Natural Antibodies Are Associated With Rejection and Long-term Renal Allograft Loss in a Multicenter International Cohort.

BACKGROUND: Potentially harmful nonhuman leukocyte antigen antibodies have been identified in renal transplantation, including natural immunoglobulin G antibodies (Nabs) reactive to varied antigenic structures, including apoptotic cells. METHODS: In this retrospective, multicenter study, we assessed Nabs by reactivity to apoptotic cells in sera collected from 980 kidney transplant recipients across 4 centers to determine their association with graft outcomes. RESULTS: Elevated pretransplant Nabs were associated with graft loss (hazard ratio [HR] 2.71; 95% confidence interval [CI], 1.15-6.39; P = 0.0232), the composite endpoint of graft loss or severe graft dysfunction (HR 2.40; 95% CI, 1.13-5.10; P = 0.0232), and T cell-mediated rejection (odds ratio [OR] 1.77; 95% CI, 1.07-3.02; P = 0.0310). High pretransplant Nabs together with donor-specific antibodies (DSAs) were associated with increased risk of composite outcomes (HR 6.31; 95% CI, 1.81-22.0; P = 0.0039). In patients with high pretransplant Nabs, the subsequent development of posttransplant Nabs was associated with both T cell-mediated rejection (OR 3.64; 95% CI, 1.61-8.36; P = 0.0021) and mixed rejection (OR 3.10; 95% CI, 1.02-9.75; P = 0.0473). Finally, elevated pre- and posttransplant Nabs combined with DSAs were associated with increased risk of composite outcomes (HR 3.97; 95% CI, 1.51-10.43; P = 0.0052) and T cell-mediated rejection (OR 7.28; 95% CI, 2.16-25.96; P = 0.0016). CONCLUSIONS: The presence of pre- and posttransplant Nabs, together with DSAs, was associated with increased risk of poor graft outcomes and rejection after renal transplantation.

Profiling non-HLA antibody responses in antibody-mediated rejection following heart transplantation.

Antibody-mediated rejection (AMR) driven by the development of donor-specific antibodies (DSA) directed against mismatched donor human leukocyte antigen (HLA) is a major risk factor for graft loss in cardiac transplantation. Recently, the relevance of non-HLA antibodies has become more prominent as AMR can be diagnosed in the absence of circulating DSA. Here, we assessed a single-center cohort of 64 orthotopic heart transplant recipients transplanted between 1994 and 2014. Serum collected from patients with ≥ pAMR1 (n = 43) and non-AMR (n = 21) were tested for reactivity against a panel of 44 non-HLA autoantigens. The AMR group had a significantly greater percentage of patients with elevated reactivity to autoantigens compared to non-AMR (P = .002) and healthy controls (n = 94, P < .0001). DSA-positive AMR patients exhibited greater reactivity to autoantigens compared to DSA-negative (P < .0001) and AMR patients with DSA and PRA > 10% were identified as the subgroup with significantly elevated responses. Reactivity to 4 antigens, vimentin, beta-tubulin, lamin A/C, and apolipoprotein L2, was significantly different between AMR and non-AMR patients. Moreover, increased reactivity to these antigens was associated with graft failure. These results suggest that antibodies to non-HLA are associated with DSA-positive AMR although their specific role in mediating allograft injury is not yet understood.

Microstructure, surface characterization and long-term stability of new quaternary Ti-Zr-Ta-Ag alloy for implant use.

The novel Ti-20Zr-5Ta-2Ag alloy was characterised concerning its microstructure, morphology, mechanical properties, its passive film composition and thickness, its long-term electrochemical stability, corrosion resistance, ion release rate in Ringer solution of acid, neutral and alkaline pH values and antibacterial activity. The new alloy has a crystalline α microstructure (by XRD). Long-term XPS and SEM analyses show the thickening of the passive film and the deposition of hydroxyapatite in neutral and alkaline Ringer solution. The values of the electrochemical parameters confirm the over time stability of the new alloy passive film. All corrosion parameters have very favourable values in time which attest a high resistance to corrosion. Impedance spectra evinced a bi-layered passive film formed by the barrier, insulating layer and the porous layer. The monitoring of the open circuit potentials indicated the stability of the protective layers and their thickening in time. The new alloy releases (by ICP-MS measurements) very low quantities of Ti, Zr, Ag ions and no Ta ions. The new alloy exhibits a low antibacterial activity.

Mechanical and corrosion resistance of a new nanostructured Ti-Zr-Ta-Nb alloy.

In this work, a multi-elementary Ti-10Zr-5Nb-5Ta alloy, with non-toxic alloying elements, was used to develop an accumulative roll bonding, ARB-type procedure in order to improve its structural and mechanical properties. The alloy was obtained by cold crucible semi-levitation melting technique and then was ARB deformed following a special route. After three ARB cycles, the total deformation degree per layer is about 86%; the calculated medium layer thickness is about 13 µm. The ARB processed alloy has a low Young's modulus of 46 GPa, a value very close to the value of the natural cortical bone (about 20 GPa). Data concerning ultimate tensile strength obtained for ARB processed alloy is rather high, suitable to be used as a material for bone substitute. Hardness of the ARB processed alloy is higher than that of the as-cast alloy, ensuring a better behaviour as a implant material. The tensile curve for the as-cast alloy shows an elastoplastic behaviour with a quite linear elastic behaviour and the tensile curve for the ARB processed alloy is quite similar with a strain-hardening elastoplastic body. Corrosion behaviour of the studied alloy revealed the improvement of the main electrochemical parameters, as a result of the positive influence of ARB processing. Lower corrosion and ion release rates for the ARB processed alloy than for the as-cast alloy, due to the favourable effect of ARB thermo-mechanical processing were obtained.

New-onset graft dysfunction after heart transplantation--incidence and mechanism-related outcomes.

BACKGROUND: Graft dysfunction (GD) after heart transplantation (HTx) is a major cause of morbidity and mortality. The impact of different pathophysiologic mechanisms on outcome is unknown. In this large, single-center study we aimed to assess the incidence of GD and compare the outcomes with different histopathologic mechanisms of rejection. METHODS: We analyzed a data set of 1,099 consecutive patients after their HTx at Columbia University Medical Center between January 1994 and March 2008, and identified all patients hospitalized with new-onset GD. Based on the histopathologic data, patients were divided into GD-unexplained (Group-GD-U), GD-antibody-mediated rejection (Group-GD-AMR), GD-cardiac allograft vasculopathy (Group-GD-CAV) and GD-acute cellular rejection (Group-GD-ACR) groups. We compared the in-hospital and 3-, 6- and 12-month mortality across these groups using the chi-square test. We also compared the 3-, 6- and 12-month survival curves across groups using the log-rank test. RESULTS: Of 126 patients (12%) identified with GD, complete histology data were available for 100 patients. There were 21, 20, 27 and 32 patients identified in Group-GD-U, Group-GD-AMR, Group-GD-CAV and Group-GD-ACR, respectively. The in-hospital mortality rates were 52%, 20%, 15% and 6%, respectively. The in-hospital mortality rate was significantly higher in Group-GD-U compared with all other groups (p = 0.0006). The 3-, 6- and 12-month survival rate was also significantly lower in Group-GD-U compared with all other groups. CONCLUSION: A significant proportion of patients presenting with new-onset GD have unexplained histopathology. Unexplained GD is associated with a significantly higher mortality rate. New diagnostic tools are necessary to better understand and detect/predict this malignant phenotype.

Synthesis and characterisation of a new superelastic Ti-25Ta-25Nb biomedical alloy.

In this study, a new Ti-25Ta-25Nb (mass%) beta alloy was synthesised by cold crucible semi-levitation melting. This technique made it possible to obtain homogeneous ingots although the elements used have very different melting points. After melting, a thermo-mechanical treatment was applied in order to obtain a perfectly recrystallised beta microstructure. For this alloy composition, the tensile tests showed a very low Young's modulus associated with an important super-elastic behaviour, which contributes to decrease the elastic modulus under stress and to increase the recoverable strain. On the other hand, the corrosion tests, which were carried out in a neutral Ringer solution, indicated a corrosion resistance higher than that of the commercially pure CP Ti alloy. These results show that this new alloy possesses all the characteristics necessary for its long-term use in medical implants.

In vitro biocompatibility and corrosion resistance of a new implant titanium base alloy.

One objective of this work was to study the corrosion resistance of the new implant Ti-10Zr-5Ta-5Nb alloy in physiological fluids of different pH values, simulating the extreme functional conditions. Another objective was in vitro biocompatibility evaluation of the new alloy using human fetal osteoblast cell line hFOB 1.19. Cytocompatibility was assessed by determination of possible material cytotoxic effects, cell morphology and cell adhesion. The thermo-mechanical processing of the new implant alloy consisted in plastic deformation (almost 90%) performed by hot rolling accompanied by an initial and final heat treatment. The new Ti-10Zr-5Ta-5Nb alloy presented self-passivation, with a large passive potential range and low passive current densities, namely, a very good anticorrosive resistance in Ringer solution of acid, neutral and alkaline pH values. Cell viability was not affected by the alloy substrate presence and a very good compatibility was noticed.

Alloantibodies in heart transplantation.

The presence of complement fixing anti-human leukocyte antigen (HLA) antibodies in the circulation of organ transplant recipients may result in heart allograft rejection. Here, we assessed the clinical impact of pre- and post-transplantation allosensitization on long-term survival of heart allografts. Sequential samples of sera from heart allograft recipients were screened pretransplantation for panel reactive antibodies using the complement-dependent cytotoxicity test. Patients were monitored post-transplantation for donor specific anti-HLA class I and class II antibodies. Kaplan-Meier graft survival plots were generated to analyze the effect of anti-HLA antibodies on transplantation outcomes. Statistical analysis showed that the post-transplantation development of alloantibodies was a significant risk factor that was associated with low long-term survival rates; in contrast, recipients' gender, age, previous transplantations, and degree of HLA matching with the donor had no effect on long-term survival. The presence in pretransplantation sera of antibodies against more than 10% of the HLA reference panel (PRA >10%) was associated with AMR and with a relatively lower rate of graft survival after 1 year but did not affect 10-year survival. The present data underline the importance of monitoring the development of anti-HLA antibodies as a tool for early diagnosis and treatment of AMR.

Sensitivity, specificity and clinical relevance of different cross-matching assays in deceased-donor renal transplantation.

To assess the significance of antibodies detected by complement-dependent cytotoxicity (CDC), solid phase (SPA) and flow cytometry (FC) assays we compared their predictive value in 354 consecutive cases of deceased-donor kidney transplantation. Pre-transplantation screening of anti-HLA class I and class II antibodies was performed by CDC and SPA. The direct crossmatch between recipients' sera and donors' T and B cells was performed by CDC followed by FC and SPA ("virtual cross-match"). The past history of antibodies displayed by the recipient was not considered a contraindication for transplantation even when it showed DSA. A side-by-side comparison of the correlation between graft loss, history of DSA and cross-match results indicated that sensitivity was 5%, 16% and 17% while specificity was 99%, 93% and 86% in CDC, SPA, FC crossmatches respectively. There was no significant difference between the 3 year survival of primary and secondary kidney allografts. We conclude that screening and cross-matching the sera by CDC provides reliable results and optimizes the patient's chances to receive a transplant. SPA and FC, however, are of great importance for identifying patients which require close monitoring by biopsy and serology for early diagnosis and treatment of acute antibody mediated rejection (AAMR).

Polymorphism and linkage disequilibrium of immunoglobulin-like transcript 3 gene.

Immunoglobulin-like transcript 3 (ILT3) is an inhibitory receptor molecule expressed by dendritic cells, monocytes, and endothelial cells. Upon upregulation of ILT3 expression, antigen presenting cells (APCs) become tolerogenic, triggering the differentiation of antigen-specific CD8(+) and CD4(+) regulatory T cells. To analyze the polymorphism of ILT3, we screened DNA from a panel of 150 healthy subjects for single nucleotide polymorphisms (SNPs) within genomic region encoding the extracellular domain (exons 1-8). Here we report the identification of 15 SNPs, including nine nonsynonymous, three synonymous base-pair substitutions, and three intronic, including one deletion polymorphism within 3.6 kb of the ILT3 genomic region. Analysis of three physically linked SNP in healthy individuals indicates that c.356-41-46del, a 6-base-pair (bp) deletion located in intron 3/4, is predominantly associated with c.678A allele, a nonsynonymous SNP located in exon 5. Linkage studies in five nuclear families showed that these two minor alleles co-segregate. Our results demonstrate that ILT3 is highly polymorphic and may be associated with susceptibility to immune disorders.

WS/PIDS: standard interoperable PIDS in web services environments.

An electronic health record depends on the consistent handling of people's identities within and outside healthcare organizations. Currently, the Person Identification Service (PIDS), a CORBA specification, is the only well-researched standard that meets these needs. In this paper, we introduce WS/PIDS, a PIDS specification for Web Services (WS) that closely matches the original PIDS and improves on it by providing explicit support for medical multimedia attributes. WS/PIDS is currently supported by a test implementation, layered on top of a PIDS back-end, with Java- and NET-based, and Web clients. WS/PIDS is interoperable among platforms; it preserves PIDS semantics to a large extent, and it is intended to be fully compliant with established and emerging WS standards. The specification is open source and immediately usable in dynamic clinical systems participating in grid environments. WS/PIDS has been tested successfully with a comprehensive set of use cases, and it is being used in a clinical research setting.

Long-term assessment of the implant titanium material--artificial saliva interface.

This paper studies the long-term (20,000 exposure hours) behavior of titanium and Ti-5Al-4V alloy-Carter-Brugirard saliva interface and the short-term (500 exposure hours) resistance of titanium and Ti-5Al-4V alloy-Tani&Zucchi saliva interface. Potentiodynamic polarization method was applied for the determination of the main electrochemical parameters. Linear polarization measurements for to obtain the corrosion rates were used. Monitoring of the open circuit potentials (E(oc)) for long-term have permitted to calculate the potential gradients due to the pH, DeltaE(oc)(pH) and to the saliva composition DeltaE(oc)(c) changes which can appear "in vivo" conditions and can generate local corrosion. Atomic force microscopy (AFM) has analyzed the surface roughness. Ion release was studied by atomic absorption spectroscopy (AAS). In Carter-Brugirard saliva both titanium and Ti-5Al-4V alloy present very stable passive films, long-term stability, "very good" resistance, low values of the open circuit potential gradients, which cannot generate local corrosion. In Tani&Zucchi artificial saliva, pitting corrosion and noble pitting protection potentials (which cannot be reached in oral cavity) were registered; titanium ion release is very low; surface roughness increase in time and in the presence of the fluoride ions, denoting some increase in the anodic activity.

Anti-CD25 treatment and FOXP3-positive regulatory T cells in heart transplantation.

The interleukin-2 receptor alpha chain (IL-2Ra, CD25) plays a major part in shaping the dynamics of T cell populations following immune activation, due to its role in T cell proliferation and survival. Strategies to blunt the effector responses in transplantation have been developed by devising pharmaceutical agents to block the IL-2 pathways. However, such strategies could adversely affect the CD25(+)FOXP3(+)T regulatory (T reg) populations which also rely on intereukin-2 signaling for survival. The present study shows that a cohort of heart allograft recipients treated with Daclizumab (a humanized anti-CD25 antibody) display FOXP3 expression patterns consistent with functional T regulatory cell populations. High levels of FOXP3 were observed to correlate with lower incidence of and recovery from acute rejection, as well as lower levels of anti-donor HLA antibody production. Therefore, T reg populations appear fully functional in patients treated with Daclizumab, even when 5 doses were administered. By comparison, patients treated with fewer doses or no Daclizumab had a higher incidence of acute rejection, antibody production and graft failure. Therefore, our data indicates that Daclizumab treatment does not interfere with the generation of regulatory T cells and has a beneficial effect on heart allograft survival.

Monitoring of titanium base alloys-biofluids interface.

Monitoring of the titanium, Ti-5Al-4V, Ti-6Al-4Fe implant materials--Ringer 1 and Ringer 2 solutions (of different pH values) interface for long term was studied in this work. In Ringer 1 solution (with high chloride ion content) all biomaterials present self-passivation. On Ti-6Al-4Fe alloy, the breakdown of the passive film was registered but at high pitting potential; pitting protection potential is very noble and can not be reached in human fluids. In Ringer 2 solution was obtained more electropositive corrosion potential values than in Ringer 1 solution; pitting corrosion of Ti-6Al-4Fe alloy is characterised by nobler breakdown and pitting protection potential values, therefore a better pitting corrosion resistance and tendency. Ion release increases in time, for the first 400-600 immersion hours and then tend to a constant level with very low values, non-dangerous for human body. All open circuit potentials oscillate around some electropositive values. The potential gradients calculated for extreme pH values have low values during 20,000 exposure hours and can not accelerate the corrosion. Atomic Force Microscopy images obtained after different exposure periods in Ringer 1 solution revealed that the roughness increased in time, suggesting a dynamic process at biomaterial-biofluid interface. X-ray Photoelectron spectra obtained after 2880 immersion hours in Ringer 2 solution show the existence of protective titanium dioxide TiO(2) and TiO and Ti(2)O(3) oxides both for titanium and Ti-5Al-4V alloy. Also, Al(2)O(3) oxide was detected.

[Surgical treatment in strabismus with a vertical component]. / Tratamentul chirurgical în strabismele cu componenta verticala.

In the paper we studied 87 patients with vertical or combined deviations treated in Eye Clinic from Cluj-Napoca between 1994-1998. The most patients show vertical deviation due to inferior muscle overaction (70 patients). 17 patients had a vertical deviation due to another causes (superior oblique paresis, III-nerve paresis and dissociated vertical deviations). We treated vertical deviation due to superior oblique muscle overaction only when was an important deviation in the primary position of gate. In superior muscle paresis we did a superior oblique muscle resection or weaken of inferior oblique muscle secondary overacting. In III-nerve paresis with contralateral superior rectus muscle overaction we did recession of this muscle. The results are favourable: the deviation disappear in the primary position of the gaze and decrease or disappear in the lateral gaze.

O.H.--a strong slow wave sleep inducing factor in tortoise (Emys orbicularis).

The paper would be a contribution to the very complex and not yet clarified field of neurochemistry of slow wave sleep (SWS). The study was performed on 30 tortoises (Emys orbicularis): 20 "donors" and 10 "receivers". The animals were equipped with chronic cannula inserted in the third ventricular space and electrodes for electrographic recording (EEG, EOG, EMG and ECG). The controls consisted in administration into the third ventricle of receivers of 30 microliters of saline or concentrated cerebro-spinal fluid (CSF) extracts from awake donors. The results were negative, i.e. the injected tortoises conserved their waking state indefinitely. The experiments were performed by introduction of 30 microliters of concentrated CSF extracts obtained from asleep donors into the third ventricular space of receivers. All the animals presented the behavioural and electrographic signs of the physiological SWS. The logical conclusion is that in the development of reptilian SWS, an endogenous SWS-inducing factor, which I called "O.H." (orbicularis hormone), was secreted by some hypnogenic structures and discharged in the CSF, with the consequences presented above.

Rotavirus infection in gastroenteritis in children.

The electron microscopic investigation of biological materials (faeces, intestinal mucous biopsies) from 19 children and sucklings with clinically diagnosed acute gastroenteritis evidenced the presence of some rotavirus-like viral particles in 31 percent of cases. The age of hospitalized subjects varied between 4 months and three years. There have been identified viral particles in the cytoplasm of enterocytes of the intestinal villi and in suspensions of the fecal materials.

Phylogenetic and general remarks on sleep.

Sleep is conceived as a unitary phenomenon in the sense that both its phases (slow-wave sleep and paradoxical sleep) start during the same phylogenetic steps, in reptiles, and their mechanisms, though distinct, are functionally coupled in the vertebrate series. Slow-wave sleep, essentially a restoring phenomenon, seems to be required by the specific and associative thalamocortical circuits and triggered off by the subcortical hypnogenic structures, by virtue of low-frequency tranquillizing afferent volleys received from sense organs. Paradoxical sleep is appreciated as a special hypnic behavior displayed against the slow-wave sleep tonic background, with an ancestral role of "guardian" of slow-wave sleep, and with present complex functions, many of which not yet elucidated.