Polyclonal Regulatory T Cell Therapy for Control of Inflammation in Kidney Transplants.

Early subclinical inflammation in kidney transplants is associated with later graft fibrosis and dysfunction. Regulatory T cells (Tregs) can reverse established inflammation in animal models. We conducted a pilot safety and feasibility trial of autologous Treg cell therapy in three kidney transplant recipients with subclinical inflammation noted on 6-month surveillance biopsies. Tregs were purified from peripheral blood and polyclonally expanded ex vivo using medium containing deuterated glucose to label the cells. All patients received a single infusion of ~320 × 106 (319, 321, and 363.8 × 106 ) expanded Tregs. Persistence of the infused Tregs was tracked. Graft inflammation was monitored with follow-up biopsies and urinary biomarkers. Nearly 1 × 109 (0.932, 0.956, 1.565 × 109 ) Tregs were successfully manufactured for each patient. There were no infusion reactions or serious therapy-related adverse events. The infused cells demonstrated patterns of persistence and stability similar to those observed in non-immunosuppressed subjects receiving the same dose of Tregs. Isolation and expansion of Tregs is feasible in kidney transplant patients on immunosuppression. Infusion of these cells was safe and well tolerated. Future trials will test the efficacy of polyclonal and donor alloantigen-reactive Tregs for the treatment of inflammation in kidney transplants.

Propofol versus midazolam for intubating preterm neonates: a randomized controlled trial.

OBJECTIVE: The ideal combination of premedication for neonatal tracheal intubation has not been established. The aim of this preliminary study was to compare the intubation conditions between propofol and midazolam as premedication for tracheal intubation in neonates. STUDY DESIGN: A double-blinded, randomized, controlled trial was performed, and 20 preterm neonates (28 to 34 week) underwent tracheal intubation following the use of remifentanil associated to either propofol (n = 10) or midazolam (n = 10). Intubation conditions were scored according to a four-point scale. RESULT: According to the main outcome measured (identification of a 50% difference in the intubation conditions), there were no differences regarding the number of attempts and the overall intubation conditions among the groups (P = 1.00). CONCLUSION: Both combinations of premedications have no differences regarding the quality of intubation, which could be of clinical interest. Besides midazolam, propofol could be a valid alternative as hypnotic for premedication for endotracheal intubation in neonates.

[Risk factors to periventricular-intraventricular hemorrhage in newborns weighing less than 2000g] / Fatores de risco para hemorragias peri-intraventriculares.

OBJECTIVE: To study the incidence and analyze risk factors to neonatal periventricular-intraventricular hemorrhage; to suggest a working protocol for diagnosis in newborns at risk.METHODS: This is a cohort prospective study including 120 out of 129 children weighing less than 2000g born from May 18 th, 1994 to May 17 th,1995 at the Hospital das Clínicas da UFMG. The study group comprised 39 newborns with the ultrasound diagnosis of periventricular-intraventricular hemorrhage; the control group comprised 81 newborns who although submitted to the same evaluation protocol did not show any echographic signs of hemorrhage. The ultrasound examinations were all done by the same researcher who was not aware of the clinical history or the neurologic and laboratory examinations. The hemorrhage was classified according to Papilés criteria: grade I (13%); grade II (7%); grade III (9%) and grade IV (3%).RESULTS: Low gestational age, low birth weight, masculine sex, vaginal delivery, and neonatal sepsis were significantly associated (p < 0.05) with periventricular-intraventricular hemorrhage in univariate analysis. Apgar score in the first or fifth minute and Battagliás and Lubchenkós classification for the weight in relation to gestational age were not predisposing factors to the hemorrhage. Low gestational age (p = 0.002), vaginal delivery (p = 0.037), and masculine sex (p = 0.016) kept statistical significance after multivariate adjustment. Birth weight may substitute for gestational age in the multivariate model because they are highly associated. The best cutoff point to screen for periventricular-intraventricular hemorrhage was 1750 g instead of the traditionally adopted point of 1500 g. CONCLUSIONS: The incidence of neonatal periventricular-intraventricular hemorrhage was similar to those reported by other studies. Low gestational age or low birth weight, vaginal delivery and masculine sex were the most important risk factors to the hemorrhage. The screening cutoff point of 1750 g seems to be more adequate than the commonly used birth weight of 1500 g.

[The unreliability of neurologic examination in the diagnosis of neonatal periventricular-intraventricular hemorrhage] / Ineficácia do exame clínico-neurológico no diagnóstico.

OBJECTIVE: To evaluate the efficacy of the clinical neurologic examination, hematocrit and glycemia in the diagnosis of periventricular-intraventricular hemorrhage in the newborn weighing less than 2000g considering the neurosonography as the gold standard.METHODS: This is a cohort prospective study from May 18th, 1994 to May 17th, 1995 carried out at the Hospital das Clinicas da UFMG. The study group comprised 38 newborns with the ultrasound diagnosis of periventricular-intraventricular hemorrhage; the control group comprised 81 newborns who although submitted to the same evaluation protocol did not show any echographic signs of hemorrhage. The ultrasound examinations were all done by the same researcher who was not aware of the clinical history or the neurologic and laboratory examinations.RESULTS: Clinical neurologic alterations, mainly generalized hypotonia, were found to be associated with hemorrhage (p = 0.009), but there was a confounding effect due to the gestational age of the newborn. The predictive values of a positive or negative test were only 45% and 79%, respectively, which is clearly unreliable for the diagnosis of the hemorrhage. Hematocrit and glycemia were not clinically relevant either.CONCLUSIONS: The clinical neurologic examination is not reliable to indicate periventricular-intraventricular hemorrhage in the newborn. Newborns at risk should be routinely screened by neurosonography.

Sindrome de Chilaidite na infancia (interposicao hepato-diafragmatica do colo) - Relato de cinco casos. / Chilaidite syndrome in infancy (hepatodiaphragmatic interposition of the colon) - Report of 5 cases

Os autores relatam cinco casos de interposicao do colo entre o figado e o diafragma (Sindrome de Chilaidite) em criancas. A distensao das alcas do colo por gas, devido a aerofagia e diarreia, foi um achado comum. O estudo radiologico do abdome em posicao vertical foi sempre necessario para o diagnostico definitivo. O diagnostico diferencial foi feito com pneumotorax, pneumoperitonio e abscesso subfrenico principalmente. O tratamento foi expectante em quatro pacientes e cirurgico em um