Role of IL-17A in enhancing liver fibrosis induced by TGF-β1 and IL-13 in Schistosoma mansoni infected mice

Schistosoma mansoni liver fibrosis is a complicated multicellular process involving numerous cytokines, chemokines, and growth factors. Transforming growth factor beta 1 (TGF-1) and interleukin (IL)-13 have been identified as critical pro-fibrotic mediators in many studies. IL-17A was linked to enhanced TGF- and IL-13-induced pathologies. This case-control study aimed to explore the effect of IL-17A on TGF- and IL-13-induced liver fibrosis during experimentally schistosomiasis mansoni infection. A total of 40 laboratory-bred female C57BL/6 mice were divided into four equal groups (G), G1 non-infected, G2 infected wild type (WT), G3 infected/anti-IL-17 monoclonal antibodies (mAb) and G4 treated mice. Mice were infected percutaneously with 40±5 cercariae per mouse. Neutralizing IL-17 mAb was administered to G3 intraperitoneally 3 weeks after infection and then every third day until 2 days before sacrification; mice of G4 were treated with a single dose of praziquantel. Serum levels of TGF-, IL-13, IL-17A, and proinflammatory cytokines were measured by ELISA. Liver granulomas were identified by hematoxylin-eosin stain and measured by an ocular micrometer. There was a significantly increased serum concentration of TGF-, IL-13, and IL-17A in infected WT mice (P<0.01), but praziquantel treatment reduced cytokine levels (P<0.03). Neutralization of IL-17A activity remarkably reduced serum concentrations of TGF- and IL-13 (P <0.03) resulting in improved liver functions and reduced granuloma size. Secretion of IL-IL-6 and TNF-were markedly enhanced by infection, however, mice that received anti-mouse IL-17 mAb displayed fewer inflammatory mediators (P<0.03). In conclusion, IL-17A might contribute to the progress of liver fibrosis by enhancing the profibrotic effect of TGF- and IL-13 in mice infected with S. mansoni.

Short-Term Anterior Segment Changes After Nd-YAG Laser Posterior Capsulotomy in Pseudophakic Eyes with Fuchs' Endothelial Dystrophy

Purpose

To describe the changes in the central corneal thickness (CCT), endothelial cell count (ECC), intraocular lens (IOL) position, and refractive error 1 and 3 months after Nd-YAG laser posterior capsulotomy (YAG-PC) for posterior capsular opacification (PCO) in pseudophakic eyes with Fuchs' endothelial cell dystrophy (FECD).

Design

Prospective case-control.

Participants

Fifty pseudophakic eyes of 50 patients with visually significant PCO (25 with healthy corneas, and 25 with FECD grade 1 and 2).

Methods

FECD was clinically graded, and only patients without clinically evident corneal edema were included in the study (grade 1 and 2). All patients received YAG-PC and were followed up after 1 and 3 months. Best-corrected visual acuity, refractive errors, ACD, CCT, and ECC were assessed and compared between the pre-laser values and that of the 2 follow-up visits.

Results

In both groups, BCVA showed significant improvement (P<0.05). Compared to healthy controls, a significant hyperopic shift was observed in the FECD eyes at the 2 follow-up visits (P=0.027, and 0.019). A significant backward movement of the IOL was observed in the FECD eyes in the 2 follow-up visits (P=0.043, and 0.02). There was a significant correlation between the hyperopic shift in the FECD eyes and the ACD deepening during the 1st month (R= -0.6, P=0.001) and 3rd month (R= -0.4, P=0.04). Significant drop in the ECC was noted in both groups but without significant increase in the CCT.

Conclusion

Compared to controls, a hyperopic shift and backward movement of the IOL were observed in the FECD eyes after YAG-PC. No significant corneal thickening was found in both groups despite the significant drop in the ECC. Future studies are required to confirm our results and monitor the long-term changes after YAG-PC in FECD.

Longitudinal analysis of subfoveal choroidal thickness after panretinal laser photocoagulation in diabetic retinopathy using swept-source optical coherence tomography

Purpose: To describe the central three-dimensional (3D) thickness profile of the macula (CMT) and the subfoveal choroidal region (SFCT) in diabetic retinopathy (DR) following panretinal laser photocoagulation (PRP) using swept-source optical coherence tomography (SS-OCT). Methods: A prospective observational study including 17 eyes with proliferative DR (PDR) and 27 eyes with severe nonproliferative DR (sNPDR)] for whom PRP was done. All subjects received SS-OCT imaging before and 3 months after PRP (POM#3). SFCT and CMT changes were analysed at both visits. Intraclass Correlation Coefficients (ICC) and Coefficients of Variation (COV) were used to test the accuracy of thickness data. Results: SFCT has thinned from 233 ± 54 µm before PRP treatment to 216 ± 51 µm 3 months later (p < 0.001). Likewise, CMT declined at POM#3 as compared to pre-PRP status (p<0.001). SFCT was thinner in PDR before and at POM#3 (p<0.05) than sNPDR; whereas, no significant difference was observed in CMT between both groups in the two visits. No significant changes were found between groups in SFCT and CMT at POM#3. Regarding reliability, ICCSFCT=0.98 and ICCCMT=0.99. The COVs for CMT and SFCT were 5.03% and 5.91%, respectively. Conclusion: The mean SFCT and CMT decreased 3 months after PRP. We also reported reliability of SFCT measurements in DR using SS-OCT. Abbreviations: SS = Swept-Source, TD = time domain, SD = spectral domain, FD = Fourier-domain, 3D = three-dimensional, 2D = two-dimensional.

Raising awareness about driving safety in an ambulance service

Background: Worldwide ambulances are regularly involved in accidents as staff may not anticipate other drivers' actions, suffer from fatigue, or overestimate their driving privileges. An ambulance driving safety campaign started in June 2015 targeting some 935 registered HMCAS drivers. We aim to determine if our approach is effective in changing behaviours and believes, and reducing the number of accidents involving HMCAS vehicles.

Methods: This study was ethically approved as a quality improvement project and is still ongoing. The campaign made use of ambulance dashboard stickers and posters at ambulance stations' exits with respectively 4 and 6 key messages covering frequent issues resulting in collisions. An official circular also informed staff of the campaign. A month later a survey started to be distributed to staff.

Results: In two month, 189 anonymous online or paper questionnaires were fully completed. 69.2% of respondents had an HMCAS driving qualification (13.7% of qualified HMCAS drivers). On average, they reported having been involved in 0.90 accident requiring vehicle repair. Using a 5-point Likert scale (1 = very unsafe, 5 = very safe) respondents rated themselves as being safe drivers (4.24/5) and underestimated the monthly number of accidents with HMCAS vehicles to be 15.3 (Actual 21.2/month registered in 2014). Other data about self-reported driving behaviour and comparison between their perception about accidents and real data was analysed along with visibility and memorisation of the key messages.

Conclusions: Staff underestimated the number of accidents. Campaign material has been noticed by most staff except for the stickers inside the ambulances driving compartment which is not accessed by 23.2% of the respondents. Staff who saw the posters and stickers remembered nearly half of the information it contained. Although a significant decline accidents occurrences was noticed in September, the impact of the campaign cannot yet be reliably assessed over this relatively short period of time.

Steroid and azathioprine versus steroid, cyclosporine, and azathioprine therapies in primary haplo-identical living donor kidney transplantation: twenty-year experience

INTRODUCTION

Achievements in short-term graft survival since the introduction of cyclosporine has not been matched by improvement in long-term graft function, and chronic allograft nephropathy remains the second commonest cause of graft attrition over time. We aimed to evaluate the long-term results of conventional immunosuppression by steroid and azathioprine in comparison with cyclosporine-based triple therapy in living donor kidney transplants.

MATERIALS AND METHODS

We evaluated the long-term follow-up data of 369 living related kidney transplant recipients that were on prednisolone-azathioprine immunosuppressive therapy (group 1) or triple therapy by prednisolone, cyclosporine, and azathioprine (group 2). All recipients were followed-up for more than 10 years (mean, 240 +/- 12 months). Comparative analyses included patient and graft survival rates, condition at last follow-up, graft rejection, and graft function.

RESULTS

There were 130 patients in group 1 and 239 in group 2. The overall frequency of acute rejection episodes was not significantly different between the two groups. However, the proportion of patients with chronic allograft nephropathy was significantly higher in group 2 (21% versus 35%, P = .001). Graft survival rates were 85.3% versus 92.4% at 1 year, 69.9% versus 71.9% at 5 years, and 52.5% versus 50.8% at 10 years in groups 1 and 2, respectively (P = .03). The two groups were comparable regarding posttransplant malignancies, diabetes mellitus, serious bacterial infections, and hepatic diseases. However, hypertensive patients were significantly more frequent in group 2.

CONCLUSIONS

Chronic allograft nephropathy was significantly higher in patients receiving cyclosporine, possibly due to the risk of drug-induced nephrotoxicity, glomerular disease recurrence, and hypertension. Nowadays, it is possible to achieve excellent calcineurin inhibitors-free regimen using newer maintenance immunosuppressive agents.

[Cerebro-umbilical ratio--high fidelity indicator in ante-partum fetal disorder]

In this study, we have aimed to point out the reliability and importance of the cerebro-umbilical ratio obtained by Doppler exploration, in comparison with classical investigations, as well as to verify the diagnosis of ante-partum foetal disorder through the amount of the Apgar score at the fetuses having been monitored.