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IntroductionWe investigated the potential role of HLA molecular mismatches (MM) in achieving stable chimerism, allowing for donor-specific tolerance in patients undergoing combined living donor kidney and hematopoietic stem cell transplantation (HSCT).MethodsAll patients with available DNA samples (N=32) who participated in a phase 2 clinical trial (NCT00498160) where they received an HLA mismatched co-transplantation of living donor kidney and facilitating cell-enriched HSCT were included in this study. High-resolution HLA genotyping data were used to calculate HLA amino acid mismatches (AAMM), Eplet MM, three-dimensional electrostatic mismatch scores (EMS-3D), PIRCHE scores, HLA-DPB1 T-cell epitope group MM, HLA-B leader sequence MM, and KIR ligands MM between the donor and recipient in both directions. HLA MM were analyzed to test for correlation with the development of chimerism, graft vs. host disease (GvHD), de novo DSA, and graft rejection.ResultsFollow-up time of this cohort was 6–13.5 years. Of the 32 patients, 26 developed high-level donor or mixed stable chimerism, followed by complete withdrawal of immunosuppression (IS) in 25 patients. The remaining six of the 32 patients had transient chimerism or no engraftment and were maintained on IS (On-IS). In host versus graft direction, a trend toward higher median number of HLA-DRB1 MM scores was seen in patients On-IS compared to patients with high-level donor/mixed chimerism, using any of the HLA MM modalities; however, initial statistical significance was observed only for the EMS-3D score (0.45 [IQR, 0.30–0.61] vs. 0.24 [IQR, 0.18–0.36], respectively; p=0.036), which was lost when applying the Bonferroni correction. No statistically significant differences between the two groups were observed for AAMM, EMS-3D, Eplet MM, and PIRCHE-II scores calculated in graft versus host direction. No associations were found between development of chimerism and GvHD and non-permissive HLA-DPB1 T-cell epitope group MM, HLA-B leader sequence, and KIR ligands MM.ConclusionOur results suggest an association between HLA-DRB1 molecular mismatches and achieving stable chimerism, particularly when electrostatic quality of the mismatch is considered. The non-permissive HLA-DPB1 T-cell epitope group, HLA-B leader sequence, and KIR ligands MM do not predict chimerism and GvHD in this combined kidney/HSCT transplant patient cohort. Further work is needed to validate our findings.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT00498160, identifier NCT00498160.

The purpose of the STAR 2019 Working Group was to build on findings from the initial STAR report to further clarify the expectations, limitations, perceptions, and utility of alloimmune assays that are currently in use or in development for risk assessment in the setting of organ transplantation. The goal was to determine the precision and clinical feasibility/utility of such assays in evaluating both memory and primary alloimmune risks. The process included a critical review of biologically driven, state-of-the-art, clinical diagnostics literature by experts in the field and an open public forum in a face-to-face meeting to promote broader engagement of the American Society of Transplantation and American Society of Histocompatibility and Immunogenetics membership. This report summarizes the literature review and the workshop discussions. Specifically, it highlights (1) available assays to evaluate the attributes of HLA antibodies and their utility both as clinical diagnostics and as research tools to evaluate the effector mechanisms driving rejection; (2) potential assays to assess the presence of alloimmune T and B cell memory; and (3) progress in the development of HLA molecular mismatch computational scores as a potential prognostic biomarker for primary alloimmunity and its application in research trial design.

With the development of modern solid-phase assays to detect anti-HLA antibodies and a more precise histological classification, the diagnosis of antibody-mediated rejection (AMR) has become more common and is a major cause of kidney graft loss. Currently, there are no approved therapies and treatment guidelines are based on low-level evidence. The number of prospective randomized trials for the treatment of AMR is small, and the lack of an accepted common standard for care has been an impediment to the development of new therapies. To help alleviate this, The Transplantation Society convened a meeting of international experts to develop a consensus as to what is appropriate treatment for active and chronic active AMR. The aim was to reach a consensus for standard of care treatment against which new therapies could be evaluated. At the meeting, the underlying biology of AMR, the criteria for diagnosis, the clinical phenotypes, and outcomes were discussed. The evidence for different treatments was reviewed, and a consensus for what is acceptable standard of care for the treatment of active and chronic active AMR was presented. While it was agreed that the aims of treatment are to preserve renal function, reduce histological injury, and reduce the titer of donor-specific antibody, there was no conclusive evidence to support any specific therapy. As a result, the treatment recommendations are largely based on expert opinion. It is acknowledged that properly conducted and powered clinical trials of biologically plausible agents are urgently needed to improve patient outcomes.

Gram-negative bacteria include more than 20 genera. The most commonly isolated genera are: Bacteriodes spp., Porphiromonas spp., Fusobacterium spp. and Prevotella spp. The following genera were isolated somewhat less frequently: Tanerella spp., Leptotricha spp., Veilonella spp.,Wollinela spp., Selenomonas spp. and Treponema spp. Anaerobic bacteria have an anaerobic type of metabolism and therefore their incubation is significantly longer and more demanding than aerobic bacteria. The genera Prevotella spp., Porphyromonas spp. and Fusobacterium spp. are part of the resident flora of the oral cavity and in unfavorable conditions cause periodontal diseases, and sometimes dentogenic infections and systemic diseases, such as Alzheimer's disease, cardiovascular diseases, metabolic diseases and inflammatory bowel diseases. The three most important steps for the successful diagnosis of anaerobic bacteria are: proper sampling with avoiding sample contamination, rapid transport of samples to the microbiological laboratory and proper handling of samples. A combination of beta-lactam with the addition of beta-lactamase inhibitors, metronidazole, clindamycin and moxifloxacin is used for treatment for infections caused by anaerobic Gram-negative bacteria. It is important to note that antibiotics should be used only with a clear indication and to choose the right antibiotic in the optimal dose. The aim of this review is to point out the role of Gram-negative anaerobic bacteria in periodontal diseases, and its isolation, identification and antibiotic susceptibility.

Introduction Implant placement with simultaneous bone augmentation presents procedure with high risk of complications. In those situations, one of the surgical procedures with promising outcomes is the split crest technique. Case report A 69-year-old edentulous patient was referred to the Clinic of Oral Surgery, at the Faculty of Dentistry in Pancevo. The width of the mandibular alveolar ridge in the inter-canine region was 2 mm. For the ridge splitting and expansion, a special split and expansion kit was used (Esset Kit® , Osstem, South Korea). The procedure started with crestal remover carbide cylindrical bur of 7 mm diameter for flattening of the alveolar ridge to the width of 4 mm. Then, a sharp lance drill was used to mark the places for implant osteotomies and placement. After that, 1.8 mm twist drill was used to prepare a bed of 10 mm depth, and a 13 mm saw was directed vertically. Set of expansion drills were used to expand the alveolar ridge gradually. Two implants 3.5x10 mm each (TSIII SA® , Osstem, South Korea) were inserted in the region of lower canines and the space between split buccal and lingual bone lamellae remained empty. Initial stability of inserted implants was assessed by implant stability quotient (ISQ). The values for implant stability were high for both inserted implants (98 and 93). After the surgical procedure, a control CBCT was done. The wound healed uneventfully. Conclusion Split crest technique seems to be a predictable alternative for implant placement in narrow alveolar ridges.

Intrarenal B cells are indicative of poor prognosis in human renal allografts. Here the authors use single cell RNA sequencing to examine how intrarenal B cells contribute to renal rejection and find a population of innate B cells reactive to renal-specific or inflammation-associated antigens.

The XIII Banff meeting, held in conjunction the Canadian Society of Transplantation in Vancouver, Canada, reviewed the clinical impact of updates of C4d-negative antibody-mediated rejection (ABMR) from the 2013 meeting, reports from active Banff Working Groups, the relationships of donor-specific antibody tests (anti-HLA and non-HLA) with transplant histopathology, and questions of molecular transplant diagnostics. The use of transcriptome gene sets, their resultant diagnostic classifiers, or common key genes to supplement the diagnosis and classification of rejection requires further consensus agreement and validation in biopsies. Newly introduced concepts include the i-IFTA score, comprising inflammation within areas of fibrosis and atrophy and acceptance of transplant arteriolopathy within the descriptions of chronic active T cell-mediated rejection (TCMR) or chronic ABMR. The pattern of mixed TCMR and ABMR was increasingly recognized. This report also includes improved definitions of TCMR and ABMR in pancreas transplants with specification of vascular lesions and prospects for defining a vascularized composite allograft rejection classification. The goal of the Banff process is ongoing integration of advances in histologic, serologic, and molecular diagnostic techniques to produce a consensus-based reporting system that offers precise composite scores, accurate routine diagnostics, and applicability to next-generation clinical trials.

Solid phase detection and identification of HLA antibodies in kidney transplantation currently relies on single antigen bead (Luminex®) assays, which is more sensitive than the previously used enzyme‐linked immunosorbent assays (ELISA). To evaluate the impact of more sensitive HLA testing on antibody‐mediated rejection (AMR) occurrence and allograft survival, we analysed 1818 renal allograft recipients transplanted between March 2004 and May 2021. In 2008, solid phase testing switched from ELISA to Luminex. We included 393 (21.6%) transplantations before and 1425 (78.4%) transplantations after transition from ELISA‐ to Luminex‐based testing. For this study, bio‐banked ELISA era samples were tested retrospectively with Luminex. Significantly less pretransplant DSA were found in patients transplanted with pre‐existing HLA antibodies in the Luminex (109/387) versus the ELISA period (43/90) (28% vs. 48%, p < 0.01). Throughout histological follow‐up, 169 of 1818 (9.3%) patients developed AMR. After implementing Luminex‐based testing, the rate of AMR significantly decreased (p = 0.003). However, incidence of graft failure did not significantly differ between both eras. In conclusion, less patients with pretransplant DSA were transplanted since the implementation of Luminex HLA testing. Transition from ELISA‐ to Luminex‐based HLA testing was associated with a significant decrease in AMR occurrence post‐transplantation. Since the decline of AMR did not translate into improved graft survival, Luminex‐based testing has the added value of preventing low‐risk AMR cases. Therefore, Luminex' high sensitivity must be balanced against waiting time for a suitable organ. [ABSTRACT FROM AUTHOR]

Introduction: Decannulation, the removal of the tracheostomy tube, is an essential procedure that a treating team must consider for all tracheostomized patients. There is a lack of evidence available regarding the factors that are associated with the outcomes of the decannulation process. The study aims to detect the outcome of decannulation, describe factors associated with failed decannulation and to describe the decannulation practice in adult patients at a tertiary hospital in Riyadh, Saudi Arabia. Methodology: We performed a retrospective descriptive study for 210 tracheostomized patients aged 18 and above from January 2016 to December 2017. Demographic data, tracheostomy data, and decannulation process data were collected and entered in Microsoft Excel and exported to SPSS for the analysis. Results: Among 210 patients, the majority of tracheostomies were done at the bedside (55.2%). A total of 186 (88.6%) patients were successfully decannulated within 6 months. Obesity, comorbidity, and Glasgow Coma Scale (GCS) during admission were not associated with failure. Faster decannulation (73.5%) was found in those patients ventilated

Abstract Few rootstock varieties are used for ‘Tahiti’ acid lime; therefore, diversification is necessary and studying the phenological phases of new scion/rootstock combinations is important for orchard management strategies. The aim of this study was to evaluate the influence of different rootstocks on the sum of degree days (DD) and on the phenology of plants and also on the quality of ‘Tahiti’ acid lime fruits, in Pindorama, SP. Six branches were marked on plants grafted onto 13 citrandarins (H), ‘Rangpur’ lime (RL), ‘Flying Dragon’ trifoliate orange (FD) and ‘Sunki’ mandarin (SM). Phenological characterization (anthesis to harvest) was performed using a grading scale. DD accumulation (anthesis to harvest) was determined considering the base temperature of 13 °C. Physical (weight, height and diameter, juice yield) and chemical (acidity, total soluble solids and ratio) characteristics of fruits were also evaluated. The experimental design was in randomized blocks with three replicates and one plant per plot. The rootstocks under study influenced DD accumulation and phenology, with early (H5, H73, H121, H135, H145, H152, FD - 1,558 at 1,676 DD and 135 to 146 days) and later combinations (H10, H14, H42, H47, H70, H150, H173, RL and SM - 1,694 to 1,829 DD and 148 to 157 days) regarding fruit maturation. The harvest point of ‘Tahiti’ acid lime fruits grafted onto H145 citrandarin and FD was advanced about 20 days in relation to the standard rootstock, RL. Total soluble solids content and fruit size were influenced by rootstocks; however, all scion/rootstock combinations presented fruits with quality characteristics within commercial standards.

Campylobacter jejuni (C. jejuni) is one of the most frequent causes of bacterial enterocolitis globally. The disease in human is usually self-limiting, but when complications arise antibiotic therapy is required at a time when resistance to antibiotics is increasing worldwide. Mechanisms of antibiotic resistance in bacteria are diverse depending on antibiotic type and usage and include: enzymatic destruction or drug inactivation; alteration of the target enzyme; alteration of cell membrane permeability; alteration of ribosome structure and alteration of the metabolic pathway(s). Resistance of Campylobacter spp. to antibiotics, especially fluoroquinolones is now a major public health problem in developed and developing countries. In this review the mechanisms of resistance to fluoroquinolones, macrolides, tetracycline, aminoglycoside and the role of integrons in resistance of Campylobacter (especially at the molecular level) are discussed, as well as the mechanisms of resistance to β-lactam antibiotics, sulphonamides and trimethoprim. Multiple drug resistance is an increasing problem for treatment of campylobacter infections and emergence of resistant strains and resistance are important One Health issues.

Background/Aim. Dental status and oral hygiene habits are poor in young population living in deprived socioeconomic conditions. The aim of this research was to ascertain oral hygiene habits in adolescents attending high schools in urban area, determine the incidence of tooth loss at the age of 15–16 years and the gender difference. Methods. The epidemiological cross-sectional study included 234 randomly selected high school students. The research instruments were questionnaire (focusing on socio-demographic characteristics, habits, attitudes and behavior related to general and oral health) and clinical examination (tooth loss, normative need for prosthodontics restorations and presence of restorations). Results. Gender-related data comparison revealed that 32.5% of girls and 8.1% of boys had at least one tooth extracted (p < 0.05). Also, 56.2% of girls and 75.7% of boys brushed their teeth twice a day. Caries complications were identified as the indication for tooth extraction in 82.8% of participants. The data analysis confirmed the correlation between gender and tooth loss as well as treatment needs. Tooth loss was correlated with oral hygiene habits and reasons for dental visits. Treatment need was also affected by the reasons for tooth extraction and the absence of adequate prosthodontics therapy (p < 0.05). Conclusion. Sociodemographic conditions significantly influenced the number of participants with extracted teeth. A prosthodontic treatment need was influenced by the reasons for tooth extraction, adolescents’ knowledge about the importance of adequate treatment and previous unpleasant experience.

Major advancements in the development of HLA antibody detection techniques and our understanding of the outcomes of solid organ transplant in the context of HLA antibody have occurred since the relevance of sensitization was first recognized nearly 50 years ago. Additionally, kidney paired donation programs (KPD) have become widespread, deceased donor allocation policies have changed, and several new therapeutic options have become available with promise to reduce HLA antibody. In this overview we aim to provide thoughtful guidance about when desensitization in kidney transplantation should be considered taking into account the outcomes of HLA incompatible transplantation. Novel therapeutics, desensitization endpoints, and strategies for future study will also be discussed. While most of our understanding about desensitization comes from studying kidney transplant candidates and recipients, many of the concepts discussed can be easily applied to desensitization in all of solid organ transplantation.

Introduction. The medical records of 62 stallions with acquired inguinal herniation were reviewed (2007-2017). Materials and Methods. The history, clinical and laboratory findings on admission to the clinic and methods of treatment have been summarized. Results and Conclusions. The prevalence of inguinal hernia among horses with colic was 3.85 % (62/1609 cases). Indirect inguinal hernia was observed in 58 cases (93.54 %) and incarcerated inguinal hernia was observed in 55 horses (88.71 %). Hernia was found more frequently on the left side (36 cases) then on the right (26 cases). The majority of horses with acquired inguinal hernia were admitted to the clinic in the summer and spring (49/62), i.e. when air temperatures were high, significantly more (p

Background/Aim. It is estimated that about 230 million refugees and asylum seekers circulates worldwide. Parasitosis are diagnosed in recent years with increasing frequency both in Europe and other developed countries. International migration of population, as an inalienable part and a result of the process of globalization, has an increasing impact on health of the population of countries through which migrants pass or settle. The aim of this study was to determine the incidence of intestinal parasitic diseases in asylum seekers on the territory of Belgrade. Methods. The study group included 97 asylum seekers from the Centre for Asylum seekers in Obrenovac, in the period December 2013– January 2014. Stool samples were taken less than seven days after arriving to the Center and sent to the Laboratory for Parasitological Diagnosis of the Public Health Institute of Belgrade. Detection of parasites in stool samples was performed by a direct native slide made of fresh sample and direct slide made after stool concentration applying "Mini Parasep" technique. Statistical analysis included application of χ2-test of matching and χ2-test of independence. Results. The study showed that the parasites were detected in 9.3% of cases, in the group of 15–24 years of age. Protozoa were found in 6.2% and helminthes in 3.1% of the samples. Conclusion. Most intestinal parasitosis were found in asylum seekers from Bangladesh. All parasitosis were found in males and the most frequently detected parasite was Giardia lamblia.

Kidney transplantation is the treatment of choice for children with end‐stage kidney failure, yet suboptimal outcomes, the need for long‐term immunosuppression, and the dependency on consecutive transplants pose significant barriers to success. Providing better HLA‐matched organs to pediatric patients seems to be the most logical approach to improve graft and patient outcomes and to reduce risk of anti‐HLA sensitization after graft failure. We here review recent literature on HLA matching in pediatric kidney transplantation. We further review newer approaches attempting to improve matching by using molecular mismatch load analysis. Our main focus is on the role of HLA‐DQ compatibility between recipient and donor. We further emphasize the need to develop creative approaches that will support HLA (and DQ) matching utilization in organ allocation schemes, at least in those geared specifically for pediatric patients. [ABSTRACT FROM AUTHOR]