Post-transplant lymphoproliferative syndrome in the pediatric liver transplant population.

Post-transplant lymphoproliferative disease remains a complication with a high morbidity and mortality. The present study examined 291 pediatric liver transplants performed in 263 children from October 1984 to December 1999. Post-transplant lymphoproliferative disease has an overall incidence of 12%. Tacrolimus and cyclosporine had a similar incidence of post-transplant lymphoproliferative disease. Fifty-six per cent of patients who developed post-transplant lymphoproliferative disease were Epstein-Barr virus negative at the time of transplantation. Mean time of conversion to Epstein-Barr virus positivity was 1.1 years after liver transplantation. Ten per cent of those who developed post-transplant lymphoproliferative disease never had Epstein-Barr virus detected. Mean time from Epstein-Barr virus positivity to detection of post-transplant lymphoproliferative disease was 2.68 years, and 3.13 years from liver transplantation (OLTx) to post-transplant lymphoproliferative disease. There was a 35% incidence of mortality. Deaths occurred a mean of 0.76 years after diagnosis of post-transplant lymphoproliferative disease. Most cases of post-transplant lymphoproliferative disease had extranodal location. There was one recurrence in 10% of patients, and two in 3%. All recurrent cases were seen in recipients who became Epstein-Barr virus positive after transplantation. There has been a decrease in the incidence of post-transplant lymphoproliferative disease from 15% to 9% to 4%. Post-transplant lymphoproliferative disease should be diagnosed promptly and treated aggressively. The best treatment, however, seems to be prevention, starting in the immediate postoperative period. Survivors should be monitored for both recurrence of post-transplant lymphoproliferative disease and acute cellular rejection.

Hydrogen and oxygen isotope ratios of tree ring cellulose for field-grown riparian trees.

The isotopic composition of tree ring cellulose was obtained over a 2-year period from small-diameter riparian-zone trees at field sites that differed in source water isotopic composition and humidity. The sites were located in Utah (cool and low humidity), Oregon (cool and high humidity), and Arizona (warm and low humidity) with source water isotope ratio values of -125/-15‰ (δD/δ18O), -48/-6‰, and -67/-7‰, respectively. Monthly environmental measurements included temperature and humidity along with measurements of the isotope ratios in atmospheric water vapor, stream, stem, and leaf water. Small riparian trees used only stream water (both δD and δ18O of stem and stream water did not differ), but δ values of both atmospheric water vapor and leaf water varied substantially between months. Differences in ambient temperature and humidity conditions between sites contributed to substantial differences in leaf water evaporative enrichment. These leaf water differences resulted in differences in the δD and δ18O values of tree ring cellulose, indicating that humidity information was recorded in the annual rings of trees. These environmental and isotopic measurements were used to test a mechanistic model of the factors contributing to δD and δ18O values in tree ring cellulose. The model was tested in two parts: (a) a leaf water model using environmental information to predict leaf water evaporative enrichment and (b) a model describing biochemical fractionation events and isotopic exchange with medium water. The models adequately accounted for field observations of both leaf water and tree ring cellulose, indicating that the model parameterization from controlled experiments was robust even under uncontrolled and variable field conditions.

There is no temperature dependence of net biochemical fractionation of hydrogen and oxygen isotopes in tree-ring cellulose.

The isotopic composition of tree-ring cellulose was obtained over a two-year period from small diameter, riparian zone trees along an elevational transect in Big Cottonwood Canyon, Utah, USA to test for a possible temperature dependence of net biological fractionation during cellulose synthesis. The isotope ratios of stream water varied by only 3.6% and 0.2% in deltaD and delta18O, respectively, over an elevation change of 810m. The similarity in stream water and macroenvironment over the short (13km) transect produced nearly constant stem and leaf water deltaD and delta18O values. In addition, what few seasonal variations observed in the isotopic composition of source water and atmospheric water vapor or in leaf water evaporative enrichment were experienced equally by all sites along the elevational transect. The temperature at each site along the transect spanned a range of > or = 5 degrees C as calculated using the adiabatic lapse rate. Since the deltaD and delta18O values of stem and leaf water varied little for these trees over this elevation/temperature transect, any differences in tree-ring cellulose deltaD and delta18O values should have been associated with temperature effects on net biological fractionation. However, the slopes of the regressions of elevation versus the deltaD and delta18O values of tree-ring cellulose were not significantly different from zero indicating little or no temperature dependence of net biological fractionation. Therefore, cross-site climatic reconstruction studies using the isotope ratios of cellulose need not be concerned that temperatures during the growing season have influenced results.

Hydrogen and oxygen isotope ratios of tree-ring cellulose for riparian trees grown long-term under hydroponically controlled environments.

Saplings of three riparian tree species (alder, birch and cottonwood) were grown for over 5 months in a hydroponics system that maintained the isotopic composition of source water in six treatments, ranging from -120 to +180‰Î´D and -15 to +10‰Î´18O. The trees were grown in two greenhouses maintained at 25°C and at either 40 or 75% relative humidity, creating differences in transpiration rates and leaf water isotopic evaporative enrichment. The cellulose produced in the annual growth ring was linearly related to source water with differences in both slope and offset associated with greenhouse humidity. The slope of the isotopic composition of source water versus tree-ring cellulose was less than 1 for both δD and δ18O indicating incomplete isotopic exchange of carbohydrate substrate with xylem water during cellulose synthesis. Tests using the outer portion of the tree-ring and new roots were similar and showed that the tree-ring values were representative of the cellulose laid down under the imposed environmental conditions. The fraction of H and O in carbohydrate substrate that isotopically exchange with medium water was calculated to be 0.36 and 0.42 respectively, and biochemical mechanisms for these observed fractions are discussed. A mechanistic model of the biochemical fractionation events for both δD and δ18O leading to cellulose synthesis was robust over the wide range of cellulose stable isotope ratios. The experimental results indicate that both water source and humidity information are indeed recorded in tree-ring cellulose. These results help to resolve some of the disparate observations regarding the interpretation of stable isotope ratios in tree-rings found in the literature.

The Effect of Elevated [CO2] on Growth and Photosynthesis of Two Eucalyptus Species Exposed to High Temperatures and Water Deficits.

Two species of eucalyptus (Eucalyptus macrorhyncha and Eucalyptus rossii) were grown for 8 weeks in either ambient (350 [mu]L L-1) or elevated (700 [mu]L L-1) CO2 concentrations, either well watered or without water additions, and subjected to a daily, 3-h high-temperature (45[deg]C, maximum) and high-light (1250 [mu]mol photons m-2 s-1, maximum) stress period. Water-stressed seedlings of E. macrorhyncha had higher leaf water potentials when grown in elevated [CO2]. Growth analysis indicated that increased [CO2] may allow eucalyptus species to perform better during conditions of low soil moisture. A down-regulation of photosynthetic capacity was observed for seedlings grown in elevated [CO2] when well watered but not when water stressed. Well-watered seedlings grown in elevated [CO2] had lower quantum efficiencies as measured by chlorophyll fluorescence (the ratio of variable to maximal chlorophyll fluorescence [Fv/Fm]) than seedlings grown in ambient [CO2] during the high-temperature stress period. However, no significant differences in Fv/Fm were observed between CO2 treatments when water was withheld. The reductions in dark-adapted Fv/Fm for plants grown in elevated [CO2] were not well correlated with increased xanthophyll cycle photoprotection. However, reductions in the Fv/Fm were correlated with increased levels of nonstructural carbohydrates. The reduction in quantum efficiencies for plants grown in elevated [CO2] is discussed in the context of feedback inhibition of electron transport associated with starch accumulation and variation in sink strength.

Reverse, innervated latissimus dorsi flap reconstruction of congenital diaphragmatic absence.

Children with congenital diaphragmatic absence have experienced a high mortality rate regardless of early intervention due to regression to fetal circulation patterns. Advances in neonatal care, particularly extracorporeal membrane oxygenation, have led to the survival of children who previously would not have lived. With growth, the Gore-Tex patch used for emergency repair in severe cases pulls away from the rib periosteum as a result of the expansile growth of the chest wall and the indistensibility of the patch. Recurrent herniation of abdominal contents ensues, slowly restricting pulmonary function and development. When pulmonary function is significantly impaired, we perform a reverse latissimus dorsi flap reconstruction with anastomosis of the thoracodorsal nerve to the phrenic nerve. Our series includes five children aged 5 to 11 months. Follow-up ranges from 22 to 50 months. Three children have proven physiologic neodiaphragmatic motion. The other two are doing well with stable absence of paradoxical motion. There have been no complications. Long-term follow-up will be required to determine their eventual fate. The prognosis is encouraging.

Stability of diltiazem in different biological fluids.

The hydrolysis of diltiazem in biological fluids: whole blood, plasma, and gastric fluid was investigated under conditions considered close to the physiological situation. The most significant rate of hydrolytic degradation was found in whole blood (half-life of 27 h), followed by plasma (half-life of 88 h), while the least significant degradation rate was observed in gastric fluid (half-life 153 h). The kinetic profiles of diltiazem hydrolysis indicate that hydrolytic degradation in the biological fluids makes a minimal contribution to the clearance and disposition of the drug.