Long-range frequency-domain optical delay line based on a spinning tilted mirror for low-cost ocular biometry

Optical biometers are routinely used to measure intraocular distances in ophthalmic applications such as cataract surgery planning or myopia monitoring. However, due to their high cost and reduced transportability, access to them for screening and surgical planning is still limited in low-resource and remote settings. To increase patients' access to optical biometry we propose a novel low-cost frequency-domain optical delay line (FD-ODL) based on an inexpensive stepper motor spinning a tilted mirror, for integration into a time-domain (TD)-biometer, amenable to a compact footprint. In the proposed FD-ODL, the axial scan range and the A-scan rate are decoupled from one another, as the former only depends on the spinning mirror tilt angle, while the A-scan rate only depends on the motor shaft rotational speed. We characterized the scanning performance and specifications for two spinning mirror tilt angles, and compared them to those of the standard, more expensive FD-ODL implementation, employing a galvanometric scanner for group delay generation. A prototype of the low-cost FD-ODL with a 1.5 deg tilt angle, resulting in an axial scan range of 6.61 mm and an A-scan rate of 10 Hz was experimentally implemented and integrated in a dual sample beam optical low-coherence reflectometry (OLCR) setup with a detour unit to replicate the measurement window around the anterior segment and the retina. The intraocular distances of a model eye were measured with the proposed low-cost biometer and found to be in good agreement with those acquired by a custom swept-source optical coherence tomography (SS-OCT) system and two commercial biometers, validating our novel design.

Whole-Exome Sequencing Reveals Recurrent but Heterogeneous Mutational Profiles in Sporadic WHO Grade 1 Meningiomas

Human WHO grade 1 meningiomas are generally considered benign tumors; despite this, they account for ≈50% of all recurrent meningiomas. Currently, limited data exist about the mutational profiles of grade 1 meningiomas and patient outcome. We investigated the genetic variants present in 32 WHO grade 1 meningiomas using whole exome sequencing, and correlated gene mutational profiles with tumor cytogenetics and patient outcome. Overall, WHO grade 1 meningiomas harbored numerous and heterogeneous genetic variants, which most frequently affected the NF2 (47%) gene and to a less extent the PNMA6A (22%), TIGD1 (16%), SMO (13%), PTEN (13%), CREG2 (9%), EEF1A1 (6%), POLR2A (6%), ARID1B (3%), and FAIM3 (3%) genes. Notably, non-synonymous genetic variants of SMO and POLR2A were restricted to diploid meningiomas, whereas NF2 mutations were only found among tumors that showed -22/22q^─ (with or without a complex karyotype). Based on NF2 mutations and tumor cytogenetics, four genetic profiles were defined with an impact on patient recurrence-free survival (RFS). These included (1) two good-prognosis tumor subgroups-diploid meningiomas (n=9) and isolated -22/22q^─ associated with NF2 mutation (n=7)-with RFS rates at 10 y of 100%; and (2) two subgroups of poor-prognosis meningiomas-isolated -22/22q^─ without NF2 mutation (n=3) and tumors with complex karyotypes (n=11)-with a RFS rate at 10 y of 48% (p=0.003). Our results point out the existence of recurrent but heterogeneous mutational profiles in WHO grade 1 meningiomas which have an impact on patient outcome.

Multi-meridian corneal imaging of air-puff induced deformation for improved detection of biomechanical abnormalities

Corneal biomechanics play a fundamental role in the genesis and progression of corneal pathologies, such as keratoconus; in corneal remodeling after corneal surgery; and in affecting the measurement accuracy of glaucoma biomarkers, such as the intraocular pressure (IOP). Air-puff induced corneal deformation imaging reveals information highlighting normal and pathological corneal response to a non-contact mechanical excitation. However, current commercial systems are limited to monitoring corneal deformation only on one corneal meridian. Here, we present a novel custom-developed swept-source optical coherence tomography (SSOCT) system, coupled with a collinear air-puff excitation, capable of acquiring dynamic corneal deformation on multiple meridians. Backed by numerical simulations of corneal deformations, we propose two different scan patterns, aided by low coil impedance galvanometric scan mirrors that permit an appropriate compromise between temporal and spatial sampling of the corneal deformation profiles. We customized the air-puff module to provide an unobstructed SSOCT field of view and different peak pressures, air-puff durations, and distances to the eye. We acquired multi-meridian corneal deformation profiles (a) in healthy human eyes in vivo, (b) in porcine eyes ex vivo under varying controlled IOP, and (c) in a keratoconus-mimicking porcine eye ex vivo. We detected deformation asymmetries, as predicted by numerical simulations, otherwise missed on a single meridian that will substantially aid in corneal biomechanics diagnostics and pathology screening.

Heterogeneous EGFR, CDK4, MDM4, and PDGFRA Gene Expression Profiles in Primary GBM: No Association with Patient Survival

BACKGROUND

The prognostic impact of the expression profile of genes recurrently amplified in glioblastoma multiforme (GBM) remains controversial.

METHODS

We investigated the RNA gene expression profile of epidermal growth factor receptor (EGFR), cyclin-dependent kinase 4 (CDK4), murine doble minute 4 (MDM4), and platelet derived growth factor receptor alpha (PDGFRA) in 83 primary GBM tumors vs. 42 normal brain tissue samples. Interphase FISH (iFISH) analysis for the four genes, together with analysis of intragenic deletions in EGFR and PDGFRA, were evaluated in parallel at the DNA level. As validation cohort, publicly available RNA gene expression data on 293 samples from 10 different GBM patient series were also studied.

RESULTS

At the RNA level, CDK4 was the most frequently overexpressed gene (90%) followed by EGFR (58%) and PDGFRA (58%). Chromosome 7 copy number alterations, i.e., trisomy (49%) and polysomy (44%), showed no clear association with EGFR gene expression levels. In turn, intragenic EGFR deletions were found in 39 patients (47%), including EGFRvIII (46%) in association with EGFRvIVa (4%), EGFRvII (2%) or other EGFR deletions (3%) and PDGFRA deletion of exons 8-9 was found in only two tumors (2%).

CONCLUSIONS

Overall, none of the gene expression profiles and/or intragenic EGFR deletions showed a significant impact on overall survival of GBM supporting the notion that other still unraveled features of the disease might play a more relevant prognostic role in GBM.

Vision with different presbyopia corrections simulated with a portable binocular visual simulator

Presbyopes can choose today among different corrections to provide them with functional vision at far and near, and the outcomes and patient satisfaction depend on the selection. In this study, we present a binocular and portable vision simulator, based on temporal multiplexing of two synchronized tunable lenses allowing see-through and programmable visual simulations of presbyopic corrections. Seventeen binocular corrections were tested: 3 Monofocal (Far, Intermediate, Near), 4 Simultaneous Vision (bifocal, trifocal), 2 Monovision (far and near in either eye) and 8 Modified Monovision corrections (Simultaneous vision in one eye, Monofocal in the other eye). Perceived visual quality was assessed through the simulated corrections in 8 cyclopleged subjects who viewed a composite realistic visual scene with high contrast letters and a landscape at far (4 m) and a high contrast text at intermediate (66 cm) and near (33 cm) distances. Perceptual scores were obtained on a scale of 0 to 5 (low to high perceived quality). Perceptual preference was assessed by judging 36 random image pairs (6 repetitions) viewed through 9 binocular presbyopic corrections using two-interval forced choice procedures. The average score, across far and near distances, was the highest for Monovision (4.4±0.3), followed by Modified Monovision (3.4±0.1), Simultaneous Vision (3.0±0.1) and Monofocal corrections (2.9±0.2). However, the mean difference between far and near was lower for Simultaneous Vision and Monovision (0.4±0.1 PS) than Modified Monovision (1.8±0.7) or monofocal corrections (3.3±1.5). A strong significant correlation was found between the perceptual scores and the percentages of energy in focus, for each correction and distance (R = 0.64, p<0.0001). Multivariate ANOVA revealed significant influence of observation distances (p<10-9) and patients (p = 0.01) on Perceptual Score. In conclusion, we have developed a binocular portable vision simulator that can simulate rapidly and non-invasively different combinations of presbyopic corrections. This tool has applications in systematic clinical evaluation of presbyopia corrections.

Visual simulators replicate vision with multifocal lenses

Adaptive optics (AO) visual simulators based on deformable mirrors, spatial light modulators or optotunable lenses are increasingly used to simulate vision through different multifocal lens designs. However, the correspondence of this simulation with that obtained through real intraocular lenses (IOLs) tested on the same eyes has not been, to our knowledge, demonstrated. We compare through-focus (TF) optical and visual quality produced by real multifocal IOLs (M-IOLs) -bifocal refractive and trifocal diffractive- projected on the subiect's eye with those same designs simulated with a spatial light modulator (SLM) or an optotunable lens working in temporal multiplexing mode (SimVis technology). Measurements were performed on 7 cyclopleged subjects using a custom-made multichannel 3-active-optical-elements polychromatic AO Visual Simulator in monochromatic light. The same system was used to demonstrate performance of the real IOLs, SLM and SimVis technology simulations on bench using double-pass imaging on an artificial eye. Results show a general good correspondence between the TF performance with the real and simulated M-IOLs, both optically (on bench) and visually (measured visual acuity in patients). We demonstrate that visual simulations in an AO environment capture to a large extent the individual optical and visual performance obtained with real M-IOLs, both in absolute values and in the shape of through-focus curves.

[Relevance of Simpson's grading system for resections in WHO grade I meningiomas]

OBJECT

The aim of this study is to assess if the recurrence rates and recurrence/progression-free survivals (RFS) are different after Simpson's grades I, II, III and IV resections in World Health Organization (WHO) grade I meningiomas.

MATERIAL AND METHODS

A retrospective review was conducted on the data of patients who underwent surgical treatment of WHO grade I meningiomas located in convexity, falx/parasagittal, and skull base (anterior/media/posterior) between June 1991 and December 2011. In Simpson's grade IV resections, surgical treatment was supplemented with radiotherapy/radiosurgery on the tumour remains. A comparison was made on the recurrence rates and RFSs between Simpson's grades I, II, III, and IV resections, both overall and in tumour subsets according to their location.

RESULTS

A total of 208 meningiomas were included in this study. There were no significant differences in recurrence rates and RFSs between Simpson's grades I, II, III, and IV. No significant differences were noted between the different degrees of Simpson in any of the location groups. In convexity meningiomas, the recurrence rates were 7% and 33% in Simpson's grades I and III resections, respectively (P=.131).

CONCLUSIONS

It has been shown that the rates of tumour control in meningiomas are not related to Simpson grades. In falx/parasagittal and skull base meningiomas, more aggressive attempts of tumour resection must be balanced against the risks of damaging critical neurovascular structures. In convexity meningiomas, a Simpson's grade I resection should be attempted first.

SNR and Standard Deviation of cGNSS-R and iGNSS-R Scatterometric Measurements

This work addresses the accuracy of the Global Navigation Satellite Systems (GNSS)-Reflectometry (GNSS-R) scatterometric measurements considering the presence of both coherent and incoherent scattered components, for both conventional GNSS-R (cGNSS-R) and interferometric GNSS-R (iGNSS-R) techniques. The coherent component is present for some type of surfaces, and it has been neglected until now because it vanishes for the sea surface scattering case. Taking into account the presence of both scattering components, the estimated Signal-to-Noise Ratio (SNR) for both techniques is computed based on the detectability criterion, as it is done in conventional GNSS applications. The non-coherent averaging operation is considered from a general point of view, taking into account that thermal noise contributions can be reduced by an extra factor of 0.88 dB when using partially overlapped or partially correlated samples. After the SNRs are derived, the received waveform’s peak variability is computed, which determines the system’s capability to measure geophysical parameters. This theoretical derivations are applied to the United Kingdom (UK) TechDemoSat-1 (UK TDS-1) and to the future GNSS REflectometry, Radio Occultation and Scatterometry on board the International Space Station (ISS) (GEROS-ISS) scenarios, in order to estimate the expected scatterometric performance of both missions.

Cancer Incidence in Heart Transplant Recipients With Previous Neoplasia History

Neoplasm history increases morbidity and mortality after solid organ transplantation and has disqualified patients from transplantation. Studies are needed to identify factors to be considered when deciding on the suitability of a patient with previous tumor for heart transplantation. A retrospective epidemiological study was conducted in heart transplant (HT) recipients (Spanish Post-Heart Transplant Tumor Registry) comparing the epidemiological data, immu-nosuppressive treatments and incidence of post-HT tumors between patients with previous malignant noncardiac tumor and with no previous tumor (NPT). The impact of previous tumor (PT) on overall survival (OS) was also assessed. A total of 4561 patients, 77 PT and 4484 NPT, were evaluated. The NPT group had a higher proportion of men than the PT group (p < 0.001). The incidence of post-HT tumors was 1.8 times greater in the PT group (95% confidence interval [CI] 1.2-2.6; p < 0.001), mainly due to the increased risk in patients with a previous hematologic tumor (rate ratio 2.3, 95% CI 1.3-4.0, p < 0.004). OS during the 10-year posttransplant period was significantly lower in the PT than the NPT group (p = 0.048) but similar when the analysis was conducted after a first post-HT tumor was diagnosed. In conclusion, a history of PT increases the incidence of post-HT tumors and should be taken into account when considering a patient for HT.

Tumor infiltrating immune cells in gliomas and meningiomas

Tumor-infiltrating immune cells are part of a complex microenvironment that promotes and/or regulates tumor development and growth. Depending on the type of cells and their functional interactions, immune cells may play a key role in suppressing the tumor or in providing support for tumor growth, with relevant effects on patient behavior. In recent years, important advances have been achieved in the characterization of immune cell infiltrates in central nervous system (CNS) tumors, but their role in tumorigenesis and patient behavior still remain poorly understood. Overall, these studies have shown significant but variable levels of infiltration of CNS tumors by macrophage/microglial cells (TAM) and to a less extent also lymphocytes (particularly T-cells and NK cells, and less frequently also B-cells). Of note, TAM infiltrate gliomas at moderate numbers where they frequently show an immune suppressive phenotype and functional behavior; in contrast, infiltration by TAM may be very pronounced in meningiomas, particularly in cases that carry isolated monosomy 22, where the immune infiltrates also contain greater numbers of cytotoxic T and NK-cells associated with an enhanced anti-tumoral immune response. In line with this, the presence of regulatory T cells, is usually limited to a small fraction of all meningiomas, while frequently found in gliomas. Despite these differences between gliomas and meningiomas, both tumors show heterogeneous levels of infiltration by immune cells with variable functionality. In this review we summarize current knowledge about tumor-infiltrating immune cells in the two most common types of CNS tumors-gliomas and meningiomas-, as well as the role that such immune cells may play in the tumor microenvironment in controlling and/or promoting tumor development, growth and control.

[Guided and computer-assisted implant surgery and prosthetic: The continuous digital workflow]

INTRODUCTION

New continuous digital workflow protocols of guided and computer-assisted implant surgery improve accuracy of implant positioning.

TECHNICAL PROCEDURE

The design of the future prosthesis is based on the available prosthetic space, gingival height and occlusal relationship with the opposing and adjacent teeth. The implant position and length depend on volume, density and bone quality, gingival height, tooth-implant and implant-implant distances, implant parallelism, axis and type of the future prosthesis. The crown modeled on the software will therefore serve as a guide to the future implant axis and not the reverse. The guide is made by 3D printing. The software determines surgical protocol with the drilling sequences. The unitary or plural prosthesis, modeled on the software and built before surgery, is loaded directly after implant placing, if needed.

DISCUSSION

These protocols allow for a full continuity of the digital workflow. The software provides the surgeon and the dental technician a total freedom for the prosthetic-surgery guide design and the position of the implants. The prosthetic project, occlusal and aesthetic, taking the bony and surgical constraints into account, is optimized. The implant surgery is simplified and becomes less "stressful" for the patient and the surgeon. Guided and computer-assisted surgery with continuous digital workflow is becoming the technique of choice to improve the accuracy and quality of implant rehabilitation.

Longitudinal chromatic aberration of the human eye in the visible and near infrared from wavefront sensing, double-pass and psychophysics

Longitudinal Chromatic Aberration (LCA) influences the optical quality of the eye. However, the reported LCA varies across studies, likely associated to differences in the measurement techniques. We present LCA measured in subjects using wavefront sensing, double-pass retinal images, and psychophysical methods with a custom-developed polychromatic Adaptive Optics system in a wide spectral range (450-950 nm), with control of subjects' natural aberrations. LCA measured psychophysically was significantly higher than that from reflectometric techniques (1.51 D vs 1.00 D in the 488-700 nm range). Ours results indicate that the presence of natural aberrations is not the cause for the discrepancies across techniques.

Hepatitis C virus core protein enhances HIV-1 replication in human macrophages through TLR2, JNK, and MEK1/2-dependent upregulation of TNF-α and IL-6

Despite their differential cell tropisms, HIV-1 and HCV dramatically influence disease progression in coinfected patients. Macrophages are important target cells of HIV-1. We hypothesized that secreted HCV core protein might modulate HIV-1 replication. We demonstrate that HCV core significantly enhances HIV-1 replication in human macrophages by upregulating TNF-α and IL-6 via TLR2-, JNK-, and MEK1/2-dependent pathways. Furthermore, we show that TNF-α and IL-6 secreted from HCV core-treated macrophages reactivates monocytic U1 cells latently infected with HIV-1. Our studies reveal a previously unrecognized role of HCV core by enhancing HIV-1 infection in macrophages.

[Bone graft reconstruction for posterior mandibular segment using the formwork technique]

INTRODUCTION

Pre-implant bone graft in posterior mandibular segments is difficult because of masticatory and lingual mechanical constraints, because of the limited bone vascularization, and because of the difficulty to cover it with the mucosa. The formwork technique is especially well adapted to this topography.

TECHNICAL NOTE

The recipient site is abraded with a drill. Grooves are created to receive and stabilize the grafts. The bone grafts were harvested from the ramus. The thinned cortices are assembled in a formwork and synthesized by mini-plates. The gaps are filled by bone powder collected during bone harvesting.

DISCUSSION

The bone volume reconstructed with the formwork technique allows anchoring implants more than 8mm long. The proximity of the inferior alveolar nerve does not contra indicate this technique. The formwork size and its positioning on the alveolar crest can be adapted to prosthetic requirements by using osteosynthesis plates. The lateral implant walls are supported by the formwork cortices; the implant apex is anchored on the native alveolar crest. The primary stability of implants is high, and the torque is important. The ramus harvesting decreases operative risks.

Contribution of the gradient refractive index and shape to the crystalline lens spherical aberration and astigmatism

The optical properties of the crystalline lens are determined by its shape and refractive index distribution. However, to date, those properties have not been measured together in the same lens, and therefore their relative contributions to optical aberrations are not fully understood. The shape, the optical path difference, and the focal length of ten porcine lenses (age around 6 months) were measured in vitro using Optical Coherence Tomography and laser ray tracing. The 3D Gradient Refractive Index distribution (GRIN) was reconstructed by means of an optimization method based on genetic algorithms. The optimization method searched for the parameters of a 4-variable GRIN model that best fits the distorted posterior surface of the lens in 18 different meridians. Spherical aberration and astigmatism of the lenses were estimated using computational ray tracing, with the reconstructed GRIN lens and an equivalent homogeneous refractive index. For all lenses the posterior radius of curvature was systematically steeper than the anterior one, and the conic constant of both the anterior and posterior positive surfaces was positive. In average, the measured focal length increased with increasing pupil diameter, consistent with a crystalline lens negative spherical aberration. The refractive index of nucleus and surface was reconstructed to an average value of 1.427 and 1.364, respectively, for 633 nm. The results of the GRIN reconstruction showed a wide distribution of the index in all lens samples. The GRIN shifted spherical aberration towards negative values when compared to a homogeneous index. A negative spherical aberration with GRIN was found in 8 of the 10 lenses. The presence of GRIN also produced a decrease in the total amount of lens astigmatism in most lenses, while the axis of astigmatism was only little influenced by the presence of GRIN. To our knowledge, this study is the first systematic experimental study of the relative contribution of geometry and GRIN to the aberrations in a mammal lens.

[Modelization of bone graft reconstruction for posterior mandibular segment using the Simplant® software]

INTRODUCTION

Pre-implant reconstruction techniques of edentulous molar mandibular ridges take into account the height and the width of the initial ridge, but not the initial geometry. The Simplant(®) software allows modeling these techniques by taking into account this geometry.

TECHNICAL NOTE

Four surgical techniques for crestal volume reconstruction (apposition, interposition, distraction, formwork) were used on seven hemi-mandibles and modeled with the Simplant(®) software. This reconstructed volume was visualized according to the initial crestal geometry. The average gain in height was 4.1mm for the onlay graft, 2.3mm for the interposition graft, 4mm for distraction, 5.1mm for the boxing. The average gain of crestal width was -0.3mm for the onlay graft, 1mm for the interposition, -0.5mm for the distraction, and 1.3mm for the boxing.

DISCUSSION

Modeling with the Simplant(®) software shows that boxing technique gives the closest bone reconstruction to the ideal crestal geometry, whatever the initial crestal geometry.

Dynamic OCT measurement of corneal deformation by an air puff in normal and cross-linked corneas

A new technique is presented for the non-invasive imaging of the dynamic response of the cornea to an air puff inducing a deformation. A spectral OCT instrument combined with an air tonometer in a non-collinear configuration was used to image the corneal deformation over full corneal cross-sections, as well as to obtain high speed measurements of the temporal evolution of the corneal apex. The entire deformation process can be dynamically visualized. A quantitative analysis allows direct extraction of several deformation parameters, such as amplitude, diameter and volume of the maximum deformation, as well as duration and speed of the increasing deformation period and the recovery period. The potential of the technique is demonstrated on porcine corneas in vitro under constant IOP for several conditions (untreated, after riboflavin instillation and under cross-linking with ultraviolet light), as well as on human corneas in vivo. The new technique has proved very sensitive to detect differences in the deformation parameters across conditions. We have confirmed non-invasively that Riboflavin and UV-cross-linking induce changes in the corneal biomechanical properties. Those differences appear to be the result of changes in constituent properties of the cornea, and not a consequence of changes in corneal thickness, geometry or IOP. These measurements are a first step for the estimation of the biomechanical properties of corneal tissue, at an individual level and in vivo, to improve diagnosis and prognosis of diseases and treatments involving changes in the biomechanical properties of the cornea.

Visual performance with real-life tasks under adaptive-optics ocular aberration correction

We measured the effect of the correction of the natural aberrations of the eye by means of adaptive optics on the subject's performance on three different visual tasks: subjective sharpness assessment of natural images, familiar face recognition, and facial expression recognition. Images were presented through a dedicated psychophysical channel and viewed through an electromagnetic deformable mirror. Experiments were performed on 17 normal subjects. Ocular aberrations (astigmatism and higher order aberrations) were reduced on average from 0.366 +/- 0.154 to 0.101 +/- 0.055 mum for a 5-mm pupil diameter. On average, subjects considered to be sharper 84 +/- 14% of the images viewed under AO correction, and there was a significant correlation between the amount of corrected aberrations and the percentage of images that the subject considered sharper when observed under AO-corrected aberrations. In all eyes (except one), AO correction improved familiar face recognition, by a factor of x1.13 +/- 0.12 on average. However, AO correction did not improve systematically facial expression recognition.

Optical distortion correction in optical coherence tomography for quantitative ocular anterior segment by three-dimensional imaging

A method for three-dimensional 3-D optical distortion (refraction) correction on anterior segment Optical Coherence Tomography (OCT) images has been developed. The method consists of 3-D ray tracing through the different surfaces, following denoising, segmentation of the surfaces, Delaunay representation of the surfaces, and application of fan distortion correction. The correction has been applied theoretically to realistic computer eye models, and experimentally to OCT images of: an artificial eye with a Polymethyl Methacrylate (PMMA) cornea and an intraocular lens (IOL), an enucleated porcine eye, and a human eye in vivo obtained from two OCT laboratory set-ups (time domain and spectral). Data are analyzed in terms of surface radii of curvature and asphericity. Comparisons are established between the reference values for the surfaces (nominal values in the computer model; non-contact profilometric measurements for the artificial eye; Scheimpflug imaging for the real eyes in vivo and vitro). The results from the OCT data were analyzed following the conventional approach of dividing the optical path by the refractive index, after application of 2-D optical correction, and 3-D optical correction (in all cases after fan distortion correction). The application of 3-D optical distortion correction increased significantly both the accuracy of the radius of curvature estimates and particularly asphericity of the surfaces, with respect to conventional methods of OCT image analysis. We found that the discrepancies of the radii of curvature estimates from 3-D optical distortion corrected OCT images are less than 1% with respect to nominal values. Optical distortion correction in 3-D is critical for quantitative analysis of OCT anterior segment imaging, and allows accurate topography of the internal surfaces of the eye.

Malignancy after heart transplantation: incidence, prognosis and risk factors

The Spanish Post-Heart-Transplant Tumour Registry comprises data on neoplasia following heart transplantation (HT) for all Spanish HT patients (1984-2003). This retrospective analysis of 3393 patients investigated the incidence and prognosis of neoplasia, and the influence of antiviral prophylaxis. About 50% of post-HT neoplasias were cutaneous, and 10% lymphomas. The cumulative incidence of skin cancers and other nonlymphoma cancers increased with age at HT and with time post-HT (from respectively 5.2 and 8.9 per 1000 person-years in the first year to 14.8 and 12.6 after 10 years), and was greater among men than women. None of these trends held for lymphomas. Induction therapy other than with IL2R-blockers generally increased the risk of neoplasia except when acyclovir was administered prophylactically during the first 3 months post-HT; prophylactic acyclovir halved the risk of lymphoma, regardless of other therapies. Institution of MMF during the first 3 months post-HT reduced the incidence of skin cancer independently of the effects of sex, age group, pre-HT smoking, use of tacrolimus in the first 3 months, induction treatment and antiviral treatment. Five-year survival rates after first tumor diagnosis were 74% for skin cancer, 20% for lymphoma and 32% for other tumors.

The relationship of anti-MICA antibodies and MICA expression with heart allograft rejection

The role of MICA antibodies in acute heart allograft rejection was examined utilizing 190 pre- and post-transplant serum samples from 44 patients collected during the first year after transplantation. MICA antibodies were detected by CDC test on recombinant cell lines and by the newly developed Luminex MICA antibody detection assay. Additionally, MICA expression was analyzed by 'real time' RT-PCR and by immunohistochemistry in 10 endomyocardial biopsies. Only two subjects had HLA antibodies post-transplant. Nevertheless, MICA antibodies were found in a significant number of subjects. The prevalence of MICA antibodies was significantly higher among those with severe acute rejection (AR) than in those without rejection (60.7% vs. 14.3%, p = 0.0038 by CDC; 55.5% vs. 5.7%, p = 0.0020 by Luminex). In most cases, the appearance of MICA antibodies post-transplant precedes AR. Following transplantation, MICA up-regulation correlated with histological evidence of severe rejection. Monitoring for MICA antibodies post-transplant may be useful to establish new risk factors for acute rejection.

Soluble HLA-G in heart transplantation: their relationship to rejection episodes and immunosuppressive therapy

The aims of this study were to quantify the level of soluble HLA-G in heart transplant patients, to determine the relationship between the sHLA-G levels and the appearance of acute rejection episodes, and to identify the influence of immunosuppressive therapy on sHLA-G levels. Analysis of sHLA-G, measured by enzyme-linked immunosorbent assay in the transplant patients, revealed the existence of two similarly sized groups of patients. One group displayed a significant increase (p < 0.001) in sHLA-G during the first month after transplantation while the other group maintained low levels of the molecule (0-30 ng/ml) throughout the study. The latter group displayed a high incidence of recurrent severe rejection. A significant increase (p < 0.01) in sHLA-G 2 hours after administration of immunosuppressive treatment (mycophenolate mofetil, cyclosporine A/FK506, corticoids) was found. These results suggest that sHLA-G participates in the induction of certain levels of immunological tolerance in these recipients.

Epidermal naevus syndrome (Solomon's syndrome) associated with bladder cancer in a 20-year-old female

Epidermal naevus syndrome was first described by Solomon et al. in 1968, based on a study of 12 patients. Herein we report the case of a 20-year-old female diagnosed with epidermal naevus syndrome at the age of 3 years. Subsequently she experienced several different symptoms and at the last exploration a suspicious lesion was found in her bladder. The definitive pathology diagnosis was transitional cell carcinoma of the bladder, which is extremely rare in patients aged <21 years. It seems that this neoplastic lesion was directly related to the essential pathology of the patient, namely epidermal naevus syndrome.

The involvement of 5-HT3 and 5-HT4 receptors in two models of gastrointestinal transit in mice

Our aim was to study the involvement of 5-hydroxytryptamine (5-HT)(3) and 5-HT(4) receptors in two models of gastrointestinal transit (GIT) in mice: the 5-hydroxytryptophan (5-HTP)-induced diarrhea and intestinal inflammation produced by an irritant agent, croton oil (CO). 5-HTP (10 mg/kg) produced diarrhea that was significantly inhibited after pretreatment with ondansetron (5-HT(3) antagonist) or RS 39604 (5-HT(4) antagonist) (1-5 mg/kg). The GIT speed was increased after CO and 5-HTP administration. 5-HT(3-4) antagonists decreased GIT after 5-HTP-treatment but not after CO-treatment. Our results show that 5-HT(3) and 5-HT(4) receptors are involved in 5-HTP-induced diarrhea. This may be the reason why 5-HT(3-4) antagonists could be useful in the treatment of carcinoid syndrome diarrhea. 5-HT(3-4) antagonists were not effective in the modifications of GIT; nevertheless, they could be useful in the treatment of inflammatory bowel diseases because some symptoms as abdominal pain, discomfort or abnormal bowel function are modulated via 5-HT(3).