Krzysztof Kobylarz

The B-cell Compartment in the Peripheral Blood of Children With Different Types of Primary Humoral Immunodeficiency

The aim of this study was to evaluate the B-cell compartment in the peripheral blood of children with different types of hipogammaglobulinemia: common variable immunodeficiency (CVID), transient hypogammaglobulinemia of infancy (THI), and selective IgA deficiency (SIgAD). We analyzed by flow cytometry the changes in the B-cell subsets with age and showed that children with an early-onset CVID develop similar pattern of B-cell subsets as adult patients with CVID with age, as the levels of memory B cells (CD19+/CD27+) and class-switched memory B cells (CD19+/CD27+/IgD−/IgM−), in contrast to age-matched control group, did not increase with age. Children with SIgAD displayed similar changes as patients with CVID only within the class-switched memory B-cell subpopulation. No significant differences in the level of memory B cells and class-switched memory B cells in children with THI in comparison to age-matched control group were observed. There were no differences in the percentage of immature B cells (CD19+/CD21low) among all studied groups. As B-cell subsets in children with THI were normal during entire period of hypogammaglobulinemia, the persistence of low levels of memory B-cell subsets in some children may facilitate the diagnosis of CVID.

Stanowisko Sekcji Pediatrycznej Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii w sprawie znieczulenia ogólnego dzieci do 3. roku życia

1Department of Anaesthesiology and Intensive Therapy, Children`s Memorial Health Institute in Warsaw, Poland 2Department of Paediatric Anaesthesiology and Intensive Therapy, Karol Marcinkowski University of Medical Sciences in Poznan, Poland 3Department of Paediatric Anaesthesiology and Intensive Therapy, University Hospital in Wroclaw, Poland 4Department of Anaesthesiology and Intensive Therapy, University Children Hospital in Cracow-Prokocim, Poland 5Department of Intensive Therapy and Anaesthesiology, Medical University in Łodz 6Department of Paediatric and neonatal Anaesthesiology and Intensive Therapy, Regional Medical Centre in Opole, Poland 7Department of Anaesthesiology, Intensive Therapy and Post-operative Care, University Children Hospital in Warsaw, Poland

Benefits of ultrasound-guided transversus abdominis plane block for open appendectomy in children

BACKGROUND One of the most frequently performed emergency surgical procedures in children is an appendectomy. The aim of this study was to determine the benefits of supplementing standard, general anaesthesia with the ultrasound-guided right TAP block. METHODS We analyzed the medical records of 90 children of both sexes, aged 4-16 years with a body mass of 16-78 kg who underwent general anaesthesia for open appendectomy. Sixty-two individuals were anaesthetized using the standard method, while 28 patients had an additional right-sided TAP block under ultrasound guidance. Subsequently these groups were divided into 2 subgroups: children under 8 years and those older. We evaluated the total consumption of opioids, intraoperative fentanyl requirement, the amount of non-opioid analgesic and antiemetic drugs used during the whole hospitalization, time to recovery of digestive track function and length of hospital stay. RESULTS TAP block performed under USG guidance reduced the overall consumption of opioids (0.36 vs. 0.42 mg kg⁻¹, P = 0.048), significantly shortened time of fasting after the surgery (17 vs. 29 hours, P = 0.003) as well as reduced the need for antiemetic drugs: ondansetron were used only in 21.4% of children in the group with TAP block vs. 38.7% of children with standard protocol. Additionally, we noted that the application of the TAP block shortened the length of hospitalization (3 vs. 4 days, P = 0.045). CONCLUSION The application of the TAP block, as a supplementary treatment to standard general anaesthesia for open appendectomy in children is a valuable component of multimodal analgesia, which might improve the quality of life of the patient and shorten the length of hospitalization.

Comparison of 6B11 mAb and α-GalCer-loaded CD1d dextramers for detection of iNKT cells by flow cytometry

Invariant natural killer T (iNKT) cells are a small population of thymus-derived T cells that are restricted by non-classical MHC class I molecule CD1d and express an evolutionary conserved TCR with an invariant α-chain. The frequency of iNKT cells in peripheral blood is very low, thus, accurate methods to identify and enumerate iNKT cells are needed. The aim of the study was to compare 6B11 mAb or α-GalCer-loaded CD1d dextramers usage in iNKT cell detection. The frequency of CD3+CD56+ lymphocytes is much higher, with statistical significance (p<0,001), than real iNKT cells detected by 6B11 mAb or α-GalCer-loaded CD1d dextramers. The frequency of iNKT cells, recognized by 6B11 mAb or α-GalCer-loaded CD1d dextramers, was in a similar range. Nonetheless, when we compared whether 6B11+ and α-GalCer-loaded CD1d dextramers+ are the same populations, it turned out that by this approach we were able to identify three distinct subsets of iNKT cells: i) 6B11+/α-GalCer-loaded dextramer- cells, ii) 6B11+/α-GalCer-loaded dextramer+ cells, and iii) 6B11-/α-GalCer-loaded dextramer+. Thus, although 6B11 mAb and α-GalCer-loaded dextramers may identify not exactly the same cells, application of these methods seems to give similar results of iNKT cell frequency in peripheral blood. It seems that both approaches for iNKT detection can be used for precise identification of these cells. Moreover, our results indicate that CD3+CD56+ lymphocytes are a heterogeneous population of T cells, expressing activation markers of both NK and T lymphocytes, yet with not well characterized properties.

The consensus statement of the Paediatric Section of the Polish Society of Anaesthesiology and Intensive Therapy on general anaesthesia in children over 3 years of age. Part I — general guidelines

Należy cytować anglojęzyczną wersję: Zielińska M, Bartkowska-Śniatkowska A, Mierzewska-Schmidt M et al.: The consensus statement of Paediatric Section of the Polish Society of Anaesthesiology and Intensive Therapy on general anaesthesia in children over 3 years of age. Part I — general guidelines. Anaesthesiol Intensive Ther 2016; 48: 71–78. doi 10.5603/AIT.2016.0022. Stanowisko Sekcji Anestezjologii i Intensywnej Terapii Dziecięcej Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii w sprawie znieczulania dzieci powyżej 3. roku życia. Część I — założenia ogólne