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Background: Cytomegalovirus (CMV) infection remains a common complication after allogeneic hematopoietic-cell transplantation. Letermovir is an antiviral drug that inhibits the CMV-terminase complex.Methods: In this phase 3, double-blind trial, we randomly assigned CMV-seropositive transplant recipients, 18 years of age or older, in a 2:1 ratio to receive letermovir or placebo, administered orally or intravenously, through week 14 after transplantation; randomization was stratified according to trial site and CMV disease risk. Letermovir was administered at a dose of 480 mg per day (or 240 mg per day in patients taking cyclosporine). Patients in whom clinically significant CMV infection (CMV disease or CMV viremia leading to preemptive treatment) developed discontinued the trial regimen and received anti-CMV treatment. The primary end point was the proportion of patients, among patients without detectable CMV DNA at randomization, who had clinically significant CMV infection through week 24 after transplantation. Patients who discontinued the trial or had missing end-point data at week 24 were imputed as having a primary end-point event. Patients were followed through week 48 after transplantation.Results: From June 2014 to March 2016, a total of 565 patients underwent randomization and received letermovir or placebo beginning a median of 9 days after transplantation. Among 495 patients with undetectable CMV DNA at randomization, fewer patients in the letermovir group than in the placebo group had clinically significant CMV infection or were imputed as having a primary end-point event by week 24 after transplantation (122 of 325 patients [37.5%] vs. 103 of 170 [60.6%], P<0.001). The frequency and severity of adverse events were similar in the two groups overall. Vomiting was reported in 18.5% of the patients who received letermovir and in 13.5% of those who received placebo; edema in 14.5% and 9.4%, respectively; and atrial fibrillation or flutter in 4.6% and 1.0%, respectively. The rates of myelotoxic and nephrotoxic events were similar in the letermovir group and the placebo group. All-cause mortality at week 48 after transplantation was 20.9% among letermovir recipients and 25.5% among placebo recipients.Conclusions: Letermovir prophylaxis resulted in a significantly lower risk of clinically significant CMV infection than placebo. Adverse events with letermovir were mainly of low grade. (Funded by Merck; ClinicalTrials.gov number, NCT02137772 ; EudraCT number, 2013-003831-31 .). [ABSTRACT FROM AUTHOR]

Vertical Bragg grating mirrors are realized by the anisotropic etching of Si using deep reactive ion etching (DRIE), thus producing multiple vertical interfaces between Si and air. The Bragg mirrors are used to realize two optical filter configurations. The first is a tunable Fabry–Pérot cavity composed of two mirrors, where tuning is achieved by moving one of the mirrors using silicon-on-insulator (SOI) electrostatic microelectromechanical system (MEMS) actuation. The second is a drop filter, where a tilted Bragg mirror acts as a wavelength selective reflector. The enhanced etching process involving a mix of cryogenic and Bosch DRIE processes is presented. The realized structures, fabrication process, as well as measured performance are also presented. [ABSTRACT FROM PUBLISHER]

Vascularization of the subcutaneous tissue of the upper extremity is described. Injection of coloured latex or India ink and gelatine solution showed the principal sources of the blood supply. Microdissection and transclarification of Spalteholz allowed for the study of the direct and indirect arterial branches which form the principal network of the subcutaneous tissue. The findings are of practical importance since the subcutaneous tissue can be used as a separate flap for covering soft tissue defects of the forearm and hand. [ABSTRACT FROM PUBLISHER]

The authors focus on the proposed curriculum for subspecialty training for transplant infectious disease (TID) clinicians in the U.S. They state that the curriculum is proposed by the Educational Initiatives Working Group of the Infectious Diseases Community of Practice of the American Society of Transplantation (AST). They questions what defines a TID clinician and how best to train physicians in the principles, attitudes, current knowledge, and unresolved issues.

Opportunistic infectious diseases in patients are variable and depend on the host as well as the type of immunosuppression. Cord blood transplant recipients appear to be particularly vulnerable to infectious complications. Sequential or concurrent opportunistic infectious diseases can be particularly difficult to manage and have increased mortality. We present a young patient, status post cord blood transplantation for acute myelogenous leukemia, who developed a large pulmonary mass-like infection with Aspergillus, cytomegalovirus, and Mycobacterium avium complex. Radiological, surgical, and pathological features are described., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

MR imaging is typically obtained during the work-up of patients who have undergone allogeneic hematopoietic stem-cell transplant who present with unexplained change in mental status, amnesia, or seizures. Although the differential diagnosis is broad in this setting, the presence of T2 prolongation limited to the medial aspect of one or both temporal lobes with or without associated reduced water diffusion may help limit the possible diagnoses. A frequent etiology seen in this context is human herpesvirus-6 (HHV6) infection. We report the evolution of MR imaging findings and clinical course in 4 patients with limbic encephalitis probably related to HHV6.

This paper records our experience with a new technique of providing cover for soft tissue defects of the upper extremity using flaps consisting of subcutaneous tissue only and relying on the arterial anastomotic network of this tissue layer to sustain its vascularisation. The experimental basis of this technique is described in detail and two illustrations of the clinical use of this technique are given. The main advantages of this type of flap are its ready availability from the local tissues, its elasticity, the absence of functional and aesthetic disturbance at the donor site and the preservation of the natural contour of the limb.