Th2 cells are less susceptible than Th1 cells to the suppressive activity of CD25+ regulatory thymocytes because of their responsiveness to different cytokines

AbstractT-cell clones generated from both CD4+CD25+ and CD8+CD25+ human thymocytes were assessed for their ability to suppress the proliferative response to allogeneic stimulation of type 1 T-helper (Th1) or type 2 T-helper (Th2) clones derived from autologous CD4+CD25- thymocytes. Both CD4+ and CD8+ T-regulatory (Treg) cells completely suppressed the proliferation of Th1 clones but exhibited significantly lower suppressive activity on the proliferation of Th2 clones. The partial suppressive effect on Th2 cells was further reduced by the addition in culture of interleukin-4 (IL-4), whereas it was increased in the presence of an anti–IL-4 monoclonal antibody (mAb). The suppressive activity on Th2 clones was also completely inhibited by the addition of IL-7, IL-9, and IL-15 but not of IL-2, whereas the suppressive effect on Th1 clones was only reverted by the addition of IL-15. Of note, Th2 clones expressed significantly higher amounts of mRNA for IL-4 receptor (IL-4R) and IL-9R α chains than Th1 clones, whereas the expression of mRNA for IL-2R, IL-7R, and IL-15R α chains was comparable. Taken together, these findings demonstrate that Th2 cells have a lower susceptibility than Th1 cells to the suppressive activity of human CD25+ regulatory thymocytes, because they are able to produce, and to respond to, growth factors distinct from IL-2, such as IL-4 and IL-9. (Blood. 2004; 103:3117-3121

A modified 'single patch' technique for complete atrioventricular septal defect correction

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Cartella clinica per la cardiochirurgia pediatrica: refertazione dell\u27intervento e stima della complessit? chirurgica

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Integred record system for standard reporting operations in pediatric cardiac surgey and complexity estimation

The Hospital Information System, first developed at our main institute for the integration of clinical, administrative and management resources in Cardiology, has been recently extended for use at our section specialised in Cardiac Surgery. Extension of the electronic medical record (EMR) to the management of patients admitted in Pediatric Cardiac Surgery started with the development of a system for reporting operations in structured form and for estimating their complexity, according to a model set up in a previous study involving our institute and other two pediatric cardiac surgery centers. The international congenital heart surgery nomenclature, promoted in Europe by the Pediatric European Cardiac Surgical Registry (ECSUR) project, was adopted. The ECSUR data set with associated short lists (translated into Italian) of pre-operative risk factors, diagnoses, procedures and complications was implemented in our EMR. Minor coding expansions were suggested by both surgeons and cardiologists. EMR interface was developed to record, for each operation, diagnoses and procedures, patient findings and conditions, operative events and methods. Information on patient history and on follow-up was also recorded. From the combination of underlying diagnosis and procedure each operation was classified in terms of 3-level complexity according to the developed multicenter model. The system is used daily for reporting operations in our Pediatric Cardiac Surgery department. All operations since January 2000 were archived (a total of 547 in two years) and data were periodically exported and submitted to the ECSUR database center. A comprehensive data bank is being developed allowing both clinical management and research as well as risk stratification and outcome analysis. Moreover estimation of operation complexity is useful to evaluate DRG\u27s, often underestimated in Pediatric Cardiac Surgery

Repair of congenital malformations of the mitral valve: Early and midterm results

Background. The aims of this study were to determine early and midterm survival and freedom from reoperation, and to identify the predictors for poor postoperative outcome in children undergoing mitral valve (MV) repair owing to congenital malformations of the mitral valve. Methods. Between January 1990 and February 2001, 94 consecutive children with congenital MV disease underwent valve repair. The mean age was 5.2 +/- 3.3 years (range 20 days to 15 years). Twenty-five (26.6%) children were less than 1 year old. Isolated MV disease was found in 21 (22.4%) patients. MV stenosis was the predominant lesion in 21 (22.4%) patients with a mean left atrial to left ventricle diastolic peak gradient of 24.5 +/- 9.2 mm Hg. MV regurgitation was the predominant pathophysiology in 73 (77.6%) patients with a mean regurgitation grade of 3.3 +/- 0.7. Results. The hospital mortality was 8.5% (8 of 94). Three patients required permanent pacemaker implantation owing to complete atrioventricular block. Two patients underwent mediastinal exploration for significant bleeding. Postoperatively the echocardiography color Doppler study demonstrated a significantly lower mean end diastolic left atrium to left ventricle gradient 8.7 +/- 2.2 mm Hg (p < 0.001) in patients with MV stenosis and a mean regurgitation grade of 0.9 +/- 0.6 (p < 0.001) in patients with MV regurgitation. Actuarial survival and actuarial reoperation-free survival were 89.2% and 76.3%, respectively. Multivariate analysis demonstrated that age less than 1 year (p = 0.035), hammock MV (p = 0.0093), cardiothoracic ratio greater than 0.6 (p < 0.0001), and associated cardiac anomalies (p = 0.003) were strong predictors for poor overall freedom from reoperation and midterm survival. Conclusions. Mitral valve repair for congenital mitral valve disease yields acceptable early and midterm mortality and reoperation rates. Strong predictors for poor overall freedom from reoperation and midterm survival were age less than 1 year, hammock MV, cardiothoracic ratio greater than 0.6, and associated cardiac anomalies. (C) 2002 by The Society of Thoracic Surgeons