Background The association of adipocyte-derived proteins, adiponectin and leptin, with the degree of coronary atherosclerosis has not been not been well elucidated. This study aimed to determine the relationship between serum adiponectin and leptin with the presence and degree of coronary atherosclerosis. Methods Seventy patients and 20 matched controls were recruited. Angiographic evaluation of coronary atherosclerosis was carried out by assessing three atherosclerotic indices, severity (transverse disease), extent (longitudinal disease), and pattern (lesion complexity). Results The independent predictors of atherosclerosis severity were larger waist/hip ratio, followed by higher lowdensity lipoprotein-cholesterol, low serum adiponectin level, older age, higher leptin level, current unstable angina, and finally previous myocardial infarction (MI). This model is a good one as indicated by the model-adjusted r2 (50%). For extent index, lower serum adiponectin level was by far the most important independent predictor, followed by higher low-density lipoprotein-cholesterol, older age, and previous MI, whereas higher serum leptin level was only a univariate predictor. The model-adjusted r2 was 65%. For pattern index, the independent predictors were previous MI, lower serum adiponectin level, larger waist/hip ratio, higher serum leptin level, older age, and higher fasting blood glucose level. The model-adjusted r2 was 62%. Conclusion Both serum adiponectin and leptin might play an important pathogenic role not only in the occurrence but also in the severity, extent, and lesion complexity in coronary artery disease patients. Coron Artery Dis 22:264–269 c 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Background The association of adipocyte-derived proteins, adiponectin and leptin, with the degree of coronary atherosclerosis has not been not been well elucidated. This study aimed to determine the relationship between serum adiponectin and leptin with the presence and degree of coronary atherosclerosis. Methods Seventy patients and 20 matched controls were recruited. Angiographic evaluation of coronary atherosclerosis was carried out by assessing three atherosclerotic indices, severity (transverse disease), extent (longitudinal disease), and pattern (lesion complexity). Results The independent predictors of atherosclerosis severity were larger waist/hip ratio, followed by higher lowdensity lipoprotein-cholesterol, low serum adiponectin level, older age, higher leptin level, current unstable angina, and finally previous myocardial infarction (MI). This model is a good one as indicated by the model-adjusted r2 (50%). For extent index, lower serum adiponectin level was by far the most important independent predictor, followed by higher low-density lipoprotein-cholesterol, older age, and previous MI, whereas higher serum leptin level was only a univariate predictor. The model-adjusted r2 was 65%. For pattern index, the independent predictors were previous MI, lower serum adiponectin level, larger waist/hip ratio, higher serum leptin level, older age, and higher fasting blood glucose level. The model-adjusted r2 was 62%. Conclusion Both serum adiponectin and leptin might play an important pathogenic role not only in the occurrence but also in the severity, extent, and lesion complexity in coronary artery disease patients. Coron Artery Dis 22:264–269 c 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Background. CD4
CD25

CD45RA
cells (naïve regulatory T cells [naïve-Tregs]) have been identified as a functionally premature form of CD4
CD25


CD45RA cells (conventional-Tregs). However, their contribution to transplant tolerance remains to be elucidated. Method.Weexamined the frequency and the function of conventional and naive-Tregs in the peripheral blood derived from operationally tolerant patients after pediatric living-donor liver transplant (Gr-tol ). The data were compared with those of patients who were unable to be weaned off immunosuppression due to rejection (group-intolerance [Gr-intol]), patients in the process of weaning immunosuppression (Gr-weaning) and healthy volunteers (grouphealthy volunteers [Gr-vol]). Results. In Gr-tol, the frequency of conventional-Tregs was significantly higher than that in Gr-vol and tended to be higher than that in Gr-intol. The frequency of naive-Tregs was significantly decreased in Gr-intol versus those in Gr-tol, -weaning, and -vol. In mixed lymphocyte reactions, donor-specific hyporesponsiveness of CD4
cells was observed only in Gr-tol but not in the other groups. Depletion of conventional or naive-Tregs from CD4
cells demonstrated that the suppressive properties of donor antigen-reactive conventional and naïve-Tregs were upregulated compared with those of third-party antigen-reactive conventional and naïve-Tregs in Gr-tol only. Conclusions. This is the first report providing detailed evidence that donor-specific naïve-Tregs were generated and their suppressive properties were upregulated in the peripheral blood of tolerant patients, whereas their frequency was downregulated in intolerant patients. Therefore, we speculate that not only conventional-Tregs play a role in Tx tolerance but also the role of naïve-Tregs is critica.

Infection after pediatric living donor liver transplantation (LDLT) is a major cause of morbidity and mortality. Here, we sought to determine the incidence, timing, location, and risk factors for bacterial and fungal infections. We retrospectively investigated infection for 3 postoperative months in 345 consecutive pediatric patients (56.2% were females) who underwent primary LDLT at Kyoto University Hospital, Japan. A total of 179 patients (51.9%) developed at least 1 bacterial and/or fungal infection episode, with an infection rate of 2.5 per patient. The predominant infection site was the surgical site (52%). Most of the bacterial and fungal infection occurred within the first month. Enterococcus species followed by multidrug-resistant Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were the predominant bacterial pathogens. All fungal isolates were Candida species. Prolonged preoperative hospital stay more than 7 days (P ¼ 0.025) and bile leak (P ¼ 0.047) were independent predictors of bacterial infection. Preoperative ascites (P ¼ 0.009) and prolonged insertion of intravascular catheters (P ¼ 0.001) independently predicted fungal infections. Bacterial and fungal infections were responsible for 42.9% of the causes of death in our study. To avoid bacterial and fungal infections after LDLT, broader-spectrum prophylaxis to cover the range of organisms seen in these infections should be considered as a more favorable treatment regimen to prevent prophylaxis failure, especially for patients with a preoperative hospital stay more than 7 days or operative complications in the form of a bile leak. Early drain removal and prophylactic antifungal drugs should be considered for patients with preoperative ascites. Cooperation between attending physicians and infectious disease physicians can improve the outcome of patients after LDLT.

Infection after pediatric living donor liver transplantation (LDLT) is a major cause of morbidity and mortality. Here, we sought to determine the incidence, timing, location, and risk factors for bacterial and fungal infections. We retrospectively investigated infection for 3 postoperative months in 345 consecutive pediatric patients (56.2% were females) who underwent primary LDLT at Kyoto University Hospital, Japan. A total of 179 patients (51.9%) developed at least 1 bacterial and/or fungal infection episode, with an infection rate of 2.5 per patient. The predominant infection site was the surgical site (52%). Most of the bacterial and fungal infection occurred within the first month. Enterococcus species followed by multidrug-resistant Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were the predominant bacterial pathogens. All fungal isolates were Candida species. Prolonged preoperative hospital stay more than 7 days (P ¼ 0.025) and bile leak (P ¼ 0.047) were independent predictors of bacterial infection. Preoperative ascites (P ¼ 0.009) and prolonged insertion of intravascular catheters (P ¼ 0.001) independently predicted fungal infections. Bacterial and fungal infections were responsible for 42.9% of the causes of death in our study. To avoid bacterial and fungal infections after LDLT, broader-spectrum prophylaxis to cover the range of organisms seen in these infections should be considered as a more favorable treatment regimen to prevent prophylaxis failure, especially for patients with a preoperative hospital stay more than 7 days or operative complications in the form of a bile leak. Early drain removal and prophylactic antifungal drugs should be considered for patients with preoperative ascites. Cooperation between attending physicians and infectious disease physicians can improve the outcome of patients after LDLT.