BACKGROUND.Preclinical experiments have shown that donor blood cells, modified in vitro by an alkylating agent (modified immune cells [MICs]), induced long-term specific immunosuppression against the allogeneic donor. METHODS.In this phase I trial, patients received either 1.5 × 10 6 MICs per kg BW on day -2 (n = 3, group A), or 1.5 × 10 8 MICs per kg BW on day -2 (n = 3, group B) or day -7 (n = 4, group C) before living donor kidney transplantation in addition to posttransplantation immunosuppression. The primary outcome measure was the frequency of adverse events (AEs) until day 30 (study phase) with follow-up out to day 360. RESULTS. MIC infusions were extremely well tolerated. During the study phase, 10 treated patients experienced a total of 69 AEs that were unlikely to be related or not related to MIC infusion. No donor-specific human leukocyte antigen Abs or rejection episodes were noted, even though the patients received up to 1.3 × 10 10 donor mononuclear cells before transplantation. Group C patients with low immunosuppression during follow-up showed no in vitro reactivity against stimulatory donor blood cells on day 360, whereas reactivity against third-party cells was still preserved. Frequencies of CD19 + CD24 hi CD38 hi transitional B lymphocytes (Bregs) increased from a median of 6% before MIC infusion to 20% on day 180, which was 19-and 68-fold higher, respectively, than in 2 independent cohorts of transplanted controls. The majority of Bregs produced the immunosuppressive cytokine IL-10. MIC-treated patients showed the Immune Tolerance Network operational tolerance signature. CONCLUSION. MIC administration was safe and could be a future tool for the targeted induction of tolerogenic Bregs.

Background: Healthcare is a high-risk industry that requires regular assessment of patient safety climate within healthcare organizations. This addresses the organizational cultural issues and explores the association between organizational climate and patient outcomes. This study aimed to assess patient safety culture among paramedical health employees at Fayoum general and district hospitals and to determine factors affecting their perception of patient safety. Methods: A descriptive cross-sectional study was conducted at the general hospital and four district hospitals in Fayoum Governorate, Egypt, among 479 paramedical healthcare workers. The standardized Hospital Patient Safety scale (HSOPSC) that composed of 12 safety culture dimensions was used. Results: The mean total safety score varies according to the participant's position and work area. The total patient safety score was 46.56%. No dimension reported score above 75%. The highest mean composite scores were for organizational learning and continuous improvement (65.36%) and teamwork within hospital units (63.09%). The lowest reported score was for communication openness (17.9%). More perception of safety dimensions was seen in females than males, participants in direct contact with patients, and those with work experience less than 10 years. Conclusion and recommendations: Overall, the degree of patient safety is low at Fayoum public hospitals. No dimension scored above 75%, and 7 out of 12 dimensions scored less than 50%. Hence, continuous monitoring and updating of the ways of incident reporting is highly recommended. This may be done through setting up a web-based incident reporting system accessible for 24 h.

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Background Previously, we demonstrated up-regulated activated CD4+ and CD8+ T lymphocytes as well as up-regulated cytotoxic NK cells in the blood of patients with idiopathic recurrent miscarriage. In the present study, we tried to identify deficiencies in counter-regulating immune mechanisms of these patients. Method Cytokines were determined in NK cells and in plasma samples of 35 healthy controls, 33 patients with idiopathic recurrent miscarriage, 34 patients with end stage renal disease, 10 transplant patients early and 37 transplant patients late post-transplant using flow-cytometry and luminex. In addition, cytokines were studied in supernatants of cell cultures with peripheral blood mononuclear cells stimulated in-vitro with tumor cell line K562. Results Patients with idiopathic recurrent miscarriage exhibited the highest absolute cell counts of circulating TGFß1+ NK, NKT and T lymphocytes and the lowest TGFß1 plasma levels of all study groups (for all p < 0.050). In-vitro, peripheral blood mononuclear cells of patients with idiopathic recurrent miscarriage showed high spontaneous TGFß1 production that could not be further increased by stimulation with K562, indicating increased consumption of TGFß1 by activated cells in the cell culture. Moreover, patients with idiopathic recurrent miscarriage had abnormally high IL4+ as well as abnormally high IFNy+ NK cells ( p < 0.010) but similar IL10+ NK cell numbers as female healthy controls and showed the lowest plasma levels of IL10, TGFß3, IL1RA, IL1ß, IL5, IL6, IL8, IL17, TNFα, GM-CSF, TPO and VEGF and the highest plasma levels of G-CSF, FGF-basic, CCL3 and CXCL5 as compared to female HC and female transplant recipients (for all p < 0.050). Conclusions Patients with idiopathic recurrent miscarriage show an activated immune system that can hardly be stimulated further and cannot be efficiently down-regulated by up-regulated TGFß1+ and IL4+ NK, NKT and T lymphocytes which are present concomitantly in these patients. The strongly decreased TGFß and IL10 plasma levels indicate deficient down-regulation and reflect a dysbalance of the immune system in patients with idiopathic recurrent miscarriage. These findings may be relevant for explaining the pathogenesis of idiopathic recurrent miscarriage. Electronic supplementary material The online version of this article (10.1186/s12865-019-0290-3) contains supplementary material, which is available to authorized users.