Clustered protocols use two or three injections at each weekly visit, thus Bioactive Compound Library price reducing the total time required to reach

maintenance dose (usually in 7–8 weeks). Rush desensitization protocols have been also described, but are used less often for aeroallergens than for hymenoptera venoms (see below) in view of the higher rate of systemic reactions, including anaphylaxis [16]. Dose reductions are made for delayed or missed injections, during a symptomatic period (for example during the pollen season) or following large local reactions (≥ 10 cm) and systemic reactions. General health, adverse events, changes in medication and peak expiratory flow are monitored prior to administration of SCIT. An observation period of 1 h after the injection is mandatory, with peak expiratory flow testing prior Selleckchem Ponatinib to discharge. However, severe ‘non-immediate’ reactions can occur up to 24 h after allergen injection. SLIT.  SLIT involves placing the vaccine in solution (drop preparation) or tablet

form under the tongue for 1–2 min followed by swallowing. Patient selection for sublingual immunotherapy (SLIT) is identical to that for SCIT. The safety profile of SLIT is superior to SCIT, and serious side effects such as anaphylaxis have been extremely rare [17–23]. Many patients develop minor discomfort in the early phase of treatment, including oropharyngeal pruritis and angioedema, which may require treatment with an antihistamine, but these symptoms usually settle with continued administration of the vaccine. The indications, contraindications and general considerations in administration of

SLIT are the same as described under SCIT. However, there are some special considerations listed as follows. One particular preparation (Grazax; ALK Abello, Denmark) currently licensed in the United Kingdom contains fish gelatin. It may be used cautiously in patients with a history of fish allergy, but is absolutely contraindicated in patients with history of anaphylaxis to fish. Dosage and regimens.  Sublingual immunotherapy has been used for Morin Hydrate several aeroallergens including pollens, house dust mite and cat. The optimum dosage, duration and frequency of administration have not yet been established. Sublingual immunotherapy involves a much higher dose of allergen than SCIT. The cumulative monthly dosage of SLIT used in clinical studies has been variable, but has been 0·6–500 times greater than customary SCIT [18]. Several dosing regimens have been employed, including daily (fixed or incremental dosing) [24–26], three times per week [27] and weekly [28]. With seasonal allergens such as pollen, treatment has been given preseasonally, co-seasonally, pre- and co-seasonally and perennially. Prolonged preseasonal administration induces greater clinical benefit, and if treatment is continued perennially, clinical and immunological responses improve in subsequent years of treatment [29,30].

The presence of a high titre of circulating anti-glomerular basement membrane (GBM) antibodies at the time of transplantation increases the risk of recurrence in the allograft in Goodpasture syndrome.[14] In contrast, clinical recurrence is

extremely rare if the antibody is undetectable over the 6 months prior to transplantation.[14] The prevalence of recurrent lupus nephritis is very low.[15, 16] The vast majority of recipients with ESRD due to lupus nephritis has lost serological activity of systemic lupus erythematosus, Erlotinib mw and seems to be in a burn-out state. As a result, the recurrence rate of lupus nephritis is extremely low. Recent studies indicate the possibility of early recognition of recurrence in several glomerular diseases. The existence of circulating permeability factors proposed by Savin’s group may be a notable predictor of recurrence of FSGS.[17, 18] Circulating urokinase receptor, which has been reported as a cause of FSGS, may also be a promising predictor of FSGS recurrence.[19]

To date, there is no reproducible study showing that these interesting factors play pivotal INCB018424 roles in the pathogenesis of recurrent FSGS. Anti-phospholipase A2 receptor antibody is detectable in approximately 60% of patients with primary membranous glomerulonephritis.[20, 21] Detection of anti-phospholipase A2 receptor antibody in the recipient may be a sensitive predictor of recurrence of membranous nephropathy. Disorders of complement regulatory proteins like factors I mutation, factor H mutation, C3 nephritic factors and others play pivotal roles in the development of atypical haemolytic uremic syndrome (HUS)[22, 23] and membranoproliferative glomerulonephritis (MPGN) type-II as basement membrane dense deposit disease (DDD). The

development of an analysis Atezolizumab system for complement regulatory factors and related proteins or related gene abnormalities will contribute greatly to predicting the recurrence of these diseases. The development of therapeutic approaches to regulate these factors may prevent many recurrent glomerulopathies in the near future. A humanized monoclonal antibody against terminal complement component C5b-9, the terminal complement inhibitor eculizumab, is a very potent preventative agent for the recurrence of atypical HUS.[24] New information on disorders of complement regulatory proteins (factors), like factor I mutation and factor H mutation, could deliver a useful predictor for preventing recurrent nephritis. A highly sensitive detection method for free light chains and kappa/lambda ratio is beneficial in early diagnosis of the recurrent light chain deposition disease and/or AL-amyloidosis. Protocol biopsy is widely accepted in Japan.

Here we review recent evidence in support of these seemingly opposing notions gleaned from cell and animal models as well as investigations of patient samples, with particular emphasis on studies relevant to Parkinson’s disease. “
“We report a case of an infant with unique and find more unreported combinations of brain anomalies. The patient showed distinctive facial findings, severe delay in psychomotor development, cranial nerve palsy and seizures. Brain magnetic resonance imaging performed at 5 days of age revealed complex brain malformations, including heterotopia

around the mesial wall of lateral ventricles, dysmorphic cingulate gyrus, and enlarged midbrain tectum. The patient unexpectedly died at 13 months of age. Postmortem pathological findings included a polymicrogyric cingulate cortex, periventricular nodular heterotopia, basal ganglia and thalamic anomalies, and dysmorphic midbrain tectum. Potential

candidate genes showed no abnormalities by traditional PCR-based sequencing. Whole-exome sequencing confirmed the presence of novel gene variants for filamin B (FLNB), guanylate binding protein family member 6, and chromosome X open reading frame 59, which adapt to the autosomal recessive mode or X-linked recessive mode. CYC202 purchase Although immunohistochemical analysis confirmed the expression of FLNB protein in the vessel walls and white matter in autopsied specimens, there may be functional relevance of the compound heterozygous FLNB variants during brain development.

“
“Niemann-Pick disease type C (NPC) is an autosomal recessive neurovisceral lipid storage disorder. Two disease-causing genes (NPC1 and NPC2) have been identified. NPC is characterized MycoClean Mycoplasma Removal Kit by neuronal and glial lipid storage and NFTs. Here, we report a man with juvenile-onset progressive neurological deficits, including pyramidal signs, ataxia, bulbar palsy, vertical supranuclear ophthalmoplegia, and psychiatric symptoms; death occurred at age 37 before definitive clinical diagnosis. Post mortem gross examination revealed a unique distribution of brain atrophy, predominantly in the frontal and temporal lobes. Microscopically, lipid storage in neurons and widely distributed NFTs were observed. Lipid storage cells appeared in systemic organs and filipin staining indicated intracellular cholesterol accumulation in hepatic macrophages. Electron microscopy revealed accumulation of lipids and characteristic oligolamellar inclusions. These findings suggested an NPC diagnosis. Neuronal loss and gliosis were frequently accompanied by NFTs and occurred in the frontal and temporal cortices, hippocampus, amygdala, basal forebrain, basal ganglia, thalamus, substantia nigra and brain stem nuclei. Lewy bodies (LBs) were observed in most, but not all, regions where NFTs were evident.

All procedures were performed under local anesthesia except one. In all cases, defects were obtained after skin cancer excisions. Results: The operative time ranged from 55 to 75 min. All flaps survived with an average follow-up of 8 months, reconstructions have maintained a cosmetically pleasing result. We believe that SB flaps may be a new option for reconstruction of temporal defects with the advantages of local flaps, without the inconvenience of a skin pedicle. Moreover, these flaps raise the question of the use of SB based flaps for the coverage of moderate-sized skin BAY 57-1293 defects anywhere in the body, and open new fields in reconstructive surgery. © 2014 Wiley

Periodicals, Inc. Microsurgery 34:554–557, 2014. “
“Adipose tissue-derived stem cells and insulin-like growth factor-1

(IGF-1) have shown potential to enhance peripheral nerve regeneration. The purpose of this study was to investigate the effect of an in vivo biologic scaffold, consisting of white adipose tissue flap (WATF) and/or selleck kinase inhibitor IGF-1 on nerve regeneration in a crush injury model. Forty rats all underwent a sciatic nerve crush injury and then received: a pedicled WATF, a controlled local release of IGF-1, both treatments, or no treatment at the injury site. Outcomes were the normalized maximum isometric tetanic force (ITF) of the tibialis anterior muscle and histomorphometric measurements. At 4 weeks, groups with WATF had a statistically significant improvement in maximum ITF recovery, as compared to those without (P < 0.05), and there was an increase in myelin thickness and total axon count in the WATF-only group versus control (P < 0.01). Functional and histomorphometric data suggest that IGF-1 suppressed the effect of the WATF. Use of a pedicled WATF improved the functional and histomorphometrical buy ZD1839 results after axonotmesis in a rat model. IGF-1 does not appear to enhance nerve regeneration in this model. Utilizing the WATF may have a beneficial therapeutic role in peripheral nerve injuries. © 2013 Wiley Periodicals, Inc. Microsurgery 33:367–375, 2013. “
“Extensive

and complex defects of the head and neck involving multiple anatomical and functional subunits are a reconstructive challenge. The purpose of this study is to elucidate the reconstructive indications of the use of simultaneous double free flaps in head and neck oncological surgery. This is a retrospective review of 21 consecutive cases of head and neck malignancies treated surgically with resection and reconstruction with simultaneous use of double free flaps. Nineteen of 21 patients had T4 primary tumor stage. Eleven patients had prior history of radiotherapy or chemo-radiotherapy. Forty-two free flaps were used in these patients. The predominant combination was that of free fibula osteo-cutaneous flap with free anterolateral thigh (ALT) fascio-cutaneous flap.

Fusion of the limiting MVB endosomal membrane with the plasma membrane releases the intraluminal vesicles into the extracellular environment,[14] whereafter they are known as exosomes (Fig. 1). The fusion of MVB with the plasma membrane and subsequent release of exosomes is a constitutive process in most cell types,[15] although it is also LBH589 subject to regulation by a variety of stimuli. Exosome release from MVB has been demonstrated to be regulated by endosomal and vesicular trafficking proteins,[16, 17] Rab small GTPase family members,[18, 19] ceramide[20] and calcium.[18] Exosomes are emerging as a part of the cellular response to a range of different stresses.

Increased exosome release has been reported in hypoxia,[21] acidic pH[22], heat shock[23] and oxidative stress.[24] Significantly, p53 has been implicated in regulating exosome release,[25] further providing support to the idea that exosomes may act as a intercellular signals to communicate during cellular stress. Exosome isolation protocols vary depending on the biological fluid of origin, but generally involve serial centrifugation at low speed, followed by ultracentrifugation at 100 000 g to pellet exosomes.[26, 27] Alternatively, exosomes can be isolated by immunocapture or size exclusion methods.[26, 28] Filtration and microfluidics

approaches have been developed,[29, 30] but have yet to be widely adopted. Recently, a proprietary method of exosome isolation called ExoquickTM (System Biosciences, Mountain View, INCB024360 price California, USA) has been made commercially available.[31] Exosomes have densities between 1.10–1.21 g/mL,

and this characteristic is often exploited for further purification, either by sucrose density gradients or flotation on sucrose/deuterium oxide cushion.[26, 27, 32] Velocity gradients can also be used, next especially in order to distinguish between viral and exosomal vesicles.[33, 34] A comparison of different methods showed that circulating exosomes isolated by ExoquickTM precipitation produce exosomal mRNA and miRNA with greater purity and quantity than ultracentrifugation.[35] The morphology and size of exosomes were first characterized by electron microscopy (see Fig. 2), and further characterization of exosomes has traditionally relied upon biochemical methods such as immunoblotting, mass spectrometry, 2-DIGE and microarrays, although atomic force microscopy and dynamic light scattering technologies have also been used. The ExoCarta and vesiclepedia databases provide a comprehensive record of exosomal protein, RNA and lipid profiles (http://www.microvesicles.org).[36] Detection and quantification of exosomes currently relies upon indirect methods such as immunoblotting of exosomal proteins, activity of exosomal enzymes,[37, 38] exosomal protein quantification,[23] fluorescent labelling of exosomes[39, 40] or antibody-specific bead-coupled approaches.

1c). As studies of the effects of statins in other experimental models have suggested that the actions of this class of drugs are related to

their anti-proliferative and pro-apoptotic effects on both T cells and tumours, it was important selleck products to rule out that the capacity of simvastatin to induce Foxp3 expression was not secondary to an inhibition of responder T-cell proliferation. However, simvastatin either alone or in combination with TGF-β had only a slight inhibitory effect on the proliferation of CFSE-labelled CD4+ T cells stimulated with anti-CD3/CD28 in our induction cultures (Fig. 1d). Furthermore, the addition of simvastatin did not induce apoptosis and had no effect on the cell cycle of Foxp3− T cells (Fig. S1). Hence, the effects of simvastatin are directly mediated by enhancing the conversion of Foxp3− to Foxp3+ T cells. To address whether Foxp3+ T cells induced in vitro in the presence of simvastatin and TGF-β were suppressive, Foxp3− T cells were isolated from the spleen and lymph nodes of Foxp3gfp mice and activated with plate-bound CD3/CD28 antibody in the presence of TGF-β alone or the combination of simvastatin and TGF-β. The induced GFP+ cells were sorted by FACS, added to Foxp3− responder Z-VAD-FMK supplier cells and T-depleted spleen cells as antigen-presenting

cells, and were stimulated with soluble anti-CD3. The Foxp3+ cells induced in the presence of simvastatin/TGF-β were as suppressive as the Foxp3+ T cells induced with TGF-β alone (Fig. 2). The addition of simvastatin therefore did not modulate the function of the induced Foxp3+ T cells. Simvastatin

blocks all downstream pathways of the mevalonate pathway including cholesterol biosynthesis, synthesis of farnesyl bisphosphate, and geranylgeranyl bisphosphate (Fig. 3a). To determine which downstream pathway primarily mediates the synergistic effects of simvastatin on Foxp3 induction, we added simvastatin or downstream pathway-specific inhibitors together with TGF-β to the Foxp3 induction assay (Fig. 3b). As shown above, simvastatin Nintedanib (BIBF 1120) enhanced the induction of Foxp3-expressing cells in the presence of a low concentration of TGF-β. In contrast, the addition of an inhibitor of farnesylation had no effect on the induction of Foxp3 expression whereas the inhibitor of geranylgeranylation mimicked the effects of simvastatin. This result clearly demonstrates that the synergistic effects of simvastatin on the induction of Foxp3 are secondary to inhibition of protein geranylgeranylation. We performed a kinetic study as an initial approach to the analysis of the mechanisms by which simvastatin enhances the induction of Foxp3+ Tregs. When analysed 24 hr after T-cell stimulation, cells cultured with simvastatin alone did not express Foxp3 and no differences were observed, at this time-point between the percentage of Foxp3+ T cells induced by TGF-β and the percentage induced by the combination or TGF-β and simvastatin (Fig. 4a).

We focused on the VH7183 family because it represents a manageable component of the active repertoire, because we and others had previously established patterns of VH7183 utilization during ontogeny and development in BALB/c mice, and because VH7183 gene segments have been shown to be components of antibodies with both self and nonself reactivities (reviewed in [8]). A total of 577 unique, in-frame, open transcript sequences were obtained including 72 from B (pro-B), 133 from C (early pre-B), 75 from D (late pre-B), 78 from PD0325901 E (immature B), and 219 from

F (mature, recirculating B). The C57BL/6 mouse genome contains only nine VH7183 family gene segments with open-reading frames (Fig. 1), or approximately half that of the BALB/c mouse genome.

Of these nine, only seven were identified in our sample of bone marrow transcripts (Fig. 2). As in the case of BALB/c mice, the usage of the C57BL/6 VH81X (IGHV05–2, IMGT) gene segment declined fourfold during early B-cell development (28% in B versus 7% in D, p = 0.0008). However, unlike BALB/c mice where there was a further fivefold late-stage reduction between fractions D or E to F (p < 0.02), in C57BL/6 mice the prevalence of VH81X usage did not change between fractions D, E, and F (Fig. 2). The most JH distal VH, IGHV05–17 (IMGT), exhibited a doubling of usage in the transition from pro-B-cell to immature B cell and beyond (BF, p < 0.05), ultimately contributing to almost one-third of the VH7183-containing transcripts from the mature HDAC inhibitor B-cell pool (Fig. 2). The closest BALB/c VH7183 homologue to IGHV05–17, VH7183.18, exhibited a similar increase in usage with development, but contributed to only 10% of the final repertoire. Use of the remaining five C57BL/6 VH gene segments did not vary statistically with development, also following the same pattern as their BALB/c homologues (Fig. 1). However, the VH gene segment most commonly used in BALB/c mice at all stages of development, VH7183.10, has no C57BL/6 VH7183 homologue; and thus its structure and binding

activity is missing in C57BL/6 mice. Significant differences in the complement of DH gene segments were observed between C57BL/6 and BALB/c mice. The C57BL/6 genome has only one DFL family gene segment, two DST family gene segments, and six DSP family gene segments; whereas the BALB/c genome has two DFL family gene segments, Immune system one DST family gene segment, and nine DSP family gene segments. Both strains of mice had a single DQ52 gene segment that was conserved in sequence. In total, therefore, the C57BL/6 genome contains three fewer functional D gene segments than the BALB/c genome (Fig. 1). If DH usage were primarily a function of gene number, one might expect C57BL/6 mice to halve their use of the DFL family and double the use of DST family. However, while use of the DST family did increase, use of the single DFL gene segment in C57BL/6 mice increased to match the combined usage of the two DFL gene segments in BALB/c mice.

4- or 8.2-fold in CXCL4-stimulated cells, while in the same samples SphK2 (SPHK2), which is barely detectable in monocytes and macrophages, is down-regulated by 89 or 34%, respectively. S1P-degrading enzyme sphingosine-1-phosphate phosphohydrolase 2 (SGPP2) mRNA expression is rapidly up-regulated by 190-fold within 4 h of stimulation with CXCL4 and decreases thereafter (19-fold of unstimulated control), and sphingosine-1-phosphate lyase 1 (SGPL1) expression increases 1.6- Palbociclib purchase or 1.3-fold in the presence of CXCL4 (Fig. 1, lower panels). These data clearly show that CXCL4 regulates expression of genes involved in S1P metabolism

in human monocytes. Next, we were interested in whether SphK1 is directly activated in CXCL4-stimulated monocytes. Activation of SphK1 was tested by its membrane translocation as well as by its ability to phosphorylate exogenous sphingosine in the presence of Triton X-100 14. Monocytes were stimulated for up to 30 min in the presence of 4 μM CXCL4. Subsequently, cytosol and membrane fractions were isolated and membrane fractions were tested for SphK1 by western blot analysis. As shown in Fig. 2, stimulation with CXCL4 provoked a rapid biphasic increase in membrane-bound SphK1 as well as SphK1 enzyme activity reaching

a first maximum after 30 s of stimulation. After 2 min amounts of membrane-bound SphK1 and SphK1 enzyme activity decreased again, while a second peak occurred after 10–30 min of stimulation. In summary, CXCL4 stimulates activation and membrane translocation of SphK1 in human monocytes. However, CXCL4-induced activation of https://www.selleckchem.com/products/Etopophos.html SphK1 is not accompanied by the release of S1P into the extracellular medium. This was evident from experiments where monocytes (1×106 cells/mL) were activated with CXCL4 (4 μM) for 30 min, 4 and 18 h and release was determined by competitive ELISA. Under these experimental conditions, S1P concentrations in supernatants of CXCL4 stimulated monocytes never reached levels of detection limit of the ELISA (about 30 nM; data not shown). To test whether SphK signaling is involved in CXCL4-induced monocyte

functions, the cells were preincubated in the presence or absence of increasing concentrations of SKI 17. Subsequently, the cells were stimulated with 4 μM CXCL4 and production of ROS was recorded for 60 min. Preincubation of the cells with SKI resulted in a significant Doxacurium chloride and dose-dependent reduction of CXCL4-mediated respiratory burst by 73% at 1 μM SKI to 98% at 27 μM SKI (Fig. 3A). These data provided first evidence that activation of SphK is involved in the generation of ROS in CXCL4-treated monocytes. To investigate whether the same pathway is involved in the control of CXCL4-mediated protection from spontaneous apoptosis in monocytes, the cells were pretreated with inhibitors as indicated in Fig. 3A and subsequently cultured for 72 h in the presence or absence of 4 μM CXCL4. To assess the proportion of apoptotic cells, the cultured monocytes were labeled with annexin V.

Secretion of some chemokines, such as CCL-2, CCL-5, CXCL-5

and CXCL-8, was significantly reduced when anti-IL-15 mAb was added to the culture medium (Fig. 4b). However, other cytokines, including CCL-4, CCL-11, granulocyte–macrophage Selleck PD0325901 colony stimulating factor and vascular endothelial growth factor were not affected. These data suggest that blocking by anti-IL-15 antibodies has a selective effect on secretion, of particular chemokines, rather than causing a general non-specific suppression of FDC function (Fig. 4c). CD14, CD44, CD54 (ICAM-1) and CD106 (VCAM-1) are some of the major surface molecules that play important roles in the cellular interactions between GC-B cells and FDCs.6 We therefore investigated the effect of blocking of the IL-15 signal on FDC surface expression of CD14, CD44, CD54 (ICAM-1) and

CD106 (VCAM-1) via FACS analysis. However, the expression of these surface proteins was not altered by anti-IL-15 mAb treatment (Fig. 5). During GC formation, stromal cells in primary follicles proliferate rapidly and differentiate into FDCs.6 Both TNF-α and LT from GC-B cells have been considered essential soluble factors for FDC development because genetically this website engineered TNF-α-knockout and LT-knockout mice are defective in GC formation. However, a number of gene-knockout mouse studies do not distinguish between FDC development in primary B-cell follicles rather than in the GC.6 Therefore, a proliferation assay with in vitro culture of human primary FDCs could be a plausible system with which to investigate the FDC development during the mature GC formation. Although in vitro culture of human primary FDCs has been established, and studied for decades, only a few proliferation factors, including TNF-α and IL-1β, have been identified.54,55 Previously, we demonstrated

that IL-15 expressed in human tonsillar FDCs enhanced the proliferation of GC-B cells.13 The function of IL-15 has not been extensively studied in FDCs because there is little difference in the humoral immune response of genetically modified mice.25–27 We therefore investigated the biological function of IL-15 on human FDCs. In the present study, we examined GNE-0877 the functional role of IL-15 in FDCs using human primary FDCs. First, we found that the addition of IL-15 enhanced recovery of the FDC proliferation in cultures and that the addition of anti-IL-15 antibody reduced the recovery of cultured FDCs. The FDCs have the IL-15R components necessary for signal transduction by IL-15, as well as IL-15 binding. These observations strongly suggest that IL-15 plays a functional role in FDCs. Interestingly, the effect of IL-15 in increasing the recovery of cultured FDCs is mainly attributed to enhanced proliferation rather than protection from apoptosis, as determined by CFSE labelling.

Patients were treated

with anidulafungin (±oral voriconazole) for 14–42 days. Patients not achieving negative blood/tissue cultures by day 7 were considered treatment failures and discontinued from the selleck products study. The primary endpoint was global response rate at the end of treatment (EOT) based on the modified intent-to-treat (MITT) population, which included patients who received any dose of study medication with confirmed candidaemia (positive blood culture) or invasive candidiasis (histopathological or cytopathological examination of a needle aspiration or biopsy specimen from a normally sterile site excluding mucous membranes showing yeast cells) within the 96 h before study entry. For the primary analysis, missing/indeterminate results were set to failure. Successful global response was defined as clinical success (cure/improvement – resolution/significant but incomplete resolution of signs and symptoms of candidaemia) and microbiological success (eradication – negative culture for Candida spp. present at baseline, or presumed eradication if follow-up cultures were not available, but clinical outcome was deemed a success). Key secondary endpoints included the following: global response rate at the end of IV therapy and at a week 2 follow-up assessment; all-cause mortality; incidence of adverse events

(AEs) and Opaganib in vitro discontinuations from the study; and change from baseline in clinical and laboratory parameters. The safety population included all patients who received any dose of medication. All serious adverse events (SAEs) and AEs were reported by the investigator in a case report form. The investigator was responsible for determining the causality of AEs. Laboratory evaluations

and clinical assessments including vital signs data, physical examination, bodyweight and height and APACHE II scores were also monitored. The sample size calculation was based on the desired precision (width of a two-sided 95% confidence interval [CI]) triclocarban for the estimate of a successful global response. The study required 147 patients if the expected global response rate was 70%, with the precision level of 7.3% (half width of a two-sided 95% CI for the incidence rate) using normal approximation. Assuming an evaluability rate of 70%, ~210 patients were targeted for enrolment in the study. The primary endpoint and key secondary endpoints of this study were summarised using descriptive statistics (number of patients, per cent, and 95% CI). In exploratory analyses of patient characteristics and response to treatment, the subgroups of patients who were or were not able to step-down to voriconazole were compared using Fisher’s Exact Test[16] to a significance level of P < 0.