HLA class II antibodies at the time of kidney transplantation and cardiovascular outcome : a retrospective cohort study

Background. The negative role of HLA class II donor-specific antibody on graft outcome is well recognized. However, the potentially negative cardiovascular effects of preformed HLA class II antibodies and donor HLA in kidney transplant recipients (KTRs) remain unestablished. Methods. We conducted a single-center, retrospective cohort study including 1115 KTRs (2003–2016) with up to 4449 person-years of follow-up after transplantation and a median follow-up time of 5.1 years (interquartile range, 2.7–7.6). We evaluated the unadjusted and multivariable-adjusted association between pretransplant HLA class I and II antibodies, as well as HLA-DR1 donor/recipient genotype and the primary (major adverse cardiac and cerebrovascular event [MACCE] or all-cause mortality) and secondary (MACCE or cardiovascular mortality) outcome. Results. In a multivariate Cox proportional hazard model, HLA class II antibodies before transplantation were associated with increased adjusted hazard ratio (aHR) for MACCE or all-cause mortality (aHR, 1.71 [1.13–2.60]; P = 0.012) even after adjustment for time-varying covariate graft loss (aHR, 1.68 [1.08–2.62]; P = 0.022) and biopsy-proven acute rejection (aHR, 1.71 [1.13–2.60]; P = 0.012). HLA class II antibodies were also associated with increased aHR for the secondary outcome, MACCE, or cardiovascular mortality (aHR, 1.92 [1.12–3.30]; P = 0.018). We investigated the effect of donor and recipient HLA-DR1 on these outcome parameters and demonstrated that KTRs with HLA-DR1 positive donors had an increased aHR for MACCE with all-cause (aHR, 1.45 [1.09–1.94]; P = 0.012) and cardiovascular mortality (aHR, 1.49 [1.00–2.22]; P = 0.05). Conclusions. Prior sensitization against HLA class II antigens is associated with unfavorable long-term cardiovascular outcome in KTRs independent of graft loss or rejection. Recipients of an HLA-DR1 donor also have an impaired cardiovascular outcome

Gender gap in the ERASMUS mobility program

Studying abroad has become very popular among students. The ERASMUS mobility program is one of the largest international student exchange programs in the world, which has supported already more than three million participants since 1987. We analyzed the mobility pattern within this program in 2011-12 and found a gender gap across countries and subject areas. Namely, for almost all participating countries, female students are over-represented in the ERASMUS program when compared to the entire population of tertiary students. The same tendency is observed across different subject areas. We also found a gender asymmetry in the geographical distribution of hosting institutions, with a bias of male students in Scandinavian countries. However, a detailed analysis reveals that this latter asymmetry is rather driven by subject and consistent with the distribution of gender ratios among subject areas

Kinetically Inhibited Order in a Diamond-Lattice Antiferromagnet

Frustrated magnetic systems exhibit highly degenerate ground states and strong fluctuations, often leading to new physics. An intriguing example of current interest is the antiferromagnet on a diamond lattice, realized physically in A-site spinel materials. This is a prototypical system in three dimensions where frustration arises from competing interactions rather than purely geometric constraints, and theory suggests the possibility of unusual magnetic order at low temperature. Here we present a comprehensive single-crystal neutron scattering study of CoAl2O4, a highly frustrated A-site spinel. We observe strong diffuse scattering that peaks at wavevectors associated with Neel ordering. Below the temperature T*=6.5 K, there is a dramatic change in the elastic scattering lineshape accompanied by the emergence of well-defined spin-wave excitations. T* had previously been associated with the onset of glassy behavior. Our new results suggest instead that T* signifies a first-order phase transition, but with true long-range order inhibited by the kinetic freezing of domain walls. This scenario might be expected to occur widely in frustrated systems containing first-order phase transitions and is a natural explanation for existing reports of anomalous glassy behavior in other materials.Comment: 40 pages, 9 figures, Introduction and discussion altered and expanded. Additional section and figure added to Supplementary Informatio

Utility of the Platelet Function Analyzer in Patients with Suspected Platelet Function Disorders: Diagnostic Accuracy Study.

Introduction The platelet function analyzer (PFA) is widely used as a screening tool for bleeding disorders in various settings. The diagnostic performance regarding platelet function disorders (PFDs), which are among the most common inherited bleeding disorders, is however still elusive. We aimed to assess the diagnostic value of PFA for PFD in clinical practice. Methods Comprehensive clinical and laboratory data of all consecutive patients referred to a specialized outpatient between January 2012 and March 2017 with a suspected bleeding disorder were prospectively recorded. The diagnostic work-up was performed according to a prespecified protocol following current guidelines and platelet function was tested using light transmission aggregometry as well as flow cytometry. Results Five hundred and fifty-five patients were included (median age 43.7 years; interquartile range [IQR] 29.3, 61.7; 66.9% female). Possible PFD was diagnosed in 64 patients (11.5%) and confirmed PFD in 54 patients (9.7%). In patients with confirmed PFD, median closure times were 107 seconds (ADP or adenosine diphosphate; IQR 89, 130) and 169 seconds (EPI; IQR 121, 211). In patients without bleeding disorders, PFA closure times were 96 seconds (ADP; IQR 83, 109) and 137 seconds (EPI; IQR 116, 158). The sensitivity was 19.5% in case of PFA ADP (95%CI 12.6, 30.0; specificity 86.4%; 95% CI 82.4, 89.8), and 44.3% in case of PFA EPI (95% CI 34.9, 53.9; specificity 75.6%; 95% CI 70.8, 79.9). Conclusion The diagnostic performance of PFA for PFD was moderate to poor. Our results do not support the utilization of PFA for screening of PFD in clinical practice

Remote sensing vegetation index methods to evaluate changes in greenness and evapotranspiration in riparian vegetation in response to the Minute 319 environmental pulse flow to Mexico

During the spring of 2014, 130 million m(3) of water were released from the United States' Morelos Dam on the lower Colorado River to Mexico, allowing water to reach the Gulf of California for the first time in 13 years. Our study assessed the effects of water transfer or ecological environmental flows from one nation to another, using remote sensing. Spatial applications for water resource evaluation are important for binational, integrated water resources management and planning for the Colorado River, which includes seven basin states in the US plus two states in Mexico. Our study examined the effects of the historic binational experiment (the Minute 319 agreement) on vegetative response along the riparian corridor. We used 250 m Moderate Resolution Imaging Spectroradiometer (MODIS), Enhanced Vegetation Index (EVI) and 30 m Landsat 8 satellite imagery to track evapotranspiration (ET) and the normalized difference vegetation index (NDVI). Our analysis showed an overall increase in NDVI and evapotranspiration (ET) in the year following the 2014 pulse, which reversed a decline in those metrics since the last major flood in 2000. NDVI and ET levels decreased in 2015, but were still significantly higher (P < 0.001) than pre-pulse (2013) levels. Preliminary findings show that the decline in 2015 persisted into 2016 and 2017. We continue to analyse results for 2018 in comparison to short-term (2013-2018) and long-term (2000-2018) trends. Our results support the conclusion that these environmental flows from the US to Mexico via the Minute 319 "pulse" had a positive, but short-lived (1 year), impact on vegetation growth in the delta.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Rapid immunoassays for diagnosis of heparin-induced thrombocytopenia: Comparison of diagnostic accuracy, reproducibility, and costs in clinical practice.

Immunoassays are crucial in the work-up of patients with suspected heparin-induced thrombocytopenia (HIT) and rapid tests have been recently developed. However, comparative data on diagnostic accuracy, reproducibility, and analytical costs of different immunoassays in clinical practice are limited. Samples of 179 consecutive patients evaluated for suspected HIT in clinical practice using a polyspecific enzyme-linked immunoabsorbent assay (GTI diagnostics; ELISA) and a rapid particle gel immunoassay (PaGIA), were additionally analysed with a IgG-specific chemiluminescent immunoassay (AcuStar HIT-IgG). Presence of HIT was defined as a positive functional heparin-induced platelet aggregation test. Diagnostic accuracy was determined for low, intermediate and high thresholds as previously established (ELISA: optical density 0.4, 1.3, and 2.0 respectively; PaGIA: positive/negative, titre of 4, titre of 32; AcuStar HIT-IgG: 1.0 U/ml, 2.8, 9.4) and reproducibility was assessed by repeated measurements. Costs of test determination were calculated taking reagents, controls, and working time of technicians according to Swiss health care system into account. Data on PaGIA results were available for 171 patients (95.5%), ELISA for 144 patients (80.4%), and AcuStar HIT-IgG for 179 patients (100%). Sensitivity was above 95% for all assays at low and intermediate thresholds. Specificity increased with higher thresholds and was above 90% for all assays with intermediate and high thresholds. Specificity of AcuStar HIT-IgG (92.8%; 95% CI 87.7, 96.2) was significantly higher than PaGIA (83.0%; 95% CI 76.3, 88.5) and higher than ELISA (81.8%, 95% CI 74.2, 88.0) at low threshold (p&lt;0.05). Reproducibility was adequate for all assays. Total costs per test were CHF 51.02 for ELISA, 117.70 for AcuStar HIT-IgG, and 83.13 for PaGIA. We observed favourable diagnostic accuracy measures and a high reproducibility for PaGIA and AcuStar HIT-IgG. Implementation into 24-hours-service might improve patient care but the results must be confirmed in other settings and larger populations as well