Papain-treated panels are a simple method for the identification of alloantibodies in multiple myeloma patients treated with anti-CD38-based therapies.

OBJECTIVES: To report our 2 years of experience navigating the interference of anti-CD38 monoclonal antibodies (MAs) in 33 patients and describe papain-treated panels as a complementary method to dithiothreitol (DTT). BACKGROUND: Novel anti-CD38 MAs are now approved or undergoing clinical trials to evaluate their activity in patients with multiple myeloma. A concern with the use of these drugs is that they interfere with blood bank tests in a group of patients who often require blood transfusions. METHODS: Clinical data and whole blood samples were collected from patients receiving daratumumab or isatuximab. Routine blood bank serological tests were performed. RESULTS: A total of 9·1% of patients presented with alloantibodies prior to treatment. All patients exhibited nonspecific reactivity in indirect antiglobulin tests, and 26% had positive direct antiglobulin tests after beginning treatment. This interference disappeared in all patients after discontinuing treatment. Papain panels avoided this reactivity and allowed us to identify alloantibodies. Phenotyped blood units were transfused, and no patient suffered any transfusion-related complications. CONCLUSION: Anti-CD38 MAs produce nonspecific interference in blood bank tests. This interference can be overcome by various methods, including DTT or papain treatment as proposed here. These methods have limitations that can be resolved using phenotyped blood units.

Effects of early overnutrition on the renal response to Ang II and expression of RAAS components in rat renal tissue.

BACKGROUND AND AIMS: The aim of this study was to analyze the effects of early overnutrition (EON) on the expression of the renin angiotensin aldosterone system (RAAS) components in renal cortex, renal arteries and renal perivascular adipose tissue (PVAT), as well as the vascular response of renal arteries to Angiotensin II (Ang II). METHODS AND RESULTS: On birth day litters were adjusted to twelve (L12-control) or three (L3-overfed) pups per mother. Half of the animals were sacrificed at weaning (21 days old) and the other half at 5 months of age. Ang II-induced vasoconstriction of renal artery segments increased in young overfed rats and decreased in adult overfed rats. EON decreased the gene expression of angiotensinogen (Agt), Ang II receptors AT1 and AT2 and eNOS in renal arteries of young rats, while it increased the mRNA levels of AT-2 and ET-1 in adult rats. In renal PVAT EON up-regulated the gene expression of COX-2 and TNF-α in young rats and the mRNA levels of renin receptor both in young and in adult rats. On the contrary, Ang II receptors mRNA levels were downregulated at both ages. Renal cortex of overfed rats showed increased gene expression of Agt in adult rats and of AT1 in young rats. However the mRNA levels of AT1 were decreased in the renal cortex of overfed adult rats. CONCLUSION: EON is associated with alterations in the vascular response of renal arteries to Ang II and changes in the gene expression of RAAS components in renal tissue.

Eficiencia de los sistemas sanitarios / No disponible

Fundamentos: A pesar de la disponibilidad de indicadores de gasto sanitario y resultados en salud en la práctica totalidad de los países desarrollados, pocos estudios han comparado la eficiencia entre los dos sistemas de salud preponderantes en las últimas décadas (Sistemas de Seguro Social -SSSy Sistemas Nacionales de Salud -SNS-) utilizando indicadores de salud ajustados por el gasto sanitario. Métodos: El presente trabajo compara los dos tipos de sistemas en 18 países en 2010: 10 con SNS (Portugal, Grecia, Italia, España, Finlandia, Reino Unido, Irlanda, Suecia, Dinamarca y Noruega) y 8 con SSS (Israel, Bélgica, Francia, Alemania, Austria, Luxemburgo, Países Bajos y Suiza). Resultados: No se han encontrado diferencias estadísticamente significativas entre los sistemas, pero sí ciertas tendencias favorables a los SNS en mortalidad infantil (3,2%o frente a 3,6 %o en SSS, p=0,2) y contención del gasto, como el gasto en sanidad per cápita (3567$ frente a 4232$ en SSS, p=0,10) y porcentaje del PIB destinado a sanidad (9,8% frente a 10,4% en SSS, p=0,14). Esta tendencia se mantiene al analizar los ratios beneficio-gasto como la esperanza de vida (2,2 en SNS frente a 1,2 en SSS en varones, p=0,10) y la esperanza de vida saludable (1,9 frente a 1,7 en ambos sexos, p=0,10). Conclusiones: Estos datos, referidos al pasado reciente, podrían contribuir a informar el debate actual de las reformas sanitarias en Europa y a interpretar futuros estudios de los resultados de los sistemas de salud

Background: Despite the availability of indicators of health expenditure and health outcomes in almost all developed countries, few studies have compared the efficiency between the two main health systems in the last few decades (Social Health Insurance -SHI- and National Health System -NHS-) using health indicators adjusted by health expenditure. Method: This work compares the two types of systems in 18 countries in 2010: 10 with NHS (Portugal, Greece, Italy, Spain, Finland, United Kingdom, Ireland, Sweden, Denmark and Norway) and 8 with SHI (Israel, Belgium, France, Germany, Austria, Luxembourg, The Netherlands and Switzerland). Results: We did not find statistically significant differences between the systems, nevertheless some favorable trend in NHS-based countries were observed: in infant mortality (3.2%o vs. 3.6 %o in SHI, p=0.12) and cost containment such as health expenditure per cápita (3567$ versus 4232$ in SHI, p=0.10) and percentage of the GDP for health (9.8% versus 10.4% in SHI, p=0.14). This trend remained when analyzing benefit-expenditure ratios, i.e. life expectancy (2.2 in NHS vs. 1.2 in SHI in men, p=0.10) and healthy life expectancy (1.9 versus 1.7 in both sexes, p=0.10). Conclusions: These recent-past data might contribute to inform the current debate around health systems reforms in Europe and to the interpretation of future studies of the health systems results