Ab initio Everolimus-based Versus Standard Calcineurin Inhibitor Immunosuppression Regimen in Liver Transplant Recipients.

AIM: We designed a retrospective case-control study to determine the efficacy and feasibility of everolimus (EVR) combined with low-dose tacrolimus (Tac) ab initio versus standard-dose Tac after liver transplantation (LT). METHODS: Seventy-one adult LT patients, receiving EVR and low-dose Tac without corticosteroids or induction therapy from postoperative day 1 (EVR group) were compared with a well-matched control group of 61 recipients treated with standard-dose Tac in association with antimetabolite. RESULTS: Baseline characteristics for the two groups were comparable. The overall patient and graft survival rates were similar (P = .908). Liver function was stable during the follow-up. In the EVR group, biopsy-proven acute rejection occurred in two cases (2.8%), whereas chronic rejection occurred in one (1.4%). The EVR group experienced a better renal function already after 2 weeks (estimated glomerular filtration rate: 89.85 [36.46 to 115.3] mL/min/1.73 m2 vs. 68.77 [16.11 to 115.42] mL/min/1.73 m2; P = .013), which was also observed after a median time of 27 months (range, 0 to 82 months) from LT (estimated glomerular filtration rate: 80 [45 to 118.3] mL/min/1.73 m2 vs. 70.9 [45 to 88.4] mL/min/1.73 m2; P = .04). After a median time of 27 months, the EVR group showed lower incidence of arterial hypertension and insulin-dependent diabetes mellitus. CONCLUSION: Ab initio EVR-based immunosuppression could be a valid option immediately after surgery in recipients at high-risk for post-LT renal impairment.

The greater omentum as a site for pancreatic islet transplantation.

The greater omentum is a highly vascularized anatomical structure in the peritoneal cavity. Its main components are connective, adipose and vascular cells, along with specialized immune cells. The omentum functions as a site for fat accumulation, it has adhesive properties to control traumatized and inflamed tissues, and a function in local hemostasis, immune responses, and revascularization. Other functions include the absorption of fluids, the phagocytosis of particulate matter, and foreign body reaction. The omentum is catalyzing significant interest for its potential as a site for pancreatic islet and cell transplantation. Our knowledge about this structure, its functions, and its potential as a site for transplantation is poised to grow in the coming years.

Selenium Intake in Hypertensive and Normotensive Post-Menopausal Indonesian Women.

The Indonesian Ministry of Health has predicted that the national prevalence of hypertension in Indonesia may reach 26.5% in 2013. Increasing age, stress, lack of physical activity, obesity and passive smoking are known to be risk factors of hypertension. In women over 50 y, hormonal changes that occur post-menopause may also increase the risk of hypertension and other vascular diseases. Antioxidant precursors, such as selenium, however, are known to provide protection against the development of several oxidative stress-related diseases, including hypertension. To prove the hypothesis, we compared the levels of consumption of selenium in hypertensive and normotensive post-menopausal women. An observational comparative study with cross-sectional design was conducted in groups of post-menopausal women with hypertension and those who are normotensive. Structured interviews and food recall of 2×24 h were used to determine the level of consumption, and the Depression, Anxiety and Stress Scale (DASS) questionnaire was used to measure the level of stress. The result suggests a significant difference in the levels of selenium intake between the normotensive and hypertensive groups (p=0.008). Furthermore, the passive smoking and stress levels of the hypertensive group were significantly higher than those of the normotensive group. These result support the hypothesis that selenium may play a protective role in vascular disease.

Radial head replacement in capitellocondylar total elbow arthroplasty. 2- to 6-year follow-up evaluation in rheumatoid arthritis.

We reviewed six capitellocondylar metal-to-plastic total elbow replacement prostheses with radial head components, implanted in patients with rheumatoid arthritis. At an average of 4.7 +/- 1.5 years, relief of pain, improvement of function, and a functional range of motion were preserved. Five of the six elbows (83%) were clinically rated good or excellent. Radiolucent lines were seen at the bone-cement interface in 50% of the humeral component stems and in all ulnar component boats within 2 years after surgery; none had progressed at subsequent examination. Most were less than or equal to 1 mm wide, and none were associated with clinical deterioration. Only one of the humeral components was radiographically loose. No radiolucent lines were seen along the stems of the ulnar or radial components. There were no postoperative dislocations when the radial component was used, presumably because the prosthetic radial head provided increased constraint. None of these elbows have required revision. Radial head replacement in capitellocondylar arthroplasty had been discontinued because radiolucent lines were observed at early review. However, the absence of clinical failure, dislocation, or progression of radiolucency at long-term follow-up examination favor radial head replacement in primary unconstrained total elbow arthroplasty.