Бронхоальвеолярный лаваж в диагностике поражения легких при системной склеродермии

In two groups of patients suffering from systemic scleroderma: 1st group (11 patients) without and 2nd group (7 patients) with the signs of lung damage, diagnostic broncho-alveolar lavage (BAL) was performed. Cell content and functional activity of alveolar macrofages (AM) from the BAL fluid were studied by means of spontaneous and induced NBT-test. According to cytogram data, 54,5 % of patients from the 1st group were suffering from «latent» alveolitis of neutrophil type. Spontaneous NBT-test parameters witnessed for the activated condition of AM with no significant difference in this parameter between patients with diagnosed alveolitis and those, having normal cytogram. Higher levels of cytosis and neutrophilia of BAL fluid from patients of the 2nd group corresponded to more severe cases of fibrosing alveolitis (FA) accompanied by X-ray changes and decrease in pulmonary function parameters. There was no difference in common tendencies of NBT-test parameters between the two groups. More severe and generalized damage of skin was marked in all patients with high activity of FA.В двух группах больных системной склеродермией (ССД) — без явной легочной патологии (I группа, 11 человек) и с поражением легких (II группа, 7 человек) проведен диагностический бронхоальвеолярный лаваж (БАЛ). В бронхоальвеолярных смывах (БАС) исследовалось клеточное содержимое и функциональная активность альвеолярных макрофагов (АМ) с помощью спонтанного (с) и индуцированного (и) НСТ — теста. У 54,5 % больных I группы по данным цитограммы БАС выявлен «латентный» альвеолит нейтрофильного типа. Показатели с. НСТ-теста (64,1 ±4,76 %) свидетельствовали об активизированном состоянии АМ, причем не обнаружено различия в данном показателе между больными с диагностированным альвеолитом и имеющими нормальную цитограмму. Более высокий общий цитоз и нейтрофилез БАС у больных II группы соответствовал более тяжелому течению фиброзирующего альвеолита (ФА), с рентгенологическими изменениями и снижением легочной функции. Общие тенденции в показателях НСТ-теста в группах отличий не имели. У всех больных с ФА высокой степени активности отмечалось более распространенное и тяжелое поражение кожи

Early Conversion From Calcineurin Inhibitor- to Everolimus-Based Therapy Following Kidney Transplantation: Results of the Randomized ELEVATE Trial

In a 24-month, multicenter, open-label, randomized trial, 715 de novo kidney transplant recipients were randomized at 10-14 weeks to convert to everolimus (n = 359) or remain on standard calcineurin inhibitor (CNI) therapy (n = 356; 231 tacrolimus; 125 cyclosporine), all with mycophenolic acid and steroids. The primary endpoint, change in estimated glomerular filtration rate (eGFR) from randomization to month 12, was similar for everolimus versus CNI: mean (standard error) 0.3(1.5) mL/min/1.73 2 versus - 1.5(1.5) mL/min/1.73(2) (p = 0.116). Biopsy-proven acute rejection (BPAR) at month 12 was more frequent under everolimus versus CNI overall (9.7% vs. 4.8%, p = 0.014) and versus tacrolimus-treated patients (2.6%, p < 0.001) but similar to cyclosporine-treated patients (8.8%, p = 0.755). Reporting on de novo donor-specific antibodies (DSA) was limited but suggested more frequent anti-HLA Class I DSA under everolimus. Change in left ventricular mass index was similar. Discontinuation due to adverse events was more frequent with everolimus (23.6%) versus CNI (8.4%). In conclusion, conversion to everolimus at 10-14 weeks posttransplant was associated with renal function similar to that with standard therapy overall. Rates of BPAR were low in all groups, but lower with tacrolimus than everolimus

Early Conversion From Calcineurin Inhibitor- to Everolimus-Based Therapy Following Kidney Transplantation: Results of the Randomized ELEVATE Trial

In a 24-month, multicenter, open-label, randomized trial, 715 de novo kidney transplant recipients were randomized at 10–14 weeks to convert to everolimus (n = 359) or remain on standard calcineurin inhibitor (CNI) therapy (n = 356; 231 tacrolimus; 125 cyclosporine), all with mycophenolic acid and steroids. The primary endpoint, change in estimated glomerular filtration rate (eGFR) from randomization to month 12, was similar for everolimus versus CNI: mean (standard error) 0.3(1.5) mL/min/1.732 versus −1.5(1.5) mL/min/1.732 (p = 0.116). Biopsy-proven acute rejection (BPAR) at month 12 was more frequent under everolimus versus CNI overall (9.7% vs. 4.8%, p = 0.014) and versus tacrolimus-treated patients (2.6%, p < 0.001) but similar to cyclosporine-treated patients (8.8%, p = 0.755). Reporting on de novo donor-specific antibodies (DSA) was limited but suggested more frequent anti-HLA Class I DSA under everolimus. Change in left ventricular mass index was similar. Discontinuation due to adverse events was more frequent with everolimus (23.6%) versus CNI (8.4%). In conclusion, conversion to everolimus at 10–14 weeks posttransplant was associated with renal function similar to that with standard therapy overall. Rates of BPAR were low in all groups, but lower with tacrolimus than everolimus