Live‐attenuated vaccination for measles, mumps, and rubella in pediatric liver transplantation

BACKGROUND: Infections are a serious short- and long-term problem after pediatric organ transplantation. In immunocompromised patients, they can lead to transplant rejection or a severe course with a sometimes fatal outcome. Vaccination is an appropriate means of reducing morbidity and mortality caused by vaccine-preventable diseases. Unfortunately, due to the disease or its course, it is not always possible to establish adequate vaccine protection against live-attenuated viral vaccines (LAVVs) prior to transplantation. LAVVs such as measles, mumps, and rubella (MMR) are still contraindicated in solid organ transplant recipients receiving immunosuppressive therapy (IST), thus creating a dilemma. AIM: This review discusses whether, when, and how live-attenuated MMR vaccines can be administered effectively and safely to pediatric liver transplant recipients based on the available data. MATERIAL AND METHODS: We searched PubMed for literature on live-attenuated MMR vaccination in pediatric liver transplantation (LT). RESULTS: Nine prospective observational studies and three retrospective case series were identified in which at least 833 doses of measles vaccine were administered to 716 liver transplant children receiving IST. In these selected patients, MMR vaccination was well tolerated and no serious adverse reactions to the vaccine were observed. In addition, an immune response to the vaccine was demonstrated in patients receiving IST. CONCLUSION: Due to inadequate vaccine protection in this high-risk group, maximum efforts must be made to ensure full immunization. MMR vaccination could also be considered for unprotected patients after LT receiving IST following an individual risk assessment, as severe harm from live vaccines after liver transplantation has been reported only very rarely. To this end, it is important to establish standardized and simple criteria for the selection of suitable patients and the administration of the MMR vaccine to ensure safe use

Utilization of thermal panels to increase the efficiency of the heat pump cooling circuit

Tato diplomová práce zhodnocuje zapojení solárních kolektorů s tepelným čerpadlem. V práci je dokázáno smysluplné využití solárních kolektorů ke zvyšování účinnosti chladícího okruhu tepelného čerpadla. Úvod práce uvádí čtenáře do dané problematiky a popisuje základní principy fungování obou hlavních zdrojů energie použitých v systému – tepelného čerpadla a solárního systému. V další části práce jsou analyzována a zhodnocena data, která byla naměřena během provozu systému. Ke zhodnocení bylo použito srovnání naměřeného COP tepelného čerpadla při dvou různých režimech provozu – s pomocí solárního systému a bez pomocí solárního systému.This thesis evaluates the connection of solar collectors with heat pump. The work demonstrates meaningful use of solar collector to increase cooling efficiency of the heat pump. Introduction The work introduces the reader to the issue and describes basic principles of the two main sources of energy used in the system - the heat pump and solar system. Next session is dedicated to analysis and evaluation of the data that was measured during system operation. A comparison of measured COP of the heat pump at two different modes of operation was used for the evaluation - with the help of the solar system and without using the solar system.

Long-Term Clinical Profile of Children With the Low-Penetrance R92Q Mutation of the TNFRSF1A Gene

Objective: To analyze the long-term impact of the R92Q mutation of TNFRSF1A in children with periodic fever, in comparison with children with tumor necrosis factor receptor-associated periodic syndrome (TRAPS) with TNFRSF1A structural mutations and children with periodic fever of unknown origin fulfilling the criteria for periodic fever, aphthosis, pharyngitis, and adenitis syndrome (PFAPA). Methods: The extracellular region of TNFRSF1A was analyzed in 720 consecutive children with periodic fever, using denaturing high-performance liquid chromatography and DNA sequencing. Followup data on 11 pediatric patients with TNFRSF1A structural mutations (cysteine or T50M), 23 pediatric patients with an R92Q substitution, and 64 pediatric patients with PFAPA were collected during routine clinic visits. The 50-item Child Health Questionnaire was used to assess health-related quality of life (HRQOL). Results: The frequency of typical TRAPS-related clinical manifestations was significantly lower and the impact of the disease on HRQOL was significantly reduced in patients with the R92Q mutation compared with TRAPS patients carrying structural mutations of TNFRSF1A. Followup data on 11 TRAPS patients with TNFRSF1A structural mutations (mean followup 7.9 years), 16 patients with theR92Q substitution (mean followup 7.3 years), and 64 patients with PFAPA (mean followup 5.2 years) were available. Patients with R92Q mutations and patients with PFAPA displayed a higher rate of self-resolution or amelioration of the fever episodes than did TRAPS patients with structural mutations. Conclusion: Although some cases may progress to a more chronic disease course, the majority of children with an R92Q mutation of the TNFRSFA1 gene show a milder disease course than that in children with TNFRSFA1 structural mutations and have a high rate of spontaneous resolution and amelioration of the recurrent fever episodes. \ua9 2011, American College of Rheumatology