“To clarify the association between factors

“To clarify the association between factors Small molecule library purchase regulating DNA methylation and the prognosis of autoimmune thyroid diseases (AITDs), we genotyped single nucleotide polymorphisms in genes encoding DNA methyltransferase 1 (DNMT1), DNMT3A, DNMT3B, methylenetetrahydrofolate reductase (MTHFR) and methionine synthase reductase (MTRR), which are enzymes essential for DNA methylation. Subjects for this study included

125 patients with Hashimoto’s disease (HD), including 48 patients with severe HD and 49 patients with mild HD; 176 patients with Graves’ disease (GD), including 79 patients with intractable GD and 47 patients with GD in remission; and 83 healthy volunteers (control subjects). The DNMT1+32204GG genotype was more frequent in patients with intractable GD than in patients https://www.selleckchem.com/products/Y-27632.html with GD in remission. Genomic DNA showed significantly lower levels of

global methylation in individuals with the DNMT1+32204GG genotype than in those with the AA genotype. The MTRR+66AA genotype was observed to be more frequent in patients with severe HD than in those with mild HD. The DNMT1+14395A/G, DNMT3B−579G/T, MTHFR+677C/T and +1298A/C polymorphisms were not correlated with the development or prognosis of AITD. Our study indicates that the DNMT1+32204GG genotype correlates with DNA hypomethylation and with the intractability of GD, and that the MTRR+66AA genotype may correlate with the severity of HD. Autoimmune thyroid diseases (AITDs), such as Graves’ disease (GD) and Hashimoto’s disease (HD), are typical autoimmune diseases [1,2]. The severity of HD and the intractability (that is, inducibility to remission) of GD varies among patients.

Some patients with HD develop hypothyroidism earlier in life, while some maintain a euthyroid state even up to old age. Some patients with GD achieve remission through medical treatment, whereas others do not [3,4]. However, the intractability of GD and the severity of HD are very difficult to predict at diagnosis. DNA methylation occurs at cytosine residues in cytosine–phosphate–guanosine (CpG) dinucleotides and involves methylation of the fifth carbon of the pyrimidine ring oxyclozanide leading to the formation of 5-methylcytosine (5-mC). The majority of CpG sites (70–80%) in human DNA are methylated and many of the non-methylated sites are found in so-called CpG islands, which are sites of transcription initiation [5]. Several studies have reported a strong correlation between DNA methylation and gene expression [6]. In addition, DNA methylation is one of the epigenetic processes regulating several biological events, including embryonic development, transcriptional regulation, X-chromosome inactivation, genomic imprinting and chromatin modification [7]. Altered DNA methylation patterns have been associated with tumorigenic events and development of autoimmune diseases [8]. DNA methylation is established and maintained by DNA methyltransferases (DNMTs).

This study was granted by CNPq – Senior Researcher fellow (proces

This study was granted by CNPq – Senior Researcher fellow (process n° 307009/207-6), Brazil None. “
“Changes in the systemic immune response are found in preeclampsia. This may be related to high extracellular adenosine triphosphate (ATP) levels. The question arose whether ATP could affect immune responses in pregnancy. Previously, we

investigated whether ATP affected monocyte activation and subpopulations. Here, we investigated ATP-induced changes in other immune cell populations AZD2281 order in pregnant rats, systemically and in the kidney, an affected organ in preeclampsia. Using flow cytometry or immunohistochemistry, blood and kidney leukocytes were studied in pregnant and non-pregnant rats at different intervals after ATP or saline infusion. Ixazomib order Adenosine triphosphate (ATP) infusion induced increased peripheral blood non-classical monocytes and decreased T lymphocyte subsets in pregnant rats only, higher glomerular macrophage and T lymphocyte numbers in non-pregnant animals 1 day after infusion, and higher glomerular macrophage numbers in pregnant rats 6 days after infusion. Adenosine triphosphate (ATP) infusion in pregnant rats induced a pregnancy-specific inflammatory response. Increased ATP levels could potentially

contribute to development of the inflammatory response of preeclampsia. “
“Institute of Medical Microbiology, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany Immunglobulin E (IgE) production is tightly regulated at the cellular and genetic levels and is believed to be central to allergy development. At least two cellular pathways exist that lead to systemic anaphylaxis reactions in vivo: IgE-sensitized mast cells and IgG1-sensitized basophils. Passive anaphylaxis, by application of allergen and allergen-specific antibodies in mice, indicates a differential contribution of immunoglobulin isotypes to anaphylaxis. However, analysis of a dynamic immunization-mediated antibody response

in anaphylaxis is difficult. Here, we generated IgE knock-in mice (IgEki), which express the IgE heavy chain instead of IgG1, in order to analyze the contribution of IgG1 and IgE to active anaphylaxis in vivo. IgEki mice display increased IgE production both in vitro and in vivo. The sensitization others of IgEki mice by immunization followed by antigen challenge leads to increased anaphylaxis. Homozygous IgEki mice, which lack IgG1 due to the knock-in strategy, are most susceptible to active systemic anaphylaxis. The depletion of basophils demonstrates their importance in IgE-mediated anaphylaxis. Therefore, we propose that an enhanced, antigen-specific, polyclonal IgE response, as is the case in allergic patients, is probably the most efficient way to sensitize basophils to contribute to systemic anaphylaxis in vivo. Allergy has become a major threat to public health in developed countries [1, 2]. In particular, systemic anaphylaxis, which is a rapid and often fatal allergic reaction to a systemic allergen exposure, e.g.

The potential

for iron overload (liver haemosiderosis) an

The potential

for iron overload (liver haemosiderosis) and cardiac arrhythmias are also a concern. This guideline has been rewritten to address both this clinical effect and to provide a practical guide to iron usage by physicians, nephrologists and renal nursing teams. Overall the recent Cochrane review[6] has both confirmed that IV iron is appropriate and useful in achieving Hb and iron targets and significantly better than oral iron with minimal clinical toxicity. The monitoring of iron and mode of delivery is still based on small cohort studies of the apparent effective targets Afatinib whether in dialysis or just CKD alone and in patients with or without the use of an ESA. Both the resistance to iron and the use of adjuncts

like Vitamin C or different iron compounds is not at this stage with sufficient clinical evidence to recommend them in standard care in the long term. *Explanation of grades The evidence and recommendations in this KHA-CARI guideline have been evaluated and graded selleck screening library following the approach detailed by the GRADE working group (http://www.gradeworkinggroup.org). A description of the grades and levels assigned to recommendations is provided in Tables 1 and 2. **Access to the full text version For a full text version of the guideline, readers need to go to the KHA-CARI website (http://www.cari.org.au). “
“Mark A Brown and Susan M Crail Nephrologists seek to provide dialysis to those

who will benefit most while being honest and direct with those who are unlikely to benefit or even be harmed by dialysis; these can be difficult decisions. A ‘conservative’ or ‘not for dialysis’ pathway is an important option for the management of end-stage Cyclooxygenase (COX) kidney disease (ESKD) patients who are elderly, have significant comorbidity, poor functional status, malnutrition or who reside in a nursing home. Such a pathway is best underpinned by a specific renal supportive care programme in each unit. Nephrologists need to lead realistic discussions about likely survival with patients and their families before dialysis is instituted. Key ethics principles are a good aid in this decision-making process A ‘non-dialysis’ renal supportive care programme is a very positive way of offering holistic care for patients and their families; many of these patients live much longer without dialysis than might have been expected. Perhaps the most difficult decision facing nephrologists today is that of ‘selecting’ which patients will benefit from dialysis in an overall person-centred sense, not just in terms of days survived or achievement of target haemoglobin, Phosphate, Kt/V or other outcomes. The overall aim is to help and direct patients and their families so as to encourage those who will benefit most from dialysis to have this while being honest and direct with those who are unlikely to benefit or even be harmed by dialysis.

40 Recombinant antibodies

40 Recombinant antibodies Opaganib molecular weight for clinical therapeutic use in humans are expressed in low yields in mammalian cells, which accounts for their high cost. To cut costs, cPIPP was expressed as a periplasmic protein in tobacco leaves at a high yield of 20 mg of purified protein per Kg fresh tobacco leaves.41 Being given that it was expressed in endoplasmic reticulum of the leaves, plant-specific fucose and xylose residues were not loaded on the antibody.42 cPiPP had an affinity of 1.9 × 1010 m−1 for hCG. It was totally devoid of cross-reaction with hFSH and hTSH and had <5% cross-reaction with hLH. The antibody was fully competent to block hCG-induced gain

of uterine weight of immature mice in vivo and hCG-induced testosterone production by Leydig cells in vitro.40,41 Its efficacy was also tested in a human cell system. Placental villi cytotrophoblasts, isolated from placental villi of MTP cases, on culture in a medium containing anti-hCG antibodies failed to fuse into syncytium. Furthermore, the production of progesterone by the placental cells was fully blocked by cPiPP.26 These observations vouch for the suitability of cPiPP for use as a vacation contraceptive and for non-surgical termination of pregnancy. Choriocarcinoma trophoblast cells are known to make and secrete hCG.43,44 The cells carry receptors for hCG, by virtue of CHIR-99021 which hCG

acts as an autocrine growth factor for these cells. Radio-iodinated PiPP bound to these cells in vitro. JEG cells administered to Nude mice form a cancerous implant. Injection of 131I-PiPP to such mice led to selective localization of radioactivity

at Quisqualic acid the tumor site, whereas the radioactivity of a similarly radio-iodinated non-relevant antibody is distributed randomly all over the body45 (Fig. 1a,b). The binding of the radio-iodinated PiPP to tumor cells is further confirmed by histioradiography (Fig. 1c). These studies clearly demonstrate the utility of the recombinant antibody for imaging and selective delivery of radiations to the tumor cells. It could be of particular utility for tracing of metastasis of such cancers. The curious phenomenon of cancer cells expressing hCG or its subunits has been discussed elsewhere in this article. We carried out studies on T-lymphoblastic leukemia MOLT-4 and lymphocytic leukemia U-937 cells, both available from ATCC. Both MOLT-4 and U-937 cells were bound with cPiPP. The binding as studied by flow cytometry was on the membranes and was specifically competed by authentic purified hCG.46 hCG was not picked up from other cells but was indeed synthesized by the cancer cells, as permeabilized MOLT-4 cells enabled the detection of the presence of hCG within the cells, to which the antibody permeating in the cells could bind. Incubation of MOLT-4 cells with anti-hCG antibodies did not however impair the viability and multiplication of these cells. Nor were the cells lysed by cPiPP in the presence of complement.


Inhibition check details of NF-κB by apoptotic cells has been shown 37, 40. However this study provides the first evidence of inhibition

of nuclear migration of p65, at the transcriptional or post-transcriptional level, related to CD11b/CD18 and/or CD11c/CD18 and/or iC3b-opsonized apoptotic cells. iC3b-opsonized apoptotic cells could potentially impair binding of zymosan, as the iC3b binding site is occupied by its natural ligand, which may result in a steric block of function at the lectin-binding site 35, 41. However, as shown recently, most of zymosan binding occurs via Dectin-1 18, and although we cannot exclude the possibility, it seems unlikely that the inhibition was competitive. An alternative scenario is that inhibition is triggered by the binding of iC3b-opsonized

apoptotic cells to CD11b/CD18 and CD11c/CD18. CD11b/CD18 and CD11c/CD18 were reported as being both pro-and anti-inflammatory 42, 43. However, binding and phagocytosis via the CD11b/CD18 macrophage does not trigger leukotriene release 44 or a respiratory burst 45, 46, suggesting noninflammatory functioning. Furthermore, CD11b/CD18 was shown to be immunosuppressive by downregulation of IL-12 and IFN-γ production 47–52. We can provide two explanations for the observations that CD11b/CD18 could be either pro- or anti-inflammatory. The first is colligation of other receptors, like the Fc receptor, or PLX3397 TLR2 and Dectin-1 in the case of zymosan; the second is that different binding sites may provide different responses. In that regard, it is also possible that colligation of an anti-inflammatory receptor such as the phosphatidylserine receptor contributed to the CD11b/CD18 response 53. However, the latter model is highly dependent on contributions to the clearance of non-iC3b opsonized cells, which in this model seem extremely minor fantofarone (Fig. 1). This is further supported by the lack of TGF-β secretion and the inhibition effect that characterize the phosphatidylserine receptor. Taken

together, we suggest that iC3b-opsonized apoptotic cells, by binding or phagocytosis, via CD11b/CD18 or additional unknown complement receptors, induce NF-κB inhibition in response to zymosan, at the transcriptional- or post-transcriptional level. In addition, IL-10 secretion by macrophages, as well as the lack of TGF-β secretion, characterized CD11b/CD18 interaction with iC3b-opsonized apoptotic cells. This is the opposite of what is seen in interaction via the phosphatidylserine receptor(s). Recently, we were able to show another mechanism involving non-MyD88 signaling 7. It seems that multiple mechanisms of immune suppression could be used during apoptotic cell death and the clearance of apoptotic cells. The relevance of each mechanism may be found in the specific circumstances and physiological situation.

In addition to tumour models, mice lacking CD137 receptor or CD13

In addition to tumour models, mice lacking CD137 receptor or CD137 ligand expression have been studied in models of infection and

autoimmune disorders [2,7]. Given the key role of CD8+ T cells in controlling viral infection and the potent CD8+ T cell-inducing effect of agonistic CD137 mAb, CD137 triggering as a strategy to enhance the anti-viral response showed therapeutic potential. Conversely, even in the absence of CD137 expression, anti-viral immunity LDE225 seems to be functional, as CD137−/− mice showed reduced severity in a herpetic stromal keratitis (HSK) model [33]. With regard to bacterial infection, CD137−/− mice showed lower mortality in a model of polymicrobial sepsis induced by caecal ligation and puncture [34]. In comparison to WT controls, CD137−/− mice exhibited higher numbers of macrophages and neutrophils accomplished with better bacterial clearance and enhanced survival in this infection model. Similar results were observed after treatment with blocking anti-CD137L mAb, whereas the administration of CD137 agonistic mAb aggravated polymicrobial sepsis and decreased survival of WT mice [34]. Treatment with agonistic CD137 mAb has been demonstrated to efficiently prevent or even reverse autoimmune responses in murine studies,

including models PS-341 research buy for lupus, rheumatoid arthritis PRKD3 and experimental autoimmune encephalomyelitis [35–37]. Analysis of CD137−/− mice with regard to autoimmune disorders revealed a divergent outcome. Jeon et al. showed that CD137 gene deletion results in the improvement of atherosclerosis in hyperlipidaemic mice [38]. However, lprl CD137−/− mice show increased immune activation and develop a dramatic autoimmune phenotype leading to early mortality in a lupus model [39]. Recently, it has been demonstrated that CD137 deficiency protects against obesity-induced inflammation and metabolic disorders [40]. In general, CD137−/− mice show no defect in T cell development, as percentages of CD4+ and CD8+ T cells in spleen

and thymus were similar to WT mice under steady-state conditions [19]. In vitro stimulation of CD137−/− lymphocytes with anti-CD3 or mitogens revealed an increased proliferation relative to WT cells [19]. The observed hyperreactivity of cells from CD137−/− mice did not correlate with IL-2 secretion. Besides decreased IL-2 levels, the capacity for IL-4 and IFN-γ production was also diminished in CD137−/− cell cultures. In contrast to this unspecific stimulation, we did not detect significant differences in the proliferation of CD137−/− T cells when antigen-specific stimulation with OVA was used. Lee et al. reported enhanced CD4+ T cell responsiveness to protein antigen in CD137−/− mice [41].

, 2000) On the other hand, NO inhibits surfactant gene expressio

, 2000). On the other hand, NO inhibits surfactant gene expression in primary cultures of type II cells (Lee et al., 2005). It remains to be investigated whether SP-A increases the expression of Arg1 to inhibit NO production in macrophages. Mtb-infected macrophages are able to induce Arg1 expression in non-infected neighboring macrophages by an autocrine–paracrine cytokine-mediated pathway (Qualls et al., 2010). In this scenario, it is reasonable to suggest that Arg1 production by type II cells in TB lungs could be mediated by paracrine signaling from macrophages. Our results suggest that Arg1 expression

by macrophages in human lungs of patients with TB could play a role in the disease. We thank Bruno Mietto (Instituto de Ciências X-396 Biomédicas – UFRJ) and Prof. Dr. Jorge José de Carvalho (Departamento de Histologia e Embriologia – UERJ) for technical assistance. This work was supported by grant from Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ). “
“The importance of CD8+ T cells in the control of viral infections is well established. However, what differentiates CD8+ T cell responses in individuals who control infection and those who do not is not well understood. ‘Functional sensitivity’ describes an important quality

of the T cell response and is determined click here in part by the affinity of the T cell receptor for antigen. A more sensitive T cell response is generally believed to be more efficient and associated with better control of viral infection, yet may also drive viral mutation and immune escape. Various in vitro techniques have been used to measure T cell sensitivity; however, rapid ex vivo analysis of this has

been made possible by the application of the ‘magic’ tetramer technology. Such tools have potentially important applications in the design and evaluation of vaccines. T cells play an important role in containment of persistent viral infections such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV). For example, depletion studies in models of both HCV [1] and HIV [2] have demonstrated the importance of CD8+ cytotoxic T lymphocytes (CTL) in the control of virus replication. Additionally, PJ34 HCl immunogenetic studies reveal an important impact of human leucocyte antigen (HLA) class I and class II genes, such as HLA B27 and B57, on disease outcome [3]. There has been extensive characterization of the CD8 T cell response in acute and chronic HCV [4] and HIV [5] infections, comparing responses in those who control infection to those in whom disease progresses. However, comprehensive understanding of what determines a successful as opposed to an unsuccessful response requires more precise analysis of the mechanisms involved. This endeavour is important in the development of immunotherapy and vaccines.

Here, we have developed and characterized a cytotoxic LAG-3 chime

Here, we have developed and characterized a cytotoxic LAG-3 chimeric antibody (chimeric A9H12), and evaluated its potential as a selective therapeutic depleting agent in a non-human primate model of delayed-type hypersensitivity (DTH). Chimeric A9H12 showed

a high affinity to its antigen and depleted both cytomegalovirus (CMV)-activated CD4+ and CD8+ human T lymphocytes in vitro. In vivo, a single intravenous injection at either 1 or 0·1 mg/kg was sufficient to deplete LAG-3+-activated T cells in lymph nodes and to prevent the T helper type 1 (Th1)-driven skin inflammation NVP-BGJ398 order in a tuberculin-induced DTH model in baboons. T lymphocyte and macrophage infiltration into the skin was also reduced. The in vivo effect was long-lasting, as several weeks to months were required after injection to restore a positive reaction after antigen challenge. Our data confirm that LAG-3 is a promising therapeutic target for depleting antibodies that might lead to higher therapeutic indexes compared to traditional immunosuppressive agents in autoimmune diseases and transplantation. Selectively inhibiting or deleting activated T lymphocytes represents a promising therapeutic approach as an alternative to current immunosuppressive treatments in autoimmunity and transplantation. One strategy might be the use of depleting antibodies that target specific antigens on activated T cells. This provides a competitive

advantage of targeting only pathogeneic T cells that are specific for auto- or alloantigens without modifying RG7420 manufacturer the protective immunity directed against third-party antigens [1]. The proof of concept for selective depletion of pathogeneic T lymphocytes has been demonstrated in an engineered mouse model, whereby their T cells express a viral thymidine kinase suicide gene that metabolizes the non-toxic prodrug ganciclovir into a metabolite that is toxic only to dividing cells. The result was a significant delay in the rejection of skin and heart grafts and the induction of an immune tolerance in a fraction of the recipient mice [2]. However,

the Rolziracetam therapeutic translation of this strategy requires the targeting of an antigen that is highly specific for activated T cells. So far, few molecules that are expressed selectively by activated T cells have been identified. Among these are CD25, CD152, CD154 and CD223 (lymphocyte-activation gene-3; LAG-3[3]). LAG-3 is an important regulator of T cell homeostasis [4] that is related evolutionarily to CD4 and, like CD4, is associated with the T cell receptor. It has retained an affinity 2 logs higher than CD4 for their common ligand, major histocompatibility complex (MHC) class II. LAG-3 is a transmembrane protein that forms dimers at the surface of both CD4+ and CD8+ T lymphocytes [3,5] residing in inflamed secondary lymphoid organs or tissues (i.e. human tumours or rejected allograft), but not in spleen, thymus or blood.

It has been demonstrated that cytoplasmic round inclusions and ag

It has been demonstrated that cytoplasmic round inclusions and aggregates observed in human ALS motoneurons are composed of non-membrane bound electron-dense granular FK228 materials and filamentous structures.[46] We consider that the ultrastructural characteristics of cytoplasmic

aggregates in infected motoneurons shown in the present study are, although not identical, very similar to those of aggregates observed in human ALS motoneurons. On the other hand, a number of transgenic mice and rats expressing human wild-type and mutant TDP-43 and FUS showed cytoplasmic aggregate formation in spinal motoneurons.[47-55] However, ultrastructurally many of these aggregates were predominantly composed of mitochondrial clusters,[7, 47-49, 52, 55] instead of amorphous/filamentous structures observed in human ALS motoneurons[46] and in infected rat motoneurons demonstrated

in the present study. It remains unknown what these structural differences imply; we also occasionally observed mitochondrial clusters as well as cytoplasmic aggregates in infected motoneurons as shown in Figure 9, which should be investigated further using immunoelectron microscopic selleck compound techniques to identify TDP-43 or FUS immunoreactivity in these structures. In addition, we failed in our preliminary study to demonstrate immunoreactivity for ubiquitin and p62 in the cytoplasmic aggregates induced by adenovirus infection of facial motoneurons; whether these structures are truly immunonegative for ubiquitin or p62

should be further examined. We also did (-)-p-Bromotetramisole Oxalate not examine the relationship between aggregate formation, motoneuron death and glial reaction in the present study, which should be investigated in future studies to clarify whether aggregate formation is the cause of motoneuron death or the protective response of diseased motoneurons. It is interesting to note that both TDP-43 and FUS proteins were accumulated in the cytoplasm of motoneurons in normal aged animals.[56] TDP-43 deposition occurs in a substantial subset of cognitively normal elderly human subjects.[57, 58] Since the efficiency of protein degradation machineries that include proteasome and autophagic systems declines with age in rodents as well as in humans,[13, 59, 60] aggregate formation observed in ALS motoneurons may be partially attributed to the impairment of protein degradation machineries by aging. Indeed, impaired proteasome function in sporadic ALS has been reported.[61] It has also been described that a transgenic mouse with motoneuron-specific knockout of proteasome showed motoneuron degeneration with cytoplasmic aggregate formation that replicates ALS in humans.[62] An autophagy activator rapamycin decreased aggregate formation of TDP-43 in a mouse model of frontotemporal lobar dementia with ubiquitinated inclusions (FTLD-U).

The same procedure

is repeated for the rest sutures as we

The same procedure

is repeated for the rest sutures as well as at the posterior vessel wall (Figs. 1F and 1G). We performed this technique in 30 venous and 15 arterial anastomoses during free tissue transfer. In 15 free flaps, both the arterial and venous anastomoses were performed with the described method, meanwhile in other 15 free flaps, the arterial anastomoses were performed with the conventional method Pirfenidone and the venous anastomosis with the “continuous-interrupted” technique. In both of the groups, no complications were noted performing this technique as all the flaps survived well. Furthermore, the same surgeon in anterolateral thigh flap (ALT) flaps performed 20 venous anastomoses, 10 with the conventional technique, and 10 with the proposed method in order

to compare the time difference between the two methods in vessels with the same size. Statistically significant less time was required (P < 0.05) for the venous anastomosis with the “continuous-interrupted” method. The described method for microvascular anastomosis has several advantages. First of all, the application of the sutures can be very precise as the loosely running suture leaves spaces between the vessels, allowing the lumen to be visible without extensive manipulation of the vessel. This is very useful especially when the last suture of the anterior and posterior wall is applied, which with the conventional method there is limited space between the two edges of vessels. Similarly, during the anastomosis, the posterior vessel wall is always visible, avoiding inadvertent two-wall sewing. Additionally, https://www.selleckchem.com/products/Everolimus(RAD001).html even though the suture is applied continuously, finally

tied as the interrupted fashion, hence there is no risk of stenosis at the anastomotic site. Finally, the anastomosis is performed faster than the conventional method, as the surgeon saves time applying the sutures with a running manner. Stamatis Sapountzis, M.D.* “
“The most suitable free flap alternative in upper extremity reconstruction has adequate and quality of tissue with consistent vascular pedicle. Free flap must provide convenient tissue texture to reconstruct aesthetic and functional units of upper extremity. Furthermore, minimal donor site morbidity is preferred features Pregnenolone in free flap election. In our efforts to obtain the best possible outcome for patients, we chose, as a first priority, the free superficial circumflex inferior artery (SCIA)/superficial inferior epigastric artery (SIEA) flap over other free flap options for the soft-tissue reconstruction of upper extremities. The authors retrospectively report the results of 20 free SCIA/SIEA flaps for upper extremity reconstruction during the past 3 years. Nineteen of 20 flaps were successful (95%): three required emergent postoperative reexploration of the anastomosis and one failed.