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One of the means for representing quantities/magnitudes is the mental number line. It is still a nonsolved question as to whether the method of learning mathematics in the early years could improve this type of estimating. A total of 233 students, aged four and five years, who learned mathematics with a new method called Open Algorithm Based on Number or the more traditional Closed Based on Ciphers approach, were evaluated with a reliable estimation on the number line test. Results revealed significant differences in participants’ estimation functions based on the learning method used. Students who learned mathematics through the Open Algorithm Based on Number method used a linear representation more efficiently than those who were taught with the Closed Based on Ciphers methodology. This group exhibited a logarithmic function in their approach. We discussed whether these differences can be attributed to a recurrent practice in estimation tasks at school, characterized by the Open Algorithm Based on Number methodology.

Purpose Bacterial infections are the most frequent infectious complications after heart transplantation. IgA and IgM serological response to the 23-valent pneumococcal polysaccharide vaccine (PPSV23) can be used to assess antibody function against T-cell independent type-2 antigens (anti-PPS). We evaluated if IgA and IgM anti-PPS titers after vaccination in a cohort of heart recipients were associated with the risk for development of bacterial infections. Methods A prospective follow-up study of 151 adult heart recipients (124 male, 27 female, mean age: 58 years) at a single center. The study population received one injection of PPSV23 before transplantation. Specific IgA and IgM anti-PPS were measured in pre and post vaccination sera before transplantation by ELISA (2-3 weeks interval between pre and post vaccination samples) and at distinct times after transplantation (day 7, 30, 90, 180). ELISA plate contained the 23 antigens of the pneumococcal vaccine. The prevalence of bacterial infections was registered during the first 6 months after transplantation. Results During follow-up 32 patients (21%) developed bacterial infectious complications that required IV drug therapy in hospital. Mean anti-PPS titers were significantly lower in transplanted patients who developed bacterial infections as compared with heart recipients who remained free of bacterial infections: after vaccination before transplantation (IgA anti-PPS, 12±10 vs 27±51 mg/dL, p=0.031), at day 7 after transplantation (IgA anti-PPS, 6±5 vs 13±12 mg/dL, p=0.01), at day 30 after transplantation (IgA anti-PPS, 6±5 vs 19±34 mg/dL, p=0.003 and IgM anti-PPS, 6±4 vs 14±19 mg/dL, p=0.002), at day 90 (IgA anti-PPS, 4±2 vs 17±10 mg/dL, p=0.003 and IgM anti-PPS, 7±4 vs 13±8 mg/dL, p=0.04) and at day 180 (IgA anti-PPS, 3±1 vs 15±9 mg/dL, p=0.003). Conclusion Low IgA and IgM anti-polysaccharide responses may predispose heart recipients to develop bacterial infections. IgA anti-PPS as a biomarker warrants validation in a multicenter study.

Information and Communication Technologies (ICT) have an increasing influence on the way we interact, learn, and live. The increase in teaching and learning methodologies that are mediated by ICT in the field of education and in the domestic settings encourages the design of new effective technological tools, supported by scientific research and development to improve student learning. The challenge psychology is facing in the education field is to promote those technologies and make them available to the education community. Technologies also would produce attractive items for users and realistic commercial issues for businesses. This also allows an effective transfer for scientific work, providing visibility to Research and Development. In this context, the main aim of the article is to describe the process to get an agreement between Babyradio (a children’s entertainment company: https://babyradio.es/) and our research team, starting a collaborative work between two groups of people (Babyradio’s technical designer and Psychologist-Engineers software designer), in order to create several educative applications (APPs) in the field of early mathematics cognition. The institutional framework of the relationship of the R&D project and a children’s entertainment company is described. The article also focuses on experience in Psychology, Technological Innovation, and Entrepreneurship. In considering the efficiency of the agreement, we present different APPs designed for tablets and smartphone devices, adapted to the different operating systems (IOS, Android, Windows). APPs are designed to instill the cognitive fundamentals associated with early math learning for students aged 4 to 7 years. The study developed after this babyradio-university enterprise agreement contributes to the development of mathematics skills in children, aged 4–7 years, so that they can successfully meet the mathematics school requirements; it also contributes to encouraging a more positive attitude toward mathematics. This study also suggests how the education system and software and educational content developers’ companies would manage verified instructional APPs, with a more realistic commercial perspective.

Background The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation. Methods We did this prospective, multicentre, randomised controlled trial in 21 teaching hospitals in Spain. We enrolled patients who were aged 18 years or older, were scheduled to have abdominal surgery with an expected time of longer than 2 h, had intermediate-to-high-risk of developing postoperative pulmonary complications, and who had a body-mass index less than 35 kg/m(2). Patients were randomly assigned (1: 1: 1: 1) online to receive one of four lung-protective ventilation strategies using low tidal volume plus positive end-expiratory pressure (PEEP): open-lung approach (OLA)-iCPAP (individualised intraoperative ventilation [individualised PEEP after a lung recruitment manoeuvre] plus individualised postoperative continuous positive airway pressure [CPAP]), OLA-CPAP (intraoperative individualised ventilation plus postoperative CPAP), STD-CPAP (standard intraoperative ventilation plus postoperative CPAP), or STD-O-2 (standard intraoperative ventilation plus standard postoperative oxygen therapy). Patients were masked to treatment allocation. Investigators were not masked in the operating and postoperative rooms; after 24 h, data were given to a second investigator who was masked to allocations. The primary outcome was a composite of pulmonary and systemic complications during the first 7 postoperative days. We did the primary analysis using the modified intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT02158923. Findings Between Jan 2, 2015, and May 18, 2016, we enrolled 1012 eligible patients. Data were available for 967 patients, whom we included in the final analysis. Risk of pulmonary and systemic complications did not differ for patients in OLA-iCPAP (110 [46%] of 241, relative risk 0.89 [95% CI 0.74-1.07; p=0.25]), OLA-CPAP (111 [47%] of 238, 0.91 [0.76-1.09; p=0.35]), or STD-CPAP groups (118 [48%] of 244, 0.95 [0.80-1.14; p=0.65]) when compared with patients in the STD-O-2 group (125 [51%] of 244). Intraoperatively, PEEP was increased in 69 (14%) of patients in the standard perioperative ventilation groups because of hypoxaemia, and no patients from either of the OLA groups required rescue manoeuvres. Interpretation In patients who have major abdominal surgery, the different perioperative open lung approaches tested in this study did not reduce the risk of postoperative complications when compared with standard lung-protective mechanical ventilation.

Objective To assess the diagnostic accuracy of peripheral capillary oxygen saturation (SpO(2)) while breathing room air for 5 min (the 'Air-Test') in detecting postoperative atelectasis. Design Prospective cohort study. Diagnostic accuracy was assessed by measuring the agreement between the index test and the reference standard CT scan images. Setting Postanaesthetic care unit in a tertiary hospital in Spain. Participants Three hundred and fifty patients from 12 January to 7 February 2015; 170 patients scheduled for surgery under general anaesthesia who were admitted into the postsurgical unit were included. Intervention The Air-Test was performed in conscious extubated patients after a 30 min stabilisation period during which they received supplemental oxygen therapy via a venturi mask. The Air-Test was defined as positive when SpO(2) was >= 96% and negative when SpO(2) was >= 97%. Arterial blood gases were measured in all patients at the end of the Air-Test. In the subsequent 25 min, the presence of atelectasis was evaluated by performing a CT scan in 59 randomly selected patients. Main outcome measures The primary study outcome was assessment of the accuracy of the Air-Test for detecting postoperative atelectasis compared with the reference standard. The secondary outcome was the incidence of positive Air-Test results. Results The Air-Test diagnosed postoperative atelectasis with an area under the receiver operating characteristic curve of 0.90 (95% CI 0.82 to 0.98) with a sensitivity of 82.6% and a specificity of 87.8%. The presence of atelectasis was confirmed by CT scans in all patients (30/30) with positive and in 5 patients (17%) with negative Air-Test results. Based on the Air-Test, postoperative atelectasis was present in 36% of the patients (62 out of 170). Conclusion The Air-Test may represent an accurate, simple, inexpensive and non-invasive method for diagnosing postoperative atelectasis.

Los Estilos de Aprendizaje son el conjunto de rasgos cognitivos, fisiológicos y afectivos indicadores de cómo el alumnado percibe, interacciona y responde a los diferentes ambientes del aprendizaje. Cada alumno/a tiene su propio estilo de aprendizaje de adquirir los conocimientos. Los estudiantes, además de utilizar sus habilidades cognitivas y meta cognitivas, han de saber también jerarquizar, organizar y priorizar su aprendizaje. Si bien el estudio de los Estilos de Aprendizaje es muy común en los niveles de educación obligatoria, son menos los trabajos realizados en la enseñanza superior. En el presente estudio se reconoce a los estilos de aprendizaje como recursos didácticos imprescindibles para orientar un aprendizaje significativo. El estudio se ha llevado a cabo con alumnos universitarios de ingeniería. Se emplea un diseño metodológico descriptivo, no experimental y de corte transversal realizado en la carrera Ingeniería Forestal de la Universidad de Pinar del Río (Cuba). Un total de 120 estudiantes universitarios participaron en este estudio (53.3% mujeres y 46.6 % hombres). Los participantes han realizado el Cuestionario Honey-Alonso de Estilos de Aprendizaje (CHAEA). Las respuestas permitieron determinar el perfil de estilos de aprendizaje del alumnado, siendo el estilo reflexivo el de mayor representatividad, seguido de los estilos teórico, activo y pragmático. No se detectaron diferencias estadísticamente significativas en los estilos de aprendizaje entre los años académicos para los varones, pero sí se detectaron para las mujeres. Se evidencia una evolución de los estilos reflexivo y teórico con el nivel de profesionalización de los alumnos en la medida que transitan por los cursos académicos, estando en correspondencia con los mejores rendimientos académicos alcanzados. El estudio evidenció se trata de un valioso recurso que enriquece la orientación de la enseñanza en función de la diversidad y la mejora de los aprendizajes. Se analizan sus efectos sobre la formación de los ingenieros y se discute las fortalezas y debilidades en el campo aplicado de la enseñanza superior

Purpose The IgG antibody response against polysaccharide microbial antigens is enriched for IgG2 antibodies, which possess characteristics that are likely to enhance opsonisation of these antigens. IgG2 molecules are more effective than other IgG subclasses in opsonising antigens with a high epitope density. Lower IgG2 concentration has been found to be a risk factor of death after community acquired pneumonia. Infection is still a major cause of death during the first year after heart transplantation. In this study we evaluated the prevalence of IgG2 insufficiency in heart recipients before transplantation and its relationship with the risk for development of severe deadly infections. Methods 119 patients evaluated in a single center were included. Prospective follow-up was performed to identify the clinical outcomes: early deadly infections during the first month and deadly infections during the follow-up after transplantation. In this study using the Binding Site nephelometry test, IgG2 insufficiency was defined as IgG2 levels below 2.72 mg/dL. Results In the pre-transplant evaluation 46 (38.7%) patients were found to have IgG2 insufficiency. Early deadly infections were more prevalent among patients with IgG2 insufficiency (RH 2.68, 95% CI 1.10-6.53, p=0.029). Use of mechanical ventilation, pre-transplant infections and pre transplant use of ventricular assist devices were risk factors of early deadly infections. In multivariate regression analysis IgG2 insufficiency remained in the model (RH 4.18, 95% CI 1.20-14.47, p=0.024). IgG2 insuficiency was also a risk factor of deadly infections (RH 4.27, 95% CI 1.37-13.26, p=0.012) and a risk factor of 1-year all-cause mortality (RH 2.68, 95% CI 1.10-6.53, p=0.029). Conclusion Pre-transplant IgG2 insufficiency is a risk factor of bad outcome after transplantation. This immunological biomarker warrants evaluation in a multicenter study.

Despite advances in anti-microbial prophylaxis, infection continues to be one of the most important barriers for long-term survival in solid organ transplantation. According to the 2013 report of the International Society for Heart and Lung Transplantation Registry, infections were the main cause of death in heart recipients between 1 month and 1 year after transplantation 1. Heart recipients who develop an infection before post-transplantation discharge have a higher risk of death at 5 years even if they survive the first year 1. Methods to identify heart recipients at risk of infection could allow physicians to make targeted adjustments to immunosuppressive strategy and prophylaxis aimed at decreasing patient morbidity 2. Biomarkers for the identification of transplant recipients at risk of infection must be validated clinically in large prospective multi-centre studies using standardized measurement techniques and evaluation methods. Immunoglobulin (Ig)G hypogammaglobulinaemia was investigated as a risk factor for infection in heart recipients by Avery and collaborators at the Cleveland Clinic in retrospective single-centre studies 3. We have confirmed these findings in prospective single-centre studies evaluating the role of IgG hypogammaglobulinaemia as a risk factor of severe infection in heart recipients who received non-cytolytic induction therapy with anti-CD25 monoclonal antibodies 4,5. In a recent prospective multi-centre national study, we assessed the usefulness of a panel of humoral immunity biomarkers in 267 heart recipients in Spain 6. Our study confirmed that monitoring IgG and distinct humoral immunity profiles (for example, combining IgG and C3 determinations) after transplantation can help to identify a subgroup of patients at greater risk of infection. Transplant recipients with moderate IgG hypogammaglobulinaemia and C3 hypocomplementaemia 1 month after transplantation were at greater risk of infection. In this study, most infections occurred during the first 3 months post-transplantation 6, suggesting that identification and management of risk factors would be most effective early after transplantation. The role of IgG hypogammaglobulinaemia as a risk factor for infection has also been confirmed in a recently published meta-analysis by Florescu and collaborators 7. In this study, severe IgG hypogammaglobulinaemia (defined as IgG 400 mg/dl. Opportunities for designing prevention trials that target the management of risk factors for infection in solid organ transplantation should be explored fully. In clinical trials, the use of biomarkers may allow close monitoring of response to treatment and also enable the selection of patients most likely to respond to specific therapies. An important aspect of IgG hypogammaglobulinaemia is that it is a risk factor that can be managed by replacing infusions of intravenous immunoglobulin (IVIg). The Cleveland Clinic group observed that prophylactic administration of specific anti-CMV IVIg in heart recipients with moderate hypogammaglobulinaemia (IgG

The analysis of proliferative responses using 5,6-carboxyfluorescein diacetate succinimidyl ester (CFSE) in flow cytometry is widely used to assess lymphocyte function. The aim of this study was to evaluate nonspecific and specific lymphoproliferative responses using CFSE in heart recipients before and after transplantation and their association with the development of infection. We used four-color flow cytometry to measure the response of peripheral CD3+, CD4+, and CD8+ T cells to phytohemagglutinin mitogen (PHA), tetanus toxoid, hepatitis B, and influenza vaccines using a CFSE proliferation assay in 12 heart recipients and 8 healthy control subjects. Recipients were prospectively evaluated. Immunological studies were performed before and at 3 months after transplantation. A 12-month clinical follow-up examination sought to detect the prevalence of severe infectious complications. Heart recipients (infected [n = 7] and uninfected [n = 5]) disclosed significantly lower percentages of proliferative responses than healthy controls against PHA at both study points. Baseline CD3+, CD4+, and CD8+, antitetanus proliferative responses were significantly lower in infected heart recipients than controls. Patients who developed infections displayed significantly lower percentages of CD3+CFSE and CD8+CFSE cells to PHA mitogen at 3 months after transplantation versus those without infections. In conclusion, nonspecific T-cell reactivity to PHA was lower in heart recipients with posttransplantation infections.

Background Infection remains a source of mortality in heart recipients. We previously reported that post-transplant immunoglobulin G (IgG) quantification can help identify the risk for infection. We assessed whether other standardized parameters of humoral and cellular immunity could prove useful when identifying patients at risk of infection. Methods We prospectively studied 133 heart recipients over a 12-month period. Forty-eight patients had at least one episode of severe infection. An event was defined as an infection requiring intravenous antimicrobial therapy. Results Cox regression analysis revealed an association between the risk of developing infection and the following: lower IgG2 subclass levels (day 7: relative hazard [RH] 1.71; day 30: RH 1.76), lower IgA levels (day 7: RH 1.61; day 30: RH 1.91), lower complement C3 values (day 7: RH 1.25), lower CD3 absolute counts (day 30: RH 1.10), lower absolute natural killer [NK] cell count (day 7: RH 1.24), and lower IgG concentrations (day 7: RH 1.31; day 30: RH 1.36). Cox regression bivariate analysis revealed that lower day 7 C3 levels, IgG2 concentration, and absolute NK cell count remained significant after adjustment for total IgG levels. Conclusions Data suggest that early immune monitoring including C3, IgG2, and NK cell testing in addition to IgG concentrations is useful when attempting to identify the risk of infection in heart transplant recipients.

Computer Assisted Learning (CAL) has been shown to be an efficient learningteaching procedure. Although there is an extensive educational software tradition using CAL approaches, few of them have demonstrated a better student performance than standard drill and practice methods. The purpose of this study was (a) to evaluate the effectiveness of the “Let’s Play With :::” software program, and (b) to evaluate the effectiveness of a prompt (i.e. a blinking object) used in the program. The educational software “Let’s Play With :::” was designed to teach basic concepts involving shapes and body positions to preschool students. The software structure follows a behavioral design and uses a stimulus control procedure. The study was carried out with 64 preschool students in the Cadiz (Spain) School District. Statistically significant differences were found between the experimental group and a control group.

Attention disorders are one of the major sources of poor school performance. This research project was designed to examine whether a Computer Assisted Instruction (CAI) approach would be successful in achieving higher rates of attention. In order to increase attention behaviour during school time, psychologically‐designed software was developed. The software, called “How to improve your mental skills,” consists of three games based on multimedia perception tasks. First, 155 elementary school children with an average age of 12.4 years, from Cadiz (Spain) School District, were evaluated with two attention tests, the Perception Differences Test (PDT), and the subtest Spatial of Primary Mental Aptitude (S‐PMA). Students were divided and balanced into one experimental and two control groups, according to their scores on the PDT. Then, 10 training sessions, of 25 minutes each, with the software “How to improve your mental skills”, were administered to the experimental group. Children from control group 1 played...

IgG hypogammaglobulinemia is a risk factor for infection in heart recipients. We assessed reconstitution of humoral immunity after non-specific intravenous immunoglobulin (IVIg) replacement therapy administered to treat secondary IgG hypogammaglobulinemia in heart recipients with severe infections. The study population comprised 55 heart recipients who were administered IVIg (IVIg group) and 55 heart recipients with no severe infectious complications (control group). An event was defined as a severe infection requiring intravenous drug therapy during the first year after transplantation. The IVIg protocol comprised non-specific 5% pasteurized IVIg at a dose of 300-400 mg/kg/months. IgG titers were lower in the IVIg group than in controls at seven d (577 vs. 778 mg/dL, p < 0.001) and at one month (553 vs. 684, p = 0.003). After IVIg therapy, IgG concentrations were similar in both groups at three months (681 vs. 737, p = 0.25) and at six months (736 vs. 769, p = 0.46). At three months, the IVIg group had higher levels of antitetanus toxoid and anti-HBs (ELISA, 2.07 ± 2.11 vs. 0.60 ± 1.24 mg/dL [p = 0.003] and 42 ± 40 vs. 11 ± 31 IU/mL [p = 0.005], respectively) than controls. The mean number of infectious complications was significantly lower after IVIG therapy in the IVIG group. IVIg was associated with restoration of humoral immunity in heart recipients with post-transplant IgG hypogammaglobulinemia and severe infections.

(PD-1) and increased levels of the T-box factor eomesodermin (Eomes) unlike tetramer+ cells from controllers. While impaired effector function persisted in many relapsers from acute infection, the expression of high PD-1 levels on CMV-specific CD8+ T cells was only detected during chronic infection, and not acute primary infection, suggesting exhaustion. Conclusion: Thus, impaired CMV-specific T cell responses from relapsers are not for lack of CMV-specific cells, but rather, cells that are dysfunctional with an exhausted phenotype. Ongoing studies are focusing on whether effector function can be rescued in these CMV-specific CD8+ T cells.

Computer-assisted learning can be an efficient learning-teaching procedure. Although there is an extensive educational software tradition for this approach, few have better performance than standard drill-and-practice methods. In this work, the specific software “Let's Play With …” was designed to teach concepts of colours, shapes, and body position to children with intellectual disabilities. The software structure follows the Gagné instructional design and applied behaviour analysis. The program was carried out with 39 boys and 21 girls who were special education students in the Cadiz School District. Statistically significant differences were found between groups taught with and without the software.

Purpose Infection is a leading cause of morbidity and mortality in the first year following lung transplantation. However, reliable markers performed at fixed times before and after transplantation to detect patients at risk for developing these complications are lacking. The purpose of this study is to define the kinetics of humoral immunity parameters, and to evaluate the usefulness of assessment of these parameters in the identification of recipients at risk of developing severe infections after transplantation. Methods and Materials We prospectively analyzed 97 adult lung recipients from May 2009 to May 2011 performed at 5 centers in Spain. Immunological studies were performed before transplantation and at 7 and 30 days after transplantation. The protocol included total immunoglobulin levels (IgG, IgM, IgA, nephelometry), complement factors (C3 and C4, nephelometry) and specific antibody titers to pneumococcal polysaccharides (anti-PPS, ELISA, IgG: 23 serotypes), and to cytomegalovirus (ELISA, IgG). Clinical follow-up was performed over a 6-month period. Definition of outcomes: A. Opportunistic infections (including fungal and CMV that required IV antimicrobial therapy: Prevalence 21,6%). B. Bacterial infection that required IV antimicrobial therapy (Prevalence 58.8%). Statistics: Logistic regression analysis. Results IgG, IgA, C3 and anti-PPS were significantly lower at day 7 as compared with the baseline study. At day 30 IgG, IgA and anti-PPS remained significantly lower. Immunological risk factors for opportunistic infections were: Pre-transplant IgG Conclusions Protocolized early immunologic monitoring of IgG is useful to identify lung recipients who are at risk of oportunistic infection. These patients deserve a more careful follow-up.

Background: The Maternal-Child Pastoral is a volunteer-based community organization of the Dominican Republic that works with families to improve child survival and development. A program that promotes key practices of maternal and child care through meetings with pregnant women and home visits to promote child growth and development was designed and implemented. This study aims to evaluate the impact of the program on nutritional status indicators of children in the first two years of age. Methods: A quasi-experimental design was used, with groups paired according to a socioeconomic index, comparing eight geographical areas of intervention with eight control areas. The intervention was carried out by lay health volunteers. Mothers in the intervention areas received home visits each month and participated in a group activity held biweekly during pregnancy and monthly after birth. The primary outcomes were length and body mass index for age. Statistical analyses were based on linear and logistic regression models. Results: 196 children in the intervention group and 263 in the control group were evaluated. The intervention did not show statistically significant effects on length, but point estimates found were in the desired direction: mean difference 0.21 (95%CI −0.02; 0.44) for length-for-age Z-score and OR 0.50 (95%CI 0.22; 1.10) for stunting. Significant reductions of BMI-for-age Z-score (−0.31, 95%CI −0.49; -0.12) and of BMI-for-age > 85 th percentile (0.43, 95%CI 0.23; 0.77) were observed. The intervention showed positive effects in some indicators of intermediary factors such as growth monitoring, health promotion activities, micronutrient supplementation, exclusive breastfeeding and complementary feeding. Conclusions: Despite finding effect measures pointing to effects in the desired direction related to malnutrition, we could only detect a reduction in the risk of overweight attributable to the intervention. The findings related to obesity prevention may be of interest in the context of the nutritional transition. Given the size of this study, the results are encouraging and we believe a larger study is warranted.

lymph nodes, spleen) and days (2, 5). Results: DCs morphology & numbers: the number in the allograft was slightly higher at day 2 and much higher at day 5 compared to the isograft. Also, the morphology in the allograft was matured while that in the isograft was immatured. Interestingly, administration of CTLA4-Ig in allograft results in optimized maintenance of DCs morphology and numbers compared to no treated allograft. DCs-T cell interplay: There was no interaction in isograft. In allograft, CD8 (blue) and CD11c (EYFP) cellular interactions were observed for at least 5 minutes on Day 2 at graft. Although the same interaction was observed in CTLA4-Ig treated allograft recipient, cross talk between cells (CD11c EYFP and CD4/8) didn’t last longer compared to allograft. Validation: FACS was performed on day 5. 1) Increased CD11c cells at graft/para-aortic lymph nodes and 2) increased Yae cells in allograft compared to isograft. Conclusions: We investigated the role of recipient DC-T cell interaction in graft rejection versus tolerance utilizing “state-of-the-art” imaging technologies. Its results will provide invaluable insight into temporal and spatial interplay of cellular interactions in determining the choice between tolerance and rejection.

Purpose: The aim of this study was to evaluate the maintenance of antibody response to unconjugated pneumococcal capsular polysaccharide vaccine (PPV23) in adult heart recipients. Methods and Materials: 37 heart recipients (mean age 52 10) that were vaccinated with PPV23 at the time of inclusion in the waiting list, and 29 unvaccinated healthy controls (mean age 46 9 years) were analysed. Blood samples were taken pre-HT before vaccination (n 16) and after vaccination (n 17, mean time from vaccination: 143 days). Study points after HT: 7days (n 34), 1m (n 34), 3m (n 37), 6m (n 37), 12m (n 33) and 18m (n 22). Specific antibodies were measured using a commercial enzyme-linked immunosorbent assay technique (ELISA, Binding Site, Birmingham, UK; measuring range: 0.33-27 mg/dl). Results: In the pre-HT evaluation anti-PPS concentrations before vaccination were similar in heart recipients and controls (10 9 vs 10 8 mg/dl). After vaccination heart recipients disclosed significantly higher concentrations than controls: before HT (27 0.9, p 0.001,) and at 7days (20 8, p 0.001), 1m (19 9, p 0.001), 3m (18 9, p 0.001), 6m (16 9, p 0.005), and 12m (14 9, p 0.045) after-HT. There were no significant differences between both groups at 18m (12 9, p 0.21). Median fold increase of anti-PPS was 4.56 (pre-HT vs 7 days, interval: 0.54-17.42). There was a progressive decrease in anti-PPS which were significantly lower as compared with baseline post-vaccination values at all post-HT study points. During follow-up, 8 patients (20.5%) developed bacterial infectious complications. The frequency of heart recipients that maintained anti-PPS concentrations higher than 27 mg/dl during the first 3 months was 12.5% and 48% in patients with and without bacterial infections, respectively (p 0.07). Conclusions: Heart recipients maintained higher concentrations of antiPPS as compared with unvaccinated healthy controls up to 18 months after transplantation. Lower concentrations of anti-PPS mignt be associated with development of bacterial infections.

Humoral Immunity Reconstitution after Intravenous Immunoglobulin Replacement Therapy in Heart Recipients with Post Transplant IgG Hypogammaglobulinemia and CMV Infection J. Carbone, N. Del Pozo, J. Rodriguez-Molina, J. Navarro, A. Gallego, J. Fernandez-Yanez, J. Palomo, P. Munoz, E. Sarmiento. Clinical Immunology, Gregorio Maranon Hospital, Madrid, Spain; Cardiology, Gregorio Maranon Hospital, Madrid, Spain; Microbiology, Gregorio Maranon Hospital, Madrid, Spain.

s S105 Purpose: We hypothesize that by individualizing antiviral prophylaxis according to their CMV immune response, and continuing valganciclovir until CMV-specific T-cell immunity has been established the incidence of late CMV reactivation will be reduced. We provide an interim analysis of 49/130 lung transplant (LTx) patients who have completed an interventional study of CMV-specific immune monitoring to direct the length of antiviral prophylaxis. Methods: LTx recipients were randomized 1:2 to either standard of care (cessation of antiviral prophylaxis at 5 months) or the need for continued antiviral prophylaxis as determined by the QuantiFERON-CMV assay. Those with a negative result received up to an additional 6 months of antiviral prophylaxis. The primary end-point of the study will be the incidence of CMV reactivation in the lung allograft within 18 months of LTx. Monthly blood monitoring for CMV was performed for 6 months after cessation of Valganciclovir. CMV reactivation within the lung allograft was assessed at bronchoscopy performed 9, 12 and 18 months after LTx. Results: An interim analysis of 49 LTx patients (female 57%, COPD 59%, mean age 56 years, Basiliximab 29%) was performed. CMV risk profiles defined by donor (D) and recipient CMV serostaus included D+/R+ (n = 20), D+/R(n = 12) and D-/R+ (n = 17). Low level late CMV reactivation (PCR > 150 copies) was common in both the blood (43%) and BAL (55%). Adopting a QFN-CMV directed approach to antiviral prophylaxis significantly reduced the incidence of severe viremia (40% vs 6%), with a less dramatic reduction seen in the lung allograft (33% vs 21%). The magnitude of the QFN-CMV response impacted on the subsequent risk of late severe CMV viremia, that was seen in 35% of LTx patients with a QFN-CMV response 1. Conclusion: A QFN-CMV directed approach significantly reduces late CMV viremia in LTx patients. Persistent CMV reactivation within the transplanted lung suggests that conventional CMV-specific T-cells may be less effective in the MHC-mismatched allograft.