Publications

BACKGROUND

Repeated exposure to Plasmodium falciparum is associated with perturbations in B cell sub-set homeostasis, including expansion atypical memory B cells. However, B cell perturbations immediately following acute malaria infection have been poorly characterized, especially with regard to their relationship with immunity to malaria.

METHODS

To better understand the kinetics of B cell sub-sets following malaria, the proportions of six B cell sub-sets were assessed at five time points following acute malaria in four to 5 years old children living in a high transmission region of Uganda. B cell sub-set kinetics were compared with measures of clinical immunity to malaria-lower parasite density at the time of malaria diagnosis and recent asymptomatic parasitaemia.

RESULTS

Atypical memory B cell and transitional B cell proportions increased following malaria. In contrast, plasmablast proportions were highest at the time of malaria diagnosis and rapidly declined following treatment. Increased proportions of atypical memory B cells were associated with greater immunity to malaria, whereas increased proportions of transitional B cells were associated with evidence of less immunity to malaria.

CONCLUSIONS

These findings highlight the dynamic changes in multiple B cell sub-sets following acute, uncomplicated malaria, and how these sub-sets are associated with developing immunity to malaria.

Interventional cardiovascular medicine is in continuous evolution. Introduction of drug-eluting stents (DES) in clinical practice drastically improved the efficacy of percutaneous coronary intervention by reducing the risk of in-stent restenosis through the abluminal elution of an antiproliferative drug to suppress neointimal hyperplasia. Unfortunately, safety issues rose with first-generation DES due to incomplete luminal stent strut endothelialization and subsequent risk of late and very-late thrombosis. While 2nd-generation DES addressed some of the safety issues observed with 1st-generation DES, some limitations remain. Dual therapy stenting is an innovative technology developed with the rationale of combining a highly effective antiproliferative drug elution on the abluminal side and an endothelial progenitor cell capture system on the luminal side to accelerate stent strut endothelialization; thus potentially preventing the early and late complications of incomplete endothelial coverage while maintaining an antirestenotic effectiveness. Additionally, a DES platform associated with more predictable and faster endothelialization pattern may be an important therapeutic option in patients at high-risk for bleeding who cannot tolerate even short regimens of dual antiplatelet therapy. The present article reviews the most recent developments in dual therapy stenting from its rationale to the preclinical and clinical studies.

BACKGROUND

Women with a history of hypertensive disorders of pregnancy are at an increased risk of hypertension and cardiovascular disease in later life. Lactation has been associated with a reduced risk of maternal hypertension, both in the postpartum period and later life. However, little is known about whether lactation is also cardioprotective in women with hypertensive disorders of pregnancy such as preeclampsia or gestational hypertension.

OBJECTIVE

This study aimed to characterize the relationship between lactation and postpartum blood pressure among women with preeclampsia and gestational hypertension.

STUDY DESIGN

Data were obtained from women who participated in the Prenatal Exposures and Preeclampsia Prevention study (n = 379; 66% African American; 85% overweight or obese). Women enrolled during pregnancy and attended a postpartum visit (on average, 9.1 months after delivery) during which data on lactation duration and blood pressure were collected. The significance of the associations between postpartum blood pressure and lactation among women who remained normotensive during pregnancy, developed gestational hypertension, or developed preeclampsia were assessed with an analysis of variance. Linear regression models were used to adjust for maternal age, race, education, prepregnancy weight, and time since delivery.

RESULTS

Gestational hypertension affected 42 subjects (11%) and preeclampsia affected 33 (9%). Lactation was reported by 217 (57%) with 78 (21%) reporting ≥ 6 months of lactation. Women who lactated were somewhat older, more educated, and had higher socioeconomic status. Among women who had gestational hypertension, lactation was associated with lower systolic blood pressure (P = .02) and diastolic blood pressure (P = .02). This association persisted after adjustment for age, race, education, prepregnancy weight, and time since delivery. However, for women who had preeclampsia and women who remained normotensive during pregnancy, lactation was not associated with postpartum blood pressure in either bivariate or multivariate analyses.

CONCLUSION

This study found that lactation is associated with lower postpartum blood pressure among overweight women who develop gestational hypertension but not among women who develop preeclampsia. Future studies are needed to explore the association of lactation and blood pressure in later life for women with hypertensive disorders of pregnancy.