The use of extracorporeal photopheresis in solid organ transplantation—current status and future directions

\ua9 2024 The AuthorsPrevention and management of allograft rejection urgently require more effective therapeutic solutions. Current immunosuppressive therapies used in solid organ transplantation, while effective in reducing the risk of acute rejection, are associated with substantial adverse effects. There is, therefore, a need for agents that can provide immunomodulation, supporting graft tolerance, while minimizing the need for immunosuppression. Extracorporeal photopheresis (ECP) is an immunomodulatory therapy currently recommended in international guidelines as an adjunctive treatment for the prevention and management of organ rejection in heart and lung transplantations. This article reviews clinical experience and ongoing research with ECP for organ rejection in heart and lung transplantations, as well as emerging findings in kidney and liver transplantation. ECP, due to its immunomodulatory and immunosuppressive-sparing effects, offers a potential therapeutic option in these settings, particularly in high-risk patients with comorbidities, infectious complications, or malignancies

New approaches in the management of multiple sclerosis

Multiple sclerosis (MS) is a central nervous system chronic inflammatory disease that is characterized by an extensive and complex immune response. Scientific advances have occurred in immunology, pathophysiology, and diagnostic and clinical assessment tools, and recent discovery of unique therapeutic targets has spurred numerous Phase II and Phase III clinical trials. Reductions in MS relapse rates and improvements in T2 or gadolinium-enhancing lesion burdens have been reported from Phase III trials that include fingolimod, alemtuzumab, cladribine, and rituximab. Promising Phase II trial data exist for teriflunomide, daclizumab, laquinimod, and fumarate. The optimism created by these favorable findings must be tempered with evaluation of the adverse effect profile produced by these new agents. Given the discovery of progressive multifocal leukoencephalopathy with the use of natalizumab, ongoing vigilance for rare and life-threatening reactions due to new agents should be paramount. Patients with MS often experience difficulty with ambulation, spasticity, and cognition. Recent clinical trial data from two Phase III dalfampridine-SR trials indicate certain patients receive benefits in ambulation. This article provides an overview of data from clinical trials of newer agents of potential benefit in MS

The Obesity Epidemic: Survey of Current Physical Therapy Trends in North Dakota

Background and Purpose. Many different health professionals are involved in the prevention and treatment of obesity. The APTA believes that physical therapists should be in a leadership role among other health care providers in providing patient education and instruction regarding physical activity. The purpose of this study was to determine current practice trends among physical therapists in the state of North Dakota relating to patients who are overweight or obese. Subjects and Methods. Three hundred surveys were mailed to randomly selected physical therapists licensed in the State of North Dakota. The survey consisted of23 questions concerning level of training, referral rates, comfort level in treating patients who are overweight or obese, and interventions provided to these patients. Results. Of the 300 surveys sent out, 136 (45.3%) were completed and returned for inclusion in this study. Those physical therapists who indicated they had advanced training did not have significantly higher comfort level in treating patients who are overweight or obese. Similarly there was no significant difference between advanced training and discussion or recording of weight status. Seventy-five percent of therapists surveyed had not received any referrals for weight management in the past year. Appearance, weight/height measurements, body mass index (BMI), and patient opinion were the most commonly used methods to assess weight status. The most frequently used interventions included patient education, aerobic exercise, and strength training. Discussion and Conclusion. Physical therapists have appropriate education to identify at-risk patients and provide intervention to improve weight status, but are not currently active in promoting themselves as members of the weight management team. Additional training may be necessary in the areas of objective methods of assessing weight status and weight management programs for patients with other co-morbidities

Bistability of Slow and Fast Traveling Waves in Fluid Mixtures

The appearence of a new type of fast nonlinear traveling wave states in binary fluid convection with increasing Soret effect is elucidated and the parameter range of their bistability with the common slower ones is evaluated numerically. The bifurcation behavior and the significantly different spatiotemporal properties of the different wave states - e.g. frequency, flow structure, and concentration distribution - are determined and related to each other and to a convenient measure of their nonlinearity. This allows to derive a limit for the applicability of small amplitude expansions. Additionally an universal scaling behavior of frequencies and mixing properties is found. PACS: 47.20.-k, 47.10.+g, 47.20.KyComment: 4 pages including 5 Postscript figure

Subharmonic bifurcation cascade of pattern oscillations caused by winding number increasing entrainment

Convection structures in binary fluid mixtures are investigated for positive Soret coupling in the driving regime where solutal and thermal contributions to the buoyancy forces compete. Bifurcation properties of stable and unstable stationary square, roll, and crossroll (CR) structures and the oscillatory competition between rolls and squares are determined numerically as a function of fluid parameters. A novel type of subharmonic bifurcation cascade (SC) where the oscillation period grows in integer steps as $n (2\pi)/(\omega)$ is found and elucidated to be an entrainment process.Comment: 7 pages, 4 figure

A retrospective analysis of injury risk in physical education teacher education students between 2000-2014

To identify primary target groups for injury prevention in physical education teacher education (PETE) students, risk differences between subgroups by sex and curriculum years were compared in a retrospective cohort study (2000-2014). Injuries recorded by healthcare professionals at the medical facility of a Dutch PETE college were used to calculate overall, intra- and extracurricular injury prevalence per sex, curriculum years, and semesters and to compare these by logistic regression analyses. Of 1083 PETE students, 599 (55.3%) reported at least one injury during their curriculum (60.0% intracurricular). Female students had a higher risk for overall (OR 2.29, 95%CI 1.77-2.96) and for intracurricular injuries (OR 3.12, 95%CI 2.41-4.03), but not for extracurricular injuries. Compared to the freshman year, injury risk dropped during the consecutive years (OR 0.56, 95%CI 0.46-0.67; OR 0.33, 95%CI 0.27-0.41; OR 0.04, 95%CI 0.03-0.07, respectively). The first semesters of the freshman and second year showed higher injury prevalence compared to two out of three consecutive semesters (P < .006). Primary target groups for injury preventive measures are freshman and female PETE students. Factors contributing to the predominantly higher intracurricular injury risks, most notably in female students, need to be investigated in prospective cohort studies, regardless of sex

Influence of the Soret effect on convection of binary fluids

Convection in horizontal layers of binary fluids heated from below and in particular the influence of the Soret effect on the bifurcation properties of extended stationary and traveling patterns that occur for negative Soret coupling is investigated theoretically. The fixed points corresponding to these two convection structures are determined for realistic boundary conditions with a many mode Galerkin scheme for temperature and concentration and an accurate one mode truncation of the velocity field. This solution procedure yields the stable and unstable solutions for all stationary and traveling patterns so that complete phase diagrams for the different convection types in typical binary liquid mixtures can easily be computed. Also the transition from weakly to strongly nonlinear states can be analyzed in detail. An investigation of the concentration current and of the relevance of its constituents shows the way for a simplification of the mode representation of temperature and concentration field as well as for an analytically manageable few mode description.Comment: 30 pages, 12 figure