Discontinuation of calcineurin inhibitors treatment allows the development of FOXP3+ regulatory T-cells in patients after kidney transplantation

This study investigated specific gene expression profiles in patients with donor-specific cytotoxic-hyporesponsiveness, reflected by cytotoxic T-lymphocyte precursor frequency (CTLpf). The effect of calcineurin inhibitor (CNI) withdrawal was studied on markers for cytotoxicity (perforin, granzyme B), apoptosis (Fas,FasL), Th1 and Th2 cytokines (IL-2, IL-10), Th1 and Th2 transcription factors (T-bet, GATA 3), Th17 transcription factor and cytokine (RORγt, IL-17), and for immune regulation/activation (CD25, FOXP3). Peripheral blood samples from renal allograft recipients (n = 18) more than two yr after transplantation with stable renal function were analyzed before and four months after CNI withdrawal. Additionally, systolic and diastolic blood pressure, cholesterol, serum creatinine and proteinuria were evaluated, and no significant differences were measured before and after CNI withdrawal. However, CNIs' discontinuation influenced peripheral gene expression profiles. After CNI withdrawal, the mRNA expression of Granzyme B, Perforin, Fas, FasL, T-bet, GATA3 and CD25 were significantly lower than during CNI treatment. After CNI discontinuation, donor-specific CTLpf decreased, while FOXP3 expression discriminated between detectable and non-detectable donor-specific cytolysis reactivity; FOXP3 transcript values were highest in absence of donor-specific cytotoxicity (p < 0.01). Our study shows CNI withdrawal in stable kidney transplant recipients two yr after transplantation is safe. Moreover, discontinuation of CNIs' treatment allows FOXP3+ regulatory T-cells development, resulting in a significant decrease of anti-donor immune reactivity.

The Belgian experience with intravenous thrombolysis for acute ischemic stroke

PURPOSE

We report the Belgian results of the Safe Implementation of Thrombolysis in Stroke - International Stroke Thrombolysis Register (SITS-ISTR). This prospective observational register evaluates the safety and efficacy of intravenous thrombolysis with rtPA (recombinant tissue Plasminogen Activator) for ischemic stroke in routine clinical practice.

METHODS

We compared the baseline characteristics, treatment delay, rate of symptomatic intracerebral hemorrhage and functional outcome at 90 days after treatment between patients enrolled in centres in Belgium and the non-Belgian SITS-registry population. We performed a multivariate analysis to adjust for differences in demographic and baseline characteristics.

RESULTS

743 patients were enrolled in 42 centers in Belgium between December 2002 and December 2007. These patients were older, had more severe stroke were more frequently female and more frequently had hyperlipidemia and atrial fibrillation. The median stroke onset-to-treatment delay was 140 min vs. 145 min. More patients died and were disabled 3 months after the stroke. A slight, non-significant, increase of symptomatic intracerebral hemorrhage (SICH) as per SITS protocol was observed (2.4 vs. 1.6%, p = 0.15). After adjustment for differences in baseline characteristics, functional independence (mRS < or = 2) at 3 months (OR 0.95, 95% CI 0.86-1.05, p = 0.31) was not different from non-Belgian patients, nor was the rate of SICH. However mortality at 3 months in Belgian patients was slightly higher (OR 1.15, 95% CI 1.02-1.29, p = 0.02).

CONCLUSION

Intravenous thrombolysis for ischemic stroke is safe and effective in the routine clinical use in Belgium. The higher mortality we observed is not related to a higher rate of SICH.

Organisation of inhospital acute stroke care and minimum criteria for stroke care units. Recommendations of the Belgian Stroke Council

There is ample evidence from randomized trials that for patients with stroke, stroke unit care is superior to care in general medical or neurological wards. This evidence, which has been adopted by international guidelines has to be implemented into daily stroke care. This consensus document prepared by the Belgian Stroke Council provides a set of minimum criteria to meet international standards for stroke care. It is intended to provide help in the creation of stroke units in centers who do not currently have one and to provide a benchmark for centres already having organised stroke care.

The relation between non-occupational physical activity and years lived with and without disability

OBJECTIVES

The effects of non-occupational physical activity were assessed on the number of years lived with and without disability between age 50 and 80 years.

METHODS

Using the GLOBE study and the Longitudinal Study of Aging, multi-state life tables were constructed yielding the number of years with and without disability between age 50 and 80 years. To obtain life tables by level of physical activity (low, moderate, high), hazard ratios were derived for different physical activity levels per transition (non-disabled to disabled, non-disabled to death, disabled to non-disabled, disabled to death) adjusted for age, sex and confounders.

RESULTS

Moderate, compared to low non-occupational physical activity reduced incidence of disability (HR 0.66, 95% CI 0.51 to 0.86), increased recovery (HR 1.95, 95% CI 1.32 to 2.87), and represents a gain of disability-free years and a loss of years with disability (male 3.1 and 1.2; female 4.0 and 2.8 years). Performing high levels of non-occupational physical activity further reduced incidence, and showed a higher gain in disability-free years (male 4.1; female 4.7), but a similar reduction in years with disability.

CONCLUSION

Among 50-80-year-olds promoting physical activity is a fundamental factor to achieve healthy ageing.

Lifetime risk and projected population prevalence of diabetes

AIMS/HYPOTHESIS

With incidence rates for diabetes increasing rapidly worldwide, estimates of the magnitude of the impact on population health are required. We aimed to estimate the lifetime risk of diabetes, the number of years lived free of, and the number of years lived with diabetes for the Australian adult population from the year 2000, and to project prevalence of diabetes to the year 2025.

METHODS

Multi-state life-tables were constructed to simulate the progress of a cohort of 25-year-old Australians. National mortality rates were combined with incidence rates of diabetes and the RR of mortality in people with diabetes derived from the Australian Diabetes, Obesity and Lifestyle study (a national, population-based study of 11,247 adults aged >or=25 years).

RESULTS

If the rates of mortality and diabetes incidence observed over the period 2000-2005 continue, 38.0% (95% uncertainty interval 36.6-38.9) of 25-year-olds would be expected to develop diabetes at some time throughout their life. On average, a 25-year-old Australian will live a further 56 years, 48 of these free of diabetes. On average, a 45-year-old person with diabetes can expect to live 6 years less than a person free of diabetes. The prevalence of diabetes is projected to rise from 7.6% in 2000 to 11.4% by 2025.

CONCLUSIONS/INTERPRETATION

If we maintain current diabetes incidence rates, more than a third of individuals will develop diabetes within their lifetime and in Australia there will an additional 1 million cases of diabetes by the year 2025.

Polymorphisms in the low-density lipoprotein receptor-related protein 5 (LRP5) gene are associated with peak bone mass in non-sedentary men: results from the Odense androgen study

PURPOSE

To investigate the impact of the Ala1330Val (rs3736228, exon 18) and Val667Met (rs4988321, exon 9) polymorphisms of the low-density lipoprotein receptor-related protein 5 (LRP5) gene on peak bone mass in young men.

METHODS

The Odense Androgen Study (OAS) is a population-based study comprising 783 Caucasian men aged 20-30 years. Genotyping was performed using real-time polymerase chain reaction (PCR) or fluorescence polarization. Bone mineral density (BMD) measurements were performed using dual-energy X-ray absorptiometry.

RESULTS

The CC, CT, and TT genotypes in Ala1330Val were found in 75.6%, 21.8%, and 2.6% of the participants, respectively. Similarly, the GG, GA, and AA genotypes of Val667Met were found in 89.7%, 9.8%, and 0.5%, respectively. For the Ala1330Val polymorphism, no significant differences between the genotypes were found regarding BMD in the overall study population. However, when analysis was restricted to non-sedentary men (n = 589), a significant association between the number of T-alleles and BMD in the spine and whole body were found. Each copy of the T-allele changed the Z-score of the spine by (median and 95% confidence interval) -0.21 [95% CI: -0.40; -0.03] (p < 0.02). Analysis suggested an association between the AA genotype in the Val667Met polymorphism and increased body height and decreased BMD of the femoral neck; however, no significant gene-dose effect of the A-allele could be demonstrated in the whole population. When the analysis was restricted to non-sedentary subjects, however, each number of A-alleles was associated with a change in Z-score of -0.26 [95% CI: -0.51; -0.01] (p = 0.04). No further significant results emerged with haplotype analysis.

CONCLUSION

The Ala1330Val and Val667Met polymorphisms in the LRP5 gene are significantly associated with peak bone mass in physically active men.

Hyperacute intraventricular hemorrhage: detection and characterization, a comparison between 5 MRI sequences

We aimed to evaluate the diagnostic accuracy of MRI for detecting early intraventricular hemorrhage (IVH) (within 6 hours after hemorrhage and to describe the MR features that allow diagnosis. For this purpose, MR data of 22 patients with hyperacute intraparenchymal hemorrhage were independently rated as negative or positive for IVH by two observers, in a blind, retrospective study taking computed tomography (CT) as providing the correct diagnosis of IVH. Sensitivity, specificity, intra- and interobserver agreement were assessed. On FSE-FLAIR, EPI-GRE-T2* and DWI images, all cases of IVH were correctly rated (sensitivity of 100%). For b0 EPI images, obtained from diffusion-weighted echo planar sequences, one case of IVH was missed by one reader (sensitivity of 88%). For T1 images, one patient was incorrectly rated negative for IVH by the two readers (sensitivity of 90%). Three forms of IVH were described, including clotted hematoma, layered hemorrhage and red blood cell deposit. When CT images were obtained within a time span of less than 3 hours after MRI, volume was assessed. Volume of hemorrhage on CT correlated best with DWI images but was underestimated on EPI-GRE T2* images.

Ischemic Cerebral Lesions after Carotid Surgery and Carotid Stenting

OBJECTIVES

To evaluate the risk of new ischemic cerebral lesions after carotid endarterectomy and carotid stenting and their clinical significance.

METHODS

Prospective and non-randomized single-center study including 121 patients with symptomatic and asymptomatic significant carotid stenosis. 60 patients were treated by surgery and 61 treated by carotid stenting. Stenting was restricted to patients at high risk for surgery. Neurological examination and Diffusion-Weighted Cerebral Magnetic Resonance (DW-MRI) were performed before and after each procedure. The presence, location and volume of new cerebral lesions were determined.

RESULTS

In the surgical group, 2 minor strokes were registered. DW-MRI showed new lesions in 7 patients (11.6%). All except one were located in the ipsilateral anterior circulation. In the stenting group, 1 minor stroke and 1 occurrence of quadranopsia were registered. DW-MRI showed new lesions in 26 patients (42.6%). 10 of these patients (38.4%) had lesions in the contralateral hemisphere and 7 patients (26.9%) in the posterior circulation. Deficits are found in patients with higher lesion volumes.

CONCLUSIONS

Cerebral ischemic lesions are significantly (p<0.0001) more frequent after carotid stenting than after endarterectomy. The majority of these lesions have no immediate clinical implication, but more specific tests are needed to evaluate their exact significance.

Evolution of Vocal Fold Nodules from Childhood to Adolescence

SUMMARY

Bilateral (quasi) symmetrical lesions of the anterior third of the vocal folds, commonly called vocal fold nodules (VFNs) are the most frequent vocal fold lesions in childhood caused by vocal abuse and hyperfunction. This study evaluates their long-term genesis with or without surgery and voice therapy. A group of 91 postmutational adolescents (mean age, 16 years), in whom VFNs were diagnosed in childhood, were questioned to analyze the evolution of their complaints. Thirty four of them could be clinically reexamined by means of the European Laryngological Society-protocol, including a complete laryngological investigation and voice assessment. A total of 21% of the questioned group (n=91) had voice complaints persisting into postpubescence with a statistically significant difference (P <or= 0.001) between boys (8%) and girls (37%). VFNs were still present in 47% of the girls and 7% of the boys of the clinically evaluated group (n=34). Analysis of the data before and after puberty shows that the variables gender, allergy, and degree of dysphonia ("G") in childhood enable a fairly correct prediction of persisting voice complaints in adolescence (sensitivity of 89% and specificity of 67%). The results of this study show a clearly different evolution for both sexes, with significant higher long-term risks for dysphonic girls with allergy.