Inflammatory Burden of Cardiac Allograft Coronary Atherosclerotic Plaque Is Associated With Early Recurrent Cellular Rejection and Predicts a Higher Risk of Vasculopathy Progression

ObjectivesThis study was designed to investigate tissue characterization of the coronary allograft atherosclerotic plaque with virtual histology intravascular ultrasound (VH-IVUS) imaging to assess the presence and predictors of vessel wall inflammation and its significance in cardiac allograft vasculopathy (CAV) progression.BackgroundA unique form of accelerated atherosclerosis, CAV remains the leading cause of late morbidity and mortality in heart transplant patients. The pathogenesis of CAV is not fully elucidated.MethodsA total of 86 patients with coronary allograft vasculopathy underwent VH-IVUS examination of the left anterior descending coronary artery 3.61 ± 3.04 years following cardiac transplantation. Based on the VH-IVUS plaque characteristics, coronary allograft plaque was divided on virtual histology intravascular ultrasound-derived “inflammatory” (VHD-IP) (necrotic core and dense calcium ≥30%) and “noninflammatory” plaque (VHD-NIP) (necrotic core and dense calcium <30%). Total rejection scores were calculated based on the 2004 International Society of Heart and Lung Transplantation rejection grading system.ResultsIn the whole study population, the mean percentage of fibrous, fibrofatty, dense calcified, and necrotic core plaques in a mean length of 62.3 ± 17.4 mm of the left anterior descending coronary artery were 50 ± 17%, 16 ± 11%, 15 ± 11%, and 18 ± 9%, respectively. Patients with a 6-month total rejection score >0.3 had significantly higher incidence of VHD-IP than those with a 6-month total rejection score ≤0.3 (69% vs. 33%, p = 0.011). The presence of VHD-IP at baseline was associated with a significant increase in plaque volume (2.42 ± 1.78 mm3/mm vs. –0.11 ± 1.65 mm3/mm, p = 0.010), plaque index (7 ± 9% vs. 0 ± 8%, p = 0.04), and remodeling index (1.24 ± 0.44 vs. 1.09 ± 0.36, p = 0.030) during 12 months of follow-up when compared with the presence of VHD-NIP at baseline and during follow-up.ConclusionsThe presence of VHD-IP as assessed by VH-IVUS is associated with early recurrent rejection and with higher subsequent progression of CAV. A VH-IVUS assessment may add important information in the evaluation of transplant recipients

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Not AvailableRainfed arable systems of India accounts about 55% of the total sown area (Shankar, 2011), while slightly higher parts of the it about 62% is rainfed in Madhya Pradesh state of India. The Madhya Pradesh state has 14.9 M ha cultivated area constitutes almost half of the total geographical area and agriculture is the major source of livelihood for more than 70% human population, production systems should be resilient to risks, be able to ensure food, nutritional security and strengthened livelihood systems with minimum environmental externalities. The Chambal division is consisting of Morena, Sheopur and Bhind district of Madhya Pradesh. Total geographical area (TGA) of Chambal division is 16.054 lakh ha, net crop sown area 7.52 lakh ha and area under ravines is 3.11 lakh ha, which is highly degraded land (Singh et al., 2018). Out of total area under ravines in Chambal division have 1.92 lakh ha in undivided Morena (Morena and Sheopur) district (Tomar et al., 2015). Ravines owe their origin to rill-erosion on highly erodible soils by run-off rain water. Ravines mean not only a loss of nonrenewable land-resource but also destruction of rural economy, loss of public property, creation of socioeconomic problems such as dacoitinfestation and unemployment (Singh et al., 2014). Since formation of ravines was a function of uncontrolled run-off, the management of rainwater through storage of rain water in ponds watershed basis was an appropriate approach for control of ravine and increase of irrigated areas (Verma and Singh, 2009). The groundwater table of the area is approximately 122 feet deep. The over exploitation of underground water through well and tube wells in the district the water table goes downwards to 2 to 5 feet every year and ordinary wells and open well become dry and pose problems of domestic use, animal rearing and agriculture activities in remote areas. In general, the quality of under ground water also deteriorated (salinity and alkalinity) with decreasing of water table in some patches are also seen. Rain water collection in ponds and its recycling is very important component of rainfed as well as in irrigated agriculture system. Runoff collection can be done in several ways depending upon the characteristics and suitability site. Runoff will get stored temporarily against submersible check dams, pond, stop dam, anicut, the construction of which will be very essential for stabilization of gully-bed, etc. Also, selection of suitable sites for construction of farm ponds or tanks is necessary to store runoff. Hon'ble Prime Minister of the country has urged upon doubling farmers' income by 2022. Therefore, it is essential that farm productivity should increase in irrigated as well as rainfed areas. In Morena district the pearlmillet, pigeonpea, soybean, blackgram, wheat, mustard, chickpea and vegetables are major existing crops but the productivity of these crops is low from potential yield of crops owing to adoption of local varieties, non-adoption of improved agronomic package, mono-cropping, intensive and repeat tillage, faulty crop establishment method, undulating topography, burning of crop residues and several abiotic and biotic climatic abnormalities.Not Availabl

No Major Neurologic Complications With Sirolimus Use in Heart Transplant Recipients

OBJECTIVE: To determine whether sirolimus therapy is associated with neurologic complications, including stroke, among heart transplant recipients

Substance p for evaluation of coronary endothelial function after cardiac transplantation

AbstractThe endothelium-dependent vasodilator substance P dilates normal and diseased coronary vessels in humans in vivo and produces a maximal response similar to that seen with intracoronary isosorbide dinitrate. Twelve cardiac transplant recipients underwent intracoronary infusion of substance P after routine annual investigations. All patients were well, with no evidence of rejection and with angiographically normal coronary arteries. Substance P was infused at 2 ml/min for 2 min into the coronary artery, starting at a dose of 1.4 pmol/min and increasing by doubling increments, and followed by isosorbide dinitrate (1 mg/min) infused over 2 min. Coronary artery diameter was measured in 23 vessel segments from 12 transplant recipients.The following doses were infused: saline solution (1 ml/min), substance P (0.7 [three patients], 1.4, 2.8, 5.6, 11.2, 22.4 pmol/ min) and isosorbide dinitrate (1 mg/min). The mean percent increase in diameter (± SEM) in response to increasing doses of substance P was as follows: 0. 6.5 ± 2.9%, 10.9 ± 2.9%, 12.1 ±2.9%, 16.5 ± 2.6%, 19.2 ± 3.1% and 25.8 ± 2.2%, respectively. Half maximal dilation was produced with 1.4 to 2.8 pmol/min of substance P; the maximal response (mean percent diameter change) was 22 ± 2.5%. This was not significantly different from that achieved with isosorbide dinitrate.It is concluded that coronary endothelial function as assessed by response to substance P is preserved in cardiac transplant recipients with angiographically normal coronary arteries. Substance P may be a suitable agent for testing endothelial function in these patients

Sirolimus-Based Immunosuppression Is Associated with Decreased Incidence of Post-Transplant Lymphoproliferative Disorder after Heart Transplantation: A Double-Center Study

Mammalian target of rapamycin (mTOR) inhibitors have been shown to reduce proliferation of lymphoid cells; thus, their use for immunosuppression after heart transplantation (HT) may reduce post-transplant lymphoproliferative disorder (PTLD) risk. This study sought to investigate whether the sirolimus (SRL)-based immunosuppression regimen is associated with a decreased risk of PTLD compared with the calcineurin inhibitor (CNI)-based regimen in HT recipients. We retrospectively analyzed 590 patients who received HTs at two large institutions between 1 June 1988 and 31 December 2014. Cox proportional-hazard modeling was used to examine the association between type of primary immunosuppression and PTLD after adjustment for potential confounders, including Epstein–Barr virus (EBV) status, type of induction therapy, and rejection. Conversion from CNI to SRL as primary immunosuppression occurred in 249 patients (42.2%). During a median follow-up of 6.3 years, 30 patients developed PTLD (5.1%). In a univariate analysis, EBV mismatch was strongly associated with increased risk of PTLD (HR 10.0, 95% CI: 3.8–26.6; p p = 0.02). In a multivariable model and after adjusting for EBV mismatch, conversion to SRL remained protective against risk of PTLD compared with continued CNI use (HR 0.12, 95% CI: 0.03–0.55; p = 0.006). In conclusion, SRL-based immunosuppression is associated with lower incidence of PTLD after HT. These findings provide evidence of a benefit from conversion to SRL as maintenance therapy for mitigating the risk of PTLD, particularly among patients at high PTLD risk