The extrafollicular B cell response is a hallmark of childhood idiopathic nephrotic syndrome.

The efficacy of the B cell-targeting drug rituximab (RTX) in childhood idiopathic nephrotic syndrome (INS) suggests that B cells may be implicated in disease pathogenesis. However, B cell characterization in children with INS remains limited. Here, using single-cell RNA sequencing, we demonstrate that a B cell transcriptional program poised for effector functions represents the major immune perturbation in blood samples from children with active INS. This transcriptional profile was associated with an extrafollicular B cell response marked by the expansion of atypical B cells (atBCs), marginal zone-like B cells, and antibody-secreting cells (ASCs). Flow cytometry of blood from 13 children with active INS and 24 healthy donors confirmed the presence of an extrafollicular B cell response denoted by the expansion of proliferating RTX-sensitive extrafollicular (CXCR5-) CD21low T-bet+ CD11c+ atBCs and short-lived T-bet+ ASCs in INS. Together, our study provides evidence for an extrafollicular origin for humoral immunity in active INS.

[The Keel Mesh prosthesis: an innovative surgical device for a modern Bassini inguino-crural hernia operation without limits]. / Keel mesh: un inmlovativo "device" chirurgico per una Bassini moderna e senza limiti.

Accepting the therapeutic rational underlying laparoscopic and suprapubic laparotomy access, the same therapeutic goal is achieved through direct inguinal access. In this way, using just one prosthesis, inguinal-crural hernias of the Fruchaud pectineus orifice can be treated. The patented three-dimensional pre-cut Keel Mesh prosthesis made of polypropylene monofilament interwoven in a mesh, is tension-free and endowed with plastic memory. It is applied using a slightly modified Lichtenstein technique and is composed of two assembled elements (A and B-C) of different shapes and sizes. From May 2000 to December 2005, the Keel Mesh prosthesis was used in 358 surgical inguino-crural alloplasty operations according to Lichtenstein-De Pascale in 328 patients. Thirty patients were treated with bilateral allo-plasties. Coexistence of a crural hernia was found in 13 male and 4 female patients (5%). At the present time all the patients who are entering into follow-up at different times show perfect compliance of the prosthesis with no relapses. The theoretical and practical considerations regarding the production of the Keel Mesh prosthesis and its easy application suggest it is an extremely valid, rational device for the initial and combined treatment of inguinal and crural hernia.