Acute norovirus-induced agranulocytosis in a pediatric kidney transplant recipient.

Norovirus (NoV) infection is usually limited to the gastrointestinal (GI) tract. However, in immunocompromised patients, this infection might lead to severe life-threatening complications. We herein describe a pediatric kidney transplant patient who presented with an acute NoV infection complicated by febrile agranulocytosis that resolved with improvement of her GI illness. This unusual presentation has not been described before, to our knowledge. The aim of this article is to highlight the sometimes dramatic clinical presentation of NoV infection in immunosuppressed patients, and the importance of including this infection in the differential diagnosis of neutropenia in that specific population.

Low incidence of severe respiratory syncytial virus infections in lung transplant recipients despite the absence of specific therapy.

BACKGROUND: Respiratory syncytial virus (RSV) infections in lung transplant recipients (LTRs) have been associated with significant morbidity and mortality. Immunoglobulins, ribavirin, and palivizumab are suggested treatments for both pre-emptive and therapeutic purposes. However, in the absence of randomized, placebo-controlled trials, efficacy is controversial and there is toxicity as well as cost concerns. METHODS: We retrospectively reviewed cases of lower respiratory tract RSV infections in adult LTRs. Diagnosis was based on clinical history, combined with a positive polymerase chain reaction (PCR) and/or viral cultures of bronchoalveolar lavage (BAL) specimens. RESULTS: Ten symptomatic patients were identified (7 men and 3 women, age range 28 to 64 years). All were hospitalized for community-acquired respiratory tract infections. Two patients had a concomitant acute Grade A3 graft rejection, and 1 patient had a concomitant bacterial pneumonia. Eight patients did not receive a specific anti-RSV treatment because of clinical stability and/or improvement at the time of RSV diagnosis. Only 2 patients (1 with Grade A3 allograft rejection and 1 requiring mechanical ventilation) received ribavirin and palivizumab. All patients recovered without complications and with no persistent RSV infection. However, bronchiolitis obliterans (BOS) staging worsened in 6 patients during the mean follow-up of 45 months. CONCLUSIONS: Our data suggest that mild RSV infections in LTRs might evolve favorably in the absence of specific anti-viral therapy. However, this observation needs confirmation in a large clinical trial specifically investigating the development of BOS in untreated vs treated patients.

Manitol para a conservação ex situ de coqueiro por crescimento mínimo

O objetivo deste trabalho foi determinar a concentração de manitol para a germinação e crescimento mínimo in vitro do coqueiro (Cocos nucifera). Os seguintes acessos foram utilizados: Anão-vermelho-do brasil-de-gramame (BRDG), Anão-amarelo-da-malásia (MYD), Gigante-do-brasil-praia-do-forte (BRA), Gigante-da-polinésia (PYT) e Gigante-de-rennel (RIT). Os embriões foram colocados em meio de cultura Y3 a diferentes concentrações de manitol (0, 0,1, 0,2, 0,3 e 0,4 mol L-1). Verificou-se inibição do crescimento da parte aérea na presença de 0,1, 0,2 e 0,3 mol L-1, para MYD e BRDG, e de 0,1 e 0,2 mol L-1, para PYT, BRA e RIT. O uso do manitol é uma estratégia promissora para a conservação por crescimento mínimo.

Effectiveness of substituting cyclosporin A with tacrolimus in reducing gingival overgrowth in renal transplant patients

Objectives: This study aims to evaluate the effectiveness of periodontal therapy combined with tacrolimus in the suppression of gingival overgrowth (GO) and the effect on GO of changing from cyclosporin A to tacrolimus. Patients and Methods: Sixteen renal transplant patients, averaging 52 years of age, whose kidney function was stable and were receiving treatment with cyclosporin A, were randomly assigned to one of two groups. In the experimental group, patients were instructed in oral hygiene and underwent periodontal treatment, whereas in the control group, only oral hygiene instructions were given. After the first visit and the change of medication from cyclosporine to tacrolimus in both groups, periodic clinical revisions were carried out for 3 months in order to assess the evolution of GO. Results: All patients showed a progressive decrease in GO. There were no statistically significant differences between the two groups (p>0.05). A greater decrease in GO occurred within the first month after changing the medication. Conclusions: No improved effectiveness in reducing GO was observed for periodontal therapy in combination with tacrolimus. Tacrolimus is an alternative to cyclosporine when attempting to avoid GO in patients with kidney transplants

The presence of a CD4(+) CD25(high) CD45RO(+) CD127(high) T cell population correlates with the clinical status of kidney transplant recipients

Introduction: Recent data have suggested that a population of CD4+ CD25high T cells, phenotypically characterized by the expression of CD45RO and CD127, is significantly expanded in stable liver and kidney transplant recipients and represents alloreactive T cells. We analyzed this putative new alloreactive cellular marker in various groups of kidney transplant recipients. Patients & methods: Flow cytometry was used to analyze the expression of CD25, CD45RO and CD127 on peripheral CD4+ T cells. Of 73 kidney transplant recipients, 59 had a stable graft function under standard immunosuppressive therapy (IS), 5 had biopsy-proven chronic humoral rejection (CHR), 8 were stable under minimal IS and one was an operationally "tolerant" patient who had discontinued IS for more than 3 years. Sixty-six healthy subjects (HS) were studied as controls. Results: Overall, the alloreactive T cell population was found to be significantly increased in the 73 kidney recipients (mean ± SE: 15.03 ± 1.04% of CD4+ CD25high T cells) compared to HS (5.93 ± 0.39%) (p<0.001). In the 5 patients with CHR, this population was highly expanded (31.33 ± 4.16%), whereas it was comparable to HS in the 8 stable recipients receiving minimal IS (6.12 ± 0.86%), in 4 patients who had been switched to sirolimus (4.21 ± 0.53%) as well as in the unique "tolerant" recipient (4.69%). Intermediate levels (15.84 ± 0.93%) were found in the 55 recipients with stable graft function on standard CNI-based IS. Regulatory T cells, defined as CD4+CD25high FoxP3+ CD127low, were found to be significantly reduced in all recipients except in those with minimal or no IS, and this reduction was particularly striking in recipients with CHR. Conclusion: After kidney transplantation, an alloreactive T cell population was found to be significantly expanded and it correlates with the clinical status of the recipients. Interestingly, in stable patients with minimal (or no) IS as well as in patients on sirolimus, alloreactive T cells were comparable the healthy controls. Measuring circulating CD4+CD25high CD45RO+ CD127high T cells may become a useful monitoring tool after transplantation.

1.° Opus magisterii : authore Arnaldo de Villanova ; subjecta varia experimenta chymica. — 2.° Rosae, sive liber perfecti magisterii : authore Rhasi, Philosopho. — 3.° Anonymus de origine metallorum. — 4.° Tractatus cujus titulus : opes Galeni alchimiae. — 5.° Varia experimenta chymica, ex variis authoribus excerpta. — 6.° Semita recta ; sive liber de alkimia : authore Alberto Magno. — 7.° Alia experimenta chymica. — 8.° Alkimia minor Alberti Magni, episcopi Ratisponensis. — 9.° Liber de practica roris Madii, datus Bonifacio Papae VIII. — 10.° Thesaurus secretus naturalium operationum : authore Arnaldo de Villanova. — 11.° Alia experimenta chymica. — 12.° Practica alchymiae ; gallico idiomate : ibi reperias indicem claviculae, ut vocant, Salomonis, Regis Israël.

Bigotianus

ENRAIZAMENTO EX VITRO E ACLIMATIZAÇÃO DO PORTA-ENXERTO DE MACIEIRA M.9

A micropropagação pode ser utilizada para a produção deste porta-enxerto; no entanto, o enraizamento e a aclimatização são pontos de estrangulamento para o uso comercial desta tecnologia. O presente trabalho foi conduzido com o objetivo de avaliar diferentes níveis de ácido indolbutírico (AIB) no enraizamento ex vitro e aclimatização simultânea do porta-enxerto de macieira 'M.9'. As bases das miniestacas oriundas do processo de multiplicação in vitro, com 2,5 a 3 cm de altura e dois pares de folhas, foram imersas em AIB nas concentrações de 0; 500; 1000 e 1500 mg.L-1, por 10 segundos. Após, foram transferidas para bandejas de isopor com células contendo 50mL do substrato casca de arroz carbonizada + vermiculita (1:1, v/v). As bandejas foram mantidas durante 30 dias em caixas plásticas cobertas com tampas de vidro para manter o ambiente com alta umidade. Os melhores resultados para a percentagem de enraizamento (82 e 84%) foram obtidos nos tratamentos com 500 e 1000 mg.L-1 , respectivamente. O comprimento das raízes não foi afetado pelos tratamentos aplicados, apresentando média de 4,2 cm. As concentrações maiores de AIB determinaram acréscimos lineares no número de raízes emitidas. Para avaliar a aclimatização, as plantas foram transferidas para casa de vegetação, em bandejas de isopor com alvéolos maiores, contendo o substrato Plantmax® (Eucatex, São Paulo, BR) durante 45 dias. Os maiores índices de sobrevivência das mudas após o transplante para embalagens comerciais (95%) foram obtidos com 500 mg.L-1 de AIB; no entanto, as concentrações de AIB empregadas na indução à rizogênese não modificaram o número e comprimento das raízes, número de folhas e altura das plantas.

Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011).

The detection of multi-resistant bacterial pathogens, particularly those to carbapenemases, in leukemic and stem cell transplant patients forces the use of old or non-conventional agents as the only remaining treatment options. These include colistin/polymyxin B, tigecycline, fosfomycin and various anti-gram-positive agents. Data on the use of these agents in leukemic patients are scanty, with only linezolid subjected to formal trials. The Expert Group of the 4(th) European Conference on Infections in Leukemia has developed guidelines for their use in these patient populations. Targeted therapy should be based on (i) in vitro susceptibility data, (ii) knowledge of the best treatment option against the particular species or phenotype of bacteria, (iii) pharmacokinetic/pharmacodynamic data, and (iv) careful assessment of the risk-benefit balance. For infections due to resistant Gram-negative bacteria, these agents should be preferably used in combination with other agents that remain active in vitro, because of suboptimal efficacy (e.g., tigecycline) and the risk of emergent resistance (e.g., fosfomycin). The paucity of new antibacterial drugs in the near future should lead us to limit the use of these drugs to situations where no alternative exists.

Disposition of valganciclovir during continuous renal replacement therapy in two lung transplant recipients.

OBJECTIVES: To determine whether valganciclovir 450 mg every 48 h for cytomegalovirus (CMV) prophylaxis provides appropriate ganciclovir exposure in solid organ transplant recipients during continuous renal replacement therapy (CRRT). PATIENTS AND METHODS: Ganciclovir pharmacokinetics was intensively studied in two lung transplant recipients under valganciclovir 450 mg every 48 h over one dosing interval. In vitro experiments using blank whole blood spiked with ganciclovir further investigated exchanges between plasma and erythrocytes. RESULTS: Ganciclovir disposition was characterized by apparent total body clearance of 3.3 and 5.8 L/h, terminal half-life of 16.9 and 14.1 h, and apparent volume of distribution of 60.3 and 104.9 L in Patients 1 and 2, respectively. The observed sieving coefficient was 1.05 and 0.96, and the haemofiltration clearance was 3.3 and 3.1 L/h. In vitro experiments confirmed rapid efflux of ganciclovir from red blood cells into plasma, increasing the apparent efficacy of haemofiltration. CONCLUSIONS: A valganciclovir dosage of 450 mg every 48 h appears adequate for patients under CRRT requiring prophylaxis for CMV infection, providing concentration levels in the range reported for 900 mg once daily dosing outside renal failure.

Enraizamento ex vitro e aclimatização do porta-enxerto de macieira marubakaido micropropagado

O objetivo deste trabalho foi avaliar a resposta ao enraizamento e à aclimatização do porta-enxerto de macieira Marubakaido micropropagado e submetido a diferentes substratos e condições de aclimatização antes da transferência para o viveiro. A indução ao enraizamento foi realizada ex vitro, imergindo 1,0 cm das bases das microestacas em uma solução de 1g.L-1 de AIB (ácido indolbutírico) durante 10 segundos. Os tratamentos utilizados foram de 0; 10; 15; 20 e 30 dias na sala de aclimatização, com posterior transferência para a câmara de nebulização, ali permanecendo até completar 30 dias. Como substratos, foram utilizadas as combinações de Terra Roxa Estruturada e Vermicomposto (TRE:V) e Terra Roxa Estruturada e Casca de Arroz Carbonizada (TRE:CAC), na proporção de 1:1 (v:v). Após 30 dias, foram avaliados o enraizamento, a sobrevivência e o crescimento das mudas, que foram então transferidas para casa de vegetação. Após 60 dias de cultivo na casa de vegetação, foram avaliados o número de folhas e a altura da parte aérea, e, após 90 dias, foram repetidas as avaliações efetuadas aos 30 dias. Aos 30 dias, a percentagem de enraizamento no substrato TRE:V foi de 78 % e no substrato TRE:CAC foi de 99%. Essa percentagem diminuiu para 64% no substrato TRE:V e 83% no substrato TRE:CAC aos 60 dias, e manteve-se estável aos 90 dias. O número médio de raízes foi maior em mudas que permaneceram 20 dias em sala de aclimatização e 10 dias em câmara de nebulização, com 16 raízes no tratamento que manteve 0 dia na sala de aclimatização e 30 dias na câmara de nebulização com 14 raízes. O maior crescimento médio das raízes (8,2 cm) aos 90 dias foi no substrato TRE:CAC. O substrato TRE:V possibilitou os melhores resultados médios para parte aérea. Os resultados obtidos indicam a possibilidade de enraizar este porta-enxerto ex vitro, em substrato, simultaneamente com a aclimatização em câmara de nebulização.

Influência de substratos na formação dos porta-enxertos: limoeiro-Cravo (Citrus limonia Osbeck) e tangerineira-Cleópatra (Citrus reshni Hort. Ex Tanaka) em ambiente protegido

Visando a estudar o efeito do substrato na produção de porta-enxertos de limoeiro-Cravo e tangerineira-Cleópatra em tubetes sob ambiente protegido, conduziu-se este trabalho na Faculdade de Ciências Agrárias e Veterinárias de Jaboticabal-UNESP. O estudo foi realizado em ambiente coberto com sombrite preto sem proteção lateral, adotando-se delineamento inteiramente casualizado, em esquema fatorial 5x2, 4 repetições e 20 sementes por parcela. Utilizaram-se os substratos húmus de minhoca oriundo de esterco de curral (H%) e vermiculita média (V%), sendo S1=H0 V100; S2=H25 V75; S3=H50 V50; S4=H75 V25 e S5=H100 V0. Avaliaram-se o número de plântulas emergidas, altura das plantas, diâmetro do caule, massas fresca e seca de raiz e parte aérea. Observaram-se resultados estatisticamente significativos para diâmetro do caule, aos 104 e 118 dias após a semeadura (DAS) entre espécies, com superioridade de Cravo em relação a Cleópatra, porém não aos 132 DAS. Não foi constatada diferença significativa entre os substratos. Quanto à massa fresca de parte aérea, nenhuma diferença estatística ocorreu entre as espécies; porém, quanto aos substratos, S3 mostrou-se superior a S1, não diferindo, entretanto, dos demais. Embora a análise estatística não tenha mostrado diferenças significativas entre os tratamentos para os outros parâmetros analisados, S3 destacou-se entre os substratos testados.

[Magnificentiores selectioresque Urbis Venetiarum prospectus quos olim Michael Marieschi, Venetus pictor et architectus in plerisque tabulis depinxit, nunc vero ab ipsomet acurate delineante, incidente, tyspisque mandante, iterum in sexdecim aereis tabulis in lucem aeduntur]. [18], AEdis Divi Rocchi facies rudis adhuc ex cocto latere, nec sectis marmoribus obducta : ad laevam magnum sodalitium eidem Sancto dicatum, et studio Sebastiani Serlii constructum. : [estampe] / Mich.l Marieschi del.t et inci.t

Référence bibliographique : Toledano, Marieschi, 26

Eximii prospectus Atrii ex pluribus architecturæ caracteribus excogitatus; cuius exemplum in teatro depictum plauderetur. Totum a Michaele Marieschi recens inuentum, ac incisum. : [estampe] ([2e état ?]) / [Michele Marieschi]

Référence bibliographique : Toledano, Marieschi, HC

Design and methodology of the Swiss Transplant Cohort Study (STCS): a comprehensive prospective nationwide long-term follow-up cohort.

In Switzerland, organ procurement is well organized at the national-level but transplant outcomes have not been systematically monitored so far. Therefore, a novel project, the Swiss Transplant Cohort Study (STCS), was established. The STCS is a prospective multicentre study, designed as a dynamic cohort, which enrolls all solid organ recipients at the national level. The features of the STCS are a flexible patient-case system that allows capturing all transplant scenarios and collection of patient-specific and allograft-specific data. Beyond comprehensive clinical data, specific focus is directed at psychosocial and behavioral factors, infectious disease development, and bio-banking. Between May 2008 and end of 2011, the six Swiss transplant centers recruited 1,677 patients involving 1,721 transplantations, and a total of 1,800 organs implanted in 15 different transplantation scenarios. 10 % of all patients underwent re-transplantation and 3% had a second transplantation, either in the past or during follow-up. 34% of all kidney allografts originated from living donation. Until the end of 2011 we observed 4,385 infection episodes in our patient population. The STCS showed operative capabilities to collect high-quality data and to adequately reflect the complexity of the post-transplantation process. The STCS represents a promising novel project for comparative effectiveness research in transplantation medicine.