(N Engl J Med. 2016;374:233–241) It is possible that peripartum cardiomyopathy is influenced by genetic factors, though this remains unclear. Similar to idiopathic dilated cardiomyopathy, this disease is associated with decreased systolic function, enlarged cardiac dimensions, and nonspecific histologic findings. These similarities are significant in that idiopathic dilated cardiomyopathy has been shown to be caused by a number of gene mutations. The authors of this study sequenced the DNA of 172 women suffering from peripartum cardiomyopathy to investigate whether there was a contribution from variants in the 43 genes known to be associated with dilated cardiomyopathy.

Positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose (FDG) is a very useful technique for the imaging of lymphomas in the adult population. It provides unique information about the behaviour of malignant cells and contributes to more accurate staging of the illness and better assessment of response to therapy. The purpose of this study was to evaluate the usefulness of FDG PET in childhood lymphoma compared with conventional imaging methods (CIMs) and clinical data. Between July 1998 and August 2001, 42 FDG PET examinations were performed using a dedicated PET system (27 examinations) or a hybrid coincidence PET system (15 examinations) for initial tumour staging ( n=7), restaging ( n=5) or assessment of response to therapy or residual masses ( n=30) in 27 children with Hodgkin's disease (HD) ( n=20) or non-Hodgkin's lymphoma (NHL) ( n=7). FDG PET results were compared with CIM findings and clinical data. Since 2000, a standardised questionnaire for evaluation of the clinical impact of FDG PET on both staging and therapy has been sent to the 16 referring physicians and 13 have replied. In all children, FDG PET was performed without any side-effects. FDG PET was found to be very sensitive (Se=12/12) for staging and restaging of the illness, showing more lesions than CIMs, with a 50% patient upstaging rate (6/12). It was very accurate for monitoring response to therapy and for characterisation of residual masses. False-positive results were observed in two NHL patients with thymic uptake and one false-negative result was obtained in a patient whose NHL relapsed 1 month after a negative FDG PET. The questionnaire emphasised the impact of FDG PET on clinical management, which was modified on the basis of the FDG PET results in 23% of patients. As previously demonstrated in the adult population, FDG PET appeared to be a very sensitive imaging technique for staging and restaging of lymphoma in children and was very useful for monitoring the response to therapy.

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Purpose: Lymphocytic bronchiolitis (LB) is the strongest risk factor for subsequent allograft loss due to obliterative bronchiolitis (OB), however it is poorly assessed by transbronchial biopsy (TBBx) because of sampling error, interpretation error, and the presence of non-alloreactive airway inflammation. We hypothesised that flow cytometric interrogation of small airway brushings -the 'B score' may be a better tool. Methods and Materials: 43 small airway brushings (2-3 cm from pleural surface, 2mm OD Olympus cytology brush) were obtained under radiologic guidance prior to TBBx from 28 patients (16 female, median age 41 (23-64), 14 CF, 7 COPD), and labelled with conjugated antibodies to epithelial cell antigen, CD3 and CD103 (an integrin which binds to the epithelial specific ligand e-cadherin) before undergoing flow cytometry. The B score was defined as the % of total nucleated cells which were CD3 ϩ CD103 ϩ . Results: No adverse events occurred. The mean B score was 0.71% (95% CI 0.47-0.96) and was higher in patients with A1 rejection (1.39% vs A0 0.53%, pϽ0.001), but was unrelated to B grade (B0 1.1%, B1 0.6%, B2 0.94%, Bx 0.78%, pϭNS) or A2 (nϭ2) rejection. Total CD3 ϩ cell counts were higher in B1/2 (2.16%) or Bx (2.18%) vs B0 biopsies (1.14%, pϭ0.01), however most cells were CD103 Ϫ suggesting that they were not alloreactive. Viral (Parainfluenza 2, CMV 1, Influenza B 1) or invasive fungal (Aspergillus 3, Acremonium 1) infection was associated with marked infiltration with CD3 ϩ CD103 Ϫ cells (no infection 0.46%, bacterial 0.39%, viral 2.08% (pϽ0.01), fungal 2.06% (pϽ0.01)). The B score was above the upper 95% CI in 9 (21%) cases (3 prior to or at the onset of refractory OB; 2 with unexplained (TBBx negative, infection negative) steroid responsive fall in FEV1; 2 stable OB; 1 Parainfluenza; 1 gastrooesophageal reflux). Conclusions: Flow cytometric interrogation of small airway brushings can accurately discriminate between infective and alloreactive LB. The B score is simple to obtain, low risk and may be a valuable addition to current lung allograft assessment.

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