Healthcare-associated infection in hematopoietic stem cell transplantation patients: risk factors and impact on outcome

Objective: The objective of this study was to analyze the incidence of and risk factors for healthcare-associated infections (HAI) among hematopoietic stem cell transplantation (HSCT) patients, and the impact of such infections on mortality during hospitalization. Methods: We conducted a 9-year (2001-2009) retrospective cohort study including patients submitted to HSCT at a reference center in Sao Paulo, Brazil. The incidence of HAI was calculated using days of neutropenia as the denominator. Data were analyzed using EpiInfo 3.5.1. Results: Over the 9-year period there were 429 neutropenic HSCT patients, with a total of 6816 days of neutropenia. Bloodstream infections (BSI) were the most frequent infection, presenting in 80 (18.6%) patients, with an incidence of 11.7 per 1000 days of neutropenia. Most bacteremia was due to Gram-negative bacteria: 43 (53.8%) cases were caused by Gram-negative species, while 33 (41.2%) were caused by Gram-positive species, and four (5%) by fungal species. Independent risk factors associated with HAI were prolonged neutropenia (odds ratio (OR) 1.07, 95% confidence interval (CI) 1.04-1.10) and duration of fever (OR 1.20, 95% CI 1.12-1.30). Risk factors associated with death in multivariate analyses were age (OR 1.02, 95% CI 1.01-1.43), being submitted to an allogeneic transplant (OR 3.08, 95% CI 1.68-5.56), a microbiologically documented infection (OR 2.96, 95% CI 1.87-4.6), invasive aspergillosis disease (OR 2.21, 95% CI 1.1-4.3), and acute leukemias (OR 2.24, 95% CI 1.3-3.6). Conclusions: BSI was the most frequent HAI, and there was a predominance of Gram-negative microorganisms. Independent risk factors associated with HAI were duration of neutropenia and fever, and the risk factors for a poor outcome were older age, type of transplant (allogeneic), the presence of a microbiologically documented infection, invasive aspergillosis, and acute leukemia. Further prospective studies with larger numbers of patients may confirm the role of these risk factors for a poor clinical outcome and death in this transplant population. (C) 2012 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Recipient of kidney from donor with asymptomatic infection by Paracoccidioides brasiliensis

The increase in solid organ transplantations may soon create a rise in the occurrence of endemic fungal diseases, such as paracoccidioidomycosis, due to the lack of rigorous screening of donors from endemic areas. Here we present the first case of an immunocompetent and asymptomatic kidney donor who had Paracoccidioides brasiliensis infected-adrenal tissue but no glandular dysfunction.

Characterization of NiCrAlC PTA coatings

Surface tailoring with plasma transferred arc (PTA) hardfacing involves the deposition of powder mixtures to produce coatings with an almost unlimited chemical composition. PTA hardfacing is particularly important for processing low weldability alloys, such as those for high-temperature applications, of which NiCrAlC is an example. This study analyzed NiCrAlC coatings processed by PTA using a mixture of elemental powders. Deposition on AISI316L plates was carried out with currents of 100 A and 130 A to induce variations in the chemical composition of the coatings, which were also subjected to isothermal exposure at temperatures of up to 1000 ºC for up to 72 hours in an air furnace. The results show that the aluminide compounds were stable, the coatings that solidified more slowly having the highest hardness after temperature exposure and potentially being suitable for use in high-temperature abrasion environments.

Influence of chest wall on lung mechanics during inspiration.

RATIONALE: The interaction between lungs and chest wall influences lung volume, that determines lung history during respiration cycle. In this study, the influence of chest wall mechanics on respiratory system is assessed by the evaluation of inspiration pressure-volume curve (PV curve) under three different situations: closed-chest, open-chest and isolated lung. The PV curve parameters in each situation allow us to further understand the role played by different chest wall elements in the respiratory function. Methods: Twenty-four male Wistar rats (236 ± 29 g) were used. The animals were weighted and then anesthetized with xylazine 2% (0,5mL/kg) and ketamine 10% (0,9mL/kg), exsanguinated and later tracheostomized with a metallic cannula (14 gauge). The cannula was connected to an automatic small animal insufflator. This setup was connected to a pressure transducer (32 samples/s). The 24 animals were randomly separated in three groups: (i) closed chest, (ii) open chest and (iii) isolated lung. The rats were insufflated with 20mL quasi-statically (constant speed of 0,1mL/s). Insufflated volume and measured pressure data were kept and PV curves were obtained for all animals. The PV curves were fitted (non-linear least squares) against the sigmoid equation (1) to obtain the sigmoid equation parameters (a,b,c,d). Elastance measurements were obtained from linear regression of pressure/volume measurements in a 0,8s interval before and after the calculated point. Results: The parameters a, b and c showed no significant change, but the parameter d showed a significant variation among the three groups. The initial elastance also varied between open and closed chest, indicating the need of a higher pressure for the lung expansion, as can be seen in Table 1. Table 1: Mean and Standard Deviation of parameters obtained for each protocol. Protocol: Closed Chest – a (mL) -0.35±0.33; b (mL) 13.93±0.89; c (cm H2O) 21.28±2.37; d (cm H2O) 6.17±0.84; r²** (%) 99.4±0.14; Initial Elastance* (cm H2)/mL) 12.72±6.66; Weight (g) 232.33±5.72. Open Chest - a (mL) 0.01±0.28; b (mL) 14.79±0.54; c (cm H2O) 19.47±1.41; d (cm H2O) 3.50±0.28; r²** (%) 98.8±0.34; Initial Elastance* (cm H2)/mL) 28.68±2.36; Weight (g) 217.33±7.97. Isolated Lung - a (mL) -0.09±0.46; b (mL) 14.22±0.75; c (cm H2O) 21.76±1.43; d (cm H2O) 4.24±0.50; r²** (%) 98.9±0.19; Initial Elastance* (cm H2)/mL) 7.13±8.85; Weight (g) 224.33±16.66. * Elastance measures in the 0-0,1 mL range. ** Goodness of sigmoid fit versus measured data Conclusion: A supporting effect of the chest wall was observed at the initial moments of inspiration, observed as a higher initial elastance in open chest situations than in closed chest situations (p=0,00001). The similar initial elastance for the isolated lung and closed chest may be explained by the specific method used for the isolated lung experiment. As the isolated lung is supported by the trachea vertically, the weight of the tissue may have a similar effect of the residual negative pressure in the thorax, responsible for maintaining the residual volume.

A pedigree with autosomal dominant thrombocytopenia, red cell macrocytosis, and an occurrence of t(12:21) positive pre-B acute lymphoblastic leukemia

Sampling and analyzing new families with inherited blood disorders are major steps contributing to the identification of gene(s) responsible for normal and pathologic hematopoiesis. Familial occurrences of hematological disorders alone, or as part of a syndromic disease, have been reported, and for some the underlying genetic mutation has been identified. Here we describe a new autosomal dominant inherited phenotype of thrombocytopenia and red cell macrocytosis in a four-generation pedigree. Interestingly, in the youngest generation, a 2-year-old boy presenting with these familial features has developed acute lymphoblastic leukemia characterized by a t(12;21) translocation. Tri-lineage involvement of platelets, red cells and white cells may suggest a genetic defect in an early multiliear progenitor or a stem cell. Functional assays in EBV-transformed cell lines revealed a defect in cell proliferation and tubulin dynamics. Two candidate genes, RUNX1 and FOG1, were sequenced but no pathogenic mutation was found. Identification of the underlying genetic defect(s) in this family may help in understanding the complex process of hematopoiesis.

Integrative analysis of RUNX1 downstream pathways and target genes

BACKGROUND: The RUNX1 transcription factor gene is frequently mutated in sporadic myeloid and lymphoid leukemia through translocation, point mutation or amplification. It is also responsible for a familial platelet disorder with predisposition to acute myeloid leukemia (FPD-AML). The disruption of the largely unknown biological pathways controlled by RUNX1 is likely to be responsible for the development of leukemia. We have used multiple microarray platforms and bioinformatic techniques to help identify these biological pathways to aid in the understanding of why RUNX1 mutations lead to leukemia. RESULTS: Here we report genes regulated either directly or indirectly by RUNX1 based on the study of gene expression profiles generated from 3 different human and mouse platforms. The platforms used were global gene expression profiling of: 1) cell lines with RUNX1 mutations from FPD-AML patients, 2) over-expression of RUNX1 and CBFbeta, and 3) Runx1 knockout mouse embryos using either cDNA or Affymetrix microarrays. We observe that our datasets (lists of differentially expressed genes) significantly correlate with published microarray data from sporadic AML patients with mutations in either RUNX1 or its cofactor, CBFbeta. A number of biological processes were identified among the differentially expressed genes and functional assays suggest that heterozygous RUNX1 point mutations in patients with FPD-AML impair cell proliferation, microtubule dynamics and possibly genetic stability. In addition, analysis of the regulatory regions of the differentially expressed genes has for the first time systematically identified numerous potential novel RUNX1 target genes. CONCLUSION: This work is the first large-scale study attempting to identify the genetic networks regulated by RUNX1, a master regulator in the development of the hematopoietic system and leukemia. The biological pathways and target genes controlled by RUNX1 will have considerable importance in disease progression in both familial and sporadic leukemia as well as therapeutic implications.

LakeMIP Kivu: evaluating the representation of a large, deep tropical lake by a set of one-dimensional lake models

The African great lakes are of utmost importance for the local economy (fishing), as well as being essential to the survival of the local people. During the past decades, these lakes experienced fast changes in ecosystem structure and functioning, and their future evolution is a major concern. In this study, for the first time a set of one-dimensional lake models are evaluated for Lake Kivu (2.28°S; 28.98°E), East Africa. The unique limnology of this meromictic lake, with the importance of salinity and subsurface springs in a tropical high-altitude climate, presents a worthy challenge to the seven models involved in the Lake Model Intercomparison Project (LakeMIP). Meteorological observations from two automatic weather stations are used to drive the models, whereas a unique dataset, containing over 150 temperature profiles recorded since 2002, is used to assess the model’s performance. Simulations are performed over the freshwater layer only (60 m) and over the average lake depth (240 m), since salinity increases with depth below 60 m in Lake Kivu and some lake models do not account for the influence of salinity upon lake stratification. All models are able to reproduce the mixing seasonality in Lake Kivu, as well as the magnitude and seasonal cycle of the lake enthalpy change. Differences between the models can be ascribed to variations in the treatment of the radiative forcing and the computation of the turbulent heat fluxes. Fluctuations in wind velocity and solar radiation explain inter-annual variability of observed water column temperatures. The good agreement between the deep simulations and the observed meromictic stratification also shows that a subset of models is able to account for the salinity- and geothermal-induced effects upon deep-water stratification. Finally, based on the strengths and weaknesses discerned in this study, an informed choice of a one-dimensional lake model for a given research purpose becomes possible.

Na 1 Nachlass Max Horkheimer, 550 - Korrespondenzen mit Leo Löwenthal (p. VI 20, 221-409)

130 Briefe zwischen Max Horkheimer und Leo Löwenthal, September 1946 - April 1947; 4 Briefe zwischen Samuel H. Flowerman und Max Horkheimer, 1946; 1 Brief von Walter Hallstein an Leo Löwenthal, 03.03.1947; 1 Brief von Herman L. Filene an Frederick Wild, 18.09.1946; 1 Brief von Leo Löwenthal an Frederick Pollock, 16.09.1946; 2 Briefe (Auszüge) von William M. Bennett an Leo Löwenthal, September 1946; 1 Brief von Jim Farrell an Leo Löwenthal, 06.09.1946; 1 Brief von Leo Löwenthal an Edward N. Barnhart, 21.04.1947; 1 Brief von John Slawson an Max Horkheimer, 20.03.1947; 1 Brief von Max Horkheimer an Marjorie Fiske, 12.03.1947;

Na 1 Nachlass Max Horkheimer, 559 - Korrespondenzen mit Leo Löwenthal (p. VI 25, 1-248)

124 Briefe zwischen Leo Löwenthal und Max Horkheimer; 1 Brief von Leo Löwenthal an Theodor W. Adorno, 29.12.1954; 2 Briefe zwischen Max Horkheimer und Marjorie Fiske, 1954/1955; 2 Briefe zwischen Leo Löwenthal und Frederick Ungar, Oktober 1954; 2 Briefe zwischen Daniel Lerner und Leo Löwenthal, Oktober 1954; 3 Briefe zwischen Leo Löwenthal und Herbert Blumer, Oktober 1954; 1 Brief von Alice H. Maier an H. P. Edelman, 10.06.1954; 2 Briefe von Leo Löwenthal an The Trustes of Hermann Weil Memorial Foundation (New York), 27.04.1955; 1 Brief von Max Horkheimer an The Trustes of Hermann Weil Memorial Foundation (New York), Juni 1954; 4 Briefe zwischen Leo Löwenthal und Chauncy D. Harris, 1954/1955; 2 Briefe zwischen John I. Kirkpatrick und Leo Löwenthal, 1954; 3 Briefe zwischen Leo Löwenthal und R. Wendell Harrison, Mai 1954; 2 Briefe von Leo Löwenthal an Gustave E. von Grunebaum, 1954; 1 Brief von Leo Löwenthal an Morton Grodzins, 12.05.1954; 2 Briefe von Max Horkheimer an Charles Y. Glock, 1954; 1 Brief von Jeremiah Kaplan an Leo Löwenthal, 15.03.1954; 2 Briefe zwischen Leo Löwenthal und Max Rheinstein, März 1954; 1 Brief von Frederick Pollock an Max Rheinstein, [1954];

Desarrollo de una aplicación Web empresarial de ayuda a la producción de campañas publicitarias

La creación de esta aplicación web empresarial surge con la necesidad de optimizar el tiempo en el proceso de creación de una campaña publicitaria de email marketing. El objetivo principal de este trabajo es automatizar el proceso de validación de los campos de un formulario web. Un formulario web [6] es un documento digital en el que los usuarios introducen sus datos personales como nombre, apellido, dirección, documento de identidad, entre otros. Estos datos posteriormente serán procesados y almacenados en un base de datos para luego ser enviados al anunciante. El proceso de validación se refiere a la programación del formulario web en la parte del cliente usando tecnologías web como JavaScript y HTML5, para controlar que los datos introducidos por el usuario en el formulario, sean correctos. Cada campo de un formulario web tiene una validación específica que depende de varios factores, como son el país de lanzamiento de la campaña y el campo a validar. De esta forma dependiendo del tipo de validación se genera un fichero JavaScript con todas las validaciones de dicho formulario. Una de las finalidades de este trabajo es que cualquier usuario de la empresa pueda programar un formulario web, sin tener conocimientos previos de programación, ya que la programación se realiza de forma transparente al usuario. Este es un resumen básico de la aplicación web, sin embargo se debe tener en cuenta una serie de requisitos y parámetros para hacerlo más eficiente y personalizable dependiendo de las necesidades del producto final de cada campaña publicitaria. Todos estos aspectos se explicaran en detalle en los siguientes apartados. Este trabajo se realizó en el corporativo Media Response Group, para la empresa Canalmail S.L, situada en Alcobendas, supervisado por los tutores profesionales Daniel Paz y Jorge Lázaro Molina y por el tutor académico Rafael Fernández Gallego de la Universidad Politécnica de Madrid.---ABSTRACT---The creation of this enterprise Web application arises from the need to optimize the time in the process of creating an online advertising campaign. The main objective of this work is to automate the process of validating fields in a web form. A web form [6] is a digital document that users enter data such as name, surname, address, ID number among others. These data will subsequently be processed and stored in a database and then be sent to the client. These data will subsequently be processed and stored in a database and then be sent to the advertiser. This validation process refers to programming the online form on the client‟s side using web technologies such as JavaScript, HTML5 to control that the data entered by the user in this form are correct. Each field in a web form has a specific validation that depends on several factors; like being a nationwide launch of the campaign and validating data, thus depending on the type of validation a JavaScript file is generated with all validation web form. This file is integrated into the web form by calling the service. One purpose of this work is that any business user can program a web form, without prior knowledge of web programming, since programming is transparent to the user. This is a basic summary of the web application; however we must consider a number of requirements and parameters to make it more efficient and customizable depending on the needs of the end product of each advertising campaign. All these aspects are explained in detail in the following sections. This work was performed in the corporate Media Response Group, for the company Canalmail S.L, located in Alcobendas, supervised by professional tutors Daniel Paz and Jorge Lázaro Molina and PhD Assistant Lecturer at Universidad Politécnica de Madrid. Rafael Fernández Gallego.

Synthesis and biological activity of DNA damaging agents that form decoy binding sites for the estrogen receptor

It is a goal of cancer chemotherapy to achieve the selective killing of tumor cells while minimizing toxicity to normal tissues. We describe the design of selective toxins forming DNA adducts that attract the estrogen receptor (ER), a transcription factor that is overexpressed in many human breast and ovarian tumors. The compounds consist of 4-(3-aminopropyl)-N,N-(2-chloroethyl)-aniline linked to 2-(4′-hydroxyphenyl)-3-methyl-5-hydroxy-indole. The former moiety is a DNA damaging nitrogen mustard and the latter is a ligand for the ER. The connection between these groups was refined to permit DNA adducts formed by the mustard portion of the molecule to present the ligand domain so that it was able to interact efficiently with the ER. By using 16-mers containing specific DNA adducts, it was determined that monoadducts and putative intrastrand crosslinks were preferred targets for the ER over interstrand crosslinks. A series of structurally related 2-phenylindole mustards was prepared, some of which were selectively toxic to the ER-positive breast cancer cell line MCF-7, as compared with the ER(−) negative line MDA-MB231. The ability both to bind to DNA and to interact significantly with the ER were essential to achieve selective lethality toward ER(+) cells. Compounds forming DNA adducts without the ability to bind receptor showed similar toxicities in the two cell lines. Several models could explain the selective toxicity of the mustard–phenylindole compounds toward ER(+) cells. The favored model suggests that a mustard–DNA adduct is shielded by the ER from DNA repair enzymes and hence cells possessing an abundance of the ER selectively retain the adduct and are killed.

Implications of EPHB6, EFNB2, and EFNB3 expressions in human neuroblastoma

Neuroblastoma (NB) is a common pediatric tumor that exhibits a wide range of biological and clinical heterogeneity. EPH (erythropoietin-producing hepatoma amplified sequence) family receptor tyrosine kinases and ligand ephrins play pivotal roles in neural and cardiovascular development. High-level expression of transcripts encoding EPHB6 receptors (EPHB6) and its ligands ephrin-B2 and ephrin-B3 (EFNB2, EFNB3) is associated with low-stage NB (stages 1, 2, and 4S) and high TrkA expression. In this study, we showed that EFNB2 and TrkA expressions were associated with both tumor stage and age, whereas EPHB6 and EFNB3 expressions were solely associated with tumor stage, suggesting that these genes were expressed in distinct subsets of NB. Kaplan-Meier and Cox regression analyses revealed that high-level expression of EPHB6, EFNB2, and EFNB3 predicted favorable NB outcome (P < 0.005), and their expression combined with TrkA expression predicted the disease outcome more accurately than each variable alone (P < 0.00005). Interestingly, if any one of the four genes (EPHB6, EFNB2, EFNB3, or TrkA) was expressed at high levels in NB, the patient survival was excellent (>90%). To address whether a good disease outcome of NB was a consequence of high-level expression of a “favorable NB gene,” we examined the effect of EPHB6 on NB cell lines. Transfection of EPHB6 cDNA into IMR5 and SY5Y expressing little endogenous EPHB6 resulted in inhibition of their clonogenicity in culture. Furthermore, transfection of EPHB6 suppressed the tumorigenicity of SY5Y in a mouse xenograft model, demonstrating that high-level expressions of favorable NB genes, such as EPHB6, can in fact suppress malignant phenotype of unfavorable NB.

Paleoclimate and Amerindians: Evidence from stable isotopes and atmospheric circulation

Two Amerindian demographic shifts are attributed to climate change in the northwest plains of North America: at ≈11,000 calendar years before present (yr BP), Amerindian culture apparently split into foothills–mountains vs. plains biomes; and from 8,000–5,000 yr BP, scarce archaeological sites on the open plains suggest emigration during xeric “Altithermal” conditions. We reconstructed paleoclimates from stable isotopes in prehistoric bison bone and relations between weather and fractions of C4 plants in forage. Further, we developed a climate-change model that synthesized stable isotope, existing qualitative evidence (e.g., palynological, erosional), and global climate mechanisms affecting this midlatitude region. Our isotope data indicate significant warming from ≈12,400 to 11,900 yr BP, supporting climate-driven cultural separation. However, isotope evidence of apparently wet, warm conditions at 7,300 yr BP refutes emigration to avoid xeric conditions. Scarcity of archaeological sites is best explained by rapid climate fluctuations after catastrophic draining of the Laurentide Lakes, which disrupted North Atlantic Deep Water production and subsequently altered monsoonal inputs to the open plains.