We bring you the latest news from the healthcare about the health care in the United Kingdom.

donderdag 14 juni 2018

The Lancet: [Comment] New-generation JAK inhibitors: how selective can they be?

[Comment] New-generation JAK inhibitors: how selective can they be?
Almost 20 years into the biologics era, an unmet need exists for treating patients with rheumatoid arthritis and other inflammatory diseases who either do not tolerate, do not respond to, or cannot afford effective but costly biologic medicines. Also 20 years ago, the small family of Janus kinases (or tyrosine-protein kinase JAK; JAKs) were discovered, and have since been harnessed for treating and understanding both malignancies and inflammatory diseases.
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[Articles] Belimumab in kidney transplantation: an experimental medicine, randomised, placebo-controlled phase 2 trial
Belimumab might be a useful adjunct to standard-of-care immunosuppression in renal transplantation, with no major increased risk of infection and potential beneficial effects on humoral alloimmunity.
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[Comment] Immunological investigations empower transplant drug trials
Since T-cell-mediated rejection of kidney transplants is now largely preventable or treatable, antibody-mediated rejection (AMR) has emerged as the leading and intractable cause of chronic graft dysfunction and loss. Kidney transplant recipients who develop de-novo donor-specific antibodies have a relative risk of 9·7 for acute AMR and 6·8 for chronic AMR.1–3 Non-specific targeting of B cells, plasma cells, or circulating antibodies is an unsatisfactory strategy for controlling chronic AMR, so alternatives to CD20-specific antibodies (rituximab), intravenous immunoglobulin, proteasome inhibitors (bortezomib), and antibody removal by plasma exchange are clearly needed.
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[Comment] Sodium bicarbonate for severe metabolic acidaemia
Severe metabolic acidaemia (blood pH ≤7·20) is associated with impaired haemodynamics and increased mortality in critically ill patients.1 Administration of sodium bicarbonate can increase blood pH, but its ability to improve haemodynamics and reduce mortality remains unproven.2–6 Sodium bicarbonate has been shown to increase blood pH levels but did not increase cardiac output compared with saline when examined at 30 min or 60 min after infusion,3,6 and did not reduce mortality in studies involving cohorts of 34–150 individuals with severe acidaemia.
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[Seminar] Idiopathic nephrotic syndrome in children
The incidence of idiopathic nephrotic syndrome (NS) is 1·15–16·9 per 100 000 children, varying by ethnicity and region. The cause remains unknown but the pathogenesis of idiopathic NS is thought to involve immune dysregulation, systemic circulating factors, or inherited structural abnormalities of the podocyte. Genetic risk is more commonly described among children with steroid-resistant disease. The mainstay of therapy is prednisone for the vast majority of patients who are steroid responsive; however, the disease can run a frequently relapsing course, necessitating the need for alternative immunosuppressive agents.
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