[Expert recommendations: Hepatitis C and transplantation]

With the approval of new direct acting antiviral agents (DAA), therapeutic options for patients with chronic hepatitis C virus (HCV) infection are now generally available before and after liver transplantation (LT). Interferon-free DAA regimens are highly effective therapies and provide a good safety profile. However, the body of clinical evidence in this patient population is limited and the best treatment strategies for patients on the waiting list with (de)compensated cirrhosis and after LT are not well defined. The following recommendations for antiviral therapy in the context of LT are based on the currently available literature and clinical experience of experts in the field, and have been discussed in an expert meeting. The aim of this article is to guide clinicians in the decision making when treating patients before and after LT with DAAs.

Constitutive p53 heightens mitochondrial apoptotic priming and favors cell death induction by BH3 mimetic inhibitors of BCL-xL

Proapoptotic molecules directly targeting the BCL-2 family network are promising anticancer therapeutics, but an understanding of the cellular stress signals that render them effective is still elusive. We show here that the tumor suppressor p53, at least in part by transcription independent mechanisms, contributes to cell death induction and full activation of BAX by BH3 mimetic inhibitors of BCL-xL. In addition to mildly facilitating the ability of compounds to derepress BAX from BCL-xL, p53 also provides a death signal downstream of anti-apoptotic proteins inhibition. This death signal cooperates with BH3-induced activation of BAX and it is independent from PUMA, as enhanced p53 can substitute for PUMA to promote BAX activation in response to BH3 mimetics. The acute sensitivity of mitochondrial priming to p53 revealed here is likely to be critical for the clinical use of BH3 mimetics.

Cooperative dry-electrode sensors for multi-lead biopotential and bioimpedance monitoring

Cooperative sensors is a novel measurement architecture that allows the acquiring of biopotential signals on patients in a comfortable and easy-to-integrate manner. The novel sensors are defined as cooperative in the sense that at least two of them work in concert to measure a target physiological signal, such as a multi-lead electrocardiogram or a thoracic bioimpedance.This paper starts by analysing the state-of-the-art methods to simultaneously measure biopotential and bioimpedance signals, and justifies why currently (1) passive electrodes require the use of shielded or double-shielded cables, and (2) active electrodes require the use of multi-wired cabled technologies, when aiming at high quality physiological measurements.In order to overcome the limitations of the state-of-the-art, a new method for biopotential and bioimpedance measurement using the cooperative sensor is then presented. The novel architecture allows the acquisition of the aforementioned biosignals without the need of shielded or multi-wire cables by splitting the electronics into separate electronic sensors comprising each of two electrodes, one for voltage measurement and one for current injection. The sensors are directly in contact with the skin and connected together by only one unshielded wire. This new configuration requires one power supply per sensor and all sensors need to be synchronized together to allow them to work in concert.After presenting the working principle of the cooperative sensor architecture, this paper reports first experimental results on the use of the technology when applied to measuring multi-lead ECG signals on patients. Measurements performed on a healthy patient demonstrate the feasibility of using this novel cooperative sensor architecture to measure biopotential signals and compliance with common mode rejection specification accordingly to international standard (IEC 60601-2-47) has also been assessed.By reducing the need of using complex wiring setups, and by eliminating the presence of central recording devices (cooperative sensors directly sense and store the measured biosignals on the site), the depicted novel technology is a candidate to a novel generation of highly-integrated, comfortable and reliable technologies that measure physiological signals in real-life scenarios.

[Immunological Markers in Organ Transplantation]

The immunological monitoring in organ transplantation is based mainly on the determination of laboratory parameters as surrogate markers of organ dysfunction. Structural damage, caused by alloreactivity, can only be detected by invasive biopsy of the graft, which is why inevitably rejection episodes are diagnosed at a rather progressive stage. New non-invasive specific markers that enable transplant clinicians to identify rejection episodes at an earlier stage, on the molecular level, are needed. The accurate identification of rejection episodes and the establishment of operational tolerance permit early treatment or, respectively, a controlled cessation of immunosuppression. In addition, new prognostic biological markers are expected to allow a pre-transplant risk stratification thus having an impact on organ allocation and immunosuppressive regimen. New high-throughput screening methods allow simultaneous examination of hundreds of characteristics and the generation of specific biological signatures, which might give concrete information about acute rejection, chronic dysfunction as well as operational tolerance. Even though multiple studies and a variety of publications report about important advances on this subject, almost no new biological marker has been implemented in clinical practice as yet. Nevertheless, new technologies, in particular analysis of the genome, transcriptome, proteome and metabolome will make personalised transplantation medicine possible and will further improve the long-term results and graft survival rates. This article gives a survey of the limitations and possibilities of new immunological markers in organ transplantation.

Silicon photomultipliers for improved detection of low light levels in miniature near-infrared spectroscopy instruments

Silicon photomultipliers are novel solid state photodetectors that recently became commercially available. The goal of this paper was to investigate their suitability for low light level detection in miniaturized functional near-infrared spectroscopy instruments. Two measurement modules with a footprint of 26×26 mm(2) were built, and the signal-to-noise ratio was assessed for variable source-detector separations between 25 and 65 mm on phantoms with similar optical properties to those of a human head. These measurements revealed that the signal-to-noise ratio of the raw signal was superior to an empirically derived design requirement for source-detector separations up to 50 mm. An arterial arm occlusion was also performed on one of the authors in vivo, to induce reproducible hemodynamic changes which confirmed the validity of the measured signals. The proposed use of silicon photomultipliers in functional near-infrared spectroscopy bears large potential for future development of precise, yet compact and modular instruments, and affords improvements of the source-detector separation by 67% compared to the commonly used 30 mm.