Practice variation in the diagnosis of acute rejection among pediatric heart transplant centers: An analysis of the pediatric heart transplant society (PHTS) registry.

BACKGROUND: Freedom from rejection in pediatric heart transplant recipients is highly variable across centers. This study aimed to assess the center variation in methods used to diagnose rejection in the first-year post-transplant and determine the impact of this variation on patient outcomes. METHODS: The PHTS registry was queried for all rejection episodes in the first-year post-transplant (2010-2019). The primary method for rejection diagnosis was determined for each event as surveillance biopsy, echo diagnosis, or clinical. The percentage of first-year rejection events diagnosed by surveillance biopsy was used to approximate the surveillance strategy across centers. Methods of rejection diagnosis were described and patient outcomes were assessed based on surveillance biopsy utilization among centers. RESULTS: A total of 3985 patients from 56 centers were included. Of this group, 873 (22%) developed rejection within the first-year post-transplant. Surveillance biopsy was the most common method of rejection diagnosis (71.7%), but practices were highly variable across centers. The majority (73.6%) of first rejection events occurred within 3-months of transplantation. Diagnosis modality in the first-year was not independently associated with freedom from rejection, freedom from rejection with hemodynamic compromise, or overall graft survival. CONCLUSIONS: Rejection in the first-year after pediatric heart transplant occurs in 22% of patients and most commonly in the first 3 months post-transplant. Significant variation exists across centers in the methods used to diagnose rejection in pediatric heart transplant recipients, however, these variable strategies are not independently associated with freedom from rejection, rejection with hemodynamic compromise, or overall graft survival.

Structural elucidation of a novel family of acyltrehaloses from Mycobacterium tuberculosis.

Analysis of the lipids of Mycobacterium tuberculosis H37Rv, by both normal- and reverse-phase thin-layer chromatography, revealed a series of novel glycolipids based on 2,3-di-O-acyltrehalose. The structures of these acylated trehaloses were elucidated by a combination of gas chromatography-mass spectrometry, 1H, 13C, two-dimensional 1H-1H, and 1H-13C nuclear magnetic resonance spectrometry. The fatty acyl substituents were mainly of three types: saturated straight-chain C16-C19 acids; C21-C25 "mycosanoic acids"; and C24-C28 "mycolipanolic acids." Analysis of one of the major 2,3-di-O-acyltrehaloses by two-dimensional 1H-chemical shift correlated and 1H-detected heteronuclear multiple-bond correlation spectroscopy established that the C18 saturated straight-chain acyl group was located at the 2 position and that the C24 mycosanoyl substituent was at the 3 position of the same "right-hand" glucosyl residue. At least six molecular species differing only in their fatty acid content comprised this family of di-O-acylated trehaloses. We regard these acyltrehaloses as elemental forms of the multiglycosylated acyltrehaloses (the lipooligosaccharides) perhaps due to an inability of the majority of isolates of virulent tubercle bacilli to glycosylate core acyltrehaloses. The acyltrehaloses are minor but consistent components of virulent M. tuberculosis and apparently the basis of the specific serological activity long associated with its lipid fractions.

Food intake in multiple sclerosis.

The usual dietary intake of 142 people with multiple sclerosis (MS), from different areas of Great Britain, has been assessed using the 7-day weighed intake method. This sample represents those subjects who said they had not altered their diets since diagnosis, ie, one-third of those who originally joined the management programme. Despite the low energy intakes of the subjects, intakes of other nutrients were similar to values of the general British population. The relationship of disability to energy and nutrient intake was studied. The relevance of dietary fatty acid intakes in MS is discussed with reference to epidemiological data and regional variations. The possibility that people with MS have specific requirements is considered and the need for nutritional guidance in MS is stressed.