Cell-mediated cytotoxicity: a predictor of chronic rejection in pediatric HLA haploidentical renal transplants

BACKGROUND: Recipient antidonor cytotoxic T-cell activity has been associated with graft loss and acute rejection in renal allograft recipients. The role of immunologic mechanisms in the development of chronic graft rejection is controversial. We analyzed all living related renal transplants performed at Children's Hospital (Boston, MA) from 1983 to 1995 to assess whether cell-mediated cytotoxicity, determined in vitro and measured before transplantation, was predictive of chronic rejection. METHODS: Eighty-three patients were studied retrospectively. Fifty-seven patients with one haplotype-matched renal transplants from living related donors were studied to determine the association between cell-mediated lympholysis (CML) level, acute rejection, chronic rejection, and graft failure. Acute rejection was defined by the decision to treat. Chronic rejection was defined by histology and/or the absolute serum creatinine value using an increasing serum creatinine level >1.0 mg/dl for children less than 3, a creatinine level >1.5 mg/dl for children between 3 and 10 years of age, and a creatinine level >2.0 mg/dl for children above 10 years of age. Return to dialysis or retransplantation was considered graft failure. RESULTS: Of the 57 haploidentical patients, there were 33 males and 24 females. The mean age at transplant was 11.1 years (SD=6.7). Twelve patients developed chronic rejection, 24 patients developed acute rejection, and 7 patients had graft failure. Pretransplant cytotoxic T lymphocyte activity was associated with chronic rejection (P=0.001) and graft failure (P=0.013) but only marginally with acute rejection (P=0.058). Controlling for age and sex, Cox's proportional hazards model revealed that CML level was predictive of time to chronic rejection (P<0.01) but not acute rejection (P=0.11). It was estimated that every 1-unit increase in CML level raises the monthly risk of chronic rejection by 7%. Ten children received HLA-identical kidneys from their siblings. There were no episodes of chronic rejection after 5 years. Two patients with high CML levels had episodes of acute rejection; both patients responded to treatment. CONCLUSION: Our data demonstrate an association between pretransplant cell-mediated cytotoxicity and the occurrence of chronic rejection in living related one-haploidentical renal transplants in pediatric patients.     

Simulation of leachate migration in leaky aquifers

A two-dimensional cross-section finite difference model is presented to simulate density dependent leachate migration in leaky aquifers. Unlike existing models, a new approach is adopted to couple the groundwater-flow equation and the hydrodynamic dispersion equation with the elimination of the intermediate step of calculating velocities. The concept of the reference density is employed, permitting increased accuracy (over pressure-based models) in the representation of the transport process. The model is then used to study the effect of several hydraulic and transport parameters on the flow pattern and plume migration which are found to be very sensitive to most of these parameters. Equiconcentration and equipotential lines are overlapped to provide a better understanding of the coupling effect.     

Theory of a multiply fed and loaded insulated linear antenna in air

Analytic expressions are derived for the input admittance and the current distribution along the multiply fed and loaded insulated antenna in air which is excited across feed gaps of nonzero widths. The Wiener-Hopf type analysis for a center fed insulated antenna is combined with the axial field discontinuity (AFD) method to develop the current and admittance expression. This AFD method considers the metallic surface of the linear antenna as a series combination of longitudinal, electric-field surface functions that exist due to feeding and/or loading. The analysis, which does not employ superposition of even and odd distributions of sources and loads, yields final expressions in terms of the excitation location, its aperture electric field within the feed gaps, impedance locations, and their values. The current distribution for cases of unity dielectric constant shows an excellent agreement with data based on the moment method. The input admittances and current distributions are reported for different multiple excitations and loads and dielectric constants of the insulator     

Flow reversal in the descending aorta: a guide to intraoperative assessment of aortic regurgitation with transesophageal echocardiography

This study assessed the value of biplane transesophageal echocardiographic assessment of diastolic flow reversal in the descending aorta as an alternative to Doppler color flow imaging in determining severity of aortic regurgitation. In 45 patients undergoing cardiac operations, the severity of aortic regurgitation was assessed by semiquantitative grading of the width of the Doppler color flow regurgitant jet relative to the left ventricular outflow tract, and the presence of diastolic flow reversal was assessed with pulsed-wave Doppler measurements at three sites in the descending aorta. In four patients, the diastolic flow reversal method was the only available form of assessment because of inadequate visualization of the left ventricular outflow tract beneath a mitral valve prosthesis. Diastolic flow reversal in the descending aorta was not observed in patients without aortic regurgitation and was always present in patients with severe aortic regurgitation. Aortic valve replacement successfully eliminated descending aortic flow reversal in all 19 patients in whom it was present before valve replacement. Identification of diastolic flow reversal at multiple sites in the descending aorta with biplane transesophageal echocardiography helps to confirm the presence of severe aortic regurgitation and can serve as an alternative method of assessment when visualization of the left ventricular outflow tract is impaired.     

A new method of excitation control based on fuzzy set theory

The synthesis of the structure of the power system stabiliser (PSS) and its parametrization are based entirely on methods of linear system theory. Thus the desired effect of the PSS is limited to a bounded area around one system operating point. The use of a controller based on fuzzy set theory introduces an event controlled excitation of the synchronous machine taking into account the power system operation. The desired response of the fuzzy controller is given by a set of rules which are obtained from the limits of the voltage regulator and the undesired performance of the conventional excitation control. A fuzzy controller has been developed for which simulation results are provided. These results support the concept of a fuzzy controller for the purpose of excitation control. They show that a well designed fuzzy controller is superior to a fast excitation control with an additional PSS     

Thermal stability in bulk cryomilled ultrafine-grained 5083 Al alloy

Thermal stability in bulk ultrafine-grained (UFG) 5083 Al that was processed by gas atomization followed by cryomilling, consolidation, and extrusion, and that exhibited an average grain size of 305 nm, was investigated in the temperature range of 473 to 673 K (0.55 to 0.79 T _m , where T _m is the melting temperature of the material) for different annealing times. Appreciable grain growth was observed at temperatures > 573 K, whereas there was limited grain growth at temperatures < 573 K even after long annealing times. The values of the grain growth exponent, n, deduced from the grain growth data were higher than the value of 2 predicted from elementary grain growth theories. The discrepancy was attributed to the operation of strong pinning forces on boundaries during the annealing treatment. An examination of the microstructure of the alloy suggests that the origin of the pinning forces is most likely related to the presence of dispersion particles, which are mostly introduced during cryomilling. Two-grain growth regimes were identified: the low-temperature region (<573 K) and the high-temperature region (>573 K). For temperatures lower than 573 K, the activation energy of 25 ± 5 kJ/mol was determined. It is suggested that this low activation energy represents the energy for the reordering of grain boundaries in the UFG material. For temperatures higher than 573 K, an activation energy of 124 ± 5 kJ/mol was measured. This value of activation energy, 124 ± 5 kJ/mol, lies between that for grain boundary diffusion and lattice diffusion in analogous aluminum polycrystalline systems. The results show that the strength and ductility of bulk UFG 5083 Al, as obtained from tensile tests, correlate well with substructural changes introduced in the alloy by the annealing treatment.     

Production of fungal enzymes and proteins from high salt cheese wheys

A fermentation procedure using wheys from buffalo milk, sweet rennet and salted wheys containing up to 15% NaC1, and based on the selection of salt-tolerant fungal cultures for production of microbial proteins and some economically important enzymes, is described. Certain strains of Aspergillus flavus, A. niger, A. ochraceus and A. terreus gave yields of mycelium ranging between 1.5 and 30 g on a dry weight basis. Strong proteolytic activities were exhibited by A. ochraceus, A. flavus and, to a lesser extent, by A. niger in the presence of salt up to 10% as final concentration. Powerful milk-clotting activities were also detected in culture supernatants of A. flavus and A. ochraceus. Extracellular β-galactosidases were released in to the culture fluids of these fungal strains with variable activities, depending upon the salt content of the growth medium. The application of the procedure is discussed.