Transplantation tolerance may be defined as normal graft survival sans immunosuppression, maintaining intact immunity. Tolerance induction (TI) strategies include induction of chimerism and/or clonal deletion. Donor specific transfusion (DST) and stem cells (SCs) have come-up as TI. In this parallel 2-armed open labeled study under non-myeloablative conditioning with DST as first arm and SCs as second arm, without using conventional immunosuppression. Monitoring included SCr (mg/dL), DSA and MLR. Protocol biopsies were planned after 100 days and yearly in willing patients. In event of rejection/DSA/MLR, rescue immunosuppression was planned. Patient survival for the first 2 years was 100% in both arms; at 5 years post-transplant 80% with SC and 90% with DST. Death-censored graft survival for 1st year was 100 % in both arms, and at 5 years, 80% with SC and 70% with DST. Mean SCr was 1.52 with SC and 1.97 with DST. Five patients from SC-arm and 3 from DST-arm had successful TI. MLR was negative in both groups. DSA appeared in 2 patients of SC without graft dysfunction and 4 of DST causing graft dysfunction. Thus SCs facilitate TI in LDRT under non-myeloablative conditioning.
Endoscopic ultrasound-guided biliary drainage (EUS-BD) is being increasingly used as an alternate therapeutic modality to percutaneous transhepatic biliary drainage (PTBD) for biliary obstruction in patients who fail ERCP. We conducted a systematic review and meta-analysis to compare the efficacy and safety of these 2 procedures. We searched several databases from inception to September 4, 2016, to identify comparative studies evaluating the efficacy and safety of EUS-BD and PTBD. Primary outcomes of interest were the differences in technical success and postprocedure adverse events. Secondary outcomes of interest included clinical success, rate of reintervention, length of stay in hospital, and cost comparison for these 2 procedures. Odds ratios (OR) and standard mean difference were calculated for categorical and continuous variables respectively. These were analyzed using random effects model of meta-analysis.
The book serves as a rigorous introduction to the basic principles and practice of the building 3D model creation process. It presents five photogrammetric methods utilised for 3D modelling of urban area, as follows: close range photogrammetry, by using digital non-metric images taken with a Canon EOS Rebel XSi/450D digital camera, UAV photogrammetry by using digital non-metric images acquired with a low-cost UAV platform, namelly DJI Phantom 3 Standard, the traditional technologies of terrestrial photogrammetry by using metric images, acquired with terrestrial photogrammetric camera UMK 10/1318, the terrestrial laser scanner method (TLS) and the aerial laser scanner method (ALS). We are reviewing the data sources, their preliminary processing to be brought in a common system and the software used for the creation of the final 3D models of the buildings. The comparative studies between the five methods were accomplished by analyzing the object space representation fidelity and the precision of the 3D models created for the buildings that were study in this book.
Obstructive sleep apnea (OSA) syndrome is characterized by recurrent episodes of pharyngeal collapses occurring during sleep, leading to chronic intermittent hypoxia (IH). Long time ago, OSA has been recognized as a cardiovascular risk factor. Furthermore, it is associated with increased prevalence of type 2 diabetes and has been shown to be a risk factor for insulin resistance and incident diabetes independently of obesity. Since the benefits of physical activity on cardiometabolic health have been largely recognized and the effects of reference treatment of OSA (Continuous Positive Airway Pressure device) are limited, exercise could limit IH-induced cardiometabolic morbidity in OSA patients. To explore this possibility we conducted 2 studies on human beings and mice in order to characterize physical fitness, fat oxidation capacity, their link with cardiometabolic morbidity in non-obese OSA and to assess the specific effects of IH and the needs in terms of physical activity adaptations. The aims of the second study were to confirm the specific effects of IH on insulin resistance on mice and to explore the possible benefits of different modalities of aerobic exercise training.
Appropriate use criteria in echocardiography are essential tools for aligning indications of echocardiography with the best clinical standards, improving clinical outcome, restraining abuse and preserving healthcare resources. Assessment of 501 inpatients who received transthoracic cardiac echo was conducted according to the 2011 appropriate use criteria report. Indications were classified as appropriate, uncertain or inappropriate, and patients not matching any of the above divisions were grouped in the non-fitting category. Of the 501 eligible patients, 374 (74.65%) were in the appropriate group, 85 (16.96%) in the inappropriate group, 20 (3.99%) in the uncertain group and 22 (4.39%) in the non-fitting category. Interpretation and analysis of the obtained results are presented, along with results of many comparable studies; moreover, a quality improvement project was set up accordingly. Appropriate use criteria are useful to assess local practice, to preserve healthcare resources, and to improve clinical outcome.
