Antibody desensitization therapy in highly sensitized lung transplant candidates.

As HLAs antibody detection technology has evolved, there is now detailed HLA antibody information available on prospective transplant recipients. Determining single antigen antibody specificity allows for a calculated panel reactive antibodies (cPRA) value, providing an estimate of the effective donor pool. For broadly sensitized lung transplant candidates (cPRA ≥ 80%), our center adopted a pretransplant multi-modal desensitization protocol in an effort to decrease the cPRA and expand the donor pool. This desensitization protocol included plasmapheresis, solumedrol, bortezomib and rituximab given in combination over 19 days followed by intravenous immunoglobulin. Eight of 18 candidates completed therapy with the primary reasons for early discontinuation being transplant (by avoiding unacceptable antigens) or thrombocytopenia. In a mixed-model analysis, there were no significant changes in PRA or cPRA changes over time with the protocol. A sub-analysis of the median fluorescence intensity (MFI) change indicated a small decline that was significant in antibodies with MFI 5000-10,000. Nine of 18 candidates subsequently had a transplant. Posttransplant survival in these nine recipients was comparable to other pretransplant-sensitized recipients who did not receive therapy. In summary, an aggressive multi-modal desensitization protocol does not significantly reduce pretransplant HLA antibodies in a broadly sensitized lung transplant candidate cohort.

Reconfigurable photonic crystal waveguides created by selective liquid infiltration.

We experimentally demonstrate reconfigurable photonic crystal waveguides created directly by infiltrating high refractive index (n≈2.01) liquids into selected air holes of a two-dimensional hexagonal periodic lattice in silicon. The resulting effective index contrast is large enough that a single row of infiltrated holes enables light propagation at near-infrared wavelengths. We include a detailed comparison between modeling and experimental results of single line defect waveguides and show how our infiltration procedure is reversible and repeatable. We achieve infiltration accuracy down to the single air hole level and demonstrate control on the volume of liquid infused into the holes by simply changing the infiltration velocity. This method is promising for achieving a wide range of targeted optical functionalities on a "blank" photonic crystal membrane that can be reconfigured on demand.

Slow-light dispersion engineering of photonic crystal waveguides using selective microfluidic infiltration.

We experimentally demonstrate dispersion engineering of slow light photonic crystal (PhC) waveguides using selective infiltration of the first two rows of air holes with high index ionic liquids. The infiltrated PhC waveguide exhibits a dispersion window of 3 nm with a nearly constant group velocity of ~c/80 that depends on the liquid physical properties. We investigate how the effective refractive index changes in time due to the dynamics of the liquids in the holes. This demonstration highlights the versatility, flexibility, and tunability offered by optofluidics in PhC circuits.

Liquid crystal dynamics in a photonic crystal cavity created by selective microfluidic infiltration.

A microfluidic double heterostructure cavity is created in a silicon planar photonic crystal waveguide by selective infiltration of a liquid crystal. The spectral evolution of the cavity resonances probed by evanescent coupling reveals that the liquid crystal evaporates, even at room temperature, despite its relatively low vapor pressure of 5 × 10(-3) Pa. We explore the infiltration and evaporation dynamics of the liquid crystal within the cavity using a Fabry-Perot model that accounts for the joint effects of liquid volume reduction and cavity length variation due to liquid evaporation. While discussing how the pattern of the infiltrated liquid can be optimized to restrict evaporation, we find that the experimental behavior is consistent with basic microfluidic relations considering the small volumes of liquids and large surface areas present in our structure.

Thermal effusivity measurement of conventional and organic coffee oils via photopyroelectric technique.

In this work, oil samples extracted from organic and conventional coffee beans were studied. A fatty acids profile analysis was done using gas chromatography and physicochemical analysis of density and acidity index to verify the oil purity. Additionally, Mid-Infrared Fourier Transform Photoacoustic Spectroscopy (FTIR-PAS) aided by Principal Component Analysis (PCA) was used to identify differences between the intensities of the absorption bands related to functional groups. Thermal effusivity values between 592±3 and 610±4Ws1/2m-2K-1 were measured using the photopyroelectric technique in a front detection configuration. The acidity index was between 1.11 and 1.27% and the density changed between 0.921 and 0.94g/mL. These variables, as well as the extraction yield between 12,6 and 14,4%, showed a similar behavior than that observed for the thermal effusivity, demonstrating that this parameter can be used as a criterion for discrimination between oil samples extracted from organic and conventional coffee beans.

Differential characteristics of AIDS patients with a history of imprisonment.

BACKGROUND: AIDS is among the leading causes of death in prisons, but there is little information about AIDS patients with a history of imprisonment. METHODS: AIDS patients diagnosed in Barcelona between 1988 and 1993 were studied. Those with prison histories were compared to those without, with respect to epidemiological variables, including survival analysis. RESULTS: 28.5% of 2336 AIDS patients, 49.4% of intravenous drug users (IVDU) and only 2.6% of homosexuals who were not IVDU had a prison history. Those with prison histories, compared to those without, were younger (median age of 30.6 versus 36.4, P < 0.0001), more often IVDU than homosexuals (87.8% versus 35.8%, OR = 36.9, 95% CI: 22.6-60.8, P < 0.0001), and diagnosed with AIDS because of extrapulmonary tuberculosis (32.0% versus 14.7%, P < 0.001). Among IVDU, those with prison histories were more frequently males (OR: 2.2; 95% CI: 1.6-2.9), lived in the poorest district of Barcelona more frequently than in the richest district (OR: 6.6; 95% CI: 3.4-12.9) and presented with extra-pulmonary tuberculosis more frequently than Pneumocystis carinii pneumonia (OR: 1.7; 95% CI: 1.2-2.4). Longer survival in the prison group did not persist when adjusted for age and AIDS-defining disease. Those with prison histories who presented with AIDS with only extrapulmonary tuberculosis had better probability of survival than those who presented only with P. carinii pneumonia (P < 0.001). CONCLUSIONS: AIDS patients in Barcelona with prison histories tended to be younger, more likely to be IVDU, and to present with extrapulmonary tuberculosis as an AIDS-defining illness than other patient groups. Better survival appears to be related to age and AIDS-defining illnesses in the prison group. The fact that half the IVDU AIDS cases had prison histories has important implications for the care and prevention of HIV, tuberculosis, and drug abuse in comparable prison settings.

Radiation-induced lung injury in vivo: expression of transforming growth factor-beta precedes fibrosis.

Cytokine release from irradiated cells has been postulated to start soon after irradiation preceding detectable clinical and pathological manifestation of lung injury. The expression of transforming growth factor beta (TGF beta), a fibrogenic and radiation-inducible cytokine, was studied from 1-16 weeks after the 15 and 30 Gray (Gy) of thoracic irradiation to rats. Thoracic irradiation caused an increase in TGF beta protein in bronchoalveolar lavage (BAL) fluid peaking at 3-6 weeks as compared to sham-irradiated control rats. Steady state TGF beta mRNA expression as shown by whole lung northern blot assay paralleled the TGF beta protein expression in BAL fluid. The peak of TGF beta protein increase in BAL fluid between 3 and 6 weeks coincided with the initial influx of inflammatory cells in BAL fluid, but preceded histologically discernable pulmonary fibrosis that was not apparent until 8-10 weeks after irradiation. In conclusion. TGF beta and mRNA and protein upregulation preceded the radiation-induced pulmonary fibrosis, suggesting a pathogenetic role in the development of radiation fibrosis.

The intratracheal administration of endotoxin: X. Dexamethasone downregulates neutrophil emigration and cytokine expression in vivo.

Intratracheal instillation of endotoxin (LPS) causes acute pulmonary inflammation characterized by the accumulation of plasma proteins and leukocytes within the pulmonary airways. The synthetic glucocorticoid dexamethasone 1) inhibits the LPS-initiated vascular leak of plasma proteins into the airspace, 2) inhibits the LPS-initiated emigration of neutrophils and lymphocytes into the airspace in a dose-dependent fashion, and 3) inhibits LPS-initiated mRNA and/or bronchoalveolar lavage protein expression of cytokines (TNF, IL-1 and IL-6) and chemokines (MIP-1 alpha, MIP-2 and MCP-1). In conclusion, dexamethasone inhibits both the vascular and cellular aspects of acute inflammation by downregulation of a broad spectrum of inflammatory cytokines and chemokines.

Pneumocystis carinii pneumonia versus wasting syndrome among AIDS cases in Puerto Rico: a survival analysis.

OBJECTIVE: To compare mortality of wasting syndrome (WS) versus Pneumocystis carinii pneumonia (PCP) in AIDS patients reported in Puerto Rico after controlling for gender, age, and CD4 levels. METHODS: AIDS patients for which a diagnosis of WS (n = 1,180) or PCP (n = 765), who were reported to the AIDS Surveillance System of Puerto Rico between 1989 and 1992, were used to analyze the mortality risk among these diagnoses using a Cox's proportional hazard regression model. RESULTS: Cox model showed that WS patients had a 14% to 33% reduction in mortality risk compared with PCP patients after adjusting for gender and age (95% confidence level). Mortality risks for males were 18% (95% CI: 1%, 39%) higher than females risk after adjusting for AIDS defining condition and age. It was shown that a decrease in 100 CD4 cells increased the mortality by 37% (95% CI: 16%, 62%) after adjusting for AIDS defining conditions, gender, and age.

[Profile of the patient who drops out of neuropediatric follow-up]. / Perfil del paciente que abandona el seguimiento neuropediátrico.

INTRODUCTION: Patients who drop out of programmed follow-up cause adverse effects to both themselves and the running of the medical. OBJECTIVE: To obtain information which would permit us to modify guidelines for medical care in cases with particular diagnoses, so as to avoid interrupting follow-up. PATIENTS AND METHODS: We selected all the patients who attended during 1995, and on 31 December 1995 had not been discharged or died. We considered a patient to have dropped out of follow-up when there was failure to attend the centre during two consecutive years without a justifiable reason. Logistic regression analysis was used to determine the profile of the patients who dropped out of follow-up. RESULTS: Of the patients attended during one year and whose treatment should have been continued, 16% dropped out; 70% of those who dropped out of their follow-up treatment were somewhat older than the rest and came in particular from two of the five health districts of the province. They had tics, tension headaches and migraine. Only three independent factors are associated with dropping out: absence of complementary tests, which is favorable, and epilepsy or previous long-term follow-up which is unfavorable. CONCLUSION: Reduction in the programmed follow-up of patients with conditions which do not require complementary tests may reduce the drop out rate and improve the functioning of the Neuropaediatric Clinic.

[Bacterial contamination of needles after intravitreal injection in Paraguay]. / Bakterielle Kontamination von Injektionskanülen nach intravitrealer operativer Medikamenteneingabe in Paraguay.

PURPOSE: The study was designed to prospectively evaluate the bacterial contamination of needles used for intravitreal injection during surgery. MATERIAL AND METHODS: Between December 2007 and December 2010, 549 eyes of 413 patients were treated with intravitreal injections of 1.25 mg bevacizumab. Of the patients 322 received a single injection and 91 multiple injections. Preoperatively the periorbital skin of all patients was treated with 10% povidone iodine (PVI) and the conjunctival sac was irrigated with 1% PVI. No pre-injection antibiotics were administered. Immediately after the injection the needles were rinsed 3 times in thioglycolate broth which was then cultured at 37°C for 5 days. As a negative control 73 sterile unused needles were treated in the same way. RESULTS: Out of the 549 needle points tested 8 (1,45%) were found to be contaminated after intravitreal injections. The isolated bacteria were coagulase negative Staphylococcus (n = 7), Propionibacterium acnes (n = 1) and Klebsiella pneumoniae (n = 1) (co-contamination in one case). CONCLUSION: Contamination of needles is minimal after prophylactic povidone iodine irrigation before intravitreal injections. Therefore, this prophylaxis technique is recommended before intravitreal injections in order to prevent postoperative infections.

Luxación carpometacarpiana: presentación de dos casos clínicos / Carpometacarpal dislocations: presentation of two clinical cases

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Dental arch size, biting force, bizygomatic width and face height in three Colombian ethnic groups / Tamaño del arco dental, fuerza de mordida, anchura bizigomatica y altura facial en tres grupos étnicos colombianos

The objective of this study was to describe transversal dimensions of the dental arches, bite force and facial index in three ethnic groups representative of Colombia. The sample size included 197 adolescents, 12 to 14 year old, 33% mestizo, 35% of African ancestry and 32% Amazon Indian; 50.3% male and 49.7% female. The comparative analysis to determine differences between ethnic groups was made by the Kruskal Wallis test and then the Principal Component Analysis was used to establish the pattern of measurements identifying ethnic characteristics. All measurements showed statistically significant differences among ethnic groups except facial height (p=0.157). It was evidenced that Amazon indian have a higher bite force (p <0.05) than the other twoethnic groups. Regarding dental arch transversal dimensions, Amazon Indian have a higher arch transversal width with a length average of 44.1 mm. This length was greater than mestizo adolescents (M=36.7 mm) and Afroamerican (M=38.3 mm). In conclusion, the amazon Ticuna Indian ethnia has a significantly higher bite force, higher dental arch transversal width and higher bizygomatic width than the other two ethnic groups considered.

El objetivo fue describir las dimensiones transversales de los arcos dentales, la fuerza de mordida y el índice facial en tres grupos étnicos de Colombia. El tamaño de la muestra fue de 197 adolescentes, de 12 a 14 años; 33% mestizos, 35% de ascendencia africana y 32% indio amazónico; 50,3% hombres y 49,7% mujeres. El análisis comparativo para determinar las diferencias entre los grupos étnicos se hizo mediante la prueba de Kruskal Wallis y luego el Componente Principal de Análisis se utilizó para establecer el patrón de las mediciones para identificar las características étnicas. Todas las mediciones mostraron diferencias estadísticamente significativas entre los grupos étnicos, excepto la altura facial (p=0,157). Se evidencia que el indio amazónico tiene una mayor fuerza de mordida (p<0,05) que los otros dos grupos étnicos. En cuanto a las dimensiones transversales del arco dental, el indio amazónico se caracterizó por tener un mayor ancho, con una longitud media de 44,1 mm. Esta longitud es mayor que en los adolescentes mestizos (M=36,7 mm) y afroamericanos (M=38,3 mm). En conclusión, la etnia india amazónica Ticuna tiene una fuerza de mordida significativamente mayor, así como mayor ancho del arco dental transversal y ancho bicigomático que los otros dos grupos étnicos considerados.

[Incidence of suicide in Catalan prisons: a descriptive and comparative study]. / Incidencia del suicidio en las prisiones de Cataluña: análisis descriptivo y comparado.

INTRODUCTION: The prevention of suicide in prison is one of the most important challenges facing prison health care services in developed countries. The aim of this study is to analyse the incidence of suicide in Catalan prisons and accumulate data about a number of variables that have also been studied in other prison populations. MATERIALS AND METHODS: Retrospective study of suicide cases in prisons administrated by the Catalan Regional Government (Generalitat de Catalunya) between 1990 and 2005 (n=65). Comparative study of incidence with European countries using published data. RESULTS: The average annual incidence for the period is of 59/100.000, multiplying by eight the level corresponding to the general population. CONCLUSIONS: Entry into prison is the most important event trigger for suicide. Other data open the way to new research.

Analysis of dental arch dimensions in three Colombian ethnic groups / Análisis de las dimensiones del arco dental en tres grupos étnicos colombianos

The purpose of this study was to compare dental arch transversal and anteroposterior dimensions in three ethnic groups from Colombia. A digital caliper was used to take 16 transversal and two sagittal measurements, 9 for the upper jaw and 9 for the lower jaw. The sagittal measure determining arch length was drawn from a mesial line traced from first right permanent molar to first left permanent molar, and a perpendicular line from the point of contact between central incisive teeth, both for the upper and lower jaw. The dimensions of upper dental arch in the three ethnic groups showed differences in intercanine distance, as well as between premolar and between molar teeth. The same differences were found for lower dental arches. The populations evaluated show distinctive characteristics in dental arch dimensions, thus the mestizo population had narrow arches while the natives had wide arches.

El propósito de éste estudio fue comparar las dimensiones transversal y anteroposterior del arco dental en tres grupos étnicos de Colombia. Se utilizó un calibrador digital para tomar 16 medidas transversales y dos sagitales, 9 maxilares y 9 mandibulares. La medida sagital para determinar la longitud del arco se elaboró a partir de una línea trazada desde mesial primera molar derecho permanente al primer molar izquierdo permanente, y una línea perpendicular desde el punto de contacto entre los incisivos centrales, tanto para el maxilar y mandíbula. Las dimensiones del arco dental maxilar en los tres grupos étnicos mostraron diferencias en la distancia intercanina, así como entre premolares y molares. Las mismas diferencias se encontraron en la mandíbula. Las poblaciones evaluadas presentan características distintivas en las dimensiones del arco dental, por lo que la población mestiza tuvo arcos estrechos, mientras que los nativos tuvieron arcos anchos.