HLA-DR mismatching correlates with early cardiac allograft rejection, incidence, and graft survival when high-confidence-level serological DR typing is used

To determine if cardiac allograft outcome is improved among patients with fewer HLA-DR mismatches with their donors, we studied 132 recipients of a primary cardiac allograft who were transplanted between December 1985 and December 1991. These recipients and their donors all had high-confidence-level serological HLA-DR typing, previously shown to correlate highly with DNA DR typing. Patients were divided in two groups based on the HLA-DR mismatch with their donors. Group I consisted of 78 patients with 1 or zero DR mismatch and group II of 54 patients with 2 DR mismatches. Allograft outcome measurements included incidence of moderate rejection, incidence of allograft vasculopathy at 12 months, cardiac function measured as left ventricular ejection fraction (LVEF) and cardiac index (CI), and actuarial graft survival up to 7 years. Groups I and group II were not different with regard to recipient age, donor age, ischemia time, pulmonary vascular resistance, sex, or PRA greater than 0%. Group II had a higher incidence of moderate rejection on the first-week biopsy (47% vs. 25%, P = 0.019), and during the first month (84% vs. 58%, P = 0.006), but no difference was found in frequency of rejection from months 2 to 12. LVEF was not different in the groups at any point. CI was better in group I at 12 months (2.76 vs. 2.5, P = 0.03). No statistically significant difference was found in incidence of allograft vasculopathy (17% vs. 26%, P = 0.204). Actual graft survival at 1 year was better for group I (91% vs. 74%, P = 0.008), and actuarial graft survival at 6 years also favored group I (76% vs. 56%, P = 0.04). Using high-confidence-level serological HLA-DR typing assignments we demonstrated that HLA-DR mismatching correlates highly with cardiac allograft outcome. Implications are that heart transplant survival could be improved if prospective matching were feasible and prioritized or if immunosuppression were tailored to the HLA-DR match.     

Do You Know What I Know? A Shared Understandings Perspective on Text‐Based Communication

This article illustrates how the hermeneutic analysis of text illuminates how shared understandings affect our interpretations of lean communication in distributed work environments. It is proposed that in contrast to the pessimistic conclusions of media richness theory that lean communication channels cannot support complex or equivocal work tasks, miscommunications are not the result of technology, but rather occur due to a lack of shared understandings among the individuals communicating. An illustrative case study based on fieldwork in franchise organizations is presented to demonstrate the possibilities for how the hermeneutic analysis of coherence, invention, intention, and reference can be used to discover how workers create and recreate shared understandings through text.     

Recent advances in raisingT c and establishing the gap-symmetry of high-T c cuprate superconductors

The most recent attempts in raising T_c of cuprate superconductors were successful by synthesizing new Hg-based cuprate materials. We discuss some properties of materials from this series with varying numbers of Cu-O planes per unit cell, including the considerable rise of the critical temperature under the influence of external pressure.In the second part of this contribution, various attempts to directly determine the symmetry of the superconducting order parameter of high-T_c cuprates are mentioned and set into perspective. The experimental approaches are all based on probing the phase of the order parameter in suitably connected closed superconducting loops. The evidence for unconventional order-parameter symmetry in these materials is growing.     

Superconductivity in heavy-electron metals

Some of the most outstanding experimental evidences for unconventional superconductivity in heavy-electron materials are rewiewed and discussed.     

Interpretation of the results of the CORA-33 dry core boiling water reactor test

All boiling water reactor (BWR) degraded core experiments performed prior to CORA-33 were conducted under ‘wet’ core degradation conditions, in which water remains within the core and continuous steaming feeds metal-steam oxidation reactions on the in-core metallic surfaces. However, one dominant set of accident scenarios would occur with reduced metal oxidation under ‘dry’ core degradation conditions and, prior to CORA-33, this set had been neglected experimentally. The CORA-33 experiment was designed specifically to address this dominant set of BWR ‘dry’ core severe accident scenarios and to resolve partially phenomenological uncertainties concerning the behavior of relocating metallic melts that drain into the lower regions of a ‘dry’ BWR core (the ex-reactor experiments at Sandia National Laboratories will further address these uncertainties). CORA-33 was conducted on 1 October 1992, in the CORA test facility at Karlsruhe. A review of the CORA-33 data indicates that the objectives were achieved; i.e. core degradation occurred at a core heat-up rate (characterized by the absence of any temperature escalation caused by oxidation) and a test section axial temperature profile (at incipient structural melting) that are prototypic of full-core nuclear power plant simulations under ‘dry’ core conditions. Simulations of the CORA-33 test at Oak Ridge National Laboratory (ORNL) have required the modification of existing control blade-canister materials interaction models to include the eutectic melting of the stainless steel-zircaloy interaction products and the heat of mixing of stainless steel and zircaloy. The timing and location of canister failure and melt intrusion into the fuel assembly appear to be adequately simulated by the ORNL models. This paper will present the results of the post-test analyses carried out at ORNL based on the experimental data and the post-test examination of the test bundle at Karlsruhe. The implications of these results with respect to degraded core modelling and the associated safety issues are also discussed.     

Abdominal T-cell non-Hodgkin's lymphoma of the gamma/delta type in a patient with selective immunoglobulin A deficiency

A 28-year-old man presented with selective immunoglobulin A deficiency and severe diarrhea responding to a gliadin-free diet. Biopsy samples of the small intestine showed dense T-cell infiltrations in the lamina propria and a slight increase of intraepithelial T-lymphocytes. No clonal rearrangement of the T-cell receptor c-beta chain genes was detectable by Southern blotting. Four years later, at the age of 32, the patient was hospitalized again with liver failure, abdominal lymphadenopathy, pancytopenia, and recurrent bacterial infections. Retrospective polymerase chain reaction analysis of formalin-fixed tissues of the intestinal biopsy samples obtained 4 years earlier showed monoclonal T-cell receptor gamma-chain gene rearrangement. Lymphoid cells of the peripheral blood showed an immunophenotype of CD3-positive gamma/delta T cells with a negativity for CD4 and CD8. A clonally rearranged T-cell receptor delta chain gene and a germline configuration of the c-beta chain genes was found by Southern blotting. Cytogenetics showed an abnormal karyotype with unbalanced translocations t(1;5) and t(9;13). The patient died of extensive lung infiltrations by gamma/delta T cells; autopsy showed a peripheral T-cell lymphoma of the gamma/delta type in the enlarged abdominal lymph nodes. This is the first report of an abdominal T-cell lymphoma of the gamma/delta type in a patient with selective immunoglobulin A deficiency.     

Scale-up and control of droplet production in coupled microfluidic flow-focusing geometries

A single microfluidic chip consisting of six microfluidic flow-focusing devices operating in parallel was developed to investigate the feasibility of scaling microfluidic droplet generation up to production rates of hundreds of milliliters per hour. The design utilizes a single inlet channel for both the dispersed aqueous phase and the continuous oil phase from which the fluids were distributed to all six flow-focusing devices. The exit tubing for each of the six flow-focusing devices is separate and individually plumbed to each device. Within each flow-focusing device, the droplet size was monodisperse, but some droplet size variations were observed across devices. We show that by modifying the flow resistance in the outlet channel of an individual flow-focusing device it is possible to control both the droplet size and frequency of droplet production. This can be achieved through the use of valves or, as is done in this study, by changing the length of the exit tubing plumbed to the outlet of the each device. Longer exit tubing and larger flow resistance is found to lead to larger droplets and higher production frequencies. The devices can thus be individually tuned to create a monodisperse emulsion or an emulsion with a specific drop size distribution.