Role of autoimmunity in patients transplanted for acute liver failure of unknown origin: a clinical and graft-biopsy analysis

Abstract Background The etiology and prognosis of acute liver failure (ALF) remains unknown in a significant proportion of cases. Signs of autoimmunity may be present, but no consistent pattern has been observed. We aimed to analyse if pretransplant immunological findings, HLA haplotypes and clinical features among patients with unknown etiology differ from those of autoimmune or other known etiology. We also analysed whether such signs impact post-transplant biopsy findings or complications. Methods All adult ALF patients undergoing liver transplantation (LT) in Finland during 1987-2015 were followed to 2016. Data were from the LT registry, pathology database and patient records. 124 patients were included in the analysis. Study subgroups were acute autoimmune hepatitis (AIH) (n=25), known non-AIH etiology (n=54), and unknown etiology (n=45). Results The unknown etiology group differed from the known non-AIH group with regard to the following pretransplant autoimmunity-associated features: positive pANCA (35% vs 8%; P=0.02), higher mean IgA (3.2±1.7 vs 2.1±1.4, P=0.006) and IgG (12.7±4.3 vs 8.5±3.6, P=0.001). AIH-associated HLA haplotypes B8, DR3 and B8DR3 were more common in the AIH group (40%, 44% and 36%) and in the unknown group (29%, 33% and 29%) than in the known non-AIH group (11%, 17% and 11%) or in the Finnish general population (17%, 18% and 8%). However, these findings had no association with protocol biopsies, extrahepatic autoimmune diseases or survival. Patients with ≥1 rejection episode had higher pretransplant IgA (3.7±2.3 vs 2.6±1.2, P=0.02) and IgG (16.4±10.2 vs 12.4±6.8, P=0.03) than those without rejections. Conclusions Autoimmunity-associated pretransplant laboratory findings and HLA haplotypes were common in ALF of unknown etiology, but showed minimal predictive value for post-transplant biopsy findings, clinical complications or survival.Peer reviewe

Регіональні й глобальні наслідки незалежності Косово

У статті розглянуто регіональні й міжнародні аспекти проголошення незалежності Косово. Проаналізовано конфліктні аспекти косовської проблеми у регіональному й глобальному контекстах.В статье рассматриваются региональные и международные аспекты провозглашения независимости Косово. Проанализировано конфликтные аспекты косовской проблемы в региональном и глобальном контекстах.The article presents the regional and international aspects of Kosovo Independents. Special attention is to the conflict of Kosovo in the regional and global context

Diatoms and acid lakes. Proceedings of a workshop of the 8th International Diatom Symposium, Paris, September 1984

Diatom analysis of lake sedimentshasbecome one of the most important techniques used in the contemporary debate on lake acidification. In recent years the relationship between diatom assemblages and pH has been quantified allowing the pH history of individual lakes to be reconstructed. Much reliance is placed on these reconstructions yet we have little understanding of the causal mechanisms that underlie the impressive statistics. There has been little research on the ecology and physiology of diatom taxa in acid and acidifying waters and we have little information on the role of either planktonic or non-planktonic diatoms in acid lake ecosystems. This Workshop, hence, was not only devoted to the exchange of information on current research projects but also to a discussion of some of the ecological questions that require resolution to improve our understanding of the diatom:pH relationship

Identifying technical, physiological, tactical and psychological characteristics that contribute to career progression in soccer

This study sought to examine which technical, physiological, tactical and psychological characteristics at age 15 years contribute to successful soccer performance at age 19 years. Participants were male soccer players (n = 114; mean age 15.4±0.3 years), divided into elite and sub-elite groups based on their performance level at age 19 years. Technical, physiological, tactical and psychological characteristics were recorded when players were 15-year olds. Binary logistic regression analysis showed that performance level at age 19 was clearly associated with technical skills of passing and centering as well as agility and motivation levels recorded at age 15 years. These results extend our understanding of career progression in youth soccer and highlight the multidimensional nature of talent development processes in soccer. Moreover, it seems crucial that coaching support should be devoted to the development of passing and centering skills, agility and motivation in the development of youth players

High BMI and the risk of lower extremity fractures in fertile-aged women : A nationwide register-based study in Finland

Objectives: Both high and low body mass index (BMI) is known to be associated with increased risk for osteoporotic fractures in the postmenopausal population. However, the association between BMI and risk for fracture in the fertile-aged (15–49 years) population is not well studied. We aim to examine how increased BMI affects the risk for fracture leading to hospitalization after delivery in fertile-aged women. Material and methods: In this nationwide registry-based study, data on all women aged 15–49 years with fractures leading to hospitalization were retrieved from the Care Register for Health Care for the years 2004–2018. The data were linked with data from the National Birth Register, where the BMI status is collected for each pregnancy. Cox regression was used to examine the effect of increased BMI on the risk for fracture within five years after delivery. Risks were analyzed separately for upper extremity, spine and pelvis, and lower extremity fractures. The results were interpreted with hazard ratios (HR), adjusted hazard ratios (aHR), and 95% confidence intervals (CI). Results: A total of 529 992 pregnant women with 3276 fractures leading to hospitalization within 5-year follow-up were included in this study. Of these, a total of 548 fractures required surgical treatment. Patients with BMI of 30 kg/m2 or more had a higher rate of fractures in the lower extremity (≥50%). In lower extremity fractures, risk for fracture increased with increasing BMI. The risk fracture was highest in the group with BMI of 35–40 kg/m2 (overall lower extremity aHR 2.43 95% CI 1.92–3.06; knee aHR 2.04, 95% CI 1.45–2.87; ankle aHR 3.01, 95% CI 2.16–4.20). Conclusions: Higher BMI was associated to the increased risk for lower extremity fractures, especially ankle fractures, within five years of delivery. Information gained from this study is important in the clinical setting, as patients can be informed of the negative effect of obesity on the post-delivery risk for fractures.Peer reviewe

Previous induced abortion or miscarriage is associated with increased odds for gestational diabetes : a nationwide register-based cohort study in Finland

Aims: The aim of this study was to investigate the association between previous induced abortion or miscarriage and the development of gestational diabetes mellitus (GDM) using high-quality register data. Methods: In this retrospective nationwide register-based cohort study, data from the national medical birth register (MBR) were used to evaluate the association between a history of miscarriage or induced abortion and GDM. We included all first pregnancies ending in delivery in which the oral glucose tolerance test was performed between 2004 and 2018. A logistic regression model was used to assess the development of GDM in the first pregnancy ending in delivery. Adjusted odds ratios (aOR) with 95% confidence intervals (Cis) were compared between groups. Results: In total, 15,873 nulliparous women with a history of induced abortions, 22,337 with a history of miscarriages and 3594 with a history of both were found. The reference group consisted of 138,869 women without a history of induced abortions or miscarriages. Women with a history of induced abortions (24.7%, aOR 1.15 [CI 1.11–1.20]), a history of miscarriages (24.8%, aOR 1.14 [CI 1.10–1.18]) and a history of both (27.7% aOR 1.18 [CI 1.09–1.28]) had higher odds for the development of GDM when compared to the reference group (20.8%). The odds for GDM increased along with the increasing number of previous induced abortions and miscarriages. Conclusion: Women with a history of induced abortions or miscarriages had higher odds for GDM in their first pregnancy leading to birth. Knowledge of this association will be helpful in the prevention and screening of GDM.publishedVersionPeer reviewe