First Study of the

New astronomical observations point to a nucleosynthesis picture that goes beyond what was accepted until recently. The intermediate "i" process was proposed as a plausible scenario to explain some of the unusual abundance patterns observed in metal-poor stars. The most important nuclear physics properties entering i-process calculations are the neutron-capture cross sections and they are almost exclusively not known experimentally. Here we provide the first experimental constraints on the ^{139}Ba(n,γ)^{140}Ba reaction rate, which is the dominant source of uncertainty for the production of lanthanum, a key indicator of i-process conditions. This is an important step towards identifying the exact astrophysical site of stars carrying the i-process signature.

Proactive psychological and psychiatric support of patients with chronic non-communicable diseases in a randomised trial: a Ukrainian experience.

Background: Presently, approaches for the early treatment of pathological anxiety in patients with chronic non-communicable diseases are lacking, thus delaying the initiation of symptom management at the early onset of the illness. Proactive psychological and psychiatric support, to alleviate subclinical symptoms of anxiety and to improve the quality of life in patients with chronic non-communicable diseases, is a promising candidate for the role of such therapy. Aims: To investigate and determine the effectiveness of proactive psychological and psychiatric support for alleviating subclinical symptoms of anxiety and improving quality of life, in patients with chronic non-communicable diseases. Methods: The study design was a monocentric randomised controlled trial with parallel groups. The study, involving 193 inpatients with chronic non-communicable diseases, complied with the ethical and deontological norms in accordance with the principles set out in the Declaration of Helsinki. Instruments used in the study included the Hamilton Anxiety Scale (HAM-A) to assess subclinical symptoms, the Scale of Somatic Symptoms and the Chaban Quality of Life Scale. Block randomisation was used to randomise patients to a 2-month-long study group with a proactive counselling psychiatry model care or a control group with standard regulated treatment for chronic non-communicable diseases. The allocation ratio was 1.15:1 owing to the expectancy of a higher percentage of dropout in the intervention group. Results: After 60 days of treatment (T2), there was a statistically significant difference in all clinical parameters between the study and control groups. The median HAM-A value differed between the groups by 4.87 points, with statistically significant lower results in the study group. The comparison of the study group's scale values on day 1 and day 60 demonstrated statistically significant changes in all three indicators. Conclusions: Our results support existing evidence for the effectiveness of proactive psychological and psychiatric support to reduce subclinical anxiety and somatisation symptoms and to improve the quality of life for patients with common chronic non-communicable diseases. However, continued research on the effectiveness of proactive psychological and psychiatric support for patients with chronic non-communicable diseases is needed.

Production of Stem Cell Antigen 1 Sca-1/Ly-6A/E by Freshly Isolated NK Cells Cultured with Relevant Cytokines.

Activated NK cells in appropriate conditions are known to express stem cell antigen 1 (Sca-1/Ly-6A/E). To investigate its production, NK cells isolated from mouse spleens were incubated ex vivo in the presence of different combinations of cytokines (IL-12, IL-15, IL-18, and IFNγ). Expression of Sca-1 was found to be considerably higher in NK cells incubated in the presence of IL-18, IL-15, and IL-12 than in those treated with IL-15 and IL-18 only. To test the hypothesis that the effect of IL-12 was due to stimulation of IFNγ production, we replaced IL-12 with IFNγ in some samples and added specific anti-IFNγ antibody to some samples cultured with IL-15/IL-18+IL-12. In the subpopulations incubated in the presence of IL-15/IL-18 with added IFNγ instead of IL-12, the expression of Sca-1 was not increased. By contrast, in samples treated with IL-15/IL-18+IL-12 and anti-IFNγ antibody, the expression of Sca-1 was activated to a similar extent as in those stimulated by IL-15/IL-18+IL-12 combination without the antibody. The obtained data suggest that IL-12 activates the production of Sca-1 by NK cells through an IFNγ-independent mechanism.

[The development of portal hypertension and liver failure on the background of long-term intake of vitamin A in a young woman. Case report].

The use of over-the-Counter (OTC) pharmaceuticals is a common phenomenon in today's society. We present a case of liver injury associated with long-term OTC use of vitamin A. The young patient took daily up to 15 capsules of a combined preparation for 2 years containing retinol palmitate 55 mg (100,000 IU) + Alpha-Tocopherol acetate 100 mg, the content of vitamin A in which significantly exceeded the recommended daily dose. Gradually, the patient noted the appearance of arthralgia, skin itching, hyperemia of the palms and feet, exfoliation of the skin on the soles, profuse hair loss, cracks in the corners of the mouth and in the area of the earlobes. Patient's condition worsened with the development of signs of liver cirrhosis in the form of portal hypertension (ascites, splenomegaly) and a decrease in the protein-synthetic function of the organ. Chronic viral hepatitis, autoimmune hepatitis, primary biliary cirrhosis, hemochromatosis, Wilson's disease, alcoholic liver disease were exclude. Liver biopsy showed characteristic signs of hypervitaminosis A without fibrosis. A complete regression of symptoms was observe within 8 months after discontinuation of the drug. A toxicity can lead to serious liver injury and should be considere in the differential diagnosis of chronic liver disease. Vitamin A should only be prescribe for medical reasons, for a limited period of time, and under close medical supervision.

[PSYCHOLOGICAL PECULIARITIES OF PATIENTS WITH DISORDERS OF THE MUSCULOSKELETAL SYSTEM].

The purpose of the study was to identify the psychological peculiarities of patients with disorders of the musculoskeletal system in order to identify in the future the targets of medical and psychological intervention, correction and complex treatment of this contingent. The study methods: Inventory form SF-36 - short form of the nonspecific Inventory for determination of a life quality (The 36-Item Short Form Health Survey, Coping Inventory for Stressful Situations, CISS), S. Norman, D. F. Endler, D. A. James, M. I. Parker, adopted by T. L. Kryukova, A. Buss and A. Durkee Hostility Inventory, BDHI, adopted by A. L. Osnitsky), Test of self-assessment of stress resistance of S. Kouhen and G. Willianson The study showed a significant difference (p<0,05) in the quality of life of the examined main group and comparison group. In the course of the study it was confirmed that the significant reasons for the decrease in the quality of life of the patient are age-related, individual-psychological differences and social ones. Correlation analysis revealed the relationship of aggression with indicators of the quality of life of the subjects, a direct relationship between indicators of "physical health" and "physical functioning" and between indicators of "pain" and "physical functioning", an inverse relationship between indicators of stress resistance and "physical health". Identification of the targets of medical and psychological correction will make it possible to develop a program of prevention, rehabilitation of people of mature age with with disorders of the musculoskeletal system, taking into account the factors of influence and the involvement of relevant specialists while maintaining an individual approach.

Comprehensive Test of the Brink-Axel Hypothesis in the Energy Region of the Pygmy Dipole Resonance.

The validity of the Brink-Axel hypothesis, which is especially important for numerous astrophysical calculations, is addressed for ^{116,120,124}Sn below the neutron separation energy by means of three independent experimental methods. The γ-ray strength functions (GSFs) extracted from primary γ-decay spectra following charged-particle reactions with the Oslo method and with the shape method demonstrate excellent agreement with those deduced from forward-angle inelastic proton scattering at relativistic beam energies. In addition, the GSFs are shown to be independent of excitation energies and spins of the initial and final states. The results provide a critical test of the generalized Brink-Axel hypothesis in heavy nuclei, demonstrating its applicability in the energy region of the pygmy dipole resonance.

Prostaglandin F2α Causes Fast Degenerative Changes in Ovulated Mouse Oocytes.

The effects of prostaglandin F2α on the cytoskeleton and membrane organelles of oocytes was investigated by culturing ovulated mouse oocytes in its presence (50 or 100 ng/ml) for 3 h. Tubulin, fibrillar actin, membranes and chromatin were visualized by specific antibodies, phalloidin, lipophilic dye DiOC6 and Hoechst 33342, respectively. Control oocytes were characterized by a meiotic spindle with chromosomes aligned at its equator, and a cortical layer of microfilaments with an actin cap. Intracellular membranes were localized mostly in the central region in metaphase I and in a broader volume, but still excluding the cell periphery, in metaphase II, and were slightly concentrated around the chromosomes. In oocytes treated with 50 ng/ml prostaglandin, cortical actin staining was diminished, the membrane distribution was clustered, and chromosomes showed signs of misalignment despite the apparently preserved spindle. In cells treated with 100 ng/ml prostaglandin, both the spindle and the actin cortex had degenerated or disappeared as microscopic objects. Metaphase plates were on average broader and more disorganized than in the 50 ng/ml group, and the distribution of membrane organelles had become uniform. These effects, to our knowledge observed for the first time, did not require presence of the cumulus during the incubation. They could be regarded as acceleration of the oocyte postovulatory aging, in which cytoskeletal deterioration seemed to have a leading role.

The impact of balance specific physiotherapy, intensity of therapy and disability on static and dynamic balance in people with multiple sclerosis: A multi-center prospective study.

BACKGROUND: A high-quality research identifying the best physiotherapeutic approach for the improvement of balance in people with multiple sclerosis is missing. This study compared aspects of balance improvement such as therapy specificity to balance, therapy method and category, country, intensity and medical conditions. METHODS: A multicentric randomised rater-blinded controlled trial comprised three different physiotherapy programs (Czech and Italian outpatient or inpatient programs). All patients received 20 therapy sessions. Experimental group underwent balance specific physiotherapy (it was Motor Program Activating Therapy in the Czech cohort and Sensory-motor Integration Training in the Italian cohort), control group underwent non-balance specific physiotherapy (it was Vojta reflex locomotion in the Czech cohort and conventional dynamic strengthening exercises in the Italian cohort, respectively). Static balance was evaluated by Berg Balance Scale and dynamic balance was assessed by Timed Up-and-Go Test. RESULTS: A total of 149 patients entered the study. Physiotherapy significantly improved static balance (p < 0.0001, increase by mean 2.6 points (95% confidence interval 2.0-3.5) in BBS score). Balance specific approach had a higher effect than non-specific balance approach (increase in BBS by 1.9 points, 95% confidence interval 0.9-3.7 points). The intensity of the physiotherapy significantly influenced static balance (BBS by 2.7 points higher in the inpatient setting, p= 0.007). Dynamic balance was also improved (TUG decrease by -0.8 s (95% CI -1.4 - -0.1s, p = 0.011)); the balance specificity had no impact. The level of disability played the most important role (p= 0.022). CONCLUSION: Although the overall changes in static and dynamic balance were statistically significant, they were quite small in a clinical sense. A small statistically significant difference between balance specific and non-specific treatment was found. It seems that a high intensity of the therapy is critical to maximize the effectiveness.

Endoscopic approaches in head and neck endocrine surgery introduction of TOETVA (TransOral Endoscopic Thyroidectomy by Vestibular Approach) into clinical use at the Department of Surgery of the University Hospital in Brno.

Transoral endoscopic surgery of the thyroid and parathyroid glands is a modification of neck surgery using natural orifices. The classic approach in neck surgery is the gold standard, which we modified in 2007 by introducing Minimally Invasive Video-Assisted Thyroidectomy/Parathyroid-ectomy (MIVAT/P). We have been using TransOral Endoscopic Thyroidectomy/Parathyroidectomy by Vestibular Approach (TOETVA/TOEPVA) since the end of the last year and have operated on four patients. This method is more attractive for patients because it does not leave a visible scar on the neck, which is common in MIVAT/P. TOETVA is a promising procedure with many advantages, such as healing without visible scars, less pain, minimally invasive dissection and a clear operating field to both thyroid lobes and parathyroid glands. Presentation of the first case. Patients indicated for TOETVA must meet certain criteria - nodule(s) up to 3.5 cm, gland volume up to 30 ml, benign FNAB, papillary, follicular carcinoma not advanced, well differentiated, up to the nodule size of 10 mm with 1 lymph node up to 10 mm. The contraindications include a large goiter, previous neck surgery, history of thyroiditis, lymphadenopathy of the neck, advanced thyroid cancer. Relative contraindications include previous radiotherapy to the throat, Grave´s disease, and obese patients with a short neck. Intraoperative findings may result in a modification of the procedure. TOETVA is an excellent choice for selected patients who want to avoid a neck incision. This method provides the benefit of using standard endoscopic instruments and techniques. It is a safe and effective procedure that provides a good cosmetic result and considerable comfort in terms of clarity of the operating field by zooming in with an endoscopic camera. Longer operating times become shorter due to the learning curve effect.

[Changes of the auditory function in he children with chronic kidney failure]. / Izmeneniia slukhovoi funktsii u detei s khronicheskoi bolezn'iu pochek.

The risk factors that contribute to the development of hearing loss in the children with chronic kidney failure (CRF) are complications and/or manifestations of the disease itself as well as the side effects of its treatment. There are many similarities between the anatomical, physiological, and pharmacological features of the nephron and the striavascularis of the cochlea. The objective of the present study was the evaluation of the status of the auditory function in the children presenting with CRF. MATERIAL AND METHODS: A total of 62 children with CRF were examined. 40 patients were on peritoneal dialysis and 9 on hemodialysis whereas 13 children did not receive hemodialysis. Kidney was transplanted in 7 patients. The registration of transient evoked otoacoustic emission (TEOAE) was performed in all the children. For patients without TEOAE complex underwent the audiological examination. RESULTS: The TEOAE was not registered in 17 of the 62 examined children. According to the results of the comprehensive audiological examinations, 13 children suffered from the hearing loss of different forms and severity while 5 children presented with bilateral deafness. As the duration of CRF progressed, the patients became more prone to develop hearing impairment. Hearing loss is possibly genetically determined. Among the etiological factors underlying the development of the hearing loss the high doses of immunosuppressants and aminoglycosides are considered to be the principal ones.

Dynamics of Lamins B and A/C and Nucleoporin Nup160 during Meiotic Maturation in Mouse Oocytes.

This study was aimed at elucidating the fate of three important nuclear envelope components - lamins B and A/C and nucleoporin Nup160, during meiotic maturation of mouse oocytes. These proteins were localized by epifluorescence and confocal microscopy using specific antibodies in oocytes at different stages from prophase I (germinal vesicle) to metaphase II. In immature germinal vesicle oocytes, all three proteins were detected at the nuclear periphery. In metaphase I and metaphase II, lamin B co-localized with the meiotic spindle, lamin A/C was found in a diffuse halo surrounding the spindle and to a lesser degree throughout the cytoplasm, and Nup160 was concentrated to the spindle poles. To our knowledge, this is the first report on nucleoporin localization in mammalian oocytes and the first successful detection of lamins in mature oocytes. While the distribution patterns of both lamins closely paralleled the respective stages of mitosis, Nup160 localization in metaphase oocytes corresponded to that in mitotic prometaphase rather than metaphase. The peculiar distribution of this nucleoporin in oocytes may reflect its role in meiosis-specific mechanisms of spindle assembly and its regulation.

Mechanobehavioral Scores in Women with and without TMJ Disc Displacement.

Cartilage fatigue may be a factor in the precocious development of degenerative changes in the temporomandibular joint (TMJ). This cross-sectional study estimated potential for cartilage fatigue via TMJ energy densities (ED) and jaw muscle duty factors (DF), which were combined to calculate mechanobehavioral scores (MBS) in women with (+) and without (-) bilateral TMJ disc displacement (DD). All subjects gave informed consent to participate and were examined using Diagnostic Criteria (DC) for Temporomandibular Disorders (TMD) and magnetic resonance (MR) and computed tomography (CT) images. Forty-seven subjects were categorized into +DD ( n = 29) and -DD ( n = 18) groups. Dynamic stereometry (MR images combined with jaw-tracking data) characterized individual-specific data of TMJ stress-field mechanics to determine ED (ED = W/ Q mJ/mm3, where W = work done, Q = volume of cartilage) during 10 symmetrical jaw-closing cycles with a 20-N mandibular right canine load. Subjects were trained to record masseter and temporalis electromyography over 3 days and 3 nights. Root mean square electromyography/bite-force calibrations determined subject-specific masseter and temporalis muscle activities per 20-N bite-force (T20 N, µV), which defined thresholds. Muscle DF (DF = % duration of muscle activity/total recording time) were determined for a range of thresholds, and MBS (ED2 × DF) were calculated. Intergroup differences in ED, DF, and MBS were assessed via analyses of variance with Bonferroni and Tukey honest significant difference post hoc tests. Average ED for contralateral TMJs was significantly larger ( P = 0.012) by 1.4-fold in +DD compared to -DD subjects. Average DF were significantly larger (all P < 0.01) for +DD compared to -DD subjects by 1.7-, 2.5-, and 1.9-fold for day, night, and overall, respectively. Daytime MBS were significantly larger (all P < 0.04) by up to 8.5-fold in +DD compared to -DD subjects. Significantly larger ED, DF, and MBS were shown in women with compared to women without bilateral TMJ DD.

TMJ energy densities in healthy men and women.

OBJECTIVE: Cartilage fatigue, due to mechanical work, may account for the early development of degenerative joint disease (DJD) in the temporomandibular joint (TMJ), and why women are three times more likely to be afflicted. This study tested for gender differences in mechanical energy densities in women and men with healthy TMJs. DESIGN: Eighteen women and eighteen men gave informed consent. Research diagnostic criteria including imaging were used to ensure that subjects' TMJs were normal, without disc displacement or signs of DJD. Numerical modeling determined TMJ loads (Fnormal). Jaw tracking and three-dimensional dynamic stereometry characterized individual-specific data of stress-field dynamic mechanics during 10 symmetrical jaw closing cycles. These data were used to estimate tractional forces (Ftraction). Energy densities were then calculated, where: Energy Density = W/Q (W = work done or mechanical energy input = Ftraction*distance of stress-field translation, Q = volume of cartilage). Two-way analysis of variance (ANOVA) and follow-up two-group comparisons tested mean energy densities for ipsilateral and contralateral TMJs in women vs men. RESULTS: Mean energy densities ± standard deviations in ipsilateral and contralateral TMJs in women were 9.0 ± 9.7 and 8.4 ± 5.5 mJ/mm3, respectively, and were significantly larger (P = 0.004 and 0.001, respectively) compared to ipsilateral and contralateral TMJs in men, which were 5.6 ± 4.2 and 6.3 ± 4.2 mJ/mm3, respectively. CONCLUSIONS: Energy densities were significantly larger in healthy TMJs of women than men. Larger TMJ energy densities during normal jaw functions could predispose earlier mechanical fatigue of the TMJ disc.

Multiple roles of mitochondria in aging processes.

Aging is a multifactorial process influenced by genetic factors, nutrition, and lifestyle. According to mitochondrial theory of aging, mitochondrial dysfunction is widely considered a major contributor to age-related processes. Mitochondria are both the main source and targets of detrimental reactions initiated in association with age-dependent deterioration of the cellular functions. Reactions leading to increased reactive oxygen species generation, mtDNA mutations, and oxidation of mitochondrial proteins result in subsequent induction of apoptotic events, impaired oxidative phosphorylation capacity, mitochondrial dynamics, biogenesis and autophagy. This review summarizes the major changes of mitochondria related to aging, with emphasis on mitochondrial DNA mutations, the role of the reactive oxygen species, and structural and functional changes of mitochondria.

Propofol-induced mitochondrial and contractile dysfunction of the rat ventricular myocardium.

Propofol is a short-acting hypnotic agent used in human medicine for sedation and general anesthesia. Its administration can be associated with serious cardiovascular side-effects that include decrease in arterial blood pressure and cardiac output. The aim of the present study was to evaluate propofol effects on mitochondrial respiration, myocardial contractility and electrophysiology in the same samples isolated from the heart ventricles of adult rats. Mitochondrial oxygen consumption was measured in permeabilized samples dissected from free walls of both ventricles using high-resolution respirometry. State LEAK was determined with malate and glutamate. Active respiration was induced by ADP (state PI) and further by succinate, a Complex II substrate (PI+II). Rotenone was injected to measure state PII. Antimycin A, a Complex III inhibitor was used to determine residual oxygen consumption (ROX). N,N,N',N'-tetramethyl-p-phenylenediamine dihydrochloride and ascorbate were injected simultaneously for respirometric assay of cytochrome c oxidase activity (CIV). Isometric contractions and membrane potentials were determined on multicellular preparations isolated from right and left ventricles. Propofol concentrations used ranged from 0.005 to 0.5 mmol/l. All respiratory parameters were significantly higher in the left control ventricles compared to the right ones. Propofol significantly decreased Complex I activity at concentration 0.025 mmol/l and papillary muscle contraction force at 0.1 mmol/l. Propofol did not affect action potential duration at any concentration studied. Our study suggests that mechanisms contributing to the impaired myocardial contraction during propofol anesthesia might include also mitochondrial dysfunction manifested by compromised activity of the respiratory Complex I.

Neonatal capsaicin administration impairs postnatal development of the cardiac chronotropy and inotropy in rats.

The present study evaluated the impact of neonatal administration of capsaicin (neurotoxin from red hot pepper used for sensory denervation) on postnatal development of the heart rate and ventricular contractility. In the rats subjected to capsaicin administration (100 mg/kg) on postnatal days 2 and 3 and their vehicle-treated controls at the ages of 10 to 90 days, function of the sympathetic innervation of the developing heart was characterized by evaluation of chronotropic responses to metipranolol and atropine, norepinephrine concentrations in the heart, and norepinephrine release from the heart atria. Sensory denervation was verified by determination of calcitonin gene-related peptide levels in the heart. Direct cytotoxic effects of capsaicin were assessed on cultured neonatal cardiomyocytes. Capsaicin-treated rats displayed higher resting heart rates, lower atropine effect, but no difference in the effect of metipranolol. Norepinephrine tissue levels and release did not differ from controls. Contraction force of the right ventricular papillary muscle was lower till the age of 60 days. Significantly reduced viability of neonatal cardiomyocytes was demonstrated at capsaicin concentration 100 micromol/l. Our study suggests that neonatal capsaicin treatment leads to impaired maturation of the developing cardiomyocytes. This effect cannot be attributed exclusively to sensory denervation of the rat heart since capsaicin acts also directly on the cardiac cells.

Reconstitution of cytomegalovirus-specific T-cell response in allogeneic hematopoietic stem cell recipients: the contribution of six frequently recognized, virus-encoded ORFs.

BACKGROUND: The reactivation of human cytomegalovirus (HCMV) in immunosuppressed patients is associated with significant morbidity. Testing HCMV-specific T-cell responses can help determine which patients are at high risk of HCMV disease. We optimized selection of HCMV antigens for detection of T-cell response of patients after allogeneic hematopoietic stem cell transplantation (HSCT) with the aim of identifying patients with insufficient control of HCMV reactivation. METHODS: T-cell immune response to HCMV was monitored in 30 patients during the first year after HSCT. The HSCT recipients were classified according to their anti-HCMV T-cell response and the presence of HCMV DNA in the blood. RESULTS: We observed an inverse relationship between the magnitude of HCMV-specific T-cell responses against CMV lysate, phosphoprotein (pp) 65, immediate early-1 (IE-1), UL36, and UL55, but not to US3 and US29 detected by interferon-gamma (IFNγ)- ELISPOT and the level of HCMV DNA in the blood of patients during the 30 days following sampling. The study has revealed that patients who received a graft from a seronegative donor have a lower T-cell response against HCMV and increased probability of HCMV reactivation in comparison to the patients who had received their graft from a seropositive donor. CONCLUSION: The individual peptide pools and native HCMV antigens were useful for monitoring the time course of the anti-HCMV response by IFNγ-ELISPOT, which proved to have a prognostic value. Besides widely employed peptide pools of pp65 and IE-1, the use of antigens UL36 and UL55, but not US3 or US29, increased sensitivity of the test.

Evolution of human cytomegalovirus-seronegative donor/-seropositive recipient high-risk combination frequency in allogeneic hematopoietic stem cell transplantations at Institute of Hematology and Blood Transfusion during 1995-2014.

BACKGROUND: Human cytomegalovirus (HCMV) establishes lifelong latent infection that can result in severe life-threatening disease in immunosuppressed patients after hematopoietic stem cell transplantation (HSCT). An HCMV-seropositive transplant recipient who receives a graft from a seronegative donor (R+/D-) is at high risk of recurrent HCMV reactivation. METHODS: To assess the incidence of R+/D- combination, we retrospectively evaluated HCMV-seronegative donors for 746 allogeneic HSCT treatments carried out at our center during 1995-2014. In our cohort, 20% HCMV-seronegative HSCT recipients, 21% HCMV-seronegative related graft donors, and 52% HCMV-seronegative unrelated graft donors were included. RESULTS: Analyses of the HCMV serostatus of hematopoietic stem cell donors during 2 consecutive calendar periods (1995-2005 and 2006-2014) showed a significant increase in the proportion of seronegative donors (odds ratio [OR] = 1.947). In addition, the number of HSCT treatments using an unrelated donor increased (OR = 2.376). Finally, the use of grafts from countries with a very low HCMV prevalence increased. CONCLUSION: This increase in HCMV seronegativity in unrelated donors and the increased proportion of unrelated donors were responsible for the increased occurrence of the high-risk combination R+/D- (OR = 1.680). If the reduction in the rate of HCMV-seropositive graft donors continues, an increased frequency of HCMV reactivation events in our transplant recipients can be expected, because of the increasing occurrence of the high-risk R+/D- combination.

Balloon dilatation of pediatric subglottic laryngeal stenosis during the artificial apneic pause: experience in 5 children.

INTRODUCTION: Balloon dilatation is a method of choice for treatment of laryngeal stenosis in children. The aim of procedure in apneic pause is to avoid new insertion of tracheostomy cannula. PATIENTS AND METHODS: The authors performed balloon dilatation of subglottic laryngeal strictures (SGS) in 5 children (3 girls and 2 boys) without tracheotomy. Two of them with traumatic and inflammatory SGS had a tracheal cannula removed in the past. The other 3 children with postintubation SGS had never had a tracheostomy before. The need for tracheostomy due to worsening stridor was imminent for all of them. RESULTS: The total of seven laryngeal dilatations by balloon esophagoplasty catheter in apneic pause was performed in the 5 children. The procedure averted the need for tracheostomy placement in 4 of them (80%). Failure of dilatation in girl with traumatic stenosis and concomitant severe obstructive lung disease led to repeated tracheostomy. CONCLUSION: Balloon dilatation of laryngeal stricture could be done in the absence of tracheostomy in apneic pause. Dilatation averted threatening tracheostomy in all except one case. Early complication after the procedure seems to be a negative prognostic factor for the outcome of balloon dilatation.