The diaphragm is the most important muscle in respiration. Nevertheless, its function is rarely evaluated. Patients with systemic sclerosis (SSc) could be at risk of diaphragmatic dysfunction because of multiple factors. These patients often develop interstitial lung disease (SSc-ILD) and earlier studies have indicated that patients with different ILDs have decreased diaphragmatic mobility on ultrasound (US). This study aimed to evaluate diaphragmatic function in SSc patients using US with regard to the ILD, evaluated with the Warrick score on high-resolution computed tomography (HRCT), and to investigate associations between ultrasonic parameters and dyspnea, lung function, and other important clinical parameters. In this cross-sectional study, we analyzed diaphragm mobility, thickness, lung function, HRCT findings, Modified Medical Research Council (mMRC) dyspnea scale, modified Rodnan skin score (mRSS), autoantibodies, and esophageal diameters on HRCT in patients with SSc. Fifty patients were enrolled in the study. Patients with SSc-ILD had lower diaphragmatic mobility in deep breathing than patients without ILD. The results demonstrated negative correlations between diaphragmatic mobility and mMRC, mRSS, anti-Scl-70 antibodies, esophageal diameters on HRCT, and a positive correlation with lung function. Patients with SSc who experience dyspnea should be evaluated for diaphragmatic dysfunction for accurate symptom phenotyping and personalized pulmonary rehabilitation treatment.

IgG hypogammaglobulinemia has been demonstrated as a risk factor of severe infection in solid organ tranplantation in single center studies and metanalysis. Kidney transplant patients are more prone to CMV infection due to immunosuppressive therapy. IgG testing is suggested when CMV is difficult to control. We here present the results of a multicenter study with the aim to evaluate distinct humoral immunity biomarkers as potential predictors of CMV infection. In a prospective multicenter study of a cohort of 212 patients in 2 centers in Spain who underwent kidney transplantation we identified patients who developed CMV infection during a 6 month follow-up after transplantation. Levels of IgG, IgM, IgA and complement C3 and C4 were prospectively measured in both centers using the routine laboratory. Assessment times were before transplantation, at day 7 and at day 30 after transplantation. Logistic regressión analysis was performed to assess potential biomarkers. During follow up 18 (8.5%) kidney recipients developed at least one episode of CMV infection. Day 30 IgG level was lower in patients who developed CMV infections after transplantation compared to patients without this complication (704±276 and 894±281%, respectively, p = 0.013). IgG level <700 mg/dL (IgG hypogammaglobulinemia) was significantly associated with risk for development of CMV infection in logistic regression analysis, RH 3.33, 95% CI 1.05-10.48, p = 0.04. Patients with hypogammaglobulinemia also disclosed a higher risk of developing recurrent infections (defined as 3 or more episodes caused by distinct pathogens, 24.1%), RH 2.4, 95% CI, 1.12-4.95, p=0.024). The results obtained in this multicenter study suggest that lower levels of IgG are a risk factor for development of CMV infection and recurrent infections in kidney transplantation. IgG assessmnent is easily available, rapid and low cost. The inclusion of this biomarker in immunomonitoring protocols should be taken into account as well as in clinical guidelines. Fondo de Investigacion Sanitaria. Project FIS 1501472. With participation of FEDER Funds, a new way of making Europe. ISR global grant Grifols, California, USA.