of the grass family (Poaceae) can sense soil air humidity to initiate successful germination under partial caryopsis-soil contact conditions remain unknown. Here, we found that grass embryos have the unique ability to absorb water from atmospheric water vapor under partial caryopsis-soil contact conditions. To absorb atmospheric moisture, grass embryos developed profuse and highly elongated hairs on the embryo surface. These hairs, classically known as coleorhiza hairs, developed only on the embryo surface exposed to humid air, and submergence of the embryo surface inhibited their development. In addition to humid air-dependent development, almost all other developmental features of coleorhiza hairs were substantially different from root hairs. However, coleorhiza hair development was regulated by ROOTHAIRLESS 1. Besides the genetic control of coleorhiza hair development, we also identified how caryopses manage to keep the hairs turgid in natural open environments as the hairs were highly sensitive to dry air exposure. Moreover, we video-documented the regulation of developmental processes. The unique humid air-dependent coleorhiza hair development and their ability to absorb water from water vapor present in microsites or soil air give grasses advantages in germination and seedling establishment. Ultimately, coleorhiza hairs may have contributed to the ecological success of the grass family.

Molecular characterization of Staphylococcus aureus strains in bovine mastitis milk in Bangladesh.

Staphylococcus aureus is a common causative agent of bovine mastitis in dairy herds worldwide. This study was designed to assess the prevalence of mastitis in cows through screening tests and molecular characterization of Staphylococcus aureus strains. Out of 175 randomly screened cows, mastitis was detected in 50 cows by California Mastitis Test (CMT), and from those mastitic cows, 200 quarter milk samples were collected for subsequent culture and PCR based identification. The herd, cow and quarter level prevalence of mastitis was 73.3, 28.6 and 29.5% respectively, and subclinical mastitis (SCM) was the predominant type in all cases. According to bacteriology the overall prevalence of herd, cow and quarter level Staphylococcus aureus mastitis was 72.7, 74.0 and 62.0%, respectively, and the pathogen was mostly associated with clinical mastitis (CM). Cows breed, parity, daily milk yield, regular teat dipping, and dry cow therapy were significantly associated (P < 0.05) risk factors for mastitis onset. This study identifies 145 Staphylococcus aureus isolates which varied greatly with the categories of mastitis (higher in CM), udder quarter location (highest in right rear quarters), and to a lesser extent in the study areas (P < 0.05). Antimicrobial susceptibility testing revealed that 79.3% Staphylococcus aureus strains were resistant to at least one antimicrobial, 49.0% to two or more antimicrobials, and clinical isolates showed more resistance to all tested antibiotics. The highest resistance rate was found to oxytetracyclin, and no resistance to ceftriaxone and azithromycin. Seven enterotoxin gene profile were detected in the tested isolates, and mecA was found in 20.0% isolates indicating the emergence and spread of methicillin-resistant Staphylococcus aureus (MRSA). The isolates were carrying genes in combination, and were found higher in SCM cases. In this study, plasmids (>23 kb to 2.9 kb) were detected in 70.3% strains, and 54.9% plasmid bearing strains were multiple drug resistant (MDR). Thus, the high prevalence of Staphylococcus aureus mastitis is an important concern for diary industry of Bangladesh since the strains of this pathogen is becoming more resistant to commercially available antimicrobials, and this is an alarming concern for both animal and public health.

Preferential Geographic Distribution Pattern of Abiotic Stress Tolerant Rice.

Crop productivity and stability of the food system are threatened by climate change, mainly through the effects of predicted abiotic stresses. Despite extensive research on abiotic stress tolerance in the past decades, the successful translation of these research to fields/farmers is scarce. The impelling demand of climate resilient varieties, and the poor translation of research into the field despite the availability of high throughput technologies lead us to critically analyse a neglected aspect of current abiotic stress tolerance research. Although environmental factors play the most important role in the development of adaptive traits of plants, most abiotic stress tolerance research ignores eco-geographic aspects of highly stress tolerant accessions. In this review, we critically examined the geographic distribution pattern of highly tolerant rice accessions of all major abiotic stresses along with one micronutrient deficiency. Remarkably, we identified a shared geographic distribution pattern of highly tolerant accessions for all abiotic stresses including zinc deficiency despite the sparseness of highly tolerant accessions. The majority of these tolerant accessions predominately originated from Bangladesh centred narrow geographic region. We therefore analysed the climatic and agro-ecological features of Bangladesh. Considering the threat of climate change on global food security and poverty, urgent concerted research efforts are necessary for the development of climate resilient rice varieties utilizing the technological advancement, know-hows, and the preferential distribution pattern of abiotic stress tolerant rice.

FRAGILE ENVIRONMENT, SEASONALITY AND MATERNAL AND CHILDHOOD UNDERNUTRITION IN BANGLADESH.

This study assessed whether agricultural and household incomes were the same across different agro-ecological environments in Bangladesh. An in-depth analysis of the effect of unfavourable ecologies on maternal and child malnutrition was carried out. Data were from a longitudinal data set comprising a nationally representative data sample collected in 2014 and the Food Security Nutrition Surveillance Project (FSNSP) conducted in 2011 and 2012. Anthropometric indices were used to assess the nutritional status of mothers and under-five children. The key variables of interest were food seasonality and geographical location. Data were analysed using the General Linear Model and multinomial and binary logistic regression analysis. Panel data analysis showed that household income was not equal across agro-ecological zones, indicating that the fragility of the environment affects a household's ability to access food, and thus the nutritional status of mothers and children. Coastal areas of Bangladesh were found to be less dependent on agriculture, particularly cultivation, which had diminished during last few decades. Per capita income has been increasing in coastal areas of Bangladesh, led by remittance (money sent home by migrant workers) growing at 8% per year against 6% in other areas. Regression analysis showed that a household in a coastal zone earned 19% less than one in more favourable zones. Although the income from farm practices was found to be lower in unfavourable areas, the deficiency was compensated by increased non-farm incomes. The results from the FSNSP data showed that overall the rates of stunting and wasting among under-five children were 37% and 11.7%, respectively, and nearly 28% of mothers suffered from undernutrition. A highly significant regional heterogeneity in undernutrition was found, with alarmingly high levels in the Haor Basin and coastal belt areas. There were significantly higher rates of underweight and wasting in the monsoon season compared with the two harvest seasons among children under the age of five. The findings stress the importance of bringing geographical location and seasonality thinking into debates on hunger and nutrition in Bangladesh.

Effect of administration of vitamin E, selenium and antimicrobial therapy on incidence of mastitis, productive and reproductive performances in dairy cows.

Administration of vitamin, mineral and antimicrobials at the end of lactation plays potential role in preventing mastitis in dairy cows. A total of 255 cows dividing into five groups (A = 50, B = 50, C = 50, D = 50 and E = 55) at their late gestation period were selected to explore the effect of vitamin E, selenium and antimicrobial therapy on mastitis incidence, their productive and reproductive performances. Each cow of group A received α-tocopherol + sodium selenite orally daily for last 30 days before calving, while each cow of group B, C and D was treated with α-tocopherol + sodium selenite intramuscular injection, procaine penicillin + neomycin sulfate, and dicloxacillin sodium intramammary infusions at Day 30-20 before calving, respectively. Group E cows served as untreated control. California mastitis test (CMT) revealed that 70.0%, 76.0%, 84.0% and 100.0% cows in group A, B, C and D, respectively were free from new intramammary infections (IMIs) during early lactation period. The bacteriological results showed highest IMIs rates (76.3%) in group E and lowest IMIs (2.0%) in group D (P < 0.05). Staphylococcus aureus and Escherichia coli were the most predominant udder pathogens in all groups except group D (only CNS). The mean IMIs incidence (20.5%) was significantly lower in treated cows (P < 0.001). The treated cows had higher cure rates (81.9%) than control cows (23.1%) and overall efficacy of treatments on cure rates was 71.8% for all mastitis pathogens (P < 0.0001). The productive and reproductive performances of the treated cows at postpartum and early lactation period remained always higher than their non-treated counterparts (P < 0.001). A number of cow and herd related factors were identified to be significantly associated with mastitis (P < 0.001). The results concluded that antimicrobial therapy had more beneficial effect in preventing mastitis over vitamin-mineral administration and intramammary infusion with dicloxacillin sodium remained as the best effective preventive strategies for mastitis in dairy cows.

Rayada specialty: the forgotten resource of elite features of rice.

Crop domestication and thereafter gradual selection or directional breeding have narrowed the genetic diversity of elite varieties and even promoted gathering of deleterious mutations in their stress response mechanisms, whereas local ecotypes, landraces and wild relatives still growing on native environment and preferences keep the genetic diversities for features like stress tolerance. Rayada is such an exceptional ecotype, variant of typical deepwater rice, completely endemic to certain areas of Madhumati river tracts of Bangladesh and still shares some features of wild rices. Multiple physiological features of Rayadas are distinctly different from typical deepwater rice. Tolerance to prolonged flood, submergence and cold are special features along with strong photoperiod sensitivity and lack of dormancy. Moreover, longer root system and prompt recovery capacity make it as an elite resource of stress tolerance. However, it has long been neglected because of mainly its long life cycle and poor yield. This review examines the specialty of Rayada rice and the potential use of its unique traits.

Class III peroxidases are activated in proanthocyanidin-deficient Arabidopsis thaliana seeds.

BACKGROUND AND AIMS: It has previously been shown that proanthocyanidins (PAs) in the seed coat of Arabidopsis thaliana have the ability to scavenge superoxide radicals (O2(-)). However, the physiological processess in PA-deficit seeds are not clear. It is hypothesized that there exist alternative ways in PA-deficient seeds to cope with oxidative stress. METHODS: The content of hydrogen peroxide (H2O2) and its relevance to the activities of superoxide dismutase (SOD), catalase (CAT) and peroxidases was investigated in both wild-type and PA-deficit mutant seeds. A biochemical staining approach was used to detect tissue localizations of peroxidase activities in PA-deficit mutant seeds. KEY RESULTS: PA-deficient mutants possess significantly lower levels of H2O2 than the wild-type, despite their higher accumulation of superoxide radicals. Screening of the key antioxidant enzymes revealed that peroxidase activity was significantly over-activated in mutant seeds. This high peroxidase activity was mainly confined to the seed coat zone. Interestingly, neither ascorbate peroxidase nor glutathione peroxidase, just the guaiacol peroxidases (class III peroxidases), was specifically activated in the seed coat. However, no significant difference in peroxidase activity was observed in embryos of either mutants or the wild-type, although gene expressions of several candidate peroxidases were down-regulated in the embryos of PA-deficient seeds. CONCLUSIONS: The results suggest that enhanced class III peroxidase activity in the seed coat of PA-deficient mutants is an adaptive strategy for seed development and survival.

Proanthocyanidins inhibit seed germination by maintaining a high level of abscisic acid in Arabidopsis thaliana.

Proanthocyanidins (PAs) are the main products of the flavonoid biosynthetic pathway in seeds, but their biological function during seed germination is still unclear. We observed that seed germination is delayed with the increase of exogenous PA concentration in Arabidopsis. A similar inhibitory effect occurred in peeled Brassica napus seeds, which was observed by measuring radicle elongation. Using abscisic acid (ABA), a biosynthetic and metabolic inhibitor, and gene expression analysis by real-time polymerase chain reaction, we found that the inhibitory effect of PAs on seed germination is due to their promotion of ABA via de novo biogenesis, rather than by any inhibition of its degradation. Consistent with the relationship between PA content and ABA accumulation in seeds, PA-deficient mutants maintain a lower level of ABA compared with wild-types during germination. Our data suggest that PA distribution in the seed coat can act as a doorkeeper to seed germination. PA regulation of seed germination is mediated by the ABA signaling pathway.

Prolonging the interval from ovarian hyperstimulation to laparoscopic ovum pick-up improves oocyte yield, quality, and developmental competence in goats.

The objective was to evaluate the effect of the interval between ovarian hyperstimulation and laparoscopic ovum pick-up (LOPU) on quality and developmental competence of goat oocytes before and after in vitro maturation (IVM) and intracytoplasmic sperm injection (ICSI). Estrus was synchronized with an intravaginal insert containing 0.3g progesterone (CIDR) for 10d, combined with a luteolytic treatment of 125 microg cloprostenol 36 h prior to CIDR removal. Ovaries were hyperstimulated with 70 mg FSH and 500 IU hCG given im 36, 60, or 72 h prior to LOPU (n=15, 16, and 7 does, respectively). For these groups, oocyte retrieval rates (mean+/-S.E.M.) were 24.7+/-2.9, 54.5+/-4.7, and 82.8+/-4.6% (P<0.001), and the proportions of cumulus-oocyte complexes (COC) with more than five layers of cumulus cells were 29.7+/-8.3, 37.6+/-6.9, and 37.3+/-7.0% (P<0.001). The proportion of IVM oocytes was highest at 72 h (82.1+/-2.8%; P<0.05), with no significant difference between 36 and 60 h (57.3+/-8.9% and 69.0+/-8.4%). Cleavage rates of ICSI embryos were 4.2+/-4.2, 70.9+/-8.4, and 78.9+/-8.2% with LOPU 36, 60, and 72 h post FSH/hCG (P<0.01), with a lower proportion of Grade-A embryos (P<0.05) following LOPU at 36 h compared to 60 and 72 h (29.7+/-8.3%, 37.6+/-6.9%, and 37.3+/-7.0%). In summary, a prolonged interval from FSH/hCG to LOPU improved oocyte retrieval rate and oocyte quality. Therefore, under the present conditions, LOPU 60 or 72 h after FSH/hCG optimized yields of good-quality oocytes for IVM and embryo production in goats.

Cardiac transplantation for cardiomyopathy and ischemic heart disease: differences in outcome up to 10 years.

BACKGROUND: Ischemic heart disease (IHD) and cardiomyopathy (CM) are the most common indications for heart transplantation. The aim of this study was to investigate the difference in clinical outcome between these two groups. METHODS: At our institution between 1987 and 1998 transplantation was performed in 133 patients with IHD and 87 with CM. Follow-up was complete for all patients (mean 87 months). RESULTS: Mean age at time of surgery was 51 +/- 5 years for IHD versus 39 +/- 9 years for CM recipients (p = 0.02). There was no difference in donor age, donor gender, or pre-operative hemodynamics between the two groups. The operative mortality was 11.2% in IHD recipients and 10.6% in CM recipients (p = 0.9). No differences were observed in intra-cardiac pressures or incidence of renal dysfunction, infection, or malignancy between the two groups. The incidence of peripheral vascular incidents was significantly higher for IHD recipients (13% vs 3%, p = 0.02). At 10 years, the incidence of coronary artery disease was 35% and 9%, respectively (p = 0.02). Mean NYHA status was 2.0 +/- 0.3 and 1.1 +/- 0.2 for IHD and CM recipients, respectively (p = 0.013). The actuarial survival at 1, 5, and 10 years was 77%, 62%, and 39% for IHD recipients compared with 85%, 82%, and 80% for CM recipients (p = 0.7, p < 0.0001 and p < 0.0001, respectively). CONCLUSION: After heart transplantation, medium- and long-term outcome is significantly better for CM than IHD recipients. In view of limited donor availability, it is appropriate to explore more vigorously alternative treatments for patients with severe ischemic left ventricular dysfunction.

Orthotopic cardiac transplantation technique: a survey of current practice.

BACKGROUND: The Lower and Shumway technique has been the gold standard for orthotopic heart transplantation (OHT) for the past 35 years. In the last decade the bicaval and total techniques have been introduced but it is unclear how these alternative techniques have influenced the current surgical practice of OHT. METHODS: A worldwide survey of 210 International Society of Heart and Lung Transplantation centers was conducted by questionnaire: 169 replies were received; a response rate of 80%. RESULTS: Seventy-four centers (44%) use a combination of more than one technique with the remaining centers (n = 95 centers) employing one technique exclusively. The bicaval technique is the most frequently used technique in the majority of transplant procedures in 92 (54%) centers. In only 38 centers (22%), the standard technique was the most frequently employed technique. The total technique was the choice in 8 centers (5%). The maximum acceptable ischemic time varied from 3 to 9 hours with a median of 5.7 hours. Only 92 centers (54%) do not use cardioplegia during implantation. CONCLUSIONS: Since its introduction, the bicaval technique has become the most commonly used procedure for OHT. The long-term advantage of right atrial preservation with the bicaval technique will require further studies.

Risk factors for tricuspid valve regurgitation after orthotopic heart transplantation.

BACKGROUND: Tricuspid regurgitation (TR) may occur following orthotopic heart transplantation (OHT) and although a number of etiological factors have been suggested, the relative contribution of each of these remains to be elucidated. We aimed to assess the risk factors for TR in our 10-year experience of orthotopic heart transplantation (OHT). METHODS: OHT was performed in 249 patients (161 by the standard technique and 88 by the bicaval technique). TR was assessed using transthoracic color Doppler echocardiography. RESULTS: Recipients who underwent operation by the standard technique displayed higher incidence of moderate and severe TR than did bicaval-technique recipients. The development of early TR was also correlated to rejection greater than or equal to grade 2, preoperative raised transpulmonary gradient, and raised pulmonary vascular resistance. Risk factors for late TR were standard technique (p < 0.0001), number of rejection greater than or equal to grade 2 (p < 0.004), and the total number of heart biopsies (p < 0.02). Recipients with moderate and severe TR revealed elevated right-side pressures and advanced New York Heart Association statues compared to those with no, trivial, or mild TR. CONCLUSIONS: Various factors contribute to TR after OHT, the prevalence of which might be lowered by adopting the bicaval technique, early treatment of rejection, and reduction of the number of biopsies performed.

Heart transplantation for peripartum cardiomyopathy: a report of three cases and a literature review.

Peripartum cardiomyopathy is a devastating medical condition and carries a mortality of up to 60% with medical treatment. The authors describe their experience of successful outcome of three cases with heart transplantation and review the literature. The importance of performance of endomyocardial biopsy for all peripartum cardiomyopathy patients is emphasized. It is recommended that heart transplantation should only be offered to myocarditis negative patients.

The influence of histocompatibility on graft rejection and graft survival within a single center population of heart transplant recipients.

BACKGROUND: We report a consecutive single center series of 261 patients who received first orthotopic heart transplants from 1986 to 1997. The 1- and 5-year graft survivals were 78 and 68%. The influence of histocompatibility was investigated by comparing graft survival and numbers of treated rejection episodes with HLA-A, -B, and -DR mismatches over different time periods. FINDINGS: Recipients with six mismatches for HLA-A+-B+-DR combined (13.4%) had reduced survival at 7 years (47%) when compared with other recipients (64%). In the first year of transplant, recipients with four HLA-A+-B mismatches had significantly reduced actuarial graft survival (P=0.03) with the greatest influence apparent at 6 months [0-3 mismatches (n=193) 85% versus 4 mismatches (n=68) 69%; P=0.005, OR=2.1]. For 182 recipients with functioning hearts at 1 year, the number of rejection episodes treated within this time was strongly influenced by HLA-DR mismatch [0 DR mismatch (n=15) mean 1.2 rejection episodes versus 1 DR mismatch (n=76) mean 2.7 rejection episodes versus 2 DR mismatches (n=91) mean 3.8 rejection episodes: P=0.0002]. Of these 182 transplants, recipients who had more than four treated rejection episodes during the first year had a significantly reduced 7- year survival [<5 rejection episodes (n=133) 85% versus more than four rejection episodes (n=49) 66%; P=0.02, OR=3.4], as did those with two HLA-DR mismatches [0+1 mismatch (n=91) 87% versus 2 mismatches (n=91) 70%; P<0.05, OR=2.4]. INTERPRETATION: We show that graft loss in the first 6 months of transplant is significantly influenced by four HLA-A+-B mismatches. HLA-DR mismatch significantly increases the number of rejection episodes within the first year, without influencing graft survival. After 12 months both >4 rejection episodes in the first year and two HLA-DR mismatches are markers for late graft loss. We postulate that immunological graft loss in the first 6 months is dominated by the direct allorecognition pathway driven by HLA-DR mismatch. This mechanism is later lost or suppressed. Our data highlight HLA-DR mismatch as a marker for late graft loss and we show an advantage to avoiding transplanting hearts with six HLA-A+-B+-DR mismatches and to minimizing HLA-DR mismatches whenever possible.