Eosinophils expressing indoleamine 2, 3-dioxygenase (IDO) may contribute to T-helper cell (Th)2 predominance. To characterize human thymus IDO؉ eosinophil ontogeny relative to Th2 regulatory gene expression, we processed surgically obtained thymi from 22 children (age: 7 days to 12 years) for immunohistochemistry and molecular analysis, and measured cytokine and kynurenine levels in tissue homogenates. Luna؉ eosinophils (ϳ2% of total thymic cells) decreased in number with age (P ؍ 0.02) and were IDO؉. Thymic IDO immunoreactivity (P ؍ 0.01) and kynurenine concentration (P ؍ 0.01) decreased with age as well. In addition, constitutively-expressed interleukin (IL)-5 and IL-13 in thymus supernatants was highest in youngest children. Eosinophil numbers correlated positively with expression of the Th2 cytokines IL-5, IL-13 (r ؍ 0.44, P ؍ 0.002), and IL-4 (r ؍ 0.46, P ؍ 0.005), transcription factor signal transducer and activator of transcription-6 (r ؍ 0.68, P ؍ 0.001), and the chemokine receptor, CCR3 (r ؍ 0.17, P ؍ 0.04), but negatively with IL-17 mRNA (r ؍ ؊0.57, P ؍ 0.02) and toll-like receptor 4 expression (r ؍ ؊0.74, P ؍ 0.002). Taken together, these results suggest that functional thymic IDO؉ eosinophils during human infant life may have an immunomodulatory role in Th2 immune responses.
The Freestyle valve in the pulmonary position in a congenital population is associated with low medium-term incidences of SVD and reintervention. It performs equally well to the homograft when a conduit is required and can be considered a valid alternative to stented bioprostheses when PVR alone is required.
To the best of our knowledge, this is the largest reported series of anomalous RCA managed by surgical reimplantation. Our results suggest that this technique is safe and has excellent medium to long-term results regarding symptom-free survival.
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