Impact of targeted antifungal prophylaxis in heart transplant recipients at high risk for early invasive fungal infection.

BACKGROUND: Invasive fungal infection (IFI) is associated with high mortality after heart transplantation (HTx). After two undiagnosed fatal cases of early disseminated fungal infections in our heart transplant program, a retrospective analysis was conducted to identify risk factors for the development of IFI and implement a new antifungal prophylaxis policy. METHODS: Clinical characteristics of HTx recipients hospitalized in our center (2004-2010) were recorded (Period 1), and risk factors associated with IFI were investigated using Cox regression analysis. From October 2010 to October 2012 (Period 2), targeted caspofungin prophylaxis was administered to all recipients at high risk for IFI, based on the results of the Period 1 analysis. RESULTS: During Period 1, 10% (6/59) of the patients developed IFI at a median onset of 9 days after transplantation. By multivariate analysis, the use of posttransplant extracorporeal membrane oxygenation (ECMO) was the strongest predictor for fungal infection (OR, 29.93; 95% CI, 1.51-592.57, P=0.03), whereas renal replacement therapy (RRT) and Aspergillus colonization were significant predictors only by univariate analysis. During Period 2, only 4% (1/26) of the patients developed IFI. In patients at high risk for IFI, antifungal prophylaxis was administered to 17% (4/23) in Period 1 versus 100% (13/13) in Period 2 (P<0.01). By survival analysis, antifungal prophylaxis was associated with a reduction in 90-day IFI incidence (HR, 0.14; 95% CI, 0.03-0.84, P=0.03) and 30-day mortality (HR, 0.25; 95% CI, 0.09-0.8, P=0.02). CONCLUSION: Extracorporeal membrane oxygenation was identified an important risk factor for IFI after HTx, and its use may require targeted administration of antifungal prophylaxis in the immediate posttransplant period.

Associations of serum EBV DNA and gammopathy with post-transplant lymphoproliferative disease.

BACKGROUND: Post-transplant lymphoproliferative disease (PTLD) is a life-threatening complication of immunosuppression following transplantation. Epstein-Barr virus (EBV) and gammopathy in serum are associated with PTLD, but these two parameters have not been evaluated in parallel for their association with PTLD. METHODS: We evaluated the incidence of EBV load positivity, gammopathy, and protein expression in sera from all PTLD patients diagnosed at our hospital during the past seven yr. Results were compared with those of a control group including matched transplanted patients who did not develop PTLD. RESULTS: Seven of 10 PTLD patients presented EBV(+) PTLD, for which five patients had detectable serum EBV DNA levels compared with none of 38 controls (RR between two groups =121, p &lt; 0.0001). Five out of 10 patients had gammopathy at PTLD diagnosis compared with 5/38 controls (RR between two groups = 6.6, p = 0.022). Additionally, protein serum analysis by high-resolution two-dimensional gel electrophoresis and image examination failed to evidence specific abnormality in patients with PTLD compared with controls. CONCLUSIONS: Our results confirm an association between EBV in sera and gammopathy with PTLD, and highlight the high specificity of the former analysis. Whether a combination of both analyses will improve the clinical detection of PTLD remains to be evaluated in a larger prospective cohort study.

Vencer en el diálogo. Justicia y retórica en Esquilo y Platón

«Tú (Polo) sostenías que los injustos son felices si no pagan justicia» «Exacto». «Yo en cambio digo que son muy desgraciados, pero los que pagan justicia, menos. ¿Quieres refutar también esto?» «Eso, Sócrates, es aún más difícil de refutar que aquello» « No difícil, Polo, sino imposible, pues lo verdadero jamás puede refutarse» (Gorg. 473b). En este momento del diálogo con Polo, Sócrates introduce el presupuesto que está en la base de su práctica dialogal, a saber, que la verdad no es refutable, y, por tanto, el discurso que vence en el diálogo es el verdadero. Claro que las implicaciones de tal proposición varían considerablemente según se enfatice el sujeto o el predicado: lo primero supone la existencia de una verdad objetiva, que va descubriéndose a través del debate; lo segundo, la dependencia de la noción de verdad de la de triunfo lógico, lo que deja abierta una amplia casuística.

Qualidade física de um cambissolo sob sistemas de manejo

A Chapada do Apodi vem se destacando como um promissor polo de fruticultura irrigada em virtude da potencialidade agrícola dos seus solos, que são submetidos a diferentes tipos de manejo, condicionando mudanças em seus atributos físicos. Este trabalho teve como objetivo avaliar fisicamente um Cambissolo cultivado com mamoeiro (Carica papaya L.), sob dois sistemas de manejo, comparado com um sob vegetação nativa secundária. Foram coletadas amostras de solo com estruturas deformada e indeformada para determinação de: granulometria, argila dispersa em água, densidade do solo e de partículas, estabilidade de agregados, carbono orgânico e resistência à penetração. Foram calculados o grau de floculação das argilas e o teor de matéria orgânica. No campo, foi realizado ensaio de condutividade hidráulica do solo. Os dados experimentais foram analisados considerando o delineamento inteiramente casualizado, adotando-se para todas as análises o esquema em parcela subdividida 3 x 3 x 5 (dois sistemas de manejo do solo - plantio do mamoeiro em sulco e camalhão - e mata nativa secundária; três camadas de solo - 0,0-0,1; 0,1-0,2; e 0,2-0,3 m; e cinco repetições), exceção para a condutividade hidráulica, em que se adotou o esquema fatorial 3 x 2 x 5 (dois sistemas de manejo do solo e mata nativa secundária; duas tensões - 0 e 5 hPa; e cinco repetições). Foram aplicados os testes de Kolmogorov-Smirnov para verificar a normalidade dos dados, o F para a análise de variância e o de Tukey para a comparação de médias, todos a 5 %. Concluiu-se que a hipótese de que os sistemas de cultivo pioram os solos fisicamente foi refutada, indicando que a qualidade dos atributos do solo sob cultivo, em geral, está mantida ou melhorada em relação à condição atual da mata nativa secundária; o decréscimo do teor de matéria orgânica, da porcentagem de agregados estáveis na classe de 4,76-2,00 mm de diâmetro e do diâmetro médio ponderado em solo cultivado, apesar de ainda estarem distantes de limites considerados críticos, é indicador da necessidade de adoção de práticas de manejo que evitem o desencadeamento de um processo de degradação do solo; e os indicadores de qualidade foram sensíveis às alterações provocadas pelos sistemas de manejo do solo e, portanto, podem ser utilizados como fonte para a interpretação da dinâmica de processos físicos do solo no tempo.

Optical absorption and graphitic clusters of hydrogenated amorphophous carbon thin films

The optical absorption of hydrogenated amorphous carbon films (a‐C:H) was measured by spectroscopic ellipsometry. The a‐C:H films were deposited at different substrate temperatures by rf‐plasma of methane. A volume distribution of graphitic cluster size was assumed to reproduce the experimental spectra of the absorption coefficient. The changes in the absorption coefficient and the optical gap, induced by deposition temperature, have been interpreted in terms of changes in the graphitic cluster size of the network. The increase in the deposition temperature produces an increase in the size of the graphitic clusters.

Plasma-enhanced chemical vapor deposition of boron nitride thin films from B2H6-H2-NH3 and B2H6-N2 gas mixtures

Highly transparent and stoichiometric boron nitride (BN) films were deposited on both electrodes (anode and cathode) of a radio-frequency parallel-plate plasma reactor by the glow discharge decomposition of two gas mixtures: B2H6-H2-NH3 and B2H6-N2. The chemical, optical, and structural properties of the films, as well as their stability under long exposition to humid atmosphere, were analyzed by x-ray photoelectron, infrared, and Raman spectroscopies; scanning and transmission electron microscopies; and optical transmittance spectrophotometry. It was found that the BN films grown on the anode using the B2H6-H2-NH3 mixture were smooth, dense, adhered well to substrates, and had a textured hexagonal structure with the basal planes perpendicular to the film surface. These films were chemically stable to moisture, even after an exposition period of two years. In contrast, the films grown on the anode from the B2H6-N2 mixture showed tensile stress failure and were very unstable in the presence of moisture. However, the films grown on the cathode from B2H6-H2-NH3 gases suffered from compressive stress failure on exposure to air; whereas with B2H6-N2 gases, adherent and stable cathodic BN films were obtained with the same crystallographic texture as anodic films prepared from the B2H6-H2-NH3 mixture. These results are discussed in terms of the origin of film stress, the effects of ion bombardment on the growing films, and the surface chemical effects of hydrogen atoms present in the gas discharge.

A new and simple variable-angle accessory for infrared specular reflectance

A simple, low-cost accessory (patent pending) with only two flat mirrors and a new variable-angle mechanism has been developed for infrared specular reflectance measurements. The system allows the angles of incidence to be varied continuously from 15° (near normal incidence) to 85° (near grazing angle) without losing the alignment of the accessory. The reflectivity of boron nitride thin films deposited on metallic substrates has been measured at different angles of incidence to demonstrate the utility of this accessory.

Chirurgie viscérate chez le patient greffé ou en attente d'une transplantation [Visceral surgery in organ transplant recipients or in patients awaiting transplantation]

Patients receiving immunosuppression are at higher risk for gastrointestinal complications: mortality is high if they are not diagnosed and treated rapidly. Systematic screening for cholelithiasis or diverticular disease, and prophylactic surgery, are not recommended systematically anymore. Patients awaiting a transplant with abdominal symptoms should be investigated without delay and surgery, if indicated and whenever possible based on the anaesthetic evaluation, should be performed. In the transplant population, a high degree of suspicion must be raised in case of any abdominal symptom. Radiological investigations and surgery without delay are often the only ways to preserve the function of the graft and optimize the patient's survival.

Valganciclovir to prevent or treat cytomegalovirus disease in organ transplantation.

Cytomegalovirus (CMV) is generally considered the most significant pathogen to infect patients following organ transplantation. Significant improvements have been achieved in the management of CMV disease over recent years, especially since the introduction of oral drugs such as oral ganciclovir followed by valganciclovir (VGC), a prodrug of ganciclovir with enhanced bioavailability. Several randomized controlled trials have shown that VGC is an efficacious and convenient oral drug to prevent or treat CMV disease in solid-organ transplant recipients. In this article, we discuss the clinical and pharmacological experience with the use of VGC for the management of CMV in solid-organ transplant recipients. Finally, novel strategies to further reduce the incidence of CMV disease after transplantation are also reviewed.

Petrou types D and II perfect-fluid solutions in generalized Kerr-Schild form.

Petrov types D and II perfect-fluid solutions are obtained starting from conformally flat perfect-fluid metrics and by using a generalized KerrSchild ansatz. Most of the Petrov type D metrics obtained have the property that the velocity of the fluid does not lie in the two-space defined by the principal null directions of the Weyl tensor. The properties of the perfect-fluid sources are studied. Finally, a detailed analysis of a new class of spherically symmetric static perfect-fluid metrics is given.