Clinical medicine (London, England)
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Kidney transplants do not last for the natural lifespan of most recipients. Of the reasons why transplants fail, damage by the immune system is the commonest cause. Understanding how the immune system recognises transplanted organs has increased significantly in recent years, but there is little insight into how organs are damaged, and no still no way of suppressing immune-mediated damage without exposing patients to the detrimental effects of long-term immunosuppression. In this article, we review the role of antibodies and B cells in immune-mediated damage of kidney transplants, and discuss the potential for manipulation of B cells to improve clinical outcomes.
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Diabetes is an increasingly common health problem, and accounts for one-tenth of NHS spending, chiefly managing avoidable complications. Approximately one-third of people with diabetes have psychological and/or social problems which impede their ability to self-manage their diabetes. ⋯ Ensuring that any mental health problems are treated and social needs are met, will be valuable in improving the individuals health. Addressing the psychiatric and psychological barriers to good glucose control can help to reduce the burden of diabetes and its complications, on both the individual and the wider health service.
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IgG4-related disease (IgG4-RD) is increasingly recognised in Western societies as a multi-system, inflammatory, fibrosing disease of unknown aetiology that typically, though not exclusively, presents in older men. The clinical manifestations are diverse and almost any organ may be affected. The cardinal histological features are a lymphoplasmacytic infiltrate, storiform fibrosis, obliterative phlebitis and an abundance of IgG4+ plasma cells in affected organs. ⋯ Extending our understanding of the role of IgG4 immunoglobulins in health and disease, the assessment of B and T cell immune phenotype, and large genetic studies of IgG4-RD may enhance our understanding of disease pathogenesis. Ultimately it may be that there is not a single, simple unifying aetiology and so careful stratification of disease by clinical phenotype will be required in multi-centre prospective clinical cohorts. These cohorts will also be essential for the study of treatment outcomes with novel therapies.
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The past century has witnessed accelerated development in imaging modalities. Better anatomical visualisation and improved data analysis have improved survival rates. Through emerging functional, molecular and structural imaging modalities, better anatomical visualisation has been extended to cellular and molecular detail, improving diagnosis and management of diseases. This article reviews the advances made in emerging imaging modalities as well as their potential applications in targeted therapy.
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Our knowledge of the morphological heterogeneity of cancer has recently been augmented by the genomic heterogeneity revealed by the use of next-generation sequencing technology. We now know that no two cancers are alike and that even different regions within the same tumour vary in their composition. Tumours consist of multiple clonal populations and they evolve under Darwinian principles. This review summarizes some of the causes of such diversity and its implication for cancer management.